Why do patients with psychosis listen to and believe derogatory and threatening voices? 2 21 reasons given by patients

Abstract

Background: Around two thirds of patients with auditory hallucinations experience derogatory 37 and threatening voices (DTVs). Understandably, when these voices are believed then common 38 consequences can be depression, anxiety, and suicidal ideation. There is a need for treatment 39 targeted at promoting distance from such voice content. The first step in this treatment 40 development is to understand why patients listen to and believe voices that are appraised as 41 malevolent. 42 Aims: To learn from patients their reasons for listening to and believing DTVs. 43 Method: Theoretical sampling was used to recruit 15 participants with non-affective psychosis 44 from NHS services who heard daily DTVs. Data were obtained by semi-structured interviews and 45 analysed using grounded theory. 46 Results: Six higher order categories for why patients listen and/or believe voices were theorised. 47 These were: i) to understand the voices (e.g. what is their motive?); ii) to be alert to the threat (e.g. 48 prepared for what might happen); iii) a normal instinct to rely on sensory information; iv) the 49 voices can be of people they know; v) the DTVs use strategies (e.g. repetition) to capture attention; 50 vi) patients feel so worn down it is hard to resist the voice experience (e.g. too mentally defeated 51 to dismiss comments). In total, twenty-one reasons were identified, with all participants endorsing 52 multiple reasons. 53 Conclusions: The study generated a wide range of reasons why patients listen to and believe 54 DTVs. Awareness of these reasons can help clinicians understand the patient experience and also 55 identify targets in psychological intervention.