Chapter

Appraisals: Voices’ power and purpose

Peter Trower, Max Birchwood and Alan Meaden

in Hallucinations

Published on behalf of Oxford University Press

Published in print June 2010 | ISBN: 9780199548590
Published online February 2013 | e-ISBN: 9780191754623 | DOI: http://dx.doi.org/10.1093/med/9780199548590.003.0006
Appraisals: Voices’ power and purpose

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What should the focus of treatment be in Cognitive-Behaviour Therapy (CBT; see Smith et al., this volume)—the hallucinations as symptoms of the schizophrenic illness or the clients’ distressed reaction to the hallucinations? Judging by a recent review of outcome studies on CBT for schizophrenia (Wykes et al., 2008), the prevailing approach is to target the symptoms, an approach modelled on the traditional prescribing of neuroleptics to treat the symptoms (see Sanjuan et al., this volume). The alternative and we believe more relevant approach for cognitive-behavioural as opposed to neuroleptic treatment (Birchwood & Trower, 2006) is to target the distress and associated behaviour directly. We know from research reviewed below that clients respond in a wide variety of ways to their voices, both emotionally and behaviourally. Some are greatly distressed and frightened, some become depressed, and others angry. Some may harm themselves or others, some become avoidant and withdrawn or try to get relief through substance or alcohol misuse, and others shout and swear at the voices. Yet others are reassured and amused and seek contact with their voices.

It is now well established that this diversity of reactions is largely a consequence of each individual's appraisal of their voice rather than simply being an integral part of a psychotic illness. Romme and Escher (1989; see Romme & Escher, this volume) originally showed in their classic study how a person's ability to cope with voices varied according to their appraisal of the voice.

Chapter.  9994 words.  Illustrated.

Subjects: Psychiatry

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