REFLECTIONS ON VOICES
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Voice hearing (auditory hallucinations) is associated with multiple problems : disturbed behaviour, anxiety, depression, social stigma, and suicide ( Siris 1991 , Barnes et al. 1989, Caldwell & Gottesman 1990). Traditionally voices are seen as a symptom of schizophrenia , psychosis, and mental illness, even though recent estimates of prevalence are 2-4% of the population (Siris 1990, Tien et al. 1993). This view has been challenged by research that has shown that there are many different experiences of voices, positive and negative, and that they are not confined to particular diagnoses or clinical populations (Romme & Escher 1989, Bentall 1990). The aetiology of voice hearing is still unknown and to date a comprehensive cognitive model has yet to be elaborated. This study explores the role of metacognition in the maintenance of distress about voices and offers an alternative to the prevailing cognitive account of voices suggested by Chadwick & Birchwood (1994). Morrison, Haddock & Tarrier 's(1995) idea that voices arise because of particular metacognitive beliefs concerning intrusive thoughts is also explored. Using multiple regression analysis this study has shown that metacognitive factors can be used to make a fairly good prediction of levels of distress about voices (Rsq. = 0.64, F=9.64, p<0.001). Important elements of metacognition that were highlighted by the analysis were fears of madness as a result of hearing voices, degree of personal responsibility taken for thoughts in general, degree of responsibility for voices, perceived abnormality of hearing voices for others, desired positivity of thoughts in general, and perceived weak-mindedness. The presence of malevolent content and anxiety were also found to be important in giving a comprehensive account of distress associated with voices. Methodological limitations, theoretical contributions and implications for future research are discussed. The idea of a metacognitive therapy for voices is introduced.
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