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Making sense of voices

Making sense of voices. A multimodel approach for auditory hallucinations Dirk Corstens From: “Giv stemmene mening” by Marius Romme and Sandra Escher. Our own surveys on auditory hallucinations over the last 20 years.

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Making sense of voices

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  1. Making sense of voices A multimodel approach for auditory hallucinations Dirk Corstens From: “Giv stemmene mening” by Marius Romme and Sandra Escher

  2. Our own surveys on auditory hallucinationsover the last 20 years • An experiment in which people with auditory hallucinations were brought into contact with each other: meeting non-patients • Schizophrenia Bulletin 1989 vol 15 (2) 209-16 • British Journal of Psychiatry 1992 (161) 99-103 • Intensive case studies with 26 patients and non-patients experiencing auditory hallucinations • Accepting voices, 1993. Mind London • A Systematic Comparative study of Patients and non Patients experiencing auditory hallucinations • Cognitive Bahavioural Interventions with Psychotic Disorder 1996 page 137-151 Routledge London. • Understanding voices 1996 Hansell publications Gloucester

  3. Our own surveys on auditory hallucinationsover the last 15 years • A study on analysing the relation ship with the persons life history and the treatment process. • Making Sense of Voices, 2000 Mind London. • A three year follow-up study on 80 children. • British Journal of Psychiatry, 2002 (181 suppl.) s10-18 • American Journal of medical Genetics, 2002 (114) 913-20 • Journal of Mental Health, 2003 (12,1) 91-99 • Pathways from trauma to psychosis (still running)

  4. Ongoing studies and activities • Expertgroup: what do users find usefull, respectfull and effective • Educational model: changing attitudes towards psychosis in general, from the user-perspective. • Anthologies: What did help voice-hearers.

  5. Core concept of hearing voices • Hearing voices in itself is not a sign of mental illness but a signal of problems. • Hearing voices is apparent in healthy people. • Becoming a patient is due to the inability to cope with voices and the underlying problems. • Voices are messengers that sometimes bring awful messages.

  6. Auditory hallucinations in the general populationPopulation surveys Tien 1991 15000 subjects Prolongedauditory hallucinations2-4% level 2 Elicited with D.I.S 1/3 level 5= subjective negative effect _________________________________________________________ EATON 1991 810 subjects Prolonged auditory hallucinations4% Assesed by psychiatrist 45% criteria for psychiatric diagnosis 16% criteria for diagnosis of schizophrenia

  7. CIDI 1 T1 CIDI 2 T2 CIDI 3 T3 The Dutch Nemesis Study ± 7000 1 year ± 5600 2 years ± 4800 Bijl et al, 1998

  8. Lifetime epidemiology of psychosis

  9. Lifetime psychotic experiences N=7076 – CIDI interviews 17.5%

  10. Comparative study in patients and non-patients • One group of patients diagnosed schizophrenia • One group of patients diagnosed with a dissociative disorder • One group of people who hear voices without characteristics for a psychiatric diagnosis: the non-patients

  11. Characteristics of auditory hallucinations

  12. Similarities and differences between patients and non-patients

  13. Problems not denied Problems solved or compensated Consequence after all positive Capacity to cope with stress Problems denied or deformed. Problems not solved because of power structure and lack of compensation Negative consequences, because of blackmail and unjustified identification . Damage of the capacity to cope with stress Non-patients Patients

  14. Phases in the process of hearing voices in patients and non-patients • Startling phase • High Anxiety • Isolation • Searching for Explanation We don’t have a proper scientific concept for heaing voices and the mind. • Organisation phase • Explanations • Sharing with other people • Stabilisation phase • Embedded in social life

  15. Predictors for continuation of the voicesfrom the children research • Frequency of the voices (MIC) • Anxiety (BPRS) • Depression (BPRS) • Severity of dissociation (DES)

  16. The onset of the voices has a relation with social circumstances: • Unbearable living situation • Recent traumas • Conflicts between ideal and reality • Trauma from childhood

  17. 1 John G. Allen (2001) Traumatic relationships and Serious Mental Disorders 2 Van der Kolk (2000) Traumatic Stress. • 3 O’Brien (1998) Traumatic Events and Mental Health • 4 Bruce P, Dohrenwend (1998) Adversity, Stress and Psychopathology • 5 Follette (2001) Cognitive Behavioural Therapies for Trauma

  18. Frequency of trauma in people with serious mental illness

  19. Overpowering and imprisoning

  20. Background to voicesOverpowering social interactions, trauma and conflicts that cannot be solved with the normal fight or flight reactions.

  21. Hearing voices works as a defense mechanism: To protect the person against • Overwhelming feelings • Unaccepted feelings

  22. Voices have a metaphorical meaning • What the voices say corresponds with the way the environment treats or treated the person who hears the voices, or corresponds with the attitude of the environment towards the problems of the voice hearer. • The attitude of the voice hearer towards the voices and the way he reacts on the voices, is the same as the way the voice hearer deals with her/his problems and relations.

  23. Context analysis - Identity of the voices - Which important change in their life was related to the beginning of voices - Characteristics of their communication: -the way they talk - age of the voices - what they have to tell - What triggers the appearance of the voice - Characteristics of their upbringing during their childhood and any special experiences that occurred in that period.

  24. Construct • Deconstruct the diagnostic label into the original complaints and reaction patterns Who do the voices represent? What problem(s) do the voices represent? • Contextual analysis: relation with life history, emotions involved and power structure of the voices » setting goals for a treatment plan

  25. Multi models • Normalising (psycho education) • Epidemiology ( health illness ratios) • Social stress theory (creating safety) • Trauma theory (working through guilt and aggression) • Attachment theory (stress coping capacity) • Psychotherapy (coping with emotions) Voice Dialogue • Cognitive behavioural theory (coping with anxiety) • Context analysis (relation with life history) • Spiritual theory (relation with meaning)

  26. Multi model approach • Relationship: normal social relationship: open, respectful and supportive; creating social safety • Anxiety reduction: psycho education; CBT ; Voice Dialogue; medication • Contextual analysis: relation life history, emotions involved and power structure voices • Recovery: reconnecting and taking power.

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