Transformation of Methodological Understanding about “Voices” and Versions of Interventions by Experts in the Field of Auditory Hallucinations



An analytical review of the directions for auditory hallucinations (AH) interventions in the context of the development of ideas about the phenomenon of “voices” is presented. The transformation of methodological approaches evolves from the conceptualization of hallucinations as “perceptions without an object” and “production of sick brain” to an acknowledgment of the connection with the stimulus and the significance of the subject's activity; from the concept of AH as a symptom to the analysis of perception as a mediated activity, the differentiation of AH cognitive and perceptual models. Changes in conceptualization determine the contemporary goals of the intervention. In the cultural-activity approach methods are used to improve the psychological state based on the comprehension of the systemic nature of the defect in mental activity. The limitations of comparing the effectiveness of pharmacological treatment and psychotherapy are shown. In the development of evidence-based intervention strategies the integration of cultural-activity approach thesis and cognitive-behavioral therapy (CBT) models is productive. Within the framework of the “third wave” CBT and therapy based on social relations the leading techniques for adapting to “voices” are presented. Conceptualization the mechanisms of AH allows to move from the goal of intervention related to adaptation in defect – to distress reduction, increase the controllability of AH, to overcoming the consequences of psychosis.

General Information

Keywords: auditory hallucinations, anxiety, cultural-activity approach, cognitive-behavioral intervention “third wave” techniques

Journal rubric: Theoretical Research

Article type: scientific article


Funding. the reported study was funded by Russian Foundation for Basic Research (RFBR), project 17-29-02420

For citation: Sagalakova O.A., Zhirnova O.V., Truevtsev D.V. Transformation of Methodological Understanding about “Voices” and Versions of Interventions by Experts in the Field of Auditory Hallucinations [Elektronnyi resurs]. Klinicheskaia i spetsial'naia psikhologiia = Clinical Psychology and Special Education, 2020. Vol. 9, no. 2, pp. 34–61. DOI: 10.17759/cpse.2020090202. (In Russ., аbstr. in Engl.)


  1. Vlasenkova I.N., Zvereva N.V. Izbiratel'nost' myshleniya i osobennosti assotsiativnoi deyatel'nosti v raznykh modal'nostyakh u detei 8–11 let v norme i pri shizofrenii [Elektronnyi resurs] [Selectivity of thinking and particularity of association activity in different modalities in normal and schizophrenia children 8–11 years old]. Klinicheskaya i spetsial'naya psikhologiya=Clinical Psychology and Special Education, 2017, vol. 6, no. 2,
    pp. 17–29. DOI: 10.17759/cpse.2017060203. (Accessed: 29.01.2020). (In Russ., abstr. in Engl.).
  2. Zvereva N.V., Kutyreva Ya.S., Kazakova M.V. Vospriyatie i vyrazhenie emotsii podrostkami v norme i pri shizofrenii [Elektronnyi resurs] [The perception and expression of emotions in normative teenagers and those who suffers from schizophrenia]. Klinicheskaya i spetsial'naya psikhologiya=Clinical Psychology and Special Education, 2016, vol. 5, no. 4, pp. 76–92. DOI: 10.17759/cpse.2016050406. (Accessed: 29.01.2020).
    (In Russ., abstr. in Engl.).
  3. Zeigarnik B.V. Patopsikhologiya [Pathopsychology]. Moscow: Publ. of MSU, 1976. 240 p. (In Russ.).
  4. Rubinshtein S.Ya. Eksperimental'noe issledovanie obmanov slukha [Experimental study of auditory deceptions]. Voprosy patopsikhologii=Issues of Pathopsychology. Moscow, 1970. pp. 55–69. (In Russ.).
  5. Rychkova O.V. Struktura narushenii sotsial'nogo intellekta pri shizofrenii [Elektronnyi resurs] [The structure of social intelligence impairments in schizophrenics]. Psikhologicheskie issledovaniya=Psychological Studies, 2013, vol. 6, no. 28, pp. 11.
    URL: (Accessed: 02.02.2020). (In Russ., abstr. in Engl.).
  6. Sagalakova O.A., Truevtsev D.V., Stoyanova I.Ya. Sindrom sotsial'noi fobii i ego psikhologicheskoe soderzhanie [A psychological content of social phobia syndrome]. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova=S.S. Korsakov Journal of Neurology and Psychiatry, 2017, vol. 117, no. 4, pp. 15–22. DOI: 10.17116/jnevro20171174115-22.
    (In Russ., abstr. in Engl.).
  7. Sagalakova O.A., Truevtsev D.V., Stoyanova I.Ya. Sindromno-faktornyi metod v istoricheskom i sovremennom kontekste: vozmozhnosti issledovaniya sotsial'no-trevozhnogo rasstroistva [Syndrome-factor method in historical and modern context: possibilities of studying social anxiety disorder]. Sibirskii psikhologicheskii zhurnal =Siberian Journal of Psychology, 2018, no. 70, pp. 75–91. DOI: 10.17223/17267080/70/6. (In Russ., abstr. in Engl.).
  8. Strogova S.E., Sergienko A.A., Zvereva N.V. Kognitivnyi defekt pri rasstroistvakh shizofrenicheskogo kruga u detei i podrostkov: psikhometricheskii i neiropsikhologicheskii podkhody k otsenke kognitivnykh narushenii [Elektronnyi resurs] [Cognitive defect in children and adolescents with schizophrenia spectrum disorders: psychometric and neuropsychological approaches to the assessment of cognitive disorders]. Klinicheskaya i spetsial'naya psikhologiya=Clinical Psychology and Special Education, 2016, vol. 5, no. 1, pp. 61–76. DOI: 10.17759/cpse.2016050105. (Accessed: 01.02.2020). (In Russ., abstr. in Engl.).
  9. Takkueva E.V., Kholmogorova A.B., Palin A.V. Konsolidatsiya dostizhenii organizatsionnoi i klinicheskoi psikhologii v reabilitatsii bol'nykh shizofreniei: integrativnaya programma motivatsionnogo treninga [Consolidation of achievements of organizational and clinical psychology in the rehabilitation of patients with schizophrenia: an integrative programme of motivational training]. Sovremennaya terapiya psikhicheskikh rasstroistv=Contemporary Therapy of Mental Disorders, 2019, no. 1, pp. 38–48. DOI: 10.21265/PSYPH.2019.36.92.005. (In Russ., abstr. in Engl.).
  10. Kholmogorova A.B., Garanyan N.G., Dolnykova A.A. i dr. Programma treninga kognitivnykh i sotsial'nykh navykov (TKSN) u bol'nykh shizofreniei [The program for cognitive and social skills trainingin schizophrenic patients]. Sotsial'naya i klinicheskaya psikhiatriya=Social and Clinical Psychiatry, 2007, vol. 17, no. 4, pp. 67–77. (In Russ.).
  11. Kholmogorova A.B. Znachenie kul'turno-istoricheskoi teorii razvitiya psikhiki
    L.S. Vygotskogo dlya razrabotki sovremennykh modelei sotsial'nogo poznaniya i metodov psikhoterapii [The value of L.S. Vygotsky’s cultural-historical theory of mental development for the development of modern models of social cognition and methods of psychotherapy]. Kul'turno-istoricheskaya psikhologiya [Cultural-Historical Psychology], 2016, vol. 12, no. 3, pp. 58‒92. DOI:10.17759/chp.2016120305 (In Russ.).
  12. Bais L., Liemburg E., Vercammen A., et al. Effects of low frequency rTMS treatment on brain networks for inner speech in patients with schizophrenia and auditory verbal hallucinations. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 2017,
    vol. 78, pp. 105–113. DOI: 10.1016/j.pnpbp.2017.04.017
  13. Bighelli I., Leucht C., Huhn M., et al. Are randomized controlled trials on pharmacotherapy and psychotherapy for positive symptoms of schizophrenia comparable? A systematic review of patient and study characteristics. Schizophrenia Bulletin, 2020,
    vol. 46, no. 3, pp. 496–504. DOI: 10.1093/schbul/sbz090
  14. Bighelli I., Salanti G., Huhn M., et al. Psychological interventions to reduce positive symptoms in schizophrenia: systematic review and network meta-analysis. World Psychiatry, 2018, vol. 17, no. 3, pp. 316–329. DOI: 10.1002/wps.20577
  15. Birchwood M., Gilbert P., Gilbert J., et al. Interpersonal and role-related schema influence the relationship with the dominant 'voice' in schizophrenia: a comparison of three models. Psychol Med, 2004, vol. 34, no. 8, pp. 1571–1580. DOI: 10.1017/s0033291704002636
  16. Birchwood M., Michail M., Meaden A., et al. Cognitive behaviour therapy to prevent harmful compliance with command hallucinations (COMMAND): a randomized
    controlled trial. Lancet Psychiatry, 2014, vol. 1, no. 1, pp. 23–33. DOI: 10.1016/S2215-0366(14)70247-0
  17. Birtchnell J. Relating therapy with individuals, couples and families. Journal of Family Therapy, 2001, vol. 23, no. 1, pp. 63-84. DOI: 10.1111/1467-6427.00169
  18. Braehler C., Gumley A., Harper J., et al. Exploring change processes in compassion focused therapy in psychosis: results of a feasibility randomized controlled trial. British Journal of Clinical Psychology, 2013, vol. 52, no. 2, pp. 199–214. DOI: 10.1111/bjc.12009
  19. Browne J., Penn D.L., Raykov T., et al. Social cognition in schizophrenia: factor structure of emotion processing and theory of mind. Psychiatry Research, 2016, vol. 242, pp. 150–156. DOI: 10.1016/j.psychres.2016.05.034
  20. Chadwick P., Strauss C., Jones A.M., et al. Group mindfulness-based intervention for distressing voices: a pragmatic randomised controlled trial. Schizophrenia Research, 2016, vol. 175, no. 1-3, pp. 168–173. DOI: 10.1016/j.schres.2016.04.001
  21. Chaix J., Ma E., Nguyen A., et al.  Safety-seeking behaviours and verbal auditory hallucinations in schizophrenia. Psychiatry Research, 2014, vol. 220, no. 1-2, pp. 158–162.
  22. Cisneros-Franco J.M., Ouellet L., Kamal B., et al. A brain without brakes: reduced inhibition is associated with enhanced but dysregulated plasticity in the aged rat auditory cortex. eNeuro, 2018, vol. 5, no. 4, pp. 1–15. DOI: 10.1523/ENEURO.0051-18.2018
  23. Craig T.K., Rus-Calafell M., Ward T., et al. AVATAR therapy for auditory verbal hallucinations in people with psychosis: a single-blind, randomised controlled trial. Lancet Psychiatry, 2018, vol. 5, no. 1, pp. 31–40. DOI: 10.1016/S2215-0366(17)30427-3
  24. Craig T.K., Rus-Calafell M., Ward T., et al. The effects of an Audio Visual Assisted Therapy Aid for Refractory auditory hallucinations (AVATAR therapy): study protocol for a randomised controlled trial. Trials, 2015, vol. 16, p. 349. DOI: 10.1186/s13063-015-0888-6
  25. Freeman D., Dunn G., Startup H., et al. Effects of cognitive behavior therapy for worry on persecutory delusions in patients with psychosis (WIT): a parallel, single-blind, randomised controlled trial with a mediation analysis. Lancet Psychiatry, 2015, vol. 2, no. 4, pp. 305–313. DOI: 10.1016/S2215-0366(15)00039-5
  26. Fuentes-Claramonte P., Soler J., Hinzen W., et al. The interfering effects of frequent auditory verbal hallucinations on shadowing performance in schizophrenia. Schizophrenia Research, 2019, vol. 208, pp. 488–489. DOI: 10.1016/j.schres.2019.01.019
  27. Gaudiano B.A., Herbert J.D. Acute treatment of inpatients with psychotic symptoms using Acceptance and Commitment Therapy: pilot results. Behaviour Research and Therapy, 2006, vol. 44, no. 3, pp. 415–437. DOI: 10.1016/j.brat.2005.02.007
  28. Gumley A., White R., Briggs A., et al. A parallel group randomised open blinded evaluation of Acceptance and Commitment Therapy for depression after psychosis: Pilot trial outcomes (ADAPT). Schizophrenia Research, 2017, vol. 183, pp. 143–150. DOI: 10.1016/j.schres.2016.11.026
  29. Guo Z.H., Li Z.J., Ma Y., et al. Brief cognitive-behavioural therapy for patients in the community with schizophrenia: randomized controlled trial in Beijing, China. British Journal of Psychiatry, 2017, vol. 210, no. 3, pp. 223–229. DOI: 10.1192/bjp.bp.116.183285
  30. Hayward M., Jones A.M., Bogen-Johnston L., et al. Relating Therapy for distressing auditory hallucinations: A pilot randomized controlled trial. Schizophrenia Research, 2017, vol. 183, pp. 137–142. DOI: 10.1016/j.schres.2016.11.019
  31. Hazell C.M., Hayward M., Cavanagh K., et al. Guided self-help cognitive-behaviour Intervention for Voices (GiVE): results from a pilot randomised controlled trial in a transdiagnostic sample. Schizophrenia Research, 2018, vol. 195, pp. 441–447. DOI: 10.1016/j.schres.2017.10.004
  32. Kingdon D., Turkington D. Cognitive therapy of psychosis: Research and implementation. Schizophrenia Research, 2019, vol. 203, pp. 62–65. DOI: 10.1016/j.schres.2017.09.023
  33. Leff J., Williams G., Huckvale M.A., et al. Computer-assisted therapy for medication-resistant auditory hallucinations: proof-of-concept study. British Journal of Psychiatry, 2013, vol. 202, pp. 428–433. DOI: 10.1192/bjp.bp.112.124883
  34. Leucht S., Leucht C., Huhn M., et al. Sixty years of placebo-controlled antipsychotic drug trials in acute schizophrenia: systematic review, Bayesian meta-analysis, and meta-regression of efficacy predictors. The American journal of psychiatry, 2017, vol. 174, no. 10, pp. 927–942. DOI: 10.1176/appi.ajp.2017.16121358
  35. Lincoln T.M., Peters E. A systematic review and discussion of symptom specific cognitive behavioural approaches to delusions and hallucinations.  Schizophrenia Research, 2019, vol. 203, pp. 66–79. DOI: 10.1016/j.schres.2017.12.014
  36. Louise S., Fitzpatrick M., Strauss C., et al. Mindfulness- and acceptance-based interventions for psychosis: Our current understanding and a meta-analysis.  Schizophrenia Research, 2018, vol. 192, pp. 57–63. DOI: 10.1016/j.schres.2017.05.023
  37. Mike L., Guimond S., Kelly S., et al. Social cognition in early course of schizophrenia: Exploratory factor analysis. Psychiatry Research, 2019, vol. 272, pp. 737–743. DOI: 10.1016/j.psychres.2018.12.152
  38. Mondino M., Jardri R., Suaud-Chagny M.F., et al. Effects of Fronto-temporal Transcranial direct current stimulation on auditory verbal hallucinations and resting-state functional connectivity of the left Temporo-parietal junction in patients with schizophrenia. Schizophrenia Bulletin, 2016, vol. 42, no. 2, pp. 318–326.  DOI: 10.1093/schbul/sbv114
  39. Moritz S., Larøi F. Differences and similarities in the sensory and cognitive signatures of voice-hearing, intrusions and thoughts. Schizophrenia Research, 2008, vol. 102, no. 1-3, pp. 96–107. DOI: 10.1016/j.schres.2008.04.007
  40. Murray R.M. Mistakes I have made in my research career. Schizophrenia Bulletin, 2017, vol. 43, no. 2, pp. 253–256.
  41. Naeem F., Habib N., Gul M., et al. A qualitative study to explore patients', carers' and health professionals' views to culturally adapt CBT for psychosis (CBTp) in Pakistan. Behavioural and Cognitive Psychotherapy, 2016, vol. 44, no. 1, pp. 43–55. DOI: 10.1017/S1352465814000332
  42. Pontillo M., De Crescenzo F., Vicari S., et al. Cognitive behavioural therapy for auditory hallucinations in schizophrenia: a review. World Journal of Psychiatry, 2016, vol. 6, no. 3, pp. 372–380. DOI: 10.5498/wjp.v6.i3.372
  43. Rossell S.L., Schutte M.J.L., Toh W.L., et al. The Questionnaire for Psychotic Experiences: an examination of the validity and reliability. Schizophrenia Bulletin, 2019,
    vol. 45, no. 1, pp. 78–87. DOI: 10.1093/schbul/sby148
  44. du Sert O.P., Potvin S., Lipp O., et al. Virtual reality therapy for refractory auditory verbal hallucinations in schizophrenia: A pilot clinical trial. Schizophrenia Research, 2018, vol. 197, pp. 176–181. DOI: 10.1016/j.schres.2018.02.031
  45. Shawyer F., Farhall J., Thomas N., et al. Acceptance and commitment therapy for psychosis: randomised controlled trial. British Journal of Psychiatry, 2017, vol. 210, no. 2, pp. 140–148. DOI: 10.1192/bjp.bp.116.182865
  46. Shawyer F., Mackinnon A., Farhall J. Command hallucinations and violence: implications for detention and treatment. Psychiatry, Psychology and Law, 2003, vol. 10,
    no. 1, pp. 97–107. DOI: 10.1375/pplt.2003.10.1.97
  47. Thomas P., Mathur P., Gottesman I.I., et al. Correlates of hallucinations in schizophrenia: a cross-cultural evaluation. Schizophrenia Research, 2007, vol. 92, no. 1-3, pp. 41–49. DOI: 10.1016/j.schres.2007.01.017
  48. Torrey E.F., Yolken R.H. Schizophrenia as a pseudogenetic disease: A call for more gene-environmental studies. Psychiatry Research, 2019, vol. 278, pp. 146–150. DOI: 10.1016/J.Psychres.2019.06.006
  49. Trower P., Birchwood M., Meaden A., et al. Cognitive therapy for command hallucinations: randomised controlled trial. British Journal of Psychiatry, 2004, vol. 184,
    pp. 312–320. DOI: 10.1192/bjp.184.4.312
  50. Tully S., Wells A., Morrison A.P. An exploration of the relationship between use of safety-seeking behaviours and psychosis: A systematic review and meta-analysis. Clinical Psychology and Psychotherapy, 2017, vol. 24, no. 6, pp. 1384–1405. DOI: 10.1002/cpp.2099
  51. Yates K., Lång U., Cederlöf M., et al. Association of psychotic experiences with subsequent risk of suicidal ideation, suicide attempts, and suicide deaths: a systematic review and meta-analysis of longitudinal population studies. JAMA Psychiatry, 2019, vol. 76, no. 2, pp. 180–189.  DOI: 10.1001/jamapsychiatry.2018.3514.

Information About the Authors

Olga A. Sagalakova, PhD in Psychology, associate professor, Senior Researcher, Laboratory of Experimental Pathopsychology, Moscow State University of Psychology & Education, Moscow, Russia, ORCID:, e-mail:

Olga V. Zhirnova, Junior Researcher, Laboratory of Experimental Pathopsychology, Moscow State University of Psychology & Education, Medical Psychologist, Altai Regional Clinical Psychiatric Hospital Named J.K. Erdman, Barnaul, Russia, ORCID:, e-mail:

Dmitry V. Truevtsev, PhD in Psychology, Associate Professor, Researcher, Laboratory of Experimental Pathopsychology, Moscow State University of Psychology and Education, Moscow, Russia, ORCID:, e-mail:



Total: 1141
Previous month: 22
Current month: 19


Total: 453
Previous month: 6
Current month: 12