Listening to Voices: Understanding and Self-Management of Auditory Verbal Hallucinations in Young Adults

Background: Auditory Verbal Hallucinations (AVH) are a hallmark of psychosis, but affect many other clinical populations. Patients’ understanding and self-management of AVH may differ between diagnostic groups, change over time, and influence clinical outcomes. This study aimed to explore patients’ understanding and self-management of AVH in a young adult clinical population.

Methods: 35 participants with AVH were purposively sampled from a youth mental health service. Participants completed diary and photo-elicitation tasks, and the resulting materials were discussed at in-depth, unstructured interviews. Themes were derived using conventional content analysis.

Results: Three themes emerged. (1) Searching for answers, forming identities – voice-hearers sought to explain their experiences, resulting in the construction of identities for voices and themselves. Explanations were drawn from participants’ life-stories and belief-systems. (2) Coping strategies and goals – patients’ self-management strategies were diverse, reflecting the diverse negative experiences of AVH, e.g. as unpleasant sounds, overwhelming emotions, or as threats to agency. (3) Outlook – participants formed an overall outlook reflecting their self-efficacy in managing AVH. Resignation and hopelessness in connection with disabling AVH are contrasted with “acceptance” or integration, which were described as positive, ideal, or mature.

Conclusions: Trans-diagnostic commonalities in understanding and self-management of AVH are highlighted. These offer targets for individual therapies and further research.