Mediation of the relationship between inner voice experiences and health-related quality of life

The phenomena of auditory hallucination as described by Indonesian people living with schizophrenia

This study was a phenomenological inquiry of the experience of auditory hallucinations as described by 13 Indonesian people diagnosed with schizophrenia. The interviewees included 6 men and 7 women and they were aged between 19 and 56 years. Four themes emerged from this study: feeling more like a robot than a human being; voices of contradiction--a point of confusion; tattered relationships and family disarray; and normalizing the presence of voices as part of everyday life. The findings of this study have the potential to contribute to new understandings of how people live with and manage auditory hallucinations and so enhance client-centered nursing care.

Accuracy of nurses' perceptions of voice hearing and psychiatric symptoms

AIM

This article reports a study of nurses' assessments of a voice hearer's voices and psychiatric symptoms, and associations of these perceptions with nurses' education, career experience and primary care role.

BACKGROUND

Traditional views in nursing suggest that to engage voice hearers in a discussion of their voices is to support the psychopathology of the voice hearers. Research into how voice hearers conceptualize voice hearing has generated a range of perspectives, raising concerns about whether nurses capture sufficient, accurate and specific assessment data about the experiences of voice hearers.

METHOD

One hundred and fifteen psychiatric nurses rated items on an Inventory of Voice Experiences and the Brief Psychiatric Rating Scale while viewing a videotaped assessment of a voice hearer with serious and persistent mental illness. The voice hearer in the videotape used the same instruments to rate his own voices and symptoms. This self-assessment was undertaken 30 days before and immediately before production of the video-recorded assessment. The data were collected between 2000 and 2002.

RESULTS

The voice hearer's ratings of his voice hearing experiences and psychiatric symptoms were consistent over a 30-day period. Most nurse ratings of the voice hearer's voices and psychiatric symptoms did not match those of the voice hearer. However, the voice hearer and nurses demonstrated a moderately positive association between the voice hearer's voices and symptoms. Ratings of graduate-educated case managers and clinical nurse specialists (n=30) in clinical practice settings were more consistent with one another and corresponded more closely with the ratings of the voice hearer, particularly for the association between the voice hearer's voices and symptoms.

CONCLUSION

Accurate and specific assessment of voice hearing may facilitate engagement with voice hearers and improve the selection of strategies to help them manage the voices that upset them.

Efficacy of cognitive nursing intervention for voice hearing

PROBLEM

Many individuals who hear negative voices are troubled by their voices even when they adhere to prescribed neuroleptic medication regimens. At the same time, recent clinical trials provide evidence that structured, cognitive intervention can reduce distress tied to refractory auditory hallucinations and other psychiatric symptoms.

PURPOSE

The purpose of this randomized controlled trial was to determine whether usual care (UC), or usual care plus 12, 90-min episodes of cognitive nursing intervention (UC + CNI) led to sustained improvement in the psychiatric symptoms and self-esteem of 65 voice hearers assigned a diagnosis of schizophrenia or schizoaffective disorder. ANALYSIS AND FINDINGS: Analysis of covariance with repeated measures procedures indicate that the 44 participants exposed to UC + CNI, were significantly more likely than the 21 participants exposed to UC only, to sustain significant improvement in psychiatric symptoms and self-esteem 1 year following treatment.

IMPLICATIONS

These findings provide encouragement for nurses to further develop and investigate cognitive strategies to treat psychiatric symptoms of voice hearers.

Cognitive intervention for voice hearers

Cognitive behavioral therapy is an emerging treatment being used to attenuate negative thoughts and emotions tied to the formation, expression, and maintenance of verbal auditory hallucinations. This paper describes the theoretical underpinnings for the intervention and a clinical application of a prototype cognitive nursing intervention for treating faulty thinking and beliefs linked with problematic voice hearing experiences. The paper ends with a review of current evidence and implications concerning the efficacy of cognitive intervention approaches with voice hearers.