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The outline below provides a roadmap for treatment of auditory hallucination within a CBTp framework. The roadmap provides direction in the following areas: Assessment, Psychoeducation, and Coping Strategies. Clinicians are encouraged to supplement these recommendations with other domains not specific to voice hearing from the CBT Roadmap – Early in Treatment guide; for example, materials relevant to goal setting could be tailored to voice-hearing. Resources are drawn primarily from the IRT Training Manual. 

Additional recourses are drawn from other publicly available guides for treating auditory hallucinations:

Assessments

Assessment can be helpful for establishing clients’ beliefs or dimensions of voice-hearing. Several options exist for clinicians to use during an assessment phase and across therapy to monitor treatment progress. We are agnostic about which are “best” measures but provide several options within each domain. Please note that you do not have to use all these measures.

  • Relationship with Voices
    • Beliefs about Voices Questionnaire-Revised (BAVQ-R) (IRT Manual, p. 399)

Psychoeducation

Psychoeducation about voice-hearing can in and of itself be very therapeutic as it may help normalize and destigmatize the experience of hearing voices.

  • Basic Information about Psychosis (IRT Manual, pp. 133-138)
  • Stress-Vulnerability Model (IRT Manual, pp. 140-144)
  • Statistics for Normalization of Voice-Hearing (IRT Manual, p. 491)

Coping Strategies

The following list of coping strategies is not exhaustive and consists of selected coping strategies from the material referenced in this guide.

  • Distraction
  • Relaxation-Bases Strategies
    • Diaphragmatic or Relaxed Breathing (IRT Manual, pp. 184-187)
    • Muscle Relaxation (IRT Manual, p. 188)
    • Imagining a Peaceful Scene (IRT Manual, p. 189)
    • Soothing or Savoring (IRT Manual, p. 341-345)
  • Refocusing or Attention Training
  • Cognitive-Behavioral Approaches
    • Cognitive Restructuring (IRT Manual, p. 493)
      • Introducing the Cognitive Triangle (IRT Manual, pp. 406-409)
      • Common Styles of Thinking (IRT Manual, pp. 410-415)
      • Cognitive Restructuring (IRT Manual, pp. 416-432; video demonstration part 1 and part 2)
        • 5 Steps of Cognitive Restructuring Note Card (IRT Manual, pp. 402-403)
    • Behavioral Approaches
  • Third-Wave Approaches (acceptance and commitment, compassion, mindfulness)