{"id":3900,"date":"2025-12-19T14:41:19","date_gmt":"2025-12-19T19:41:19","guid":{"rendered":"https:\/\/www.med.unc.edu\/psych\/epi-nc\/?page_id=3900"},"modified":"2026-01-13T09:59:30","modified_gmt":"2026-01-13T14:59:30","slug":"auditory-hallucinations-roadmap","status":"publish","type":"page","link":"https:\/\/www.med.unc.edu\/psych\/epi-nc\/for-clinicians-2\/cbtp-roadmaps\/auditory-hallucinations-roadmap\/","title":{"rendered":"Auditory Hallucinations Roadmap"},"content":{"rendered":"<p>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 &#8211; Early in Treatment guide; for example, materials relevant to goal setting could be tailored to voice-hearing. Resources are drawn primarily from the <a href=\"https:\/\/www.med.unc.edu\/psych\/epi-nc\/wp-content\/uploads\/sites\/720\/2025\/03\/IRT-Manual.pdf\" target=\"_blank\" rel=\"noopener\">IRT Training Manual.\u00a0<\/a><\/p>\n<p>Additional recourses are drawn from other publicly available guides for treating auditory hallucinations:<\/p>\n<ul>\n<li><a href=\"https:\/\/www.med.unc.edu\/psych\/epi-nc\/wp-content\/uploads\/sites\/720\/2025\/12\/CBT_for_Voices_and_Worries_Therapist_Workbook.pdf\" target=\"_blank\" rel=\"noopener\">CBT for Voices and Worries: Therapists Manual<\/a> (From Dimitri Perivoliotis and Yulia Landa)<\/li>\n<li><a href=\"https:\/\/www.med.unc.edu\/psych\/epi-nc\/wp-content\/uploads\/sites\/720\/2025\/12\/Cognitive-Behavioral-Therapy-for-Psychosis-Intensive-Training-Handouts-Fall-2021-1-1.pdf\" target=\"_blank\" rel=\"noopener\">Cognitive Behavior Therapy for Psychosis Handouts\u00a0<\/a>(From Valeri Kreider and Harry Sivec). Handouts:<\/li>\n<\/ul>\n<div class=\"bs-callout bs-callout-default\">\n<h2>Assessments<\/h2>\n<p>Assessment can be helpful for establishing clients\u2019 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 \u201cbest\u201d measures but provide several options within each domain. Please note that you do not have to use all these measures.<\/p>\n<\/div>\n<table style=\"border-collapse: collapse;width: 100%\">\n<tbody>\n<tr>\n<td style=\"width: 100%\">\n<div class=\"bs-callout-info\">\n<ul>\n<li><em>Symptoms (e.g., frequency, intensity, type, antecedents)<\/em>\n<ul>\n<li>Symptoms of Hallucinations Checklist (IRT Manual, pp. 489-490)<\/li>\n<li><a href=\"https:\/\/www.med.unc.edu\/psych\/epi-nc\/wp-content\/uploads\/sites\/720\/2025\/12\/PSYRATS.pdf\" target=\"_blank\" rel=\"noopener\">PSYRATS<\/a>\n<ul>\n<li><a href=\"https:\/\/www.med.unc.edu\/psych\/epi-nc\/wp-content\/uploads\/sites\/720\/2025\/12\/PSYRATS-Psychotic-Sympton-Rating-Scales.pdf\" target=\"_blank\" rel=\"noopener\">PSYRATS Psychotic Symptom Rating Scale<\/a><\/li>\n<\/ul>\n<\/li>\n<li><a href=\"https:\/\/www.med.unc.edu\/psych\/epi-nc\/wp-content\/uploads\/sites\/720\/2025\/12\/Voice-Diary.pdf\" target=\"_blank\" rel=\"noopener\">Voice Diary<\/a> (Kreider &amp; Sivec)<\/li>\n<li><a href=\"https:\/\/www.med.unc.edu\/psych\/epi-nc\/wp-content\/uploads\/sites\/720\/2025\/12\/Informal-Assessment-of-Voice-Hearing.docx\" target=\"_blank\" rel=\"noopener\">Informal Assessment of Voice Hearing<\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<table style=\"border-collapse: collapse;width: 100%\">\n<tbody>\n<tr>\n<td style=\"width: 100%\">\n<div class=\"bs-callout-info\">\n<ul class=\"wp-block-list\">\n<li><em>Relationship with Voices<\/em>\n<ul class=\"wp-block-list\">\n<li>Beliefs about Voices Questionnaire-Revised (BAVQ-R) (IRT Manual, p. 399)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"bs-callout bs-callout-default\">\n<h2>Psychoeducation<\/h2>\n<\/div>\n<p>Psychoeducation about voice-hearing can in and of itself be very therapeutic as it may help normalize and destigmatize the experience of hearing voices.<\/p>\n<table style=\"border-collapse: collapse;width: 100%\">\n<tbody>\n<tr>\n<td style=\"width: 100%\">\n<ul class=\"wp-block-list\">\n<li>Basic Information about Psychosis (IRT Manual, pp. 133-138)<\/li>\n<li>Stress-Vulnerability Model (IRT Manual, pp. 140-144)\n<ul class=\"wp-block-list\">\n<li>Normalization of Symptoms (<a href=\"https:\/\/www.youtube.com\/watch?v=-Wc7MUNBSRo\" target=\"_blank\" rel=\"noreferrer noopener\">Video Demonstration<\/a>)<\/li>\n<\/ul>\n<\/li>\n<li>Statistics for Normalization of Voice-Hearing (IRT Manual, p. 491)<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"bs-callout bs-callout-default\">\n<h2>Coping Strategies<\/h2>\n<\/div>\n<p>The following list of coping strategies is not exhaustive and consists of selected coping strategies from the material referenced in this guide.<\/p>\n<table style=\"border-collapse: collapse;width: 100%\">\n<tbody>\n<tr>\n<td style=\"width: 100%\">\n<ul class=\"wp-block-list\">\n<li><em>Distraction<\/em>\n<ul class=\"wp-block-list\">\n<li>Distraction Activities (e.g., talking to someone; IRT Manual, p. 491)\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.med.unc.edu\/psych\/epi-nc\/wp-content\/uploads\/sites\/720\/2025\/12\/Assorted-coping-strategies-for-AH.pdf\" target=\"_blank\" rel=\"noopener\">Assorted coping strategies for AH<\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li><em>Relaxation-Bases Strategies<\/em>\n<ul class=\"wp-block-list\">\n<li>Diaphragmatic or Relaxed Breathing (IRT Manual, pp. 184-187)<\/li>\n<li>Muscle Relaxation (IRT Manual, p. 188)<\/li>\n<li>Imagining a Peaceful Scene (IRT Manual, p. 189)<\/li>\n<li>Soothing or Savoring (IRT Manual, p. 341-345)<\/li>\n<\/ul>\n<\/li>\n<li><em>Refocusing or Attention Training<\/em>\n<ul class=\"wp-block-list\">\n<li>Look, Point, Name Game (Perivoliotis &amp; Landa and Kreider &amp; Sivec)\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.med.unc.edu\/psych\/epi-nc\/wp-content\/uploads\/sites\/720\/2025\/12\/Refocusing.pdf\" target=\"_blank\" rel=\"noopener\">Refocusing<\/a><\/li>\n<li><a href=\"https:\/\/www.med.unc.edu\/psych\/epi-nc\/wp-content\/uploads\/sites\/720\/2025\/12\/Refocusing-pt-2.pdf\" target=\"_blank\" rel=\"noopener\">Refocusing pt 2<\/a><\/li>\n<\/ul>\n<\/li>\n<li><a href=\"https:\/\/www.med.unc.edu\/psych\/epi-nc\/wp-content\/uploads\/sites\/720\/2025\/12\/Refocusing.pdf\" target=\"_blank\" rel=\"noopener\">Subvocalization<\/a> (Kreider &amp; Sivec)<\/li>\n<li><a href=\"https:\/\/www.med.unc.edu\/psych\/epi-nc\/wp-content\/uploads\/sites\/720\/2025\/12\/Assorted-coping-strategies-for-AH.pdf\" target=\"_blank\" rel=\"noopener\">Meta-Cognitive Techniques<\/a> (Kreider &amp; Sivec)<\/li>\n<\/ul>\n<\/li>\n<li><em>Cognitive-Behavioral Approaches<\/em>\n<ul class=\"wp-block-list\">\n<li>Cognitive Restructuring (IRT Manual, p. 493)\n<ul class=\"wp-block-list\">\n<li>Introducing the Cognitive Triangle (IRT Manual, pp. 406-409)<\/li>\n<li>Common Styles of Thinking (IRT Manual, pp. 410-415)<\/li>\n<li>Cognitive Restructuring (IRT Manual, pp. 416-432; video demonstration\u00a0<a href=\"https:\/\/youtu.be\/w8A3Nt3EXu4?si=2zc7w3q_tjJz8Y4r\" target=\"_blank\" rel=\"noreferrer noopener\">part 1<\/a>\u00a0and\u00a0<a href=\"https:\/\/youtu.be\/ipjeyL1gHNM?si=sush-7bk3dIqYQcU\" target=\"_blank\" rel=\"noreferrer noopener\">part 2<\/a>)\n<ul class=\"wp-block-list\">\n<li>5 Steps of Cognitive Restructuring Note Card (IRT Manual, pp. 402-403)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Behavioral Approaches\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.med.unc.edu\/psych\/epi-nc\/wp-content\/uploads\/sites\/720\/2025\/12\/Voice-Avoidance-Hierarchy.pdf\" target=\"_blank\" rel=\"noopener\">Developing a voice avoidance hierarchy and voice avoidance hierarchy for situations<\/a> (Wright et al. book)<\/li>\n<li>Behavioral Experiments\n<ul class=\"wp-block-list\">\n<li>Tips for designing (IRT Manual, p. 390)<\/li>\n<li>Conducting Experiments (video demonstration\u00a0<a href=\"https:\/\/youtu.be\/1tfh6aK4dug?si=XtF7v2Ery7-aYzvo\" target=\"_blank\" rel=\"noreferrer noopener\">part 1<\/a>\u00a0and\u00a0<a href=\"https:\/\/youtu.be\/DK1NmjR3ZhM?si=SfZRQ9NXlb48qRIL\" target=\"_blank\" rel=\"noreferrer noopener\">part 2<\/a>)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li><em>Third-Wave Approaches (acceptance and commitment, compassion, mindfulness)<\/em>\n<ul class=\"wp-block-list\">\n<li>Positive Self-Talk (IRT Manual, p. 492)<\/li>\n<li>Acceptance\/Mindfulness Strategies (IRT Manual, pp. 346-348; IRT Manual p. 493;\u00a0<a href=\"https:\/\/youtu.be\/FHRLVC3WM04?si=xPJuoMAZNOLtJsuy\" target=\"_blank\" rel=\"noreferrer noopener\">Worry Postponement Demonstration<\/a>)<\/li>\n<li>Compassion-Focused Approaches\n<ul class=\"wp-block-list\">\n<li>Developing Compassion for Voices (<a href=\"https:\/\/www.youtube.com\/watch?v=VRqI4lxuXAw\" target=\"_blank\" rel=\"noreferrer noopener\">video explanation<\/a>)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n","protected":false},"excerpt":{"rendered":"<p>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 &#8211; Early in Treatment guide; for example, materials &hellip; <a href=\"https:\/\/www.med.unc.edu\/psych\/epi-nc\/for-clinicians-2\/cbtp-roadmaps\/auditory-hallucinations-roadmap\/\" aria-label=\"Read more about Auditory Hallucinations Roadmap\">Read more<\/a><\/p>\n","protected":false},"author":119894,"featured_media":0,"parent":3897,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"layout":"","cellInformation":"","apiCallInformation":"","footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-3900","page","type-page","status-publish","hentry","odd"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Auditory Hallucinations Roadmap - Early Psychosis Interventions of North Carolina (EPI- NC)<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.med.unc.edu\/psych\/epi-nc\/for-clinicians-2\/cbtp-roadmaps\/auditory-hallucinations-roadmap\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Auditory Hallucinations Roadmap - Early Psychosis Interventions of North Carolina (EPI- NC)\" \/>\n<meta property=\"og:description\" content=\"The outline below provides a roadmap for treatment of auditory hallucination within a CBTp framework. 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