Ever since I read the possibility that my son’s therapist may be encouraging him to yell at the voices, I have been curious. Online, there are excerpts from “The Massachusetts General Hospital Handbook of Cognitive Behavioral Therapy”. I found this interesting in regards to voices.
“The cognitive model can be applied to voices because it is believed the emotional and behavioral reactions to the voice is mediated by the beliefs about the voice (Beck et al., 2011) It is therefore important to elicit information about the omnipotence , malevolence and benevolence of the voices. Understanding the voices’ identity, purpose, power and perceived consequences of obedience or disobedience is critical in reducing the patient’s distress. The voices are not the problem, but rather the patient’s appraisal of the voices. The distress associated with the inaccurate perceptions lead(s) to vigilance, safety behaviors and avoidance.”
The passage continues talking about how patients are affected by command voices and moves on to voices that call them names.
“Similarly, a patient who hears voices that call him nasty names may disrupt neighbors yelling at them to stop. Therapy can help the patient learn that the voices have no power. Experiments that defy the voices teach the patient that the voices lie and have no power. Experiments that activate stress like running in place, over-breathing or mental calculations can increase the volume of the voices, while anti-anxiety tools can reduce the volume, showing the patient the voices are not the menace he thinks they are. Coping with the voices means the patient no longer feels distress when he knows the voices have no power and do not have to get in the way. Ideally the patient learns that the voice is simply a reaction to stress that in internally generated. Cognitive behavioral therapy for hallucinations and delusions is designed to reduce stress and disability; reducing delusions and hallucinations is only a means to that end.”
If you have made it though this so far, the handbook also talks about confabulations being conclusions that the patients jump to without any thought process being involved. Like -I hear a voice calling me a name, there is a man over there, he just called me a name. Thought projection being the same sort of thing. Patient is waiting to place an order for fast food, person in front of him orders food, patient suddenly believes the other person “has stolen their thoughts”. Has suggestions on how a therapy session is run in which you don’t deny the confabulation, but you lead a conversation around it trying to make them question the confabulation by the conversation you make with them about the confabulation - nothing confrontational just conversational. Its like you lead them to things that could bring about the conclusion that the confabulation is not correct, but just making pleasant conversation.
Its an expensive book, really expensive. Not super textbook expensive, but…