A systematic review and empirical study investigating cognitive and social models of voice-hearing

  • Samantha Wong

Student thesis: Doctor of Clinical Psychology


This thesis was completed by Samantha Wong for the degree of Doctor of Clinical Psychology (ClinPsyD) at The University of Manchester. The thesis title is 'A systematic review and empirical study investigating cognitive and social models of voice-hearing'. This thesis was submitted on the 14th of July 2016 and is comprised of three papers. Papers 1 and 2 have been prepared for submission to Clinical Psychology Review and Psychosis respectively.Paper 1 presents a systematic review on the evidence for the relationship between appraisals of auditory verbal hallucinations and voice-related distress in psychosis. A literature search was conducted using the following electronic databases: Web of Science, PsycINFO, Embase and Pubmed. Twenty-four studies were identified that satisfied inclusion criteria for the review. Several types of appraisals were found to be associated with distress in voice-hearers: malevolence, control, power, origin of voices and benevolence beliefs. Evidence for an association was particularly strong for malevolence and control appraisals, indicating that these may be important to target in interventions. Overall findings generally supported that modification of voice appraisals, particularly malevolence, power and control appraisals, in cognitive therapy is associated with a reduction in voice-related distress.Paper 2 presents an experimental study which explored whether people who are exposed to stressful material are more likely to report hearing voices when they are not present (i.e. false alarms). Factors that may predict or moderate voice-hearing were also explored. A non-clinical sample (N = 130) completed measures of trauma history, hallucination proneness, dissociation, affect and attachment styles, before being allocated to view pictures depicting stressful interpersonal scenarios or pictures with neutral interpersonal scenarios. Participants then completed a voice detection task. False alarms were recorded as a proxy measure of voice-hearing. Participants in the stressful group reported significantly higher levels of stress than in the neutral group. No differences were found in false alarms. Physical abuse history and depersonalisation significantly correlated with false alarms. This study indicates that people with physical abuse history and dissociative tendencies may be more vulnerable to hearing voices; clinically, these factors should therefore be assessed. However, findings of this study should be interpreted tentatively due to lack of diversity within the sample.Paper 3 is a critical reflection of the systematic review, the empirical paper and the research process as a whole. Strengths and limitations of the presented research are discussed as well as directions for future research.
Date of Award31 Dec 2016
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorKatherine Berry (Supervisor) & Sandra Bucci (Supervisor)


  • voices
  • auditory hallucinations
  • stress
  • trauma
  • psychosis

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