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Title: An ecological examination of proximal psychological mechanisms related to the experience of, and therapy for, distressing voices
Author: Fielding Smith, Sarah
ISNI:       0000 0004 6495 2254
Awarding Body: University of Sussex
Current Institution: University of Sussex
Date of Award: 2017
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Voice hearing (or auditory verbal hallucinations) is a commonly reported experience across a range of psychiatric diagnoses, and is often associated with high levels of distress and disruption to everyday functioning. Many people troubled by voices see little benefit from antipsychotic medication, prompting attempts to understand and target psychological mechanisms underlying both the emergence of voices and associated distress. Research to date has typically adopted a cross-sectional approach, identifying factors associated with the tendency to hear distressing voices. However, less is known about the ‘proximal' mechanisms associated with fluctuations in voices and distress during the daily lives of voice hearers. Psychological therapies for distressing voices have demonstrated limited success in reducing voice-related distress, and it is suggested that a better understanding of the proximal mechanisms underlying voices may facilitate advancements in these interventions. The studies within this thesis utilise the Experience Sampling Method (ESM), an ecological momentary assessment (EMA) approach that allows the intensive, ‘micro-longitudinal' sampling of voice hearing experiences in the natural contexts in which they are experienced. First, ESM is used to investigate the antecedent and modulating roles of stress and dissociative experiences in voice hearing (N=31). Next, the role of behavioural responses and voice appraisals in the maintenance of voice-related distress during daily life are explored (N=31). Then, a data-based illustration of the potential of ESM for delineating key psychological mechanisms underlying gains in psychological interventions for distressing voices is provided (N=2). Finally, factors associated with stress-induced depersonalisation as a proximal mechanism for voice hearing are explored (N=29). Current findings support the role of depersonalisation as a mediator in the observed relationship between daily life stress and increases in voice intensity. Findings additionally support a role for negative voice appraisals in the experience of momentary voice distress, and a role of behavioural responses in maintaining both distress and voice appraisals over time. Preliminary evidence was obtained for a range of processes involving changes in voice appraisals and emotional reactivity potentially underlying therapeutic gains during cognitive behavioural therapy for psychosis. These findings encourage a greater focus of interventions on targeting mechanisms associated with daily life voice hearing and associated distress, including stress-induced depersonalisation, negative voice appraisals, and maladaptive behavioural responses to voices. They also suggest a parallel use for ESM as a means of enhancing treatment efficacy within the context of psychological interventions.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: RC0553.A84 Auditory hallucinations. Voices. Verbal hallucinations