Hearing Voices Coping Strategies (Excerpt)
Selective Listening
Some voice hearers find they hear positive as well as negative voices or that the same voices say both helpful and unhelpful things, so they develop their skills of selective listening, learning to take what is useful from the voices and ignoring the rest. For example “I need to get to the shops before they close”.
There is a difference between this speech pattern and “We want you to go to the shops before they close”. It is often the subtle switches between reminding yourself of something and interacting with the voices. Change statements like “We want you out of the house now” to “I’m going out”.
Rules of Engagement
Many people have increased their abilities to be assertive with their voices. This can involve making a contract with the voices. Saying something to them like “I am too busy to talk just now. “I will listen to you if you come back at 7 pm when I have finished my dinner”. Sometimes the voices stick with these contracts. Some people find ignoring the voices more helpful. Others have found just shouting and swearing at the voices makes them feel better.
Use a Mobile
Some people find that if the voices get nasty in public places they want to scream and shout at them, but this can be embarrassing. Try carrying a mobile phone or a realistic toy that is cheaper for these occasions – this way you can shout at the voices without attracting the attention of other people. This will also work if you find a public phone you can use if you need to.
TV And Radio
Some people find TV or a radio a useful distraction. Others find these interact with their voices and cause distress. But turning them off because of the voices can be allowing the voices to control you and your time. If you find that certain words or events on TV or radio trigger your voices or very difficult emotions, try changing the channel as an alternative to turning them off. If it gets too bad then you can turn off. For people whose voices make it hard to concentrate on reading, TV or radio, try children’s books or programs to help build concentration.
Manchester Hearing Voices Group, Hearing Voices Coping Strategies, Unknown Date
Strategies for Coping with Distressing Voices (Excerpt)
- Accepting that voices are not the problem, they are a consequence of a problem. Your job is to find out more.
- Identify your voices— number, gender, age and so on.
- Learn about boundaries to apply to people and your voices (i.e., make a deal with your voices, “be quiet now and I’ll listen later”).
- Listen out for positive voices too—they can be allies.
- Schedule a time to listen to the voices and ask them to leave you alone until that time.
- Tell negative voices that you will only talk with them if they are respectful towards you.
- Voice dialogue— let a trusted family member, friend or mental health worker talk directly to your voices.
- Write down what the voices are saying to you.
- Don’t beat yourself up, we all make mistakes
- List achievements
- Make a contract with your voices
- Positive self talk
- Self forgiveness (find yourself innocent)
- Talk to the voices, find out how they feel
- Wear one ear plug
NOTE: Distraction techniques are useful when voices are particularly distressing or intrusive but are not recommended as an on-going coping technique.
Hearing Voices Network Austrailia, Strategies for Coping with Distressing Voices, Unknown Date
The Construct
Corstens: They told their stories about how they cope with voices, and we started to demonstrate what we call the “construct.” In the construct, you find the relationship between what happens in people’s lives and their voices. We try to make sense of the voices.
Morin: Can you give an example of that?
Corstens: Today, we worked with a 43-year-old woman named Marie. She hears eight voices. The voices don’t have names, but she can differentiate them. They talk to her and to each other throughout the day. First, we explored how many voices there are, how old they are, their gender, and whether they have a name or not.
Morin: How do you use that information?
Corstens: We analyze every voice and try to explore what the characteristics are. So, these three voices—numbers 1, 6, and 8—are very aggressive and negative. They shout at Marie, “You are nothing! You have to die! Swallow pills! You have to mutilate yourself!” And they are there all day and every day, especially at night when she tries to sleep. There’s this child of three who is always crying. There’s this 18-year-old boy who criticizes her. And then, not very often, there’s this man who tries to protect Marie from the 18-year-old boy. There’s also this eight-year-old female voice—she’s playful and always tries to cheer Marie up, but the voice becomes angry if Marie doesn’t cheer up—which she rarely does. The group of voices, which she calls “the trustees,” shouts words to interrupt her conversations.
Morin: What do the traits of the voices indicate?
Corstens: They help us understand what problems these voices represent. A lot of it has to do with Marie being rejected, having no self-confidence, and not being able to make decisions herself. We try to find out when these voices started. In her case, they started when she was 27 and had final exams at university. But, it was all related to the divorce of her parents when she was six, and witnessing violence at home—being bullied, etcetera. All these things come back in the voices.
Morin: You mean that she internalized some of the people in her life?
Corstens: Well, they don’t have names, but we try to find out who these voices represent. The stepfather resembles one of the booing guys, another is a sister, another is an imaginary friend.
Morin: So, it’s a form of relationship therapy as well?
Corstens: Yes.
Michel: It really is. Dr. Corstens and I started to work with each other five years ago, or more. I was around 20 years old. It took about two years of work to actually figure out what the relationships were, what the triggers for the voices were, and what feelings are coupled to these voices. Once you start to learn to express yourself and work out these problems on your own, the voices don’t have to act out their part. Now, when I hear voices, I know what triggered them. I ask, “What is happening with me? What am I neglecting in my own emotions?” Does that make sense?
Morin: Because you recognize the voices are a part of yourself?
Michel: Yes. I used to experience them as different entities—not part of me. Now, I actually believe they are just a part of me I have to deal with.
…
Michel: I resolved a lot of problems by learning how to communicate. Instead of punching someone in the face, you can also talk.
Roc Morin, Learning to Live With the Voices in Your Head, 2014
If you hear voices…
If you hear a voice that tells you “You are a failure, you are nothing” you might end up thinking that what the voice says is true.
Ask questions to evaluate what the voice is saying. For example:
- Note down what the voice is saying.
- What evidence is there to support what the voice is saying?
- What evidence is there that contradicts what the voice is saying?
- Would other people agree with what the voice is saying? What does my Support Person think?
Thinking about the voices in a more realistic way helps take away their power over you. They won’t be as able to affect how you feel about things.
Fraser Health and British Columbia, Dealing with Psychosis Workbook (Page 81), 2012
Doing things differently
- Can you do anything differently at those times when you’re likely to feel more distressed by your internal experiences?
- For instance: Focus your attention on something else (see mindfulness page - www.getselfhelp.co.uk/mindfulness.htm) - listen attentively to music (use headphones?), engage in an absorbing activity, be with others rather than alone, mindful breathing, focus on the environment around you, talk to someone
- Talk into a mobile phone if you need to talk back to voices (Coleman www.workingtorecovery.co.uk)
- Teach the voice to tone down, or visualize an internal volume control (turn the dial down a little at a time)
- Give the voices a job to do elsewhere for a few minutes or hours
Ask yourself:
- What am I reacting to?
- Is it a voice or other sensory experience?
- What meaning am I giving this experience or thought?
- Is this fact or opinion?
- The “is it real” test: 1. Is it possible? 2. Check for evidence
- What goes through my mind when the voice says that?
- What do I believe about that?
- Am I agreeing with the voice? Totally?
- Does that thought or belief fit with my own inner beliefs and morals?
- How am I making sense of this?
- What is it that I think is going to happen here?
- What’s the worst (and best) that could happen? What’s most likely to happen?
- Am I getting things out of proportion?
- How important is this really? How important will it be in 6 months time?
- Am I overestimating the danger?
- Am I underestimating my ability to cope?
- How much control does this voice or belief have over me?
- Am I mind-reading what others might be thinking?
- Am I believing I can predict the future?
- Is there another way of looking at this?
- What advice would I give someone else in this situation?
- Am I putting more pressure on myself?
- Just because I feel bad, doesn’t mean things really are bad.
- What do I want or need from this person or situation? What do they want or need from me? Is there a compromise?
- What would be the consequences of responding the way I usually do?
- How would that help?
- Is there another way of dealing with this? What would be the most helpful and effective action to take? (for me, for the situation, for the other person)
Carol Vivyan, Self Help for Paranoia, Delusions & Voices, 2009
60 Coping Strategies for Hallucinations (Excerpt)
- Correct the cognitive distortions in the voices
- Respond rationally to voice content
- Use subvocalization
- Dismiss the voices
- Remind yourself that no one else can hear the voice
- Phone a voice buddy and tell him or her the voice is active
- Demonstrate controllability by bringing the voices on
- Give the voices a 10-minute slot at a specific time each day
- Play a cognitive therapy tape discussing voice control
- Use a normalizing explanation
- Use rational responses to reduce anger
- List the evidence in favor of the voice content
- List the evidence against the voice content
- Use guided imagery to practice coping with the voices differently
- Role-play for and against the voices
- Remind yourself that voices are not actions and need not be viewed that way
- Remind yourself that the voices don’t seem to know much
- Remind yourself that you don’t need to obey the voices
- Talk to someone you trust about the voice content
- Use rational responses to reduce shame
- Use rational responses to reduce anxiety
- Use a diary to manage stress
- Use a diary to manage your time
- Plan your daily activities the night before
- Use a voice diary in a scientific manner
- Mindfulness
- Try an earplug (right ear first if right-handed)
- Use schema-focused techniques
- Acceptance
- Assertiveness
- Use a biological model
- Consider shamanistic views of voice hearing
- Consider cultural aspects of voice hearing
- Keep a list of daily behaviors to prove that you are not as bad as the voices say
- Use a continuum relating your own worth to that of other people
- List your positive experiences in life
- List your achievements, friendships, etc.
- Act against the voices (show them that you are better than they say)
Wright JH, Turkington D, Kingdon DG, et. al., Cognitive-Behavior Therapy for Severe Mental Illness: An Illustrated Guide, 2009