Academic journal article Hong Kong Journal of Psychiatry

Experience and Coping with Auditory Hallucinations in First-Episode Psychosis: Relationship with Stress Coping

Academic journal article Hong Kong Journal of Psychiatry

Experience and Coping with Auditory Hallucinations in First-Episode Psychosis: Relationship with Stress Coping

Article excerpt


Objectives: To investigate subjective experiences and coping with drug-resistant auditory hallucinations in patients with first-episode psychosis, and to compare coping with auditory hallucinations as opposed to general stress.

Participants and Methods: Twenty two patients with first-episode psychosis participated in this study. Characteristics of their voices, beliefs about the voices, coping strategies used for such voices and for general stress were measured, using a semi-structured interview and questionnaires.

Results: Despite active antipsychotic medications, patients on average reported 3 persistent auditory hallucinations. Most found the voices unpleasant and personally relevant, and spontaneously coped with them with modest levels of subjective efficacy. The most frequently adopted strategies were not the most effective ones. Patients reported a broad repertoire of coping for general stress, which included both emotion-focused and problem-focused strategies. People who actively coped with voices also used more coping strategies in reaction to general stress.

Conclusions: Patients with early psychosis commonly interacted with the persistent psychotic symptoms in individually different ways. The way patients coped with residual voices was related to the characteristics of the voices, their symptomatology, as well as general stress coping. Implications for research methodology and psychological interventions were discussed.

Key words: Adaptation, psychological; Auditory perception; Hallucinations; Psychotic disorders; Schizophrenia



Auditory hallucination (AH) is a defining symptom of psychotic disorder. According to Sartorius et al, (1) more than 70% of individuals with schizophrenia experienced AH every month. Despite adequate levels of medication being prescribed, voices persist in 25 to 50% of patients. (2) Over 75% of persons hearing voices reported being 'highly distressed' by the hallucinatory experience. (3) Therefore, non-medical intervention for persistent hallucinations is important in the management of the psychotic illness.

Previous studies have shown that 72 to 100% of psychotic patients spontaneously attempted to cope with their AHs (see review by Garcelan and Rodriguez (4)); mean numbers for their coping strategies ranged from 2.2 to 18.3. (5) Using multidimensional scaling techniques, Carter et al (6) drew clusters of coping strategies based on frequency of use and efficacy. They reported that the most commonly used strategies include yelling / talking back to the voices, listening to songs / music / radio, talking to someone, and going to sleep. Other commonly employed behavioural strategies included: watching television, going for walks, and participating in sport. (4)

Inconsistency in the number of coping strategies and their frequency of use is related to the great variety of ways such information is obtained and categorised. It has been shown that participants are more ready to claim a coping strategy when prompted by a list than when asked an open question. (7,8) Therefore, using both open questions and a prompt list might elicit more comprehensive information about natural coping.

The most effective coping methods also vary between studies. (5) For example, some suggested that humming is a highly efficacious way of coping, (6,9) while others argued that direct confrontation, including humming, increases anxiety and the frequency of the voices. (7) The latter contend that strategies based on acceptance of the voices and on passive coping (such as ignoring the voices) lead to a reduction in anxiety and better coping. (7,10-12)

While many studies have shown that effectiveness improves if participants use several strategies at the same time, (6,10-11,13) others have argued the converse. (14,15) Contradictory findings may be related to different ways of measuring effectiveness. …

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