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Auditory Hallucinations

Introduction.

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The experience of auditory hallucinations, sometimes described as hearing voices, are some of the most common symptoms of schizophrenia, usually characterized by the person hearing one or more voice, talking directly to or about them. (Nayani, and David, 1996)

Hallucinations are a hallmark symptom of schizophrenia and may effect the five senses, with auditory hallucinations being the most common, effecting 70 percent of patients with schizophrenia
Although hearing voices is most frequently associated with schizophrenia, the two are not mutually exclusive. Schizophrenia is thought to effect roughly 1% of the population, whereas those experiencing voices could be anything up to 20% of the population according to various research. Auditory hallucinations can occur in healthy individuals who are under intense physiological stress, such as sleep deprivation, and may also occur as a result of using drugs with hallucenogenic properties.

Many individuals are able to cope with this phenomenom without intervention, however numerous sufferers find it difficult, and as a result suffer huge distress in their everyday lives. This may be especially dangerous if sufferers lack effective self-management skills, and think the only way they can manage them is to obey them. (Buccheri, Trygstad, Kanas, and Dowling, 2007).

It is therefore of paramount importance to develop effective strategies and coping mechanisms, to enable sufferers to lead healthy lives and attempt to realise their true potential.

Historically those who experienced voices or auditory hallucinations may have either been described as the local village idiot, or indeed may also have spent their lives in the large psychiatric hospitals, which were prevalent up until recently.
Following the closure of these hospitals and since the development of community based services, the majority of people no longer require long term inpatient care. However a significant number experience relapses of acute psychotic symptoms, and may require a period of hospitisation as a result. Hospitalisation may be a traumatic experience, even more so when the person is admitted involuntarily. However when the acute phase of illness has subsided, most people, service users and carers alike, recognise the need for their admission and treatment. This is an ideal opportunity for service users, carers, and mental health professionals to develop and implement effective coping strategies for those experiencing auditory hallucinations.

The writer is going to discuss and explore a number of areas associated with the aforementioned topic, including the prevalance of those who suffer from auditory hallucinations from the ???healthy population???, and those suffering with enduring mental illness. The writer will also describe various different treatment techniques and strategies, including Self-monitoring, Auditory stimulation, Behavioural and Cognitive therapies.

Discussion on supporting people experiencing hallucinations

The writer will discuss the approach towards supporting people experiencing hearing voices with respect to care.

When medical care is required, the person should be treated when hearing sounds and voices that do not exist. Furthermore, where a carer or family member suspects actual hallucinations, they should attempt to explain calmly what is happening, to see if the person can take in this information and retain it. If they cannot, try repeating it when the person is more rested and calm. However, if this is not possible, there is little point in arguing, which could lead to unwanted confrontation. You are extremely unlikely to convince someone with impaired logical thinking that their thoughts are incorrect. Efforts to reason logically become even more difficult when adrenalin levels are raised, as they are during an argument or debate. Trying to convince someone that they are mistaken can lead to more distress, for both parties.

Stay with and observe the person if possible, especially it they are frightened. Offer reassurance (American Psychiatric Association, 2000, 39-64). See if distraction stops the apparent hallucination. Tell them what they are sensing is not evident to you, but that you want to know what they are experiencing. Try not to make them feel insecure or stupid about what is happening (Behrendt, 2006, 356-372). Seek medical help if hallucinations worsen and start to involve multiple senses, are of a long duration, recur frequently, and/or frighten the person. If a person appears to be genuinely hallucinating and they go to seek medical advice by consulting the G.P the following information may be of help.

1. Accurate description or notes about;
-What was allegedly seen or sensed.
-Where. (Details of location)
-Whether the person was under any stress. (Causes of stress)
-Current and recent medication and doses. (Including self-prescibed)
2. Recent and past physical and mental health illnesses.
3. Recent bereavements (May be a precipitating factor)
4. Information about other perceptual abnormalities. (Delusions etc.)
5. Use of alcohol or other recreational drugs, or overdoses.

How common are Auditory hallucinations

Auditory hallucinations are perceived as noise, music, or more typically as voices. These can be heard or whispered in a clear and distinct voice, and say words, talking to or about the sufferer. Auditory hallucinations may be inferred when a patient seems to speak in response to the voices and whispering, muttering incomprehensiby, speaking as normal, or cry aloud (Behrendt, 2006, 356-372). Auditory hallucinations are perceptions experienced without any external stimulus reaching the sense organs, whose quality is similar to a correct perception. The word hallucination derives from the woed ???allucinatio???, which means loss of the mind. Illusions are mis-perceptions of concrete objects and may be experienced by most people when the senses are weakened, but illusions can occasionally become true hallucinations (Johns, Nazroo, Bebbington and Kuipers, 2002, 174-178). Although most people have experienced illusions and vivid dreams, it is believed that auditory hallucinations are an indication of abnormalities associated with brain injury, mental illness, or drug induced states.

Auditory Hallucinations in Healthy People.

Healthy people can experience auditory hallucinations. For example, the hearing of a family member??™s voice is not uncommon among the recently bereaved people. They are comforting and benign, and may become less frequent and cease over weeks or months.
Some people take hallucinogenic drugs such as LSD or mescaline with the clear intention of inducing hallucinogenic experiences. Auditory hallucinations may also occur with some medically prescribed drugs, including some anesthetics, and drugs used in the treatment of Parkinson??™s disease such as levodopa. In drug withdrawal states, particularly withdrawal from alcohol, auditory hallucinations are common. (Johns, Nazroo, Bebbington and Kuipers, 2002, 174-178)
Auditory hallucinations have been reported during sensory deprivation in healthy individuals, either as a result of solitary confinement or during prolonged blindfolding. Pilots are also reported to have experienced them during long night flights.

Auditory Hallucinations in Mental Disorders

Auditory hallucinations usually mean hearing voices. However, nonverbal auditory hallucinations do occur and include clicking and mechanical noises, muttering or mumbling, and music. In musical hallucinations, the person often hears a complete piece of music. Auditory hallucinations are most common in psychotic disorders such as schizophrenia, but can occur in mood disorders, organic mental disorders, and drug induced states (Eisner, McNeil and Binder, 2000, 1288-1292). Auditory hallucinations occasionally occur in bipolar disorder and severe depression.

Auditory hallucinations may take place with such brain disorders as dementia, multiple sclerosis and tumours. They occur more frequently than visual hallucinations in the organic mental disorders.

The most dangerous phase of these perceptual disturbances is the presence of command hallucinations, such as to harm, or kill themselves or someone else.
It is imperitive to have a community or team approach; sharing information, offering guidance and support to those who suffer. Numerous studies have been undertaken such as ???A Voice in the Head??? comprising of research conducted by medical doctors, psychiatrists, psychologists and nurses (Ohayon, 2002, 153-164). These initiatives are hugely beneficial using new technologies such as Internet and Social Media, which help connect people and build communities. They advocate the development of user focused groups in an attempt to share experiences common to themselves and reclaim ownership of their own lives.

The Symptoms of Auditory Hallucinations

When a person hears voices that do not exist, they may be experiencing symptoms of severe mental disorder. Some experts??™ in the field of auditory hallucinations are of the opinion that imaginary voices in your own head, are essentially the verbal expressions of people in their own thoughts.
Typically, auditory hallucinations are a specific sign of a shizophrenic type illness. Schizophrenia is a serious mental disorder that mainly effects young people. Meanwhile, auditory hallucinations may occur in a person suffering from mania, Alzheimers disease, and depression. Furthermore, auditory hallucinations may be caused by consumption of alcohol and drugs in large quantities. A significant number of people experiencing depression may hear voices calling out to, or talking to them according to (Kraemer, Macrae, Green and Kelley, 2005, 158-159).

What steps can be taken to eliminate the symptoms of Auditory Hallucinations

The most obvious step to take would be to seek medical attention. Following assessment by the GP, the person may be referred to a psychiatrist for more expert diagnosis and treatment. Treating teams may prescribe antipsychotic medication or in some cases antidepressants, depending on the persons history, if known or available (Kraemer, Macrae, Green and Kelley, 2005, 158-159).
The emergence of auditory hallucinations may be a consequence of side effects of other drugs, anti convulsants for example. In cases such as these a compilation of prescibed medication would help the treating team decipher the problem and change the medication regime where appropriate.

Strategies that may be utilised by service users

The experience of auditory hallucinations is a subjective phenomenon and therefore different techniques may work for different individuals. (Kraemer, Macrae, Green and Kelley, 2005, 158-159) describe some treatments that may be useful such as;

– Self-monitoring, documenting and making sense of voices.
– Auditory simulation, involving the vocal activity such as talking to another person.
– Behavioural techniques aimed at changing the state of excitation, such as relaxation, sleep or exercise.
– Cognitive techniques such as ignoring or blocking direct voices on a subject, learning to accept voices as the lived experience.
Many sufferers suggest that although these techniques may be effective in some cases, most people do not value the input of their voices.

Self Monitoring

Self-monitoring is an approach which encourages the person to monitor and write down their experiences, describing their form and content. It is the process of assessing the characteristics of the voices and the context in which they may be heard. This intervention may reduce the anxiety associated with the voices, or the duration of auditory hallucinations. It is important to identify the cognitive functioning of participants when using the self-monitoring strategy, as those with higher cognitive ability will be able to give more detailed information leading to a fuller picture (Breier and Strauss, 1983).

Auditory Stimulation

Auditory stimulation appears to be an effective method in reducing the frequency of auditory hallucinations. The nature of sound stimulation may be specific to the patient. (Haddock, Slade, Bentall, Reid and Farragher, 1998 ) describe listening to the radio or popular music with earphones as an effective strategy in combatting these unwanted intrusions.

Behavioural Treatments

Other studies report that operative techniques such as reinforcement or distraction may be of benefit or help nullify the voices. Relaxation techniques, or engaging in another form of communication may be helpful in teaching sufferers ways to disengage from the voices, however their suffering may not be reduced significantly according to some research .
(Tkachuk and Martin, 1999) advocate the use of physical exercise as a way of reducing the severity and stress of auditory hallucinations. This may range from going for a walk for some people, to a jog or cycle for others. Again a detailed history offers cues and clues to an individuals needs and abilities.

Cognitive therapies

CBT or Cognitive behavioural therapy is also used in the treatment of those who experience the positive symptoms of schizophrenia including auditory hallucinations.
People suffering from Schizophrenia or other forms of psychosis may have a distorted perception of the world, including themselves and others. CBT may be helpful in bringing some form of order to their lives.
The basic principle of cognitive therapy is that our thinking, outlook, and thoughts of ourselves and the world we live in, affect how we perceive ourselves and others, how we deal with problems, and ultimately how effective we are in coping in the world, and in fulfilling our potential (Bustillo, Lauriello, Horan and Keith, 2001).
Cognitive therapies used for those experiencing voices are essentially aimed at changing how people feel about the voices they experience.

Conclusion

In the writers opinion it is difficult to study a topic such as auditory hallucinations because it is a phenomenon that cannot be measured directly or accurately by a measuring tool, and although numerous pieces of research have taken place no concrete conclusions have been reached thus far.
There are many methods, techniques and strategies currently being utilised in the treatment of those who experience auditory hallucinations, a number of which have been described in this piece. The writer suggests that all of these may be of benefit in contemporary practice, although significant stumbling blocks persist.
These may include the continual stigma and social exclusion experienced by those with severe and enduring mental illness, and the lack of resources and continuity of care in current mental health care delivery.

The Recovery model refers to the service user as being an ???expert???. Research has demonstrated that for those experiencing auditory hallucinations peer counselor input can be of huge benefit. According to research (Rummel-Kuge, Stiegler-Kotzor, Schwarz, Hansen, and Kissing, 2008) patients felt more connected and safer with peer counselors. 96 percent of those involved in the aforementioned research recommended the use of peer counselors to others. The author feels that this is significant, and feels that empowering those who suffer may be the most important step when it comes to learning to cope and deal with auditory hallucinations.

Reference list.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

Behrendt, R.P. (2006). Dysregulation of thalamic sensory ???transmission??? in schizophrenia, neurochemical vulnerability to hallucinations, Journal of Psychopharmacology,20(3). 356-372

Breier, A. and Strauss, J.S. (1983). Self-control in psychotic disorders. Archives of General Psychiatry, (40), 1141-1145

Buccheri, R., Trygstad, L., Kanas, N., & Dowling, G. (1997). Symptom management of auditory hallucinations in schizophrenia: Results of a 1-year follow up. Journal of Psychosocial Nursing, 35(12), 20-28

Bustillo, J.R., Laureillo, J., Horan, W.P., & Keith, S.J. (2001). The psychosocial treatment of schizophrenia: An update. American Journal of Psychiatry, 158(2), 163-175

Haddock, G., Slade, P.D., Bentall, R.P., Reid, D., & Farragher, E.B. (1998) a comparison of the long-term effectiveness of distraction and focusing in the treatment of auditory hallucinations. British journal of Medical Psychology, 71(3), 339-349

Johns, L., Nazroo, J.Y., Bebbington, P., & Kuipers, E. (2002) occurrence of hallucinatory experiences in a community sample. British Journal of Psychiatry, (180), 174-178

Kraemer, D., Macrae, C.N., Green, A.E., & Kelley, W.M. (2005) Musical imagery: Sound of silence activates auditory cortex Nature, (434), 158-159

Nayani, T.H., & David, A.S. (1996) the auditory hallucination: A phenomenological survey. Psychological Medicine, (15), 206-220

Ohayon, D. (1994) prevalence of hallucinations and their pathological associations in the general population. Psychiatry Research, (97), 153-164

Rummel-Kluge, C., Stiegler-Kotzor, M., Schwartz, C., Hansen, W.P., & Kissling, W. (2008) Peer counseling in schizophrenia; Patients consult patients. Patient Education and Counseling, (70), 357-362

Tkachuk, G.A., & Martin, G.L. (1999)-exercise therapy for patients with psychiatric disorders: Research and clinical implications. Professional Psychology, Research and Practice, 30(3), 275-282

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