title: Bringing the "self" into focus: conceptualising the role of self-experience for understanding and working with distressing voices.
abstract: A primary goal of cognitive behavior therapy for psychosis (CBTp) is to reduce distress and disability, not to change the positive symptoms of psychosis, such as hearing voices. Despite demonstrated associations between beliefs about voices and distress, the effects of CBTp on reducing voice distress are disappointing. Research has begun to explore the role that the psychological construct of "self" (which includes numerous facets such as self-reflection, self-schema and self-concept) might play in causing and maintaining distress and disability in voice hearers. However, attempts to clarify and integrate these different perspectives within the voice hearing literature, or to explore their clinical implications, are still in their infancy. This paper outlines how the self has been conceptualised in the psychosis and CBT literatures, followed by a review of the evidence regarding the proposed role of this construct in the etiology of and adaptation to voice hearing experiences. We go on to discuss some of the specific intervention methods that aim to target these aspects of self-experience and end by identifying key research questions in this area. Notably, we suggest that interventions specifically targeting aspects of self-experience, including self-affection, self-reflection, self-schema and self-concept, may be sufficient to reduce distress and disruption in the context of hearing voices, a suggestion that now requires further empirical investigation.
authors: School of Psychology, University of Sussex , Brighton, UK.
authors: Sarah F
authors: SF
authors: Fielding-Smith
authors: School of Psychology, University of Sussex , Brighton, UK ; Sussex Partnership NHS Foundation Trust , Hove, UK.
authors: Mark
authors: M
authors: Hayward
authors: School of Psychology, University of Sussex , Brighton, UK ; Sussex Partnership NHS Foundation Trust , Hove, UK.
authors: Clara
authors: C
authors: Strauss
authors: School of Psychology, University of Sussex , Brighton, UK ; Sussex Partnership NHS Foundation Trust , Hove, UK.
authors: David
authors: D
authors: Fowler
authors: School of Psychology, University of Western Australia , Perth, WA, Australia ; Schizophrenia Research Institute, Darlinghurst , NSW, Australia.
authors: Georgie
authors: G
authors: Paulik
authors: Brain and Psychological Sciences Research Centre, Swinburne University, Melbourne , VIC, Australia ; Monash Alfred Psychiatry Research Centre, The Alfred, Melbourne , VIC, Australia.
authors: Neil
authors: N
authors: Thomas
keywords: auditory verbal hallucinations; phenomenology; psychological intervention; psychosis; schizophrenia; self; self-experience; voice hearing