Approaches to help Control Hallucinations in Schizophrenia

The following message was posted by a consumer (who reports on whether the techniques worked for him) would make a great consumer column:

"Sensory Deception" from Johns Hopkins press discusses several methods to control hallucinations, including focusing on them instead of trying to ignore them. This may be as simple as saying the word "Stop" until the hallucination goes away. Some of the things that patients do to cope is engaging the hallucinations and taking the hallucinations advice. The book also recommends taking personal responsibility for the hallucinations instead of attributing them to an outside source) and counter-stimulation (reading something outloud). Following is a paraphrase of some of the techniques from the book:: "Sensory Deception: A scientific analysis of hallucination" from Johns Hopkins University Press, authors Peter Slade and Richard Bentall. Psychological Treatment Approaches:

  • Operant procedures - Conditioning Use of timeouts for hallucinatory behavior
  • Systematic desensitization
  • Thought stopping - Raise finger every time you hallucinate and say stop until the hallucination stops.
  • Reduction in sensory input Conflicting results
  • Counter-stimulation use of headphones reading out loud humming and gargling
  • Self-monitoring record occurences of hallucinations rate frequence of hallucinations signal occurence, duration and termination of hallucination with a button imagine a vivid nauseous scene when experiencing hallucination take a written record of voices and rate their 'demandingness' retrospective monitoring has no effect
  • Aversion therapy shock or white noise self-administered during a hallucination (works somewhat, sometimes nature of voices changes)
  • Earplug therapy use of an earplug in one ear (no dramatic impact on hallucinations)
  • First-person-singular therapy voices are really talking to myself (worked for two patients) bring on and dismiss hallucinations + counter-stimulation worked for 1 out of 5 subjects p199


A careful examination of the data outlined above suggests that there success might be explicable in terms of three processes, namely:

(a) focusing; (b) anxiety reduction; and (c) distraction or counter-stimulation.
Focusing event recorder, contingent response, focus attention on voices. suggestion that avoiding attending to hallucinatory experiences may, in the long run, have the effect of maintaining them. Anxiety reduction systematic desensitization, try to decrease arousal.
Distraction or counter-stimulation Works in the short term, but may allow person to come up with other strategies. Table 7.2
Coping strategies reported by 40 people with persistent auditory hallucinations. From Falloon and Talbot 1981 Psychological Medicine, 11, 329-339 Type of strategy N Behaviour
change Postural (sit, lie down, stand, walk, run)
Specific activity Work (including household) 11 Leisure (hobbies, music, reading, TV) 29
Interpersonal contact: Initiate contact
19 Withdraw from contact 2 Drug taking:
Prescribed medication (extra dose) 11
Non-prescribed medication (alcohol, analgesics, illicit drugs)
Physiological arousal Reduction Relax or sleep
Decrease sensory input (block ears, close eyes)
Increase Physical exercise
Stimulating music/loud noise
Cognitive strategies Reduced attention to 'voices' (ignore, block thoughts, distracting thoughts)
Supression of 'voices' (tell to keep quiet, go away)
Reason/debate with 'voices'
Accept 'voices' (listen attentively, repeat content, accept guidance) 14
The authors go on to state that focusing was only reported by only a small proportion of the patients, in two forms: reasoning or debating with the voices and accepting the voices.
From page 203: The second study to be considered in this context was carried out by Tarrier (1987) British Journal of Clinical Psychology, 26, 141-143, who used a similar approach to elicit coping strategies from 25 patients, suffering from auditory hallucinations and coherently expressed delusions, who were living in the community and receiving phenothiazine medication.
The strategies employed included distraction or attention switching, thought stopping, self-instruction, increasing or decreasing activity, increasing external stimulation (mainly playing music), ad strategies apparently aimed at reducing arousal. .... reported at least some symptom relief; this was particularly the case with patients who employed more than one strategy.
What I have personally used: Meditation--focusing on breathing (keeps me calm) Keep a journal of your thoughts, hallucinations, and bodily functions while they are happening (anyone want me to find this and share it?) Taking long walks (doesn't work very well, I hallucinate while walking, plus I have weird happenings like a person on a motorcycle ("Zen atAoMM"?) coming up to me and saying something nonsensical) Actively engage the hallucinations, do battle with them (solve puzzles, battle psychic psychiatrists, play with the time film going through my head, etc).
This tends to wear me out. What I am looking for: A way to disable beliefs and the belief mechanism. ------------------------ >
Dan and John, As to handling positive symptoms. I'm afraid I have to tell a story (a woman thing you know)(g) about my son. He has both visual and auditory hallucinations.
Every medication he has ever tried makes him flat out sick. And he has tried a lot! So as he says he is stuck with the "noise." Well a young lady informed him that she was going to be hospitalized. My son asked her why. She replied that she was hearing voices. He looked her in the eye and told her this. "If you hear it, kick it. If it moves it is real, if it doesn't move it is a hallucination." And he let out a good laugh! I don't believe he has ever kicked anyone.
But, he has developed a method of "testing the waters" so to speak. He makes a deduction as to whether his "noise" is real or not and then acts accordingly. Not a bad plan for him at least! >Another friend of mine has a very logical mind. And he has, it seems, a sort of formula in his mind. "what are the chances that this is real" "what are the chances that this is not real." And then he acts accordingly.
>Both have very varied hallucinations. If there was a repetition of a theme both felt it would be easier to tell what was "real." But they never know what to expect from their minds. Both have made a conscious decision not to act on anything that they think might be a hallucination. >I think there is a lot to be said for prevention though. But I'll put that in another post.
Yours Sue Bretz AMI




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