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Background. Many trauma-affected voice hearers report comorbid post-traumatic stress and voices (auditory verbal hallucinations) that are directly (voices repeat phrases spoken by perpetrators) or indirectly (voice content and trauma is thematically similar) related to their trauma. Models of PTSD and positive symptoms of psychosis are insufficient in explaining the comorbidity between PTSD and voices, and interventions based on these models have limited effectiveness in treating voices. This study presents a model that generates novel research into the factors underlying trauma-related voices that may inform effective interventions.Method. Maintaining factors from existing models of PTSD and positive symptoms were combined into an integrative model of trauma-related voices. Theorised relationships between factors were used to identify possible differential pathways to direct and indirect voices. Results. An integrative, trauma-related voices (TRV) model was developed that identifies multiple causal pathways to trauma-related voices. A future research agenda is proposed to test novel hypotheses based on the integrative model. Discussion. The TRV model is a practical tool for complex case conceptualisation and generates novel hypotheses that may inform more effective treatments. Future studies are needed to test elements of the TRV model and should recruit transdiagnostic samples with diverse post-traumatic stress and voice hearing symptoms.

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Background: Most voice hearers report childhood trauma. Many voice hearers report comorbid post-traumatic stress symptoms and that the content of their voices (auditory verbal hallucinations) is directly (voices repeat phrases spoken by perpetrators) or indirectly (voice content and trauma is thematically similar) related to their trauma. The factors that maintain trauma-related voices are unknown, and there is limited research in this area. This study aimed to identify potential maintaining factors of trauma-related voices by reviewing models of post-traumatic stress disorder (PTSD) and positive symptoms of psychosis. Method: Models of PTSD and positive symptoms were reviewed to identify potential factors that are unique and common to both sets of symptoms. Results: We reviewed 10 models of PTSD, 4 models of positive symptoms, and 2 trauma-informed models of voice hearing. One model provided a theoretical explanation of different types of trauma-related voices. Twenty-one factors were extracted from 16 theoretical models. No existing model incorporated all these factors. Discussion: Existing PTSD and positive symptom models present a range of common and unique factors. There may be value in extending existing integrative models to include a broader range of potential factors that could explain different pathways to, and expressions of, trauma-related voices. A future research agenda is presented to investigate how such an extension could lead to more complete individualized case formulations and targeted treatments.

BackgroundA range of traumas have been linked to voices (auditory verbal hallucinations) and unusual perceptual experiences (UPEs) in other perceptual‐sensory domains. Models of PTSD and positive symptoms of psychosis are insufficient in explaining the relationship between trauma and voices. The trauma‐related voices (TRV) model was developed to generate novel research in this area.AimsThis study aimed to investigate pathways from trauma to the frequency of UPEs based on a subset of hypothesised relationships in the TRV model.MaterialsThe PTSD Diagnostic Scale for DSM‐5, State Adult Attachment Measure, Depression Anxiety and Stress Scales‐21, Perth Emotion and Regulation Competency Inventory, Dissociative Experiences Measure Oxford, and Multi‐modality Unusual Perceptual Experiences Questionnaire.MethodsWe used path analysis in a non‐clinical sample (N = 528) to model indirect effects from diverse trauma experiences to the frequency of multi‐sensory UPEs via a subset of mediators within the TRV model: insecure attachment, emotion regulation deficits, negative affect and dissociation.ResultsOur model was an excellent fit to the data and accounted for 37.1% of variance in UPE frequency, and all direct (βs = .14–.61) and indirect pathways (βs = .01–.08) were significant (ps < .001).DiscussionOur findings suggest that insecure attachment may link diverse trauma experiences to emotion regulation deficits and negative affect, which are linked to UPE frequency via dissociation.ConclusionOur findings provide preliminary evidence for a subset of relationships within the TRV model. Future studies are needed to gather stronger evidence of temporality and causation between these factors, and to test broader pathways within the TRV model.