Compassion Focused Approaches to Working With Distressing Voices

Abstract

This paper presents an outline of voice-hearing phenomenology in the context of evolutionary mechanisms for self- and social- monitoring. Special attention is given to evolved systems for monitoring dominant-subordinate social roles and relationships. These provide information relating to the interpersonal motivation of others, such as neutral, friendly or hostile, and thus the interpersonal threat, versus safe, social location. Individuals who perceive themselves as subordinate and dominants as hostile are highly vigilant to down-rank threat and use submissive displays and social spacing as basic defenses. We suggest these defense mechanisms are especially attuned in some individuals with voices, in which this fearful-subordinate – hostile-dominant relationship is played out. Given the evolved motivational system in which voice-hearers can be trapped, one therapeutic solution is to help them switch into different motivational systems, particularly those linked to social caring and support, rather than hostile competition. Compassion focused therapy (CFT) seeks to produce such motivational shifts. Compassion focused therapy aims to help voice-hearers, (i) notice their threat-based (dominant-subordinate) motivational systems when they arise, (ii) understand their function in the context of their lives, and (iii) shift into different motivational patterns that are orientated around safeness and compassion. Voice-hearers are supported to engage with biopsychosocial components of compassionate mind training, which are briefly summarized, and to cultivate an embodied sense of a compassionate self-identity. They are invited to consider, and practice, how they might wish to relate to themselves, their voices, and other people, from the position of their compassionate self. This paper proposes, in line with the broader science of compassion and CFT, that repeated practice of creating internal patterns of safeness and compassion can provide an optimum biopsychosocial environment for affect-regulation, emotional conflict-resolution, and therapeutic change. Examples of specific therapeutic techniques, such as chair-work and talking with voices, are described to illustrate how these might be incorporated in one-to-one sessions of CFT.

Compassion-Focused Group Therapy for Treatment-Resistant OCD: Initial Evaluation Using a Multiple Baseline Design

“…In line with our predictions, all participants except one (P7) showed a reduction in self-criticism, and we observed an improvement in compassionate self-reassuring for all eight participants involved in the study. These findings were consistent with previous investigations of compassion-focused interventions that have been found effective in improving the self-to-self relationship (increased self-compassion and reduced self-criticism) in non-clinical samples (i.e., Matos et al, 2017;Sommers-Spijkerman et al, 2018) and in different clinical populations (Au et al, 2017;Heriot-Maitland et al, 2019;Fox et al, 2020). Findings of the present pilot study suggest that this type of intervention is effective also in improving compassionate self-reassurance and self-criticism in treatment-resistant OCD patients.…”

A treatment protocol to guide the delivery of dialogical engagement with auditory hallucinations: Experience from the Talking With Voices pilot trial

“…However, it is our experience that these voices still perform a protective function (e.g., by taking on the role of aggressor in preference to feeling victimized, pre‐emptively criticizing to avoid external disapproval, drawing attention to unprocessed emotions, and/or being primed to detect potential sources of threat: see Moskowitz et al, 2017; Mosquera & Ross, 2017; Ross & Halpern, 2009). In turn, it may often be the case that very hostile, dominant voices represent the most wounded parts of the person’s internal system and are ultimately in need of the most compassion and reassurance (Heriot‐Maitland et al 2019). It is our experience that voices do not inevitably claim to be a real‐life perpetrator when asked directly about their identity.…”

“…Correspondingly, an emergent wave of treatment strategies is placing greater emphasis on the interpersonal aspects of voice‐hearing. These include compassion‐focused techniques (Heriot‐Maitland, McCarthy‐Jones, Longden, & Gilbert, 2019); Progressive Approach psychotherapy, which facilitates an attitude of acceptance and empathy from the reflective ‘Adult Self' to the distressed ‘experiencing self' (Gonzalez & Mosquera, 2012; Mosquera & Ross, 2017); Avatar therapy, a dialogical approach that incorporates digital representations of hostile voices (Leff, Williams, Huckvale, Arbuthnot, & Leff, 2014); Relating Therapy, which addresses ‘power’ and ‘proximity’ dynamics between hearer and voice (Hayward, Jones, Bogen‐Johnston, Thomas, & Strauss, 2017) and Cognitive Behavioral Therapy for psychosis (CBTp), which examines how psychosocial dynamics can influence voice phenomenology (Tai & Turkington, 2009). Taken together, these approaches expand traditional views of voices as merely perceptual anomalies by explicitly acknowledging the impact of the hearer–voice relationship both in maintaining distress and promoting recovery.…”

An exploration of relationship between self‐compassion and voice‐related distress in people who hear voices

“…In support of the role of social and relational processes, more recently, the construct of compassion and selfcompassion has been heralded as an important component of the voice-hearing experience (e.g., Gumley, Braehler, Laithwaite, MacBeth, & Gilbert, 2010;Heriot-Maitland, McCarthy-Jones, Longden, & Gilbert, 2019). Compassion more broadly can be conceptualized as the capacity to attune to the experience of suffering from the motivation to alleviate it, and typically includes orienting toward (rather than avoiding) difficult experiences with qualities such as care, connection, nonjudgment, kindness, patience, and understanding (see Strauss et al, 2016).…”