Coping with Voices: Selective Attention Training for Persistent Auditory Hallucinations in Treatment Refractory Schizophrenia

Abstract

Attentional difficulties in people with schizophrenia are common and can be disabling. A number of cognitive rehabilitation interventions aim to improve attention span by having patients practice paying attention to various types of stimuli for increasing lengths of time. However, such interventions typically assume that the attention deficit is a form of negative symptom, reflecting a reduced ability to maintain an attentional focus. In the following case study, we describe a cognitive intervention for a patient whose inability to pay attention was the result of persistent, distracting, and disabling auditory hallucinations. The dichotic listening paradigm was modified to enable the patient to repeatedly practice attending to a source of relevant information, while ignoring irrelevant information that was gradually introduced to one, two, and then three spatial locations. A graded technique was used wherein difficulty level (i.e., number of stimulus sources and stimulus intensity) was increased only after near perfect performance was achieved on prior trials. Embedding this intervention within the context of a therapeutic relationship led to clear improvement in task performance over time, with concomitant better attentiveness on the inpatient unit, and an improved ability to engage in interviews at residential settings, leading to subsequent hospital discharge.

Listening to Schneiderian Voices: A Novel Phenomenological Analysis

“…Multiple studies have hypothesized that the experience of AVHs causes one to become more internally focused on the voices which can, in turn, increase difficulties ignoring the voices or shifting attention away from them in order to better engage in/with the environment (64,65,66). Further, the experience of AVHs carries significant stigma and has been associated with poor outcomes, high level of distress and social isolation (13,67).…”

Recovering from Hallucinations: A Qualitative Study of Coping with Voices Hearing of People with Schizophrenia in Hong Kong

“…The “copers” were found to engage more often in selective listening, such as listening only to the positive voices, and were more able to ignore them, while the “non-copers” more often tried to utilize distraction techniques. In general, changes in social contacts and manipulating the level of sensory stimulation were the two basic coping strategies identified for the “copers” [19–21]. …”

Left temporal lobe structural and functional abnormality underlying auditory hallucinations

“…However, the results have varied, Fiszdon et al (2005) failed to show any training effects on auditory hallucinations, while Hatashita-Wong and Silverstein (2003) found indications of improvement. The idea behind the usage of a dichotic procedure for training to inhibit or ignore voice symptoms is that the dichotic situation gives rise to a very strong response tendency to report the right ear stimulus.…”