The challenges and opportunities of social connection when hearing derogatory and threatening voices: A thematic analysis with patients experiencing psychosis

Abstract

Objectives. Relationships with other people are important determinants of the course of psychosis, yet social isolation is common. This study sought to learn about the patient experience of being around other people when hearing derogatory and threatening voices (DTVs). Design. A qualitative interview study.Methods. Fifteen participants with experience of hearing DTVs in the context of nonaffective psychosis were recruited from NHS services. Data were obtained by semistructured interviews and analysed using thematic analysis.Results. Three themes were identified: (1) reasons why interacting with people is difficult when hearing DTVs; (2) the relationship between social connection and DTVs; and (3) factors which enable voice hearers to connect with others. A further ten subthemes are outlined as reasons why hearing DTVs led to lower social connection, including difficulties during conversations (e.g., the concentration required is hard), negative expectations of interactions (e.g., fearing negative judgement from others), and difficulties sharing experiences of voices (e.g., people will be hurt or upset if I tell them about the voices). Isolation was a common response to hearing DTVs but also a time of vulnerability for hearing voices. Managing the challenges of interacting with people led to some improvements in DTVs.Conclusions. There are understandable reasons why hearing DTVs leads to lower social connection. Yet isolating oneself can also be a time of vulnerability for DTVs. SocialThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Listening to and Believing Derogatory and Threatening Voices

“…It is also notable that the majority of variance in distress remains unexplained. There are likely other contributors to the occurrence of negative affect in this group, including perceptions of the controllability over illness, 32 loss of social roles such as employment, experiences of stigma 33 and social isolation, 34 elevated worry, 29 and the impact of other psychotic experiences. Depression and anxiety disorders, which are known to be elevated in people with psychosis, 32 may also be separate cooccurring clinical disorders.…”

Stakeholder views on mindfulness for youth at risk for psychosis

“…Groups discussed the importance of social bonding and a 'peer' group feeling to help ameliorate effects of social anxiety and paranoia. Greater social connection has a significant positive influence on the course of psychosis (Norman et al 2005;Sheaves et al 2021); and whilst some individuals expressed hesitance to participate in a group setting, the benefit of doing so once anxiety and paranoia is addressed is apparent. This is apparent in qualitative research investigating the use of group mindfulness for later stages of psychosiswhere the supportive social element of the group has been described as key in helping people learn mindfulness as well as improve relationships with others (Ashcroft et al 2012;Dennick et al 2013;May et al 2014).…”

“…2005; Sheaves et al . 2021); and whilst some individuals expressed hesitance to participate in a group setting, the benefit of doing so once anxiety and paranoia is addressed is apparent. This is apparent in qualitative research investigating the use of group mindfulness for later stages of psychosis – where the supportive social element of the group has been described as key in helping people learn mindfulness as well as improve relationships with others (Ashcroft et al .…”

“…This completed study showed significant promise for improving social functioning and subject wellbeing, however, was conducted online and individually (Alvarez-Jimenez et al 2018). Greater social connection is a significant positive influence on the course of psychosis, yet social isolation is common amongst UHR individuals, highlighting the potential benefit of inperson group interventions (Alvarez-Jimenez et al 2018;Sheaves et al 2021).…”

Speech processing in voice-hearers: Bridging the gap between empirical research and clinical implications

“…For example, voice-hearers are more likely to misidentify emotions (Rossell and Boundy, 2005) or make source monitoring errors (Johns et al, 2001) when listening to negative rather than positive emotions. Furthermore, negative topics are known to exacerbate AVH symptomology (Freeman and Garety, 2003), which can consequentially lead voice-hearers to withdraw from conversation and experience difficulties connecting with others (Sheaves et al, 2020).…”