are they exacerbating or maintaining the hallucinatory experiences? Basically, if the experience remains distressing and is affecting social functioning, the guided discovery approach will usually lead the patient to the conclusion that what they are doing to cope is perhaps not working very well, or could even be part of the problem. Using the gathered information, the clinician and patient can decide collaboratively whether the current coping strategies are dysfunctional, i.e. The patient might then complete various informal and formal questionnaires relating to their voice hearing ( Box 4). 1), identifying triggers, appraisals, affect and safety behaviours. The assessment might begin with the collaborative creation of a Morrison maintenance model ( Fig. The purpose of assessing how the patient appraises and responds to/deals with their voice hearing experience is to ask a series of questions to elicit information in a way that helps to illustrate to the patient that some explanations, behaviours and attempts to cope can be directly counterproductive to the goal of recovery. 1), as described by Reference MorrisonMorrison (1998). Instead of helping the voices to diminish, such ineffective coping strategies often perpetuate and exacerbate the maintenance cycle ( Fig. Without support and guidance, attempts to use focusing strategies can lead to exacerbation of linked affect (anxiety, anger and shame) and increase unhelpful safety behaviours such as social avoidance, thought suppression or worry ( Reference Howard, Forsyth and SpencerHoward 2012). The strategies used are almost entirely distraction-based techniques aiming to reduce distress and escape from the voices. The key problem is that individuals who experience ongoing distress with auditory hallucinations often activate dysfunctional coping strategies as they try to manage these unpleasant experiences. Focusing now includes metacognitive approaches such as acceptance and mindfulness ( Reference Wright, Sudak and TurkingtonWright 2010). They defined such focusing strategies as comprising exposure to voice content, responding to that content and modifying underlying beliefs. In a further study ( Reference Haddock, Morrison and HopkinsHaddock 1998) they found that any positive benefit of distraction approaches did not generalise and concluded that coping strategies based on focusing were preferable. Reference Haddock, Bentall, Slade, Haddock and SladeHaddock et al (1996) undertook a randomised controlled trial of distraction versus focusing for voices and were able to demonstrate that patients could exert some control over voices, but that some strategies could have a negative impact on self-concept and esteem. The purpose of this article is to reduce the distress caused by auditory hallucinatory experiences. Learn a variety of focusing approaches for delivery by mental health professionals and how these can be taught to patients in brief clinical sessions Understand how to teach patients distraction techniques and measure any benefit as an interim step If this hypothesis blurts out any measure of truth, the usual therapeutic algorithm will have to be re-evaluated.Recognise ineffective coping strategies used by patients who are distressed by auditory hallucinations in community and in-patient settings This might lead one to speculate whether the supposed core symptom of the disease, auditory hallucination, is not in fact a possible resistance mechanism. While the notable neurophysiological finding was a general slowing of delta-theta activity within the temporal lobe, an increase in beta activity was found within the same zone during auditory hallucinations, which raises the question of whether this might be an intermittent compensation mechanism of the brain, also in the sense of a self-healing function. However, under functional imaging evaluation (MEG) of a neuronal correlate of the disease, truly asymmetric relationships were found. Regarding the typology and definition, hallucinations of different qualities (auditory, visual, tactile, olfactory and gustatory) represent a so-called core symptom according to the modern classification systems ICD-10 and DSM-IV. Schizophrenia, with a lifetime prevalence of one percent, is one of the most common mental diseases.
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