The Trauma-Related Voices Model: An Integration of Auditory Verbal Hallucinations and Posttraumatic Stress

Abstract

Many trauma-affected voice hearers report comorbid posttraumatic stress and voices (auditory verbal hallucinations) that are directly (voices repeat phrases spoken by perpetrators) or indirectly (voice content and trauma are 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. 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. 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. 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 posttraumatic stress and voice hearing symptoms.