Transformation of Methodological Understanding about “Voices” and Versions of Interventions by Experts in the Field of Auditory Hallucinations

Abstract

An analytical review of the directions for auditory hallucinations (AH) interventions in the context of the development of ideas about the phenomenon of “voices” is presented. The transformation of methodological approaches evolves from the conceptualization of hallucinations as “perceptions without an object” and “production of sick brain” to an acknowledgment of the connection with the stimulus and the significance of the subject's activity; from the concept of AH as a symptom to the analysis of perception as a mediated activity, the differentiation of AH cognitive and perceptual models. Changes in conceptualization determine the contemporary goals of the intervention. In the cultural-activity approach methods are used to improve the psychological state based on the comprehension of the systemic nature of the defect in mental activity. The limitations of comparing the effectiveness of pharmacological treatment and psychotherapy are shown. In the development of evidence-based intervention strategies the integration of cultural-activity approach thesis and cognitive-behavioral therapy (CBT) models is productive. Within the framework of the “third wave” CBT and therapy based on social relations the leading techniques for adapting to “voices” are presented. Conceptualization the mechanisms of AH allows to move from the goal of intervention related to adaptation in defect – to distress reduction, increase the controllability of AH, to overcoming the consequences of psychosis.