Listening to and Believing Derogatory and Threatening Voices

McPin Hearing Voices Lived Experience Advisory Panel

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)
19 Downloads (Pure)


BACKGROUND AND HYPOTHESIS: A plausible cause of distress for voice hearers is listening to and believing the threats and criticisms heard. Qualitative research indicates that patients have understandable reasons to listen. This study aimed to develop the understanding of distress using this listening and believing framework. Measures were developed of listening and believing voices and the reasons, and associations with distress tested.

STUDY DESIGN: A cross-sectional study of patients hearing derogatory and threatening voices (N = 591). Listening and Believing-Assessment and Listening and Believing-Reasons item pools were completed, and assessments of distress. Exploratory and confirmatory factor analyses and structural equation modeling (SEM) were conducted.

STUDY RESULTS: 52% (n = 307) of participants believed their voices most or all the time. Listening and believing had 4 factors: active listening, passive listening, believing, and disregarding. Higher levels of believing, active listening, and particularly passive listening were associated with higher levels of anxiety, depression, and voice distress. Reasons for listening and believing formed 7 factors: to better understand the threat; being too worn down to resist; to learn something insightful; being alone with time to listen; voices trying to capture attention; voices sounding like real people; and voices sounding like known people. Each type of reason was associated with active listening, passive listening, and believing. SEM showed that feeling worn down in particular accounted for listening and believing. Test-retest reliability of measures was excellent.

CONCLUSIONS: A framework of listening and believing negative voices has the potential to inform the understanding and treatment of voice distress.

Original languageEnglish
Pages (from-to)151-160
Number of pages10
JournalSchizophrenia bulletin
Issue number1
Early online date10 Aug 2022
Publication statusPublished - Jan 2023
Externally publishedYes

Bibliographical note

Publisher Copyright:
© The Author(s) 2022. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.


  • assessment measures
  • auditory hallucination
  • cognitive models
  • distress
  • structural equation modelling
  • voices

ASJC Scopus subject areas

  • Psychiatry and Mental health


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