Abstract
Background
Voice-hearing refers to hearing a voice(s) when no one else is present or that other people cannot hear. Some voice hearers, although not everyone, find their voices distressing. Some people who hear voices are diagnosed with psychosis or schizophrenia, but many people also hear voices without it being part of a mental illness. Identifying whether a person experiences the voices as distressing and whether the voices interfere with daily life is more important than simply whether they are hearing voices or not. People who experience developmental trauma, defined as psychologically traumatic events occurring in childhood or adolescence, are more likely to hear voices in adulthood and find these voices distressing. Understanding what factors cause people to experience distressing voices after trauma is important, because this informs the development of interventions for reducing voice-related distress.
Developmental trauma influences how our attachment styles (patterns in relationships) develop. Also, people tend to relate to their voices like they do in their relationships with people, suggesting that these patterns may be similar to how they relate to their voices.
Researchers have started investigating how attachment styles influence voice-hearing experiences. Attachment theory argues that how humans are cared for in their early life influences how emotional bonds with others develop and patterns in our relationships throughout life. Research has identified different attachment styles, which are similar across different cultures:
• People with high levels of attachment anxiety seek out close relationships but tend to worry about them.
• People with high levels of attachment avoidance prefer to rely on themselves and avoid emotional closeness.
• People with disorganized attachment styles would like closeness in their relationships but also fear it, and fluctuate between high attachment anxiety and high attachment avoidance.
• People with secure attachments feel comfortable getting close to others and feel safe in relationships. They have low levels of attachment anxiety and avoidance.
• Some research suggests that insecurely attached people may be more likely to find their voices distressing, but it is not clear whether this is more likely in insecure-avoidant or insecure-anxious attachments.
Our Research
Our research aimed to improve understanding of the relationship between attachment and voice-hearing through two main pieces of research:
1. A conceptual review, which reviewed key concepts, models and findings from previous studies of attachment and voice-hearing.
2. An empirical study, which was a new piece of research using new data we collected.
Paper 1: Conceptual Review
Aims: The first paper reviews how attachment theory has informed theoretical models of voice-hearing and reviews what previous studies have found about how attachment style influences the development and maintenance of voice-hearing, as well as recovery from distressing voices.
Key Findings:
• The way hearing voices is understood has shifted from viewing voice-hearing as a biological symptom of mental illness to viewing it as an interpersonal experience shaped by trauma and attachment.
• There is limited research investigating how attachment style influences the development and maintenance of voices specifically, with most research collecting data from people diagnosed with psychosis. Also, most studies looked at these relationships at one point in time, which doesn’t show cause and effect.
• Attachment styles appear to influence recovery from distressing voices, but more research is needed. For example, previous research has focused on how insecure attachment styles are linked to more distress and poorer recovery, with little research studying how secure attachment might protect against distressing voices and/or help with recovery.
Conclusions: Attachment theory could help us understand and treat distressing voices better, but more research is needed to fill current gaps. Research questions and designs should be guided by models that combine biological, psychological, and cultural explanations of voice-hearing.
Paper 2: Empirical Study
Aims: More research is needed to establish how specific attachment styles influence voice-hearing specifically, because previous research has mainly focused on participants with a diagnosis of psychosis. Also, research is needed to determine whether the type of trauma experienced changes this relationship. Interpersonal traumas, such as sexual abuse, are likely to affect how attachment styles develop more than non-interpersonal traumas, such as a car accident.
Methods: 33 adult voice hearers with a developmental trauma history completed questionnaires about their experiences of developmental trauma, voice-hearing, and their current attachment style. We recruited participants regardless of whether they had received a mental health diagnosis, to help us understand common factors across different voice-hearing experiences.
Key Findings:
• Exposure to more types of interpersonal developmental trauma was linked to higher attachment avoidance and more severe voices.
• The relationships between interpersonal developmental trauma, attachment anxiety and voice-related distress were more complex and appeared to change at very high levels of interpersonal trauma.
• Some exploratory evidence suggests that anxious attachment style might influence the relationship between interpersonal developmental trauma and voice-related distress.
Conclusion: The links between trauma, attachment, and hearing voices are complex and might involve other factors like dissociation (feeling disconnected from reality). The study highlighted that it is difficult to accurately measures people’s experiences of developmental trauma and attachment style on questionnaires and this might have affected our results.
Learning and Recommendations from Our Research
Both papers highlighted the importance of attachment theory in understanding voice-hearing, especially distressing voices occurring after interpersonal developmental trauma.
Recommendations for future research include:
1. Develop theoretical models of voice-hearing to include the protective role of secure attachment and positive experiences of voice-hearing
2. Integrate biological, psychosocial, relational (attachment-informed) and culturally diverse explanations of voice-hearing into a unified model.
3. Collaborate with voice-hearers in the design and delivery of research studies.
4. Investigate the role of attachment in voice-hearers who experience other mental health difficulties or unusual perceptual experiences, such as visual hallucinations.
5. Design studies which track people over time and include larger, more diverse groups.
6. Develop questionnaires which more accurately measure attachment style, trauma and voice-hearing experiences in detail.
7. Use other methods, such as interviewing people about their experiences, to capture the complexity and richness of voice-hearing experiences.
Voice-hearing refers to hearing a voice(s) when no one else is present or that other people cannot hear. Some voice hearers, although not everyone, find their voices distressing. Some people who hear voices are diagnosed with psychosis or schizophrenia, but many people also hear voices without it being part of a mental illness. Identifying whether a person experiences the voices as distressing and whether the voices interfere with daily life is more important than simply whether they are hearing voices or not. People who experience developmental trauma, defined as psychologically traumatic events occurring in childhood or adolescence, are more likely to hear voices in adulthood and find these voices distressing. Understanding what factors cause people to experience distressing voices after trauma is important, because this informs the development of interventions for reducing voice-related distress.
Developmental trauma influences how our attachment styles (patterns in relationships) develop. Also, people tend to relate to their voices like they do in their relationships with people, suggesting that these patterns may be similar to how they relate to their voices.
Researchers have started investigating how attachment styles influence voice-hearing experiences. Attachment theory argues that how humans are cared for in their early life influences how emotional bonds with others develop and patterns in our relationships throughout life. Research has identified different attachment styles, which are similar across different cultures:
• People with high levels of attachment anxiety seek out close relationships but tend to worry about them.
• People with high levels of attachment avoidance prefer to rely on themselves and avoid emotional closeness.
• People with disorganized attachment styles would like closeness in their relationships but also fear it, and fluctuate between high attachment anxiety and high attachment avoidance.
• People with secure attachments feel comfortable getting close to others and feel safe in relationships. They have low levels of attachment anxiety and avoidance.
• Some research suggests that insecurely attached people may be more likely to find their voices distressing, but it is not clear whether this is more likely in insecure-avoidant or insecure-anxious attachments.
Our Research
Our research aimed to improve understanding of the relationship between attachment and voice-hearing through two main pieces of research:
1. A conceptual review, which reviewed key concepts, models and findings from previous studies of attachment and voice-hearing.
2. An empirical study, which was a new piece of research using new data we collected.
Paper 1: Conceptual Review
Aims: The first paper reviews how attachment theory has informed theoretical models of voice-hearing and reviews what previous studies have found about how attachment style influences the development and maintenance of voice-hearing, as well as recovery from distressing voices.
Key Findings:
• The way hearing voices is understood has shifted from viewing voice-hearing as a biological symptom of mental illness to viewing it as an interpersonal experience shaped by trauma and attachment.
• There is limited research investigating how attachment style influences the development and maintenance of voices specifically, with most research collecting data from people diagnosed with psychosis. Also, most studies looked at these relationships at one point in time, which doesn’t show cause and effect.
• Attachment styles appear to influence recovery from distressing voices, but more research is needed. For example, previous research has focused on how insecure attachment styles are linked to more distress and poorer recovery, with little research studying how secure attachment might protect against distressing voices and/or help with recovery.
Conclusions: Attachment theory could help us understand and treat distressing voices better, but more research is needed to fill current gaps. Research questions and designs should be guided by models that combine biological, psychological, and cultural explanations of voice-hearing.
Paper 2: Empirical Study
Aims: More research is needed to establish how specific attachment styles influence voice-hearing specifically, because previous research has mainly focused on participants with a diagnosis of psychosis. Also, research is needed to determine whether the type of trauma experienced changes this relationship. Interpersonal traumas, such as sexual abuse, are likely to affect how attachment styles develop more than non-interpersonal traumas, such as a car accident.
Methods: 33 adult voice hearers with a developmental trauma history completed questionnaires about their experiences of developmental trauma, voice-hearing, and their current attachment style. We recruited participants regardless of whether they had received a mental health diagnosis, to help us understand common factors across different voice-hearing experiences.
Key Findings:
• Exposure to more types of interpersonal developmental trauma was linked to higher attachment avoidance and more severe voices.
• The relationships between interpersonal developmental trauma, attachment anxiety and voice-related distress were more complex and appeared to change at very high levels of interpersonal trauma.
• Some exploratory evidence suggests that anxious attachment style might influence the relationship between interpersonal developmental trauma and voice-related distress.
Conclusion: The links between trauma, attachment, and hearing voices are complex and might involve other factors like dissociation (feeling disconnected from reality). The study highlighted that it is difficult to accurately measures people’s experiences of developmental trauma and attachment style on questionnaires and this might have affected our results.
Learning and Recommendations from Our Research
Both papers highlighted the importance of attachment theory in understanding voice-hearing, especially distressing voices occurring after interpersonal developmental trauma.
Recommendations for future research include:
1. Develop theoretical models of voice-hearing to include the protective role of secure attachment and positive experiences of voice-hearing
2. Integrate biological, psychosocial, relational (attachment-informed) and culturally diverse explanations of voice-hearing into a unified model.
3. Collaborate with voice-hearers in the design and delivery of research studies.
4. Investigate the role of attachment in voice-hearers who experience other mental health difficulties or unusual perceptual experiences, such as visual hallucinations.
5. Design studies which track people over time and include larger, more diverse groups.
6. Develop questionnaires which more accurately measure attachment style, trauma and voice-hearing experiences in detail.
7. Use other methods, such as interviewing people about their experiences, to capture the complexity and richness of voice-hearing experiences.
| Original language | English |
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| Publication status | Unpublished - 20 Sept 2024 |
