Mapping Schema Modes in Voice Hearers: Investigating the Role of Schema Modes in Voice Hearers' Experience

Abstract

Auditory verbal hallucinations, or hearing voices, occur across various mental health conditions and can vary widely in distress and content. Understanding the factors that influence these experiences is essential for effective therapy. Schema therapy, particularly its concept of schema modes, offers a framework to explore how emotional states and coping strategies shape the nature and distress of voice hearing. Despite this, there is limited research on the relationship between schema modes and voice-hearing experiences. This study aimed to address this gap by developing a schema mode profile for transdiagnostic voice hearers, and investigating whether schema modes predict voice-related distress and positive or negative voice-related content. The study included 76 voice hearers who completed assessments of their voices and schema modes. The schema mode scores in voice hearers were generally elevated compared to nonclinical and Axis I populations (e.g., those with anxiety or depressive disorders) and closely mirrored those of Axis II populations (e.g., personality disorders). The greatest elevations compared to Axis I patients were observed in the Vulnerable Child, Impulsive Child, Detached Protector, Bully and Attack and Punitive Parent modes. Regression analyses showed that Vulnerable Child mode significantly predicted greater voice-related distress. For negative voice content, both the Vulnerable Child and Detached Self-Soother modes were associated with an increased negativity. For positive voice content, the Happy Child and Enraged Child modes were positive predictors, while the Detached Self-Soother was negatively associated with positive voice experiences. These findings suggest schema modes may play a role in voice-hearing experiences, offering promising avenues for schema therapy interventions and future research.