If you hear voices, here are some empowering ways to respond

Need to know

Many people – approximately 10 per cent – will, at some point in their lives, have the experience commonly known as ‘hearing voices’. What does that mean, exactly? If this is something that happens to you, you might perceive a voice talking to you, or about you, even though nobody seems to be present. You might hear comments from different voices at different times, or voices talking to each other about you. These voices may seem familiar and belong to people you know or have known in the past. Or they could be the voices of complete strangers, or of spiritual entities. People who hear voices sometimes even recognise the voice they hear as their own; the distinction between hearing a ‘voice’ and something like an ‘inner critic’ is control, as the person hearing a voice will have no sense of control over this experience.

Some people who hear voices perceive positive comments in the form of advice, compliments or reassurance. They might hear, for example, kind words from the voice of a lost loved one. Others hear neutral comments, with the voices offering a running commentary on what they are doing. These positive and neutral comments often do not cause much distress. If this is your experience, and the voices aren’t bothering you too much, you might be happy to just carry on as usual. Hearing voices is not a problem per se. It becomes a problem and needs to be managed only when the experience is causing you distress.

For some, voices make negative comments that are very distressing. These often include critical and derogatory remarks, such as ‘You’re useless – no one likes you.’ The voices and their comments may be linked to difficult times from a person’s past. The personal nature of these comments can make them very hard to ignore. Negative comments from voices can also include commands – to go somewhere or do something, maybe to harm yourself, or (less often) to harm others. These commands might be accompanied by threats that, if you don’t obey, the voices will harm you or your loved ones (‘If you go out, bad things will happen to your family’). Again, this can make the voices very difficult to ignore.

Distressing voice-hearing experiences have historically been linked to mental health problems such as schizophrenia and related conditions. More recently, mental health researchers have learned that distressing voices can be experienced by people with a range of emotional and mental health problems (eg, borderline personality disorder), including people who have not been diagnosed with a mental health condition. Links have also been found between hearing distressing voices and past adverse experiences, such as emotional neglect during childhood, bullying at school, and physical or sexual abuse. Voice-hearing experiences might be directly related to a specific adverse experience or abusive relationship (eg, hearing the voice of someone who was abusive) or to more general difficulties (eg, voices making critical comments that reflect one’s low self-esteem).

Our learning in recent years has also provided a clearer sense of how to manage voices and reduce the distress they can cause. If you hear voices that trouble you, irrespective of how long you’ve been hearing voices and how much distress they cause, some of the approaches that I’ll describe next could be helpful for you – as they have been for many of the people I’ve worked with as a clinical psychologist. (If it’s someone you know, such as a family member, who is having this experience, you might be able to suggest that they consider these approaches.)

What to do

Get to know the voices and notice how they behave

A natural and understandable response to hearing distressing voices is to turn away and try to ignore them. However, the urge to escape can prevent you from getting to know the voices and noticing any patterns in how they work. Voices are often predictable in terms of what they say, regularly offering the same or similar criticisms and commands. Voices can also be predictable in terms of when they’re active: this may be at certain times (eg, nighttime), when you’re in certain locations (eg, crowded places), or when you’re experiencing certain emotional states (eg, anxiety or low mood). If you’re able to turn towards the voices and notice any patterns in their activity, this can help you to develop a plan for managing voice-hearing experiences.

A good way to get to know voices is to keep a diary – recording when they’re talking, what they’re saying, where you are, what you’re doing at that time and how you’re feeling. This might help you to notice any patterns in the activity of the voices, and then (as we’ll discuss in the next step) you can use this information to develop a plan.

Make a plan based on what you notice

After you have taken some time to observe any patterns in your voice-hearing experiences, you can use that information to tailor how you respond. You might want to enlist a trusted confidante or a mental health practitioner (such as a clinical psychologist) to help you develop and start to use this plan.

In planning your responses, consider:

• Time: if voices are typically active at certain times of the day or night, you can anticipate this and have coping strategies ready to employ at these times. Coping strategies could include activities that distract you (eg, listening to music through headphones), absorb your attention (eg, gaming) or help you to relax (eg, a breathing exercise).
• Place: if voices are active in certain places, you can choose not to visit those places. But if visiting those locations is necessary, you can have your coping strategies available to help you manage – for example, you can take your music and headphones with you.
• Feelings: if voices are triggered by your emotional state, can you do something to manage your emotions before voices become active? For example, could you do some relaxation exercises to reduce your anxiety, if anxiety seems to be a trigger?

As well as noticing the patterns of the voices, pay attention to the helpfulness of your coping strategies. If some of your strategies are especially helpful, can you use these strategies more often, or earlier, to maximise the benefits? If some of your strategies seem to be less helpful (eg, shouting at the voices, which might provoke an aggressive reaction) or have unhelpful side-effects (eg, self-harming, which can damage the body and attract judgments from others), can you use alternative ways of responding?

If you can turn toward voices, notice any patterns in their activity and develop a plan for enhancing the helpfulness of your coping strategies, this can give you some sense of control over an experience that can otherwise seem uncontrollable.

Play detective and question what voices say

Another approach to managing voices also involves turning toward them but, this time, it’s more about considering the accuracy of what the voices are saying.

Voices often come across as powerful and knowledgeable. If a voice says that you’re useless and worthless, it might be easy to assume that it’s telling the truth, particularly if that’s how you already see yourself. Or, if voices say that bad things will happen if you don’t obey them, you might believe that they have the ability to make these things happen.

Beliefs are best guesses, not facts. However, once the mind has formed a belief, it will work hard to maintain that belief in pursuit of stability, often disregarding any evidence to the contrary. This is the case for all minds, not just the minds of people who are distressed by hearing voices.

You can explore the accuracy of your beliefs about what voices are saying by ‘playing detective’ – searching for evidence that does not support what you’re hearing. If the voices say that you’re worthless, is there any evidence from your experience that goes against that? An example might be some recognition that you received from someone for a task that you completed well. If the voices say that bad things will happen if you disobey, ask yourself: have there been any times when you did disobey the voice, and nothing bad happened?

Playing detective can be challenging, as you’ll be working against your mind’s tendency to maintain its beliefs. This is another area in which the support of someone you trust, perhaps a mental health practitioner, can be valuable. It’s also important to note that your goal here is not to prove that the voice is wrong. Rather, you’re trying to gather all the available evidence to help you make a balanced decision based on the facts: am I useless and worthless all the time? Can voices make bad things happen? These things can feel true, but what does the evidence say?

Assert yourself when your opinion differs

If you have played detective and developed slightly different beliefs about yourself and/or about the voices, what can you do with your changing views? If you wish to, you can express these views by talking back to the voices (either in your mind or out loud, whichever you prefer and seems most appropriate). This is not about responding aggressively, but about being assertive – calmly, honestly and respectfully expressing your opinion and acknowledging that it differs from the one expressed by the voice. As best you can, try not to get drawn into an argument about whose opinion is the right one.

An assertive response to a voice might sound something like this:

Voice: ‘If you go out, I will punish you.’

Hearer: ‘I hear what you say, that I’ll be punished if I go out. I used to feel scared when you said that.’

Voice: ‘Yes, you will be punished.’

Hearer: ‘I’ve got a different opinion now – I no longer believe that you can make bad things happen to me.’

Voice: ‘I can punish you, and I will.’

Hearer: ‘I’ve been looking at the evidence and noticed many times when you threatened me, and even though I disobeyed you, nothing bad seemed to happen.’

Voice: ‘I was lenient before. This time will be different.’

Hearer: ‘I hear what you say, but the evidence says something else, and I want to go out.’

Voice: ‘I forbid you.’

Hearer: ‘I think I’ve got my view across. I’ll stop talking now and get ready to go out.’

The use of evidence is important in this kind of exchange as it can help you mean what you say. It’s also important to end the conversation when you’ve clearly stated your opinion. The voice is likely to persist, and it will probably wear you down if you try to persist in responding to it, so when you’re ready, leave the conversation and use one of your coping strategies to focus your attention away from the voice.

If you are able to regularly respond to the voice in an assertive manner, the voice may begin to seem a bit more distant as you increasingly focus on your own opinions, needs and desires. As with playing detective, this work can be challenging, and being assertive in this way does not always come naturally to people. With the assistance of a trusted confidante or therapist, you might find it helpful to role-play and to practise responding assertively to a voice.

Make connections between the voices and other parts of your life

As you learn more about the voices, you are also likely to be learning about yourself. In noticing and anticipating the patterns in their activity, you might learn that you can have some control over your responses to them. By playing detective, maybe you learn to view yourself in a more balanced and less negative way. Through talking back to voices assertively, you may learn that you can be strong, and have greater respect for yourself and your opinions.

Another possible lesson lies in connections between the voices, what they say, and previous, difficult life experiences you’ve had. These connections may be obvious if the identities of the voices are directly linked to people with whom you’ve had a difficult relationship in the past, such as a parent or authority figure, a bully from school or work, or another person who abused you. If the identities of the voices are unknown, you might find connections between the content of what a voice is saying and any negative views you have of yourself – which may, in turn, reflect how you’ve been treated by others in the past.

Developing these connections can help you to make sense of the voices – where they came from and why they persist. If you want to take further steps toward making sense of voices and their origins, you may benefit from working with an experienced therapist. You might additionally find support and increase your understanding by connecting with others who’ve had their own experiences of hearing voices. Organisations like Hearing Voices Network in the UK and Hearing Voices Network USA facilitate the creation of local peer-support groups, and you may be able to access such a group near you.

Links & books