Reduce Distress at Hearing Voices with Self-Compassion and Mindfulness

Reduce Distress at Hearing Voices with Self-Compassion and Mindfulness


By John M. de Castro, Ph.D.


“Mindfulness is increasingly being used for psychological approaches to voice-hearing and other experiences that can be seen as ‘psychotic’ . . The aim of mindfulness is to develop an accepting approach to thoughts and feelings and through understanding these experiences develop more detachment and choice about how they influence us.” – Hearing Voices Network


Hearing voices is quite common, occurring in around 2% – 4% of the population. Neuroimaging has demonstrated that the voices that people hear are experienced as if there were a real person talking to them with the same brain areas becoming active during voice hearing as during listening to actual speech. So, it would appear that voice hearers are actually experiencing voices.


Hearing voices (auditory hallucinations) is seen as a prime symptom of psychosis and is considered a first rank symptom of schizophrenia. Hearing voices, however, is not always indicative of psychosis. But, only about a third of voice hearers are considered psychotic. On the other hand, about two thirds of voice hearers are quite healthy and function well. They cope effectively with the voices they’re hearing, do not receive the diagnosis of psychosis, and do not require psychiatric care.


The differences between people with psychoses and healthy people who hear voices, is not in the form but the content of the heard speech. Non-psychotic individuals hear voices both inside and outside their head just like the psychotic patients but either the content is positive or the individual feels positive about the voice or that they are in control of it. By contrast the psychotic patients are frightened of the voices, the voices are more malevolent, and they feel less control over them. Mindfulness has been shown to be negatively related to the distress felt by the individual about hearing voices, such that the higher the level of mindfulness, the lower the level of distress.


In today’s Research News article “Mindfulness of voices, self‐compassion, and secure attachment in relation to the experience of hearing voices.” (See summary below or view the full text of the study at: ), Dudley and colleagues explore the relationships between mindfulness, self-compassion, and distress and severity of hearing voices. They recruited adults through social media who currently hear voices and administered an on-line survey. They completed scales measuring self-compassion; including self‐kindness, self‐judgement, common humanity, mindfulness, isolation, and over‐identification, mindfulness of voices, severity of voices; including frequency, negative content, loudness, distress, impact on self‐appraisal, clarity, and compliance with commands., and attachment styles: including secure, dismissing, preoccupied, and fearful.


They found that the higher the levels of mindfulness of voices and self-compassion, the lower the levels of severity of voices and fearful attachment and the higher the levels of secure attachment style. Mediation analysis demonstrated that self-compassion, in part, mediated the negative relationship between mindfulness of voices and severity of voices, and that mindfulness of voices, in part, mediated the negative relationship between self-compassion and severity of voices. In other words, people who were high in mindfulness of voices tended to also be high in self-compassion and, in turn, low in the severity of the impact of hearing voices.


These results suggest that how difficult and distressful the voices are for the individual is lower when the individual is mindful about the voices and when the individual has a high degree of compassion for themselves. These results are correlational. So, causation cannot be concluded. There is a need for future research to train mindfulness and/or self-compassion and observe whether there are commensurate changes in how distressful the voices are to determine if changes in mindfulness and self-compassion may cause reductions in the distress caused by hearing voices. If this is found to be the case then these trainings may be an effective means to reduce the distress produced by hearing voices and prevent hearing voices from becoming a basis for a psychosis.


So, reduce distress at hearing voices with self-compassion and mindfulness.


“mindfulness practice and discussion, . . .delivered over 12 weeks effectively impacts key dimensions of the voice hearing experience, supports meaningful behaviour change, and has lasting effects on mood,” – Batya Swift Yasgur


CMCS – Center for Mindfulness and Contemplative Studies


This and other Contemplative Studies posts are also available on Google+ and on Twitter @MindfulResearch


Study Summary


James Dudley, Catrin Eames, John Mulligan, Naomi Fisher. Mindfulness of voices, self‐compassion, and secure attachment in relation to the experience of hearing voices. Br J Clin Psychol. 2018 Mar; 57(1): 1–17. Published online 2017 Aug 12. doi: 10.1111/bjc.12153




Developing compassion towards oneself has been linked to improvement in many areas of psychological well‐being, including psychosis. Furthermore, developing a non‐judgemental, accepting way of relating to voices is associated with lower levels of distress for people who hear voices. These factors have also been associated with secure attachment. This study explores associations between the constructs of mindfulness of voices, self‐compassion, and distress from hearing voices and how secure attachment style related to each of these variables.


Cross‐sectional online.


One hundred and twenty‐eight people (73% female; M age = 37.5; 87.5% Caucasian) who currently hear voices completed the Self‐Compassion Scale, Southampton Mindfulness of Voices Questionnaire, Relationships Questionnaire, and Hamilton Programme for Schizophrenia Voices Questionnaire.


Results showed that mindfulness of voices mediated the relationship between self‐compassion and severity of voices, and self‐compassion mediated the relationship between mindfulness of voices and severity of voices. Self‐compassion and mindfulness of voices were significantly positively correlated with each other and negatively correlated with distress and severity of voices.


Mindful relation to voices and self‐compassion are associated with reduced distress and severity of voices, which supports the proposed potential benefits of mindful relating to voices and self‐compassion as therapeutic skills for people experiencing distress by voice hearing.

Practitioner points

  • Greater self‐compassion and mindfulness of voices were significantly associated with less distress from voices. These findings support theory underlining compassionate mind training.
  • Mindfulness of voices mediated the relationship between self‐compassion and distress from voices, indicating a synergistic relationship between the constructs.
  • Although the current findings do not give a direction of causation, consideration is given to the potential impact of mindful and compassionate approaches to voices.

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