Hearing voices that others don’t perceive is a challenging difficulty for a small but significant number of children, adolescents, and adults. While some people who hear voices do not experience functional problems, many do. Medications help some but not all people who have functional difficulties involving hearing voices, but do not always eliminate the problem. In addition unlike cardiac disease, people who hear voices also have to deal with being discriminated against and uncomfortable discussing their experiences, something medication does not address.
My experience of working with children, adolescents, and adults with functional problems related to hearing voices got me to research non-medication interventions that could help. While little non-medication research is done in the United States, support groups and coping strategies are used extensively in England to help people with functional problems related to hearing voices. Recently, the Connecticut Department of Mental Health offered a workshop by Rachel Waddingham http://www.behindthelabel.co.uk a United Kingdom interventionist whose work I’d read about. Ms. Waddingham described how support groups, mindfulness activities, and the use of coping strategies can help children and adults who hear voices as a component of their intervention.
As an occupational therapist working in psychiatry I use purposeful activities and coping strategies extensively with some children, adolescents, and young adults who have functional problems related to hearing voices. I sometimes use propelling scooter boards, exercise, taking clients to therapeutic horse back riding, mindfulness activities, and other coping strategies as part of a comprehensive treatment program to help individuals who hear voices.
Engaging in meaningful activities helps assess and promote functional skills. To help youth and adults with functional difficulties related to hearing voices find meaningful coping strategies, I ask them to select 3 from each page of the PaganoFABTriggerCopingForms copy It is helpful to build on the coping strategies the individual is already using affectively to help them better manage their biggest environmental and body triggers.
As a school occupational therapist in a psychiatric hospital school I use partial sentences to simultaneously address writing and provide opportunities to express feelings. In the following example using partial sentences a student expressed her fear of hearing voices and loneliness of not seeing her mom.
Coping cards are index cards that are constructed to address the student’s functional goal. Using an index card a student uses pictures or words to describe their functional goal, preferred interest, reinforcement schedule, and most affective coping strategies. This reminds students and staff of their individual goal and coping strategies for achieving the goal.
Public school occupational therapy bulletin boards are another way of teaching about coping strategies while showing that occupational therapy can be useful for all students. It helps address the bias some students have that occupational therapy is “only for mentally retarded and crazy kids”, and teachers are always willing to let me have one of their bulletin boards.
The needs of individuals who hear voices is inadequately addressed in the United States because of the fear and biases related to this problem and it is time we professionals address it. Coping strategies have been a useful component of my interventions for individuals with functional difficulties related to hearing voices.
References:
Farhall, J., Greenwood, K. M., & Jackson, H. J. (2007). Coping with hallucinated voices in schizophrenia: A review of self-initiated strategies and therapeutic interventions. Clinical Psychology Review, 27(4), 476-493.
Kovacs, M. & Lopez-Duran, N. (2012). Contextual emotion regulation therapy: A developmentally-based intervention for pediatric depression. Child and adolescent psychiatric clinics of North America, 21(2), 327.
