Understanding the role of self in auditory verbal hallucinations using a self‐discrepancy paradigm

OBJECTIVE: Negative auditory verbal hallucination (AVH) content is a major predictor of distress and typically occurs more frequently than positive or neutral content. Recent research has found that negative views of self are associated with the negative content of AVHs. However, research investigating the role of self in AVH content is in its infancy and warrants further study. DESIGN: The current study examined correspondence between negative voice content and internalized representations of self, using a self‐discrepancy paradigm incorporating multiple domains of self (ideal, ought, and feared). It also considered the impact of depression and anxiety. METHOD: An adapted self‐discrepancy questionnaire was administered to a transdiagnostic clinical sample of 86 current voice‐hearers. Participants rated how similar they believed themselves to be (actual self), and how similar their voices would say they are (voice self), to their ideal, ought, and feared self‐concepts. RESULTS: Voice content was related to how the person viewed themselves in relation to their ideal, ought, and feared self‐concepts. Additionally, voices reflected negative feared self‐concepts, particularly in people with anxiety. CONCLUSIONS: These findings provide further insight into the phenomenon of hearing voices and have the potential to change the way we approach formulation and treatment of AVHs. In particular, treatment approaches that reduce discrepancies between how one views themselves and their positive and negative self‐concepts, or alter the relationship one has with their self‐concepts and negative voices, have the potential to reduce the impact of distressing voices. PRACTITIONER POINTS: Voice experiences can be meaningfully related to how the person views themselves in relation to concepts of their ideal, ought, and feared selves. Negative voice content might be understood as reflecting discrepancies from these self‐representations, which may have a self‐regulatory function in relation to goal‐directed behaviour. Identifying how voice content relates to self could be useful in not only challenging the extent of perceived self‐discrepancies, but also considering how to enact valued parts of self.