Testing beliefs about control

A useful strategy is to use a procedure whereby the patient and therapist learn to engineer situations to start or increase the probability of hearing voices, and then to stop or reduce them. In this way the patient gains a surprising degree of control over the voice. The initial assessment provides information about cues that provoke voices for a particular individual; concurrent verbalization is known to stop or diminish voices temporarily. This information is combined in the following four steps.

1. Identify cues that increase and decrease voices.

2. Practise the use of 'increasing' and 'decreasing' strategies within a session.

3. Propose the notion that 'control' requires the demonstration that voice activity can be turned up/on or down/off.

4. In sessions encourage the patient to initiate or increase voice activity for short periods then reduce or stop it.

5. Elicit changes in the patient's belief about his control over the voices.

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