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This chapter is concerned with voices, that is, hallucinations which are experienced as someone talking. It argues that viewing voices from a cognitive perspective increases understanding of the maintenance of voices and reveals a new treatment approach of considerable promise. Auditory hallucinations are traditionally associated with a diagnosis of schizophrenia. The explanatory power of the cognitive model was weakest in relation to compliance. The cognitive approach within clinical psychology is based on two premises. The major premise states that extreme feelings and behaviour are consequences of particular beliefs rather than events. The minor premise states that if these beliefs can be weakened using cognitive therapy, then the associated distress and behaviour will diminish. The therapist then engineers situations to increase and then decrease the probability of hearing voices. An initial thorough cognitive assessment should identify the cues that provoke voices, and one technique with a high likelihood of eliminating voices for its duration is concurrent verbalisation.

Schizophrenia affects 0.8 per cent of the UK population, usually starts in early adult life and leads to persistent disability in most cases. It carries a high risk of suicide and deliberate self harm and, on a population basis, people with schizophrenia are more likely to perpetrate acts of aggression than their peers. Command hallucinations are very prevalent in people who experience schizophrenia. A review of eight studies by F. Shawyer et al. reported median prevalence rate of 53 per cent with a wide range in a sample of adult psychiatric patients. The relationship between command hallucinations and compliance is very complex. It is often assumed that the presence of such symptoms will inevitably trigger emotional and behavioural responses. Research has provided empirical support for the relationship between power beliefs and affective and behavioural responses to voices. The powerlessness and inferiority that voice hearers experience in their relationships with others in general is strongly linked to the power of voices.

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