Deptford Hearing Voices Service (DHVS)

FREQUENTLY ANSWERED QUESTIONS ON:

COPING WITH VOICES

INTRODUCTION TO THE FAQs on coping techniques.

The FAQs in this section of the website come from the experiences of many voice hearers themselves, researchers and other types of workers. This part of the website will take time to fill out. The worker in the mean time can answer questions logged onto the discussion board of this website. There are links from this site to other websites that will also describe coping strategies for voice hearers. It is important to cross check your own experiences with other voice hearers as well as to what is written by a variety of other sources from journals, books and the internet. You are however always your own best expert!

The meaning of coping

Use of the term ‘COPING’ (or managing) the voices should be taken as being any positive decision or action taken, with the purpose of bringing the ‘voice hearer’ relief from their voices. There are good or functional strategies and bad or dysfunctional strategies.

Good strategies will generally not produce any complications for the person, while bad strategies which offer short term relief from the voices may still impair the health of the person using them. For example some people may find short term relief in using alcohol or cannabis to bring relief from the voices but both these substances have been shown to produce long term health problems as well as becoming either totally ineffective or making the ‘voices’ worse. More will be said about these substances in the FAQs below.

Medications

It is respectful to acknowledge that some voices hearers may not always find medications given for their ‘voices’ to be effective or perhaps feel the side effects of the medication to be as bad or worse than the nuisance of their voices. In fact research shows that between 25 – 40% of people on medication still hear voices. This does not mean that the medications should be discontinued: rather a careful weighing of their other benefits or hazards should be taken into account before any decisions is taken to continue or discontinue them. Such benefits from the medication – even if ineffective with voices – such as those of increasing sleep, improving mood etc, may still be valuable enough to make them worth taking once the balance of risks are carefully discussed with the Doctor, other professional worker or advocate.

Research generally shows that most voice hearers have usually worked out some way of dealing with or coping with their voices; but the use of the same coping strategies by different people may not always work for all of them.

There are many different ways of dividing up or giving headings for the approaches people use to deal with their voices, different books or journal articles may use more technical medical or psychological terms. The main strategies listed here are the following (1) Focusing, (2) Distraction (3) Concentration (4) Social (5) Mechanical – includes - counter stimulation techniques, (6) Thinking (7) Medication. The categories under which various methods fall are a matter of choice for each author.

It is important to note that various techniques listed below are not by any means all: other people reading those mentioned in the FAQs below may know of coping techniques used by other voice hearers which are not yet listed. It this is the case do mention this to the discussion board of the DHVS website.

Also use click-on buttons for the COPING METHODS CHART which you can download to print, the chart provides a way of recording your successes or not with different coping methods suggest below. Please note focusing techniques for finding out the pattern of the voices also has its own click-on chart.

Both charts can easily be redesigned afresh if you have your own computer so that they be better suited to your needs.

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Notes on copyright: DHVS ©

Please note the copyright symbols for the FAQs or any part of the website are not to discourage people importing whatever they find useful from the dhvs website but just a reminder for people to appropriately reference that the source of this material if it comes from the DHVS, is from the DHVS: this is in respect of the author’s hard work as well that of the webmaster and provides a useful ad., for the site! I hope this makes sense.

All the material from the FAQs come from a huge variety of sources and experience obtained from the author’s clinical practice, much of it if not all of it is already well known to those in the trade! In this field there are a lot of ideas often adaptations from others! I always try to reference my sources, and when this doesn’t occur it is very likely an accidental omission or just that I got the item from a source that did not itself reference where it had obtained the item. The author of the website is always happy to take advice and to make corrections where this seems both appropriate and fair.

You will find a complete absence of references to this FAQ an omission which is simply done in recognition that the knowledge is widespread and also to keep the FAQs from being chopped around by the insertion of those references. Later on a list of authors will be attached to a section of this website as in the FAQs on voices.

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FAQ 1

**FOCUSING**

Focusing or working out if the voices have a pattern is a useful step to be taken at any time and will give you information about the behaviour of the voices. Knowing the pattern of the voices may give you ideas on how you might deal with them. One advantage of using focusing is that the method itself ENCOURAGES PEOPLE TO TAKE A STEP BACK FROM THEIR VOICES (that is being more objective) and is a way of using thinking about the voices in a more structured way. It is generally easier for people to talk about the behaviour of the voices rather than about what the voices actually say (which is often a more sensitive topic).

Most if not all ‘VOICES’ have a PATTERN of APPEARING and DISAPPEARING: or if not then of increasing or diminishing in loudness and frequency. This is often related to STRESS TRIGGERS; either a single big event (or a collection of lesser events) that produce, anxiety, fear, upset or worries. A way of working this pattern out is to keep a simply diary (or use a calendar) and mark out the days when your voices are worst.

A detailed way of recording the activity of the voices is to score them out of ten (10). Below 4 the voices are of low or negligible nuisance, scores of 4 – 6, means they are affecting concentration, at 7 upwards means they are a serious distraction. You could create your own simple hand drawn graph or use the graphs you get on fairly cheap arithmetic exercise books bought from your local stationers. The upwards (vertically drawn) scale is marked out at regular intervals from 0 – 10, the flat (or horizontal scale) is divided either into 7 days or more. On this kind of scale ‘0’ means no voices whatsoever, ‘10’ means voices are continuous from the time you’re awake to the time you have gone to sleep.

Recording or checking out the pattern of your voices can be regarded as a form of coping. You are using your time to check them out to see if they have a pattern of coming and going. Actually seeing that they do have a pattern of coming and going does two things: (1) the fact they have a pattern makes them a bit less mysterious; (2) if you are able to relate to their pattern of coming and going to (stress or worry making) events in your life (i.e. events that might trigger the voices), opens up the possibility of having some control over the voices. That is if you can see the stress triggers to your voices; it follows that it might be possible to work out ways in which you could either reduce the number of stress triggers affecting you or better still to reduce the way those triggers impact upon you.

An example of reducing a stress trigger

Its’ difficult to give examples of this but crudely lets say you have a friend who is constantly phoning you up about one thing or another, taking your space and maybe ‘doing your head in’: how do you deal with this?

An extreme measure might be to terminate your friendship with them thus removing the source of the stress; of course this would be extreme and maybe cause you more distress at losing a friend who might be a nuisance but still a valued person. The next measure is that you might simply switch your phone on answer mode only, or pull the phone socket out during the times you need a break, but the problem is you cut off other people you might want to hear from. Another measure is that you have an assertive adult chat with them in which you spell out that their frequent calls are actually increasing your stress rather than relieving it, and to propose they reduce their calls to one a day, or one a week etc (this kind of situation can equally be applied to loving parents or siblings!).

In life there are things we have control over and things we don’t have any control over. We can sometimes move location to escape bad landlords, a bad environment, or a negative relationship. But what if we can’t do those things so easily, what then?

What we are faced with, is to consider whether we can adjust to a situation i.e. accept we have a bad landlord but that the other good things in our life give us an acceptable ‘trade-off’ for the bad things. The other action we can take is to change the relationship with the landlord (or with the partner) so that it becomes better (in other words bring about a change in them so they become nicer to us).

Another form of change is one that requires a change only in our attitude to a situation from something that is negative to something that is more positive to help us live with it (not always easy): that is we don’t change the people or the situation only our own attitude to them.

For example the weather in the UK is showery and windy for about 9 months of the year: it is pointless me getting annoyed with this because its’ not going to change, so unless I actually decide to move to a sunnier part of the world all I can do is to accept that the weather is part of the deal with living in the UK. In this situation I have taken a conscious decision to adjust my attitude not my location. The weather remains the same but I don’t get so bothered about it! We often do not make conscious decisions about many situations or unsatisfactory relationships which tend to just drag on without change, so they remain an unsolved irritation to ourselves and a repeating cause of stress.

There is a ‘saying’ by an ancient Greek philosopher called Epictectus, which has a certain truth to it “People are disturbed not by things but by the view …they take of them”

To summarise Focusing is one method of coping that aims to INCREASE KNOWLEDGE of the behaviour of the ‘voices’: at the same time such knowledge may also suggest ideas of how the TRIGGERS to the ‘voices’ could in some way be affected or reduced.

However ‘focusing’ is not in itself a quick fix for the nuisance of the ‘voices’. The value of such knowledge may be more helpful with coping with the voices in the long term: so any knowledge you get of their pattern is generally not wasted and can be used to experiment with how you reduce or simply deal with the stress events that form the trigger to your voices. People can use this technique on their own but it is often better to do this with a worker or someone who can stand outside of your situation but who nonetheless wanting to constructively help you.

(2) **DISTRACTION**

By this I mean DOING SOMETHING THAT REMOVES OR DIVERTS YOUR ATTENTION AWAY FROM THE ‘VOICES’. That is the act of distraction just pushes the voices more into the background: they seem to become less loud or frequent because you are thinking of something else. Distraction activities don’t require a huge effort of concentration on something else. The impact of the voices becomes reduced because your mind is being gently occupied by other things or activities.

Common activities might include, going out for a walk, playing games like board games and video or computer games. Doing routine domestic chores at home, washing, ironing, cleaning or gardening etc.

There is also watching TV, listening to radio, a walkman or hi-fi (such methods not suitable for all voice hearers).

There are the distractions that require you to move out of your place if only temporarily. Going out for a walk, doing some shopping, travelling around on public transport as a form of diversion than without serious intent to travel to any particular place, going out for a drive or even visiting a transport hub like an airport or busy railway or station.

It might be a good exercise to create your own list of things that you particularly like to do as a reminder that you refer too when you having a particularly hard time with the voices.

N.B. Listening to music or watching TV does not generally require much effort to concentrate unless you already suffer a severe impairment to concentration by some other disability, such as medication, tinnitus, impaired eyesight etc.

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(3) **CONCENTRATION**

This means undertaking specific actions or tasks that REQUIRING YOU TO FOCUS on something specific or undertaking an activity that really requires a lot of thinking.

This could be reading, studying, writing a journal or diary, or undertaking creative writing such as for a story, play, some prose or a poem or maybe doing proof reading on someone else’s work. It might be doing art work or sculpting or something related.

N.B. Please note that studying is not recommended for those people who might for example get badly stressed by this activity due to past negative experiences. It’s a fact that some students can be tripped into an episode of mental distress or even illness just from the pressures of studying. The pressure of study may just act as the trigger for illness which may have had other contributory factors in that person’s background!

It could include putting together air-fix models, jigsaw puzzles, undertaking DIY (do-it-yourself activities) or repairing things at home or maybe at someone else’s place.

Play chess, shooting pool, going to a bowling alley, playing racket sports.

Or it could be playing a musical instrument e.g. guitar, drum, violin or keyboard instrument synthesiser: it could be things like singing specific tunes or songs, even attending a choir etc.

It might include certain types of physical exercises, like working out at the Gym, Yoga, or swimming.

Another form of concentration activity is what is termed SUBVOCALISATION. Essentially this means doing specific tasks in your head that you might otherwise use your mouth for. Examples of this method would be ‘counting’ (in your head up to 100 rather than aloud), or reciting a poem in your head or the words of a song that you like. You can use a special COPING METHODS CHART to record the DIFFERENT TYPES OF COPING THAT YOU USE. Using such chart helps you experiment or try out with the different coping methods so that the results of your success can be remembered more easily. You can then use the various charts to make a short list of the coping methods that work best for you.

N.B. MEDITATION as a technique for concentration is not generally recommended as both self reports of voice hearers and researchers suggest that such methods can appear to INCREASE the problems with ‘voices’ and or that of accompanying mental health symptoms.

Both distraction and concentration activities can include sports activities, some are gently recreational (water chutes), cycling, swimming for enjoyment as opposed to using more purposeful exercise; others require a real effort of concentration e.g. racket sports or table tennis. Some activities fall under both headings and physical activities could also be classified under the heading behavioural…

You may have worked out better headings to classify your activities or read other articles that put things in a better way for you.

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(4) ** SOCIAL ACTIVITIES**

This means undertaking activities that involve others either to distract or divert you from your voices.

You might take time to speak with a partner, a close friend, or even a sympathetic worker, if you for example live in some kind of formal residential setting.

Telephoning a friend/s

Visiting (fairly supportive) friends or relations who are fairly supportive to you even they may not necessarily understand your experience.

Attending groups, such as peer support groups such as one for voice hearers, or joining a hobby/activity groups.