Compliance with command hallucinations: The role of the power of the voice, social rank and moral disengagement

Volume 1 of this thesis consists of three parts. Part 1 discusses and reviews the literature, since 1998, on psychological interventions for auditory hallucinations. Five therapeutic interventions are reviewed. These are: cognitive behavioural therapy, group therapy, mindfulness based interventions, acceptance and commitment therapy and hallucination focussed integrated treatment. Theories and models informing these interventions are outlined followed by a summary of the intervention. The literature on the efficacy of the intervention is then discussed. The methodological strengths and weaknesses of the studies are considered. Part 2 of this thesis consists of the empirical paper. The study investigated compliance to harm-other command hallucinations. The study was informed by cognitive models of hallucinations, social rank theory and theories of moral disengagement. These are given consideration in the introduction. Four mediating variables were examined: the perceived power of the commanding voice, participants' perceived social rank in relation to the commanding voice, their perceived social rank in relation to others and moral disengagement. Thirty-two male participants who had experienced harm-other command hallucinations were recruited from forensic services. Semi-structured interviews and questionnaires were administered with participants. The findings of the study are outlined and discussed. The clinical implications and methodological weakness of the study are also considered. Part 3 of this thesis is a critical reflection. Aspects of the research process are reflected upon. This paper includes sections on how ideas for the study were generated, challenges in designing the methodology, participant recruitment difficulties and how these were overcome. Reflections on the difficulties recruiting participants who have experienced command hallucinations are also discussed and the methodological weaknesses of the empirical study are expanded upon