Acting on voices : omnipotence, sources of threat, and safety-seeking behaviours

Objectives: Previous research indicates that beliefs about voice power and omnipotence are associated with distress, depression, and compliance. The present study investigates whether acting on voices to mitigate perceived threat, in a broader sense than compliance, is driven by delusional beliefs, as the Chadwick, Birchwood, and Trower cognitive-behavioural model of voices would suggest. The role of safety behaviours in maintaining beliefs about voice omnipotence and distress is also examined. Design: A cross-sectional investigation of 30 individuals with current experience of auditory verbal hallucinations was conducted. Method: Participants were assessed on self-report measures of voice topography, voice-related threat and distress, safety behaviour use, beliefs about voices, and depression and anxiety. Results: Three sources of threat were identified: physical harm, shame, and loss of control. Twenty-six individuals had recently used safety behaviours, believing them to be effective in threat reduction. The degree of safety behaviour use and voice-related distress were associated with voice omnipotence beliefs; mood or voice characteristics did not account for this relationship. The association of safety behaviours with increased distress was mediated by beliefs about voice omnipotence. Conclusions: Acting on voices can be conceptualized as a form of safety seeking, associated with maintaining beliefs about voice omnipotence and distress