Acceptance and Commitment Therapy (Act) For People Who Are Distressed by Hearing Voices: a Case Series.

Metacognitive beliefs are ‘thoughts about thoughts’ and they have been implicated in the development and maintenance of a range of emotional disorders. Applying Wells & Matthews (1994, 1996) Self-Regulatory Executive Function (S-REF) to psychotic experiences Morrison et al. (1995) and Morrison (2001) propose that metacognitive beliefs may create cognitive dissonance and arousal with the occurrence of intrusive thoughts, leading to the thought being externalised resulting in psychotic symptoms. Current evidence supports their proposal, finding that negative beliefs, in particular thoughts about responsibility, punishment, and superstition are consistently found to be related to psychotic experiences. There is also some evidence that positive beliefs are related. However, it may be that Morrison and colleagues’ model is more parsimonious for some psychotic symptoms, such as symptoms of thought interference, than others. As the research is cross-sectional we are unable at this stage to make causal statements and so we cannot confirm the S-REF model. Nevertheless, the fact that maladaptive metacognitive beliefs are present suggests that this is an important area to target in treatment and relevant therapeutic models are discussed