Cognitive Theory and Therapy for Command Hallucinations

Individuals who experience voices respond in a variety of ways, both emotionally and behaviourally; some individuals are greatly distressed and frightened by their experience, whereas others develop a meaningful relationship with their voices and value contact with them. The traditional approach to cognitive behavioural therapy (CBT) in the treatment of psychosis focuses on the eradication or amelioration of the symptoms. However, the cognitive model of voices emphasises the importance of cognitive appraisals and the idiosyncratic relationship that a voice hearer develops with their voices in influencing affect and behaviour. This review describes the development and refinements of the cognitive model of voices, with particular emphasis on command hallucinations; the model distinctively focuses on distress and dysfunctional behaviour rather than symptoms per se. The need to identify and modify the appraisals that lead to these consequences is highlighted.