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Self-Care Reflections from Past Experience of Hearing Voices

You are not alone.

By Nikki Clark


Source: Pickett, H. 2023. Lifespan Psychology -The Diverse Practice®


This article was written by Nikki Clark while on placement with Lifespan Psychology - The Diverse Practice®. Nikki explores research that was part of Dr Esther Cole's doctoral thesis.

The article is also published on Psychology Today


Key points

  • Research has linked childhood trauma, and specifically insecure attachment, to hearing distressing voices.

  • The article reflects on self-care for living with distressing voices, from a position of lived experience.

  • Negative beliefs about ourselves and others are linked to more negative and distressing beliefs about voices.

  • Insecure attachments in relationships are more likely to be linked to greater distress from hearing voices.


Hearing voices can be a terrifying experience, that is a fact. To be wondering ‘what's wrong with me?’, ‘Am I going crazy?’ and ‘Is this stronger than me?’ are all hard-hitting questions that people ask themselves every day when they cope with auditory verbal hallucinations. As someone who has dealt with voices myself, these are questions I asked myself relentlessly and I felt unheard and dismissed by many. Dr Esther Coles's thesis (Cole at al., 2017) on where these hallucinations could primarily stem from, was an incredibly refreshing read on something I knew and experienced personally. Finally, I felt understood.

Reading this paper in a simplified form can help many others understand, or even come to terms with, the possible causes and dynamics of auditory verbal hallucinations. Because of this, I firmly believe that this paper can help many people and their peers comprehend what's going on and how to move forward.

The title of the paper was 'Echoes of others: A path analytic examination of an interpersonal-cognitive model of voice-related distress'. It was an easy read, easy to understand, and easy to apply to our own experiences. More accessible papers such as this one are a great way for regular people to discover themselves and begin the journey to self-love and self-care. Feeling heard, understood and guided in the right direction is a comforting feeling that everyone deserves.

Those suffering from voices will be subjected to stigma in numerous ways from social isolation, potential misdiagnosis, and the decline of the individual's mental health and overall quality of life. It is an unfortunate reality, but a reality that I have lived myself and I know others do too.

Voices are a constructed image of how we see ourselves and they are our own thoughts and feelings based on our experiences, traumas, and related disorders. Dr Cole et al.’s paper solidified the fact that it is not exclusive to more mind altering disorders such as Dissociative Identity Disorder and Schizophrenia. Depression and anxiety can have a powerful influence on how we see ourselves and the world around us, voices that stem from this negative view of oneself can spiral without appropriate intervention and treatment (Rammou et al, 2022; Kusztrits et al, 2022).

The World Health Organisation has shown depression and anxiety diagnoses are on the rise. In the context of the war in Ukraine and Middle East, as well as other political, economic and social strains since the COVID pandemic, the mental health of society continues to deteriorate. People also have a better understanding of anxiety and depression and a higher comprehension of warning signs and symptoms.

What exactly did this paper do?

This thesis set out to prove there was a pathway connecting insecure attachment styles and interpersonal factors to distressing auditory verbal hallucinations (see figure 1). There were 180 participants with a range of diagnoses and symptoms. The results showed that those with an insecure attachment style, which stems from childhood, and negative core beliefs, commonly associated with mental ill health, were more likely to have negative beliefs about the power and malevolence of voices, which caused greater distress from hearing voices.

Figure 1. The pathway from insecure attachment to voice-hearer distress

Source: Cole, E. & Magada, N. (2024). Lifespan Psychology - The Diverse Practice®

As such, voice-hearers are found to benefit from a more compassion-based approach in order to challenge these negative beliefs, and lessen the distress levels that come after hearing voices. This is because when someone hears negative things about themselves continuously from others or themselves, it reinforces it to the point of potentially becoming a voice. Lessening its power through self-love and a healthy support system is key! You hold the power, not the voices. Take a look at a recent illustration which was commissioned to make this paper more accessible (figure 2).

Figure 2. Source: Pickett, H. 2023. Lifespan Psychology -The Diverse Practice®

What can be done? What can I do?

The biggest note to take away from this paper is the power of compassion not just to others but to ourselves. Some say “The hardest battle is not with a sword but within the mind.” Those battling themselves every day will see the dire effect on their mental and physical health. Being surrounded with positive affirmations about oneself is a great start; a trustworthy support system have shown a consistent, positive correlation to bettering one's self-esteem, social development, and body image (Rosen et al, 2018).

Being self-loving and putting yourself first can be a difficult thing to do for many people, especially if they do not feel worthy of love, care, and support. That being said, everyone should know how much they are loved, practice positive self-talk, and be kind to themselves. Start with something small like writing down just one thing you like or enjoy about yourself; the colour of your eyes, the shirt you’re wearing, a grade you got on a recent essay or an achievement in your workplace. A thousand-mile journey starts with that single step.


We are our biggest supporters and our worst critics. Learning to love ourselves, in spite of external factors or our own self-view, is a battle against the mind, we are - and always will be - the strongest soldier.


Cole, Esther & Strauss, Clara & Fife-Schaw, Chris & McCarthy-Jones, Simon. (2017). Echoes of others: A path analytic examination of an interpersonal-cognitive model of voice-related distress. Psychology and psychotherapy. 90. 10.1111/papt.12129.

Kusztrits, Isabella & Toh, Wei Lin & Thomas, Neil & Larøi, Frank & Meyers, Denny & Hirnstein, Marco & Rossell, Susan. (2022). From core schemas about the self and others to voice phenomenology: Anxiety and depression affect voice hearers differently. Psychology and Psychotherapy: Theory, Research and Practice. 95. 10.1111/papt.12384.

Rosen, Cherise & McCarthy-Jones, Simon & Jones, Nev & Chase, Kayla & Sharma, Rajiv. (2018). Negative voice-content as a full mediator of a relation between childhood adversity and distress ensuing from hearing voices. Schizophrenia Research. 199.10.1016/j.schres.2018.03.030.

Rammou, Aikaterini & Berry, Clio & Fowler, David & Hayward, Mark. (2022). Distress factors of voice‐hearing in young people and social relating: Exploring a cognitive‐interpersonal voice‐hearing model. Psychology and Psychotherapy: Theory, Research and Practice. 95.10.1111/papt.12411.

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