Abstract
The Psychological Flexibility Model describes a process-oriented approach to behaviour change that underpins Acceptance and Commitment Therapy (ACT), a contextual cognitive behavioural intervention. ACT promotes psychological flexibility, which refers to a person’s ability to connect with the present moment fully as a conscious human being (mindfulness and non-judgemental acceptance), and to change or persist with behaviour that is in line with identified values. For people distressed and/or disabled by auditory hallucinations, it is theorised that this experience is responded to in a psychologically inflexible manner: becoming a target for avoidance, control or focus, appraised as more powerful than the person experiencing the voices, and leading to actions that come at the cost of engaging in chosen life directions. Previous research on coping, cognitive models and mindfulness interventions for voice hearing point to the possibility that promoting active acceptance and changing the relationship with voices may be associated with better outcomes. This thesis investigates the role of psychological flexibility with voice hearing using correlational, single-case and experimental research designs.The first study in this thesis investigated the relationship of psychological flexibility and mindfulness with distress, disability, and behavioural responses to voice hearing, using self-report questionnaires in a sample of 50 distressed voice hearers. The findings suggest that psychological flexibility and non-judgemental acceptance, over and above appraisals of voices and thought control strategies, is related to voice hearers’ levels of general depressive and anxiety symptoms, and behavioural resistance to voices, but not to engagement with voices, voice-related distress or life disruption. The second study reports the findings of a 10-session ACT intervention for eight distressed voice hearers using multi-baseline single case design, assessing whether outcome changes following ACT are concomitant with increasing psychological flexibility. Following ACT there were group-level improvements in depressive symptoms, quality of life and social functioning, with changes in psychological flexibility (non-judgemental acceptance, independent action from voices). The third study involved 110 non-clinical participants experiencing simulated auditory hallucinations in an experimental analogue, and investigated differences in response following training in a regulation strategy (acceptance, reappraisal or suppression). This study did not show any significant differences between groups; the potential explanations for this lack of expected difference include the features of simulated voices, sample characteristics, and participants’ degree of adherence to the coping strategy. The findings of these studies are considered within the broader context of emotional wellbeing with voice hearing, functional approaches to understanding responding to voices, and potential implications for clinical and research directions.
| Date of Award | 1 Apr 2013 |
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| Original language | English |
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| Supervisor | Emmanuelle Peters (Supervisor) & Philippa Garety (Supervisor) |