Hearing Voices (Auditory Hallucinations) in Schizophrenia

Auditory hallucinations, or hearing voices, are more common than once thought, especially among those living with schizophrenia and other mental illnesses such as bipolar disorder, borderline personality disorder, major depressive disorder, post-traumatic stress disorder, and schizoaffective disorder. Even among the general population, up to 10% have experienced hearing their names called, especially while falling asleep (hypnagogic) or waking up (hypnopompic).

This article discusses the various types of auditory hallucinations experienced in schizophrenia, common treatments, ways to help, and effective coping tactics.

Types of Auditory Hallucinations in Schizophrenia

For some, auditory hallucinations appear suddenly. Tanya Luhrmann, PhD, a professor of anthropology at Stanford and author of "Living With Voices," described the experience of a young man who started hearing rats scratching behind his ears. His auditory hallucinations began rapidly, and soon after, he destroyed a number of rats' nests.

In another example, a young man suddenly started to hear a voice coming from outside his apartment that sounded like a woman screaming that she was raped and begging for help. Many times, the voices can start gradually and are described as vague or fleeting impressions of hearing your name called or people talking about you.

Auditory hallucinations might be:

• Repetitive, screeching sounds suggestive of rats
• Painfully loud, thumping music
• Voices of people whispering or yelling mean orders or comments
• People talking about you as if you were not present

Nonsensical Voices

Eleanor Longden, a research psychologist with a diagnosis of schizophrenia, explains that these voices can order you to do completely nonsensical things, such as taking a glass of water and pouring it over your head.

Self-Harm Voices

Therapists must approach cases that involve voices that give orders to harm oneself or others with great caution. This type of auditory hallucination can be extremely frightening, with orders that tend to be screamed non-stop.

Threatening Voices

Some people hear persuasive, repetitive voices by a secret organization, for example, that threaten death or harm. Again, these voices are frightening and increase a person's risk of self-harm or violence.

Treatment for Auditory Hallucinations in Schizophrenia

Treatment for auditory hallucinations in treatment-resistant schizophrenia typically requires a combination of medications, therapy, and other elements.

• Medication: Antipsychotic medications are often the first line of treatment for schizophrenia and have been proven to rapidly decrease the severity of auditory hallucinations.
• Cognitive behavioral therapy (CBT): When used in combination with medication, CBT can help reduce the emotional distress of hearing voices and help people develop skills to cope with and quiet the voices. For example, humming the "Happy Birthday" song or reading a paragraph backward when the voices begin.
• Repetitive transcranial magnetic stimulation (rTMS): Also known as repetitive TMS, this relatively non-invasive procedure involves placing a small magnetic device directly on the skull. It has been shown to reduce the frequency and severity of auditory hallucinations in people with schizophrenia.
• Electroconvulsive therapy (ECT): Considered a last-resort treatment for reducing the severity of auditory hallucinations, ECT involves the application of a brief electrical pulse to the scalp to produce a seizure.

Helping a Loved One With Schizophrenia

Interacting with and helping someone with schizophrenia who hears voices can take a toll, but try not to lose hope. With the right treatment, your loved one may be able to control the frequency and severity of these voices.

Consider family therapy, which can help you and your loved one recognize these auditory hallucinations and develop strategies to cope.

Here are a few other ways to help.

• Educate yourself about their condition. Learn as much as you can about schizophrenia to understand how it affects your loved one. This can help you recognize when symptoms are worsening and know more about what you can do to help.
• Help them stick to their treatment. If you are in a caregiving role, it is important to work with your loved one's treatment team to make sure that they are getting the help they need. You can encourage them to take their medication and help them get to and from therapy and doctor's appointments.
• Write down the details. Keep a journal of upcoming appointments and information provided by your loved one's healthcare team. Make notes about signs including frequency, type, and severity. Jot down major life changes or sources of stress your loved one might be experiencing.
• Manage your stress. Caring for yourself is also important. Practice good self-care and find ways to cope with stress. Relaxation strategies such as mindfulness, yoga, and deep breathing can be helpful.

You might also find it helpful to join a support group where you can talk to other people with similar experiences. The National Alliance on Mental Illness (NAMI) and The Schizophrenia and Psychosis Action Alliance list options.

How to Cope With Auditory Hallucinations

Although auditory hallucinations often respond to treatment with antipsychotic medications, a person might continue to hear voices despite treatment.

Coping mechanisms that people often try include attempting to drown out the hallucinations by listening to loud music, shouting back at the voices, or focusing on the voices. Research suggests these tactics are ineffective and often backfire.

According to an article published in BJPsych Advances, effective distraction techniques that can help people cope with hearing voices include:

• Periodically listening to lyrical, harmonic, slow-paced music at a low volume
• Playing an instrument
• Spending time with an animal
• Watching non-distressing TV shows and paying attention to the voices of the performers
• Making art, which can help induce a flow state
• Reading either quietly or aloud (or switching between the two)

Breathing exercises may also be helpful, but they should be carefully modeled and practiced with a therapist before you try them on your own.

A Word From Verywell

Auditory hallucinations can be distressing, but antipsychotic medications can often help reduce their frequency and severity. In addition to getting appropriate treatment, there are also distraction tactics that can help such as reading, watching tv, and making art.