Talking With Voices: Unique Therapy for Auditory Hallucinations Found Beneficial

Patients with serious mental illness who hear distressing voices experienced significant improvement across several outcomes with a unique psychotherapy compared to those who received only usual care, according to a report in Lancet Psychiatry.

 

Championed by people with lived experience, Talking With Voices (TwV) involves a therapist engaging in dialogue with a patient’s voices to reconcile the patient-voice relationship rather than suppress it.

 

Auditory hallucinations are a debilitating feature affecting 80% of individuals with schizophrenia spectrum disorders, bipolar disorders, and personality disorders; they can cause substantial functional impairment and increase the risk of suicidality and hospitalization. Yet existing treatments show only modest effectiveness in reducing distress and supporting recovery.

 

This trial randomized 309 adults (average age 41) to eight months of either TwV plus usual care or usual care alone. TwV participants were allowed up to 26 individual 60-minute therapy sessions, plus up to four optional booster sessions to consolidate therapeutic progress.

 

• At eight months, individuals in the TwV group scored an average of 6.97 points higher on the Questionnaire About the Process of Recovery (QPR), a self-reported measure of personal recovery in psychosis, than those in the usual care group.
• Those receiving TwV also had significantly higher scores on 12 of 15 of secondary outcomes including severity of the hallucinations, negative self-beliefs, and posttraumatic stress disorder symptoms.
• At 14 months, the TwV group was still scoring an average of 3.5 points higher on the QPR than those in the usual care group.

The fact that there was no active comparison therapy—such as cognitive behavioral therapy—and that participants were not blinded to the intervention they received may have skewed results. Additionally, there was no measurement of therapist adherence to the therapy; variation in therapist skills and adherence might have contributed to the observed effects.

 

“[O]ur findings expand the range of evidence-based options available to people experiencing distressing voices, offering therapeutic pathways oriented towards outcomes that have received comparatively little attention in the literature, such as improved relationships between people who hear voices and their voices,” the researchers wrote. Further research should compare TwV’s effectiveness to existing options and examine how to implement this different approach within routine care settings.

 

“Listening With the Intent to Understand Psychotic Symptoms”

 

Eleanor Longdon, et. al. Dialogical therapy plus treatment as usual versus treatment as usual in adults with distressing and persistent auditory hallucinations in the UK (Talking with Voices-II): a randomized controlled trial. Lancet Psychiatry. Published November 10, 2026. doi: 10.1016/S2215-0366(26)00345-7