Article

Do peer-support groups for voice-hearers work? A small scale study of Hearing Voices Network support groups in Australia

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Abstract

Hearing Voices Network (HVN) support groups have proliferated in the last decade, with anecdotal evidence suggesting they contribute significantly to the recovery trajectory of the voice-hearer members who attend them. However, to date there remains little empirical research into the efficacy of these groups and the processes that might underpin their efficacy. This article describes a small project evaluating the HVN groups in the large Australian state of New South Wales. Twenty-nine group members completed questionnaires exploring self-reported recovery-related and clinical outcomes, aspects of group process, and the extent to which core HVN principles were promoted within the group. Results indicate that HVN groups are associated with reported improvements across a number of recovery-related outcomes including feeling less isolated and more skilled in being with others, having improved self-esteem, and having a better understanding of their voice experiences. Positive changes were also noted in outcomes that are more traditionally associated with clinical improvements, such as decreased need for emergency help and medication, and increased hope in personal recovery. Although this study is small and based on self-report, the findings are promising and contribute to the small but growing literature on peer-supported interventions for psychosis and psychotic-like experiences.

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... Previous literature suggests numerous distinct features and benefits of attending HVGs. Being able to share openly with peers without fear of consequences enables participants to form social connections, learn new ways of understanding and coping with voices, and feel less distressed by their experiences (Beavan et al., 2017;Dos Santos & Beavan, 2015;Longden et al., 2018;Oakland & Berry, 2015;Payne et al., 2017). As a result, participants report feeling more empowered and selfconfident (Longden et al., 2018;Oakland & Berry, 2015) and require fewer hospital admissions and crisis interventions (Beavan et al., 2017). ...
... Being able to share openly with peers without fear of consequences enables participants to form social connections, learn new ways of understanding and coping with voices, and feel less distressed by their experiences (Beavan et al., 2017;Dos Santos & Beavan, 2015;Longden et al., 2018;Oakland & Berry, 2015;Payne et al., 2017). As a result, participants report feeling more empowered and selfconfident (Longden et al., 2018;Oakland & Berry, 2015) and require fewer hospital admissions and crisis interventions (Beavan et al., 2017). Other interventions derived from the Hearing Voices approachlike Maastricht Interviewing and creating a Voice Constructhave also been associated with reduced voice-related distress and an ability to connect voices to previous life events (Schnackenberg et al., 2018). ...
... Our results support and expand upon the findings of previous researchers, who have highlighted connection with other voice hearers, exploring the meaning of voices and developing new ways of responding to them, as well as being able to share experiences without fear of judgment as crucial elements of HVGs (Beavan et al., 2017;Dos Santos & Beavan, 2015;Longden et al., 2018;Oakland & Berry, 2015;Payne et al., 2017). Our results also reveal additional key elements (e.g. ...
Article
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Despite decades of research and the development of many psychiatric medications, widespread suffering remains among people who hear voices. Hearing voices groups (HVGs) encourage an in-depth exploration of the meaning of voices and use peer support to develop coping strategies. Although HVGs continue to spread around the world, their effectiveness remains unknown and only a few studies have examined members’ experiences. To understand the mechanisms by which these groups operate, we recruited a diverse sample of 113 participants from across the US, who completed detailed qualitative questionnaires describing their voice-hearing histories, experiences in HVGs and changes in their lives outside the group. Asubset also participated in follow-up interviews. A collaborative team of researchers and voice hearers used phenomenological, grounded theory and thematic analyses to identify a distinctive set of elements that make HVGs unique: in their style of interaction (non-judgmental, curious, reciprocal and unstructured dialogue among people regarded as equals, in a shared community); and in the content of meetings (welcoming multiple perspectives and exploring coping strategies in non-prescriptive ways, with a focus on expertise by experience). We propose a three-phase model to explain how these elements interact within HVGs to enable significant transformation to occur.
... Seven publications evaluating peer-led or peer-supported interventions that did not fit into any of the other six intervention categories were identified [95][96][97][98][99][100][101] . Five studies were quantitative 97-101 , four of which were randomized trials 97-100 , one was qualitative 95 , and two used mixed methods 96,100 . ...
... Seven publications evaluating peer-led or peer-supported interventions that did not fit into any of the other six intervention categories were identified [95][96][97][98][99][100][101] . Five studies were quantitative 97-101 , four of which were randomized trials 97-100 , one was qualitative 95 , and two used mixed methods 96,100 . Four were conducted in the US 97,99-101 , and one each in Australia 96 , Chile 95 and Germany 98 . ...
... The addition of peer workers in the delivery of some of the other social interventions included in our review was also commonly noted, including as staff of recovery colleges 46-50 and co-facilitators of family interventions [90][91][92][93] , providing knowledge and experience distinct from that of health professionals. Peer involvement was noted to be particularly helpful for people in building confidence and social connections 47,50 , gaining a better understanding of their mental health issues 96 , and improving engagement with mental health services 95 . ...
Article
People living with severe mental illness (SMI) are one of the most marginalized groups in society. Interventions which aim to improve their social and economic participation are of crucial importance to clinicians, policy-makers and people with SMI themselves. We conducted a systematic review of the literature on social interventions for people with SMI published since 2016 and collated our findings through narrative synthesis. We found an encouragingly large amount of research in this field, and 72 papers met our inclusion criteria. Over half reported on the effectiveness of interventions delivered at the service level (supported accommodation, education or employment), while the remainder targeted individuals directly (community participation, family interventions, peer-led/supported interventions, social skills training). We identified good evidence for the Housing First model of supported accommodation, for the Individual Placement and Support model of supported employment, and for family psychoeducation, with the caveat that a range of models are nonetheless required to meet the varied housing, employment and family-related needs of individuals. Our findings also highlighted the importance of contextual factors and the need to make local adaptations when “importing” interventions from elsewhere. We found that augmentation strategies to enhance the effectiveness of social interventions (particularly supported employment and social skills training) by addressing cognitive impairments did not lead to transferable “real life” skills despite improvements in cognitive function. We also identified an emerging evidence base for peer-led/supported interventions, recovery colleges and other interventions to support community participation. We concluded that social interventions have considerable benefits but are arguably the most complex in the mental health field, and require multi-level stakeholder commitment and investment for successful implementation.
... The groups appear to improve attendees' functioning rather than reducing the frequency or intensity of voice hearing itself. The existing evidence base suggests improvements in coping skills (Beavan et al., 2017;Newton et al., 2007;Ruddle, 2017) understanding (Jones et al., 2016); hope (Nkouth et al., 2010); social support (Goodliffe et al., 2010;Longden et al., 2018) and self-efficacy (Beavan et al., 2017). These findings suggest similar functional benefits to the wider evidence-base for peer support for those who experience severe mental health problems (Davidson et al., 2012). ...
... The groups appear to improve attendees' functioning rather than reducing the frequency or intensity of voice hearing itself. The existing evidence base suggests improvements in coping skills (Beavan et al., 2017;Newton et al., 2007;Ruddle, 2017) understanding (Jones et al., 2016); hope (Nkouth et al., 2010); social support (Goodliffe et al., 2010;Longden et al., 2018) and self-efficacy (Beavan et al., 2017). These findings suggest similar functional benefits to the wider evidence-base for peer support for those who experience severe mental health problems (Davidson et al., 2012). ...
Article
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Background: An initiative was proposed to integrate local Hearing Voices Groups within statutory adult mental health services in a particular NHS Trust. The aim of this service evaluation was to assess clinician’s attitudes towards, and understandings, of the groups to better inform the proposal.Methods: Multi-disciplinary NHS staff members were invited to participate in a brief survey on their attitudes towards and understanding about Hearing Voices Groups. The survey was co-produced with people with lived experience of hearing voices, and local mental health professionals. Content analysis was used to analyse qualitative data from an additional free text section of the survey.Results: Forty mental health professionals responded to the survey. There was majority agreement (>50% agreement) on all items related to perceived benefit of Hearing Voices Groups. The findings also showed that only 25% of respondents felt that they were aware of the evidence base for Hearing Voices Groups and only 30% felt confident explaining Hearing Voices Groups to service users.Conclusions: The data suggest that the majority of mental health professionals hold positive attitudes towards Hearing Voices Groups. However, many expressed uncertainty about the evidence base and discussing the groups with service users, highlighting further training needs in these areas.
... Although HVGs emphasize "recovery" as personally defined, several recent studies have used standard clinical measures to investigate the effects of these groups. Beavan et al. (2017) assessed the impact of HVGs on various social and clinical recovery outcomes. A majority of their participants in Australia reported fewer admissions to psychiatric hospitals and more hope for the future. ...
... Like other researchers, we found that participants report substantial changes in their lives beyond the group context. For example, Beavan et al. (2017) found that participation in the HVG allowed many members to feel less afraid of their voices and more hopeful, as well as to have fewer hospital admissions. In their larger study, Longden et al. (2017) report that attending the HVG had a significant impact on a number of social and clinical outcomes beyond the group context. ...
Article
Hearing voices peer-support groups (HVGs) enable people coping with voices, visions, or other unshared perceptual experiences to explore the particularities and potential meanings of their experiences while receiving support from others facing similar challenges. HVGs have now spread to 30 countries on five continents, and many members report profound life changes as a result of participating. Yet systematic research exploring how and why these groups work is still in its early stages. To understand the diverse functions that HVGs can serve, we analyzed the experiences of 111 group members across the US, who provided detailed accounts of their voice-hearing histories and group participation. Using phenomenological and thematic analyses, our collaborative team of voice hearers and researchers identified key elements that make HVGs distinctive, including their prioritizing of self-determination; de-emphasizing behavioral targets or pressure to change; respecting and welcoming multiple frameworks of understanding; cultivating curiosity about perplexing experience in any form; and fostering egalitarian collaboration and genuine relationships among members seen as “experts by experience.” We illustrate the dynamic relations among these elements through case examples, and then outline comparisons between HVGs and other types of groups, as well as directions for future research.
... An Australian study by Beavan et al. (2017) showed Hearing Voices groups are associated with self-reports of feeling less isolated, interacting with others in a skilled manner, having improved self-esteem, and achieving a better understanding of voice experiences. Steel et al. (2019) demonstrated that HVM would be a viable service delivery option within the UK National Health System. ...
... Art therapists can learn more about the ways that HVM has shown that voices are often related to problems and traumas in the life history of the voice hearer (Longden, 2013). To recover from the distress, the person who hears voices needs to learn to cope with their voices and the original problems that lay at the roots of their voice-hearing (Beavan et al., 2017;Romme et al., 2009). ...
Article
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The international Hearing Voices Movement (HVM) offers a service-user generated approach to those who hear voices that encourages them to pay attention to their voices and their significance. Art therapists have been working with people with psychosis-related diagnoses for decades but there is little written on integrating the HVM framework. Attention to three main phases of adjusting to life with voices—startling phase, organizational phase; and stabilization phase—offers opportunities for art therapists to refresh their collaborative approach potentially using simple mindfulness techniques, studio environments, dialoging with images, and advocacy.
... Attendees see HV groups as a place to normalize and reframe their understanding and form a more neutral or positive relationship to their unusual experiences (Hornstein et al., 2020). HV groups have been shown to improve social connectedness and self-acceptance (Meddings et al., 2006;Oakland & Berry, 2015;Dos Santos & Beavan, 2015;Beavan et al., 2017). Findings from a recent observational survey of 113 HV group participants in the U.S. reported, "helpful changes in their voices, their relationships, and/or how they understood their voices as a result of attending the group (Hornstein et al., 2020, p. 7)." ...
Article
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The Hearing Voices (HV) Movement promotes diverse understandings of voice-hearing and seeing visions, which mental health professionals commonly refer to as ‘auditory hallucinations,’ ‘schizophrenia,’ or ‘psychosis.’ Central to this movement are peer support groups through which attendees connect with others who have similar experiences. This paper describes an adaptation of a Hearing Voices group facilitation training at VA Greater Los Angeles (VAGLA) and discusses training modifications, along with trainee perceptions and implementation and intervention outcomes. This is a first step towards adapting HV-inspired groups to VA systems of care. Data collection involved surveys of trainees (n = 18) and field notes throughout the 24 h online training. Findings indicate high acceptability and appropriateness of the training and high feasibility in implementation, suggesting the training was well-adapted to VAGLA. This research contributes to global efforts to integrate the Hearing Voices approach in diverse settings and increase awareness about its benefits among providers.
... There is a small but growing evidence base for peer-led interventions. It is likely that with improved controlled studies such approaches will soon provide greater empirical evidence as-well-as an insight into the mechanisms underpinning change ( Beavan et al., 2017). Finally, the quality assessment of studies was conducted by the first author. ...
Conference Paper
Distressing auditory verbal hallucinations (AVH) can cause suffering and significant impairment. This thesis focuses on psychological interventions for AVH and is presented in three parts. Part I is a qualitative and quantitative review on the effects group therapy has on AVH. Twenty studies met inclusion criteria. The findings taken as a whole are mixed. There is not strong evidence to suggest that group therapy is effective in reducing AVH symptoms but there are more promising findings for group approaches in targeting AVH beliefs and distress. Part II aimed to map relating behaviours observed between participants and their created avatars (visual representation of their persecutory voice) in the context of AVATAR therapy dialogue. A coding frame was developed to enable a fine-grained analysis of the therapy. The findings do indicate that relating behaviours between participants and avatars change over the course of therapy. The results also provide an insight into the specific therapeutic techniques delivered within AVATAR therapy dialogue. Part III is a critical appraisal of the methodological developments presented in the empirical paper. It explores the rationale behind analysing complex psychological interventions and offers an account of the methodological, conceptual and practical issues faced when developing a coding frame.
... However, despite the global dissemination of the approach and the substantial personal testimony attesting to its value (Romme et al., 2009;Woods, 2013;Corstens et al., 2014), little research has been conducted to evaluate the effectiveness of hearing voices groups themselves. Available literature is primarily qualitative, and demonstrates that voice hearers find the groups to be an accepting and supportive environment that foster a sense of agency in recovery from mental health difficulties, wherein connecting with other voice hearers and sharing one's experiences can additionally facilitate different aspects of social recovery (dos Santos and Beavan, 2015;Oakland and Berry, 2015;Beavan et al., 2017;Payne et al., 2017). ...
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Purpose – The distress that is associated with auditory hallucinations, or voices, is well documented. However, increasingly research into this phenomenon is also capturing those who cope with their voices, and live meaningful lives. Peer support is a popular and useful way in which to learn to manage the distress for voice-hearers. The Hearing Voices Network (HVN) acts as an umbrella organisation for which research, training and peer support groups exist (www.intervoiceonline.org). Despite the growing amount of peer support groups established, there is to date no published material on these groups. The purpose of this paper is to discuss these issue. Design/methodology/approach – The present study used Interpretive Phenomenological Analysis to explore the experiences of four informants across three New South Wales HVN groups. Findings – Results suggest that the social connections, value of sharing and desire for more group members are all important within the group. Beyond the group, informants described the increased willingness to talk to others about their voice experiences, improvements in sense of self and a positive change in their relationship with their voices. Originality/value – The study demonstrates the importance of peer participation in the mental health workforce and the provision of safe spaces for those with lived experience to share and learn from each other in meaningful ways. Research implications include the need for further research measuring outcomes on a larger scale for these support groups.
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My recent communication and travels related to peer support efforts in The Netherlands, Brazil, and Israel provide a glimpse of the integration of peer support into existing mental health services in these three countries. Country by country, peer support is evolving in unique ways specific to each culture. Based on my communication with peers and colleagues, peer support is fairly well established in The Netherlands, but has not gained as strong a foothold in countries like Brazil and Israel, where governments and mental health authorities have yet to fully embrace the concepts and practice of peer support. Also volunteerism, so essential in the start-up of peer support and self-help groups in the United States in the early 1970s, does not yet exist in Brazil or Israel where there are not as well established nongovernmental (nonprofit) organizations. After speaking with informed advocates of peer support in these three countries, the question, for me, remains whether peer support will take root in countries other than English-speaking countries. Can these voluntary, grass roots, democratic associations have a viable future in countries like the Netherlands, Brazil, and Israel? The hope is that once mental health officials see the success of peer support programs and gain confidence in peer leaders, they will provide the funding and support necessary for peer support programs to grow and thrive. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
Article
Medical therapy is the cornerstone of schizophrenia, but >50% of patients do not adhere to medication regimens. In previous reports, the reasons for non-adherence were assessed only by medical staff. We think that patients have specific reasons for non-adherence. We researched whether there was an association between patients' subjective opinions and the number of antipsychotics used. A self-rating questionnaire survey was conducted on 252 outpatients with schizophrenia at five psychiatric hospitals in Japan. Based on patients' subjective opinions, we retrospectively analyzed the patients' medications: the number of antipsychotics, concurrently used agents, and dosages of antipsychotics. There was no significant difference regarding attitudes toward medication between monotherapy and polypharmacy. The most common reason for not taking medications was 'I sometimes forget' followed by 'side-effects'. Of the latter, weight gain was the most common, and dry mouth (P < 0.05) and sexual dysfunction (P < 0.01) were significantly higher in polypharmacy. The dosages of antipsychotics (P < 0.01), concurrent use of anti-Parkinsonian agents (P < 0.01), and the number of side-effects (P < 0.01) were also higher in polypharmacy. Patients had good attitudes toward medication but a higher prevalence of side-effects was seen in polypharmacy of antipsychotics. Hence, monotherapy may be a more appropriate prescription with respect to side-effects. By using monotherapy, patients may reduce feelings of discomfort due to side-effects.
Article
To estimate the associations among measures of hope, hopelessness, and suicidality, 206 undergraduates completed the Reasons for Living Inventory, the Hopelessness Scale, and the Hope Scale. As expected, significant correlations indicated that, as hope increased, hopelessness decreased. Those who scored as relatively more suicidal had relatively fewer feelings of total hope (Agency and Pathways) and more hopelessness. Further, scores on three Reasons for Living scales (Coping Beliefs, Family Responsibility, and Child Concerns) were significantly correlated in expected directions with hope and hopelessness scores. A stepwise multiple regression indicated that scores on Survival, Coping Beliefs and the Hope subscale Agency accounted for 37% of the total variance in suicidality. Apparently in unscreened college students, survival and coping beliefs and hope rather than hopelessness or other reasons for living are most related to suicidality. An implication is that facilitating college students' hopefulness may bolster their survival and coping beliefs and discourage development of suicidal thoughts or actions.
Article
After nearly 20 years of progress in general medicine, the evidence-based practice movement is becoming the central theme for mental health care reform in the first decade of 2000. Several leaders in the movement met to discuss concerns raised by six stakeholder groups: consumers, family members, practitioners, administrators, policy makers, and researchers. Recurrent themes relate to concerns regarding the limits of science, diversion of funding from valued practices, increased costs, feasibility, prior investments in other practices, and shifts in power and control. The authors recommend that all stakeholder groups be involved in further dialog and planning to ensure that practices emerge that represent the integration of the best research evidence with clinical expertise and consumer values.
Article
Cardiovascular disease remains the leading cause of mortality and premature death in western societies. Thus, rates of interventions such as coronary artery bypass surgery are continuing to grow. Health care reform and initiatives to reduce health care expenditures have resulted in early patient discharge from hospital following cardiac surgery. With subsequent cutbacks in nursing support and community-based care, patients are leaving hospital less prepared and supported to deal with the changes that occur during the first weeks of recovery. To examine the theoretical assumptions that support the contention that peer support is an under-utilized resource for patients who are recovering from cardiac surgery and the challenges to evaluating peer support interventions. A review of current literature, which focuses on cardiac surgery recovery, transitions, social support, and peer support interventions. Peer support (lay assistance from individuals who possess experiential knowledge and similar characteristics), a form of social support, is a viable and potentially sustainable mechanism to put in place during transitional life events such as recovery from cardiac surgery. Further investigation is needed of peer support interventions for cardiac surgery patients. Specifically, investigations of the influence of peer support interventions on recovery and health outcomes are necessary in this patient population. Yet, challenges exist to undertaking well-designed investigations of social interventions such as peer support.
Article
Research and clinical perspectives are blended in this commentary on the rapidly emerging requirement for evidence-based treatment (EBT) in substance abuse programs. Although, historically, it has not been a standard of care in behavioral health, there are sound scientific, ethical, and compassionate reasons to learn and deliver an EBT as it becomes available. This article explores a series of issues, including the following: (1) Why should EBTs be used in substance abuse treatment? (2) What kinds of treatment are EBTs, and how are they determined? (3) Where can EBTs be implemented--at what levels of service delivery? (4) When should EBTs be used? and (5) How do clinicians learn EBTs? Potential pitfalls in implementing EBTs are also considered.
Article
Objective: This study investigated the impact of GROW, an Australia-wide community mental health organisation, on psychological wellbeing and mental health. Design: Triangulation of quantitative and qualitative research methods was employed. The study included a cross-sectional and a longitudinal survey of GROW members together with ethnographic and phenomenological work. Research outcomes: The results pointed to length of membership/extent of involvement in GROW activities as being associated with improved wellbeing in the areas of autonomy, environmental mastery, personal growth, and self-acceptance/purpose in life, together with a reduction in medication and hospitalisation. In a longitudinal study surveying the wellbeing of 28 new GROW members with 6-month follow-up, there were statistically significant improvements on all wellbeing factors. A major theme emerging from ethnographic and phenomenological research was that GROW offers a "real life" mini-community where people learn social and life management skills. However, beyond skills acquisition, GROW offers the potential for identity transformation by assisting the realisation of core human needs - a sense of feeling useful, valuable and belonging.
Hearing Voices Network Australia evaluation. Unpublished report. WA: Hearing Voices Network Australia
  • R Bowyer
Bowyer, R. (2010). Hearing Voices Network Australia evaluation. Unpublished report. WA: Hearing Voices Network Australia.
Recovery: An alien concept?
  • R Coleman
Coleman, R. (2004). Recovery: An alien concept?. Fife: P&P Press.
Piloting a Hearing Voices group in a high secure psychiatric setting. Paper presented at World Hearing Voices Congress
  • J Slater
Slater, J. (2010 November). Piloting a Hearing Voices group in a high secure psychiatric setting. Paper presented at World Hearing Voices Congress, Nottingham, UK.