ABSTRACT
Hearing Voices peer support groups allow people to construct understandings of their voices. The groups focus on supporting voice hearers in reducing distress associated with voices through an array of strategies. This study sought to describe the voice management strategies shared in a hearing voices peer support group within a Brazilian public mental health service. In this qualitative study we recorded 10 group meetings. Transcripts were coded and analyzed using thematic analysis. The findings indicated five themes, described as: (1) strategies used to avoid distressing experiences; (2) strategies for managing the voices; (3) strategies for seeking social support; (4) strategies for creating a sense of belonging in the community; and (5) strategies related to spirituality and religiosity. These strategies appear to be essential in helping voice hearers feel less alone, reducing the amount of distress associated with hearing voices, and developing coping strategies. These groups provide people who hear voices with the opportunity to share their stories with peers in a group setting, construct new understandings about the experience, and learn strategies for managing their voices. Accordingly, there are great possibilities for the use of these groups within mental health services throughout Latin America.
Subject(s)
Hallucinations , Mental Health Services , Humans , Brazil , Hallucinations/therapy , Social Support , HearingABSTRACT
RESUMO. A alucinação auditiva é um fenômeno que participa da vida de muitas pessoas que fazem tratamento no sistema público de saúde mental de nosso país. No cotidiano de um Centro de Atenção Psicossocial de uma capital brasileira, ouvidores de vozes relatavam com frequência que continuavam sofrendo em função de experiências alucinatórias, mesmo seguindo o tratamento prescrito pela equipe de saúde. Considerando esse problema, foi criado no local um grupo voltado para a lida com o fenômeno. Este artigo teve como objetivo analisar experiências desse grupo. Para isso, utilizou-se o método qualitativo, o qual envolveu o registro de 62 sessões sob a forma de diário de campo, e a análise do corpus. A organização dos dados se deu em três espectros temporais estruturantes de (psico)terapias de grupo em geral: "apresentação", "trocas de experiências", e "fechamento"; além de um aspecto dinâmico, denominado de "manejo terapêutico". A apresentação promoveu a ambientação dos participantes e possibilitou o surgimento de temas importantes, os quais foram trabalhados no decorrer da sessão. Ao trocarem experiências, os integrantes conseguiram compreender algumas dinâmicas relativas às vozes, e houve a promoção de determinados fatores terapêuticos. O manejo serviu para alinhavar os espectros temporais e garantir a fluidez da atividade. Recomenda-se a adoção de grupos com esse foco e formato nos serviços de saúde mental, considerando que eles ampliam a capacidade de cuidado.
RESUMEN. La alucinación auditiva es un fenómeno que forma parte de la vida de muchas personas que hacen tratamiento en el sistema público de salud mental de nuestro país. En el cotidiano de un Centro de Atención Psicosocial de una capital brasileña, oyentes de voces relataban con frecuencia que seguían sufriendo en función de experiencias alucinatorias, aun siguiendo el tratamiento prescrito por el equipo de salud. Considerando este problema, se creó un grupo orientado a la lectura del fenómeno. En este artículo se tuvo como objetivo analizar experiencias de ese grupo. Para ello, se utilizó el método cualitativo, el cual involucró el registro de sesenta y dos sesiones en forma de diario de campo, y el análisis del corpus. La organización de los datos se dio en tres espectros temporales estructurantes de (psico)terapias de grupo en general: "presentación", "intercambios de experiencias", y "cierre"; además de un aspecto dinámico, denominado "manejo terapéutico". La presentación promovió la ambientación de los participantes y posibilitó el surgimiento de temas importantes, los cuales fueron trabajados en el transcurso de la sesión. Al intercambiar experiencias, los integrantes lograron comprender algunas dinámicas relativas a las voces, y hubo la promoción de determinados factores terapéuticos. El manejo sirvió para alinear los espectros y garantizar la fluidez de la actividad. Se recomienda la adopción de grupos con ese foco y formato en los servicios de salud mental, considerando que ellos amplían la capacidad de cuidado.
ABSTRACT. Auditory hallucination is a phenomenon that is part of the lives of many people who are treated in the public mental health system of our country. In the daily life of a Psychosocial Care Center in a Brazilian capital, voice hearers frequently reported that they continued to suffer from hallucinatory experiences, even following the treatment prescribed by the health team. Considering this problem, a group was set up to deal with the phenomenon. This article aimed to analyze the experiences of this group. For this, the qualitative method was used, which involved the registration of sixty-two sessions in the form of a field diary, and the analysis of the corpus. The organization of the data occurred in three temporal spectra that structure group (psycho)therapies in general: "presentation", "exchanges of experiences", and "closure"; besides a dynamic aspect, called "therapeutic management". The presentation promoted the setting of the participants and allowed the emergence of important themes, which were worked on during the session. By exchanging experiences, the members were able to understand some dynamics related to voices, and there was the promotion of certain therapeutic factors. The management served to tie the spectra together and ensured the fluidity of the activity. It is recommended the adoption of groups with this focus and format in mental health services, considering that they increase the capacity of care.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Voice , Mental Health , Hallucinations/therapy , Psychotherapy , Therapeutics/psychology , Confusion/psychology , Health of Specific Groups , Handling, Psychological , Mental Health ServicesABSTRACT
BACKGROUND: Although auditory hallucinations are considered a psychopathological phenomenon, musical hallucinations have been reported in individuals without psychosis but with auditory symptoms (tinnitus and/or hearing loss). Thus, a possible different cognitive functioning may be involved in musical hallucinations. The aim of the study was to characterize patients with tinnitus and musical hallucinations through a multidisciplinary assessment, allowing a better understanding of these concomitant phenomena. SAMPLING AND METHODS: As this sample is rare to find, all consecutive patients with tinnitus, hearing loss and musical hallucinations were included over a 3-year period, excluding those unable to respond. All subjects underwent the following assessments: (1) otolaryngological and audiological assessment (physical examination and audiometry), (2) neurological assessment (cognition, electroencephalogram and imaging examination) and (3) psychiatric assessment (structured interview). RESULTS: A total of 16 patients were included (87.5% women; mean age 61.43 ± 15.99 years). The otolaryngological examination was normal in all cases, but audiometry revealed that the degree of hearing loss was severe to profound in 68.75% of participants. Neurological assessment showed electroencephalogram changes in only 17.6% of cases, while 25% presented with mild attention deficit and 43.75% had small foci of gliosis or ischemia on the imaging examination. Psychiatric assessment showed that 68.75% of cases had depression, 6.25% had anxiety disorder and 25% had no psychiatric conditions. CONCLUSIONS: Musical hallucinations were strongly associated with female elderly adults and with mood disorders. Thus, in contrast to common auditory hallucinations, patients with musical hallucinations associated with tinnitus and hearing loss should be offered a more multidisciplinary assessment.
Subject(s)
Hallucinations/etiology , Hearing Loss/etiology , Tinnitus/etiology , Female , Hallucinations/therapy , Hearing Loss/therapy , Humans , Middle Aged , Music , Tinnitus/therapySubject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Electric Stimulation Therapy/methods , Electric Stimulation Therapy/psychology , Schizophrenia/therapy , Schizophrenic Psychology , Antipsychotic Agents/therapeutic use , Hallucinations/etiology , Hallucinations/therapy , Psychiatric Status Rating Scales , Schizophrenia/complicationsABSTRACT
BACKGROUND: The use of repetitive transcranial magnetic stimulation (rTMS) remains a promising therapeutic tool in the treatment of schizophrenia. Symptoms such as auditory hallucinations (AH) find contradictory results in many studies. Here we present an up-to-date systematic review and meta-analysis of rTMS in the treatment of AH in schizophrenia. METHODS: We searched Pubmed-MEDLINE from 1999 to 2013 for double-blinded randomized sham-controlled trials that applied slow rTMS on the left temporoparietal cortex and assessed the outcome results using Hallucination Change Scale or Auditory Hallucination Rating Scale or Scale for Auditory Hallucinations (SAH). We identified 10 studies suitable for the meta-analysis. RESULTS: We found a positive sized effect in favor of rTMS [random-effects model Hedges' g = 0.011, I-squared = 58.1%]. There was some variability between study effect sizes, but the sensitivity analysis concluded that none of them had sufficient weight to singularly alter the results of our meta-analysis. DISCUSSION: rTMS appears to be an effective treatment for AH. The left temporoparietal cortex seems to be the area in which rTMS is effective. Although meta-analysis is a powerful analytical tool, more studies must be conducted in order to obtain a more expressive sample size to perform a more accurate analytical approach.
Subject(s)
Hallucinations/therapy , Schizophrenia/therapy , Transcranial Magnetic Stimulation/methods , Hallucinations/etiology , Humans , Schizophrenia/complicationsABSTRACT
Pattern completion in a neural network model of the thalamus and a biologically plausible model of synaptic plasticity are the key concepts used in this paper for analyzing some cognitive disorders that involve hallucinations of several kinds: visual hallucinations in the Charles Bonnet syndrome and psychedelic drugs consumption, somatic hallucination in phantom limbs, cognitive hallucinations in schizophrenia and even in multiple personality disorders. All these types of hallucinations are proposed to be the result of a pattern completion dynamics performed in thalamic deafferented areas. Effective treatments of some of these disorders involve peripheral stimulation jointly with a central inhibition so that the neural circuits generating the disorders are depressed according to the proposed model of synaptic plasticity.