- For some people it’s helpful to think about voices in terms of trauma
- Some kinds of therapy are designed to specifically help people with managing trauma
- “Working through” trauma can be useful for understanding why voices occur and why they say particular things
Trauma can mean lots of things, and what counts as traumatic is different for different people. In mental health it is often used to talk about people who have had a very distressing or disturbing experience or series of experiences which have then gone on to affect them in a negative way. For instance, if someone had repetitive nightmares and upsetting memories for a long time after a serious accident, it can help to think about the accident as a “trauma” that they are struggling to deal with.
Trauma can be really important to how some people experience and understand their voices. How the voices sound or what they say might be just like someone they know, or prompt a memory of a traumatic event (for instance, the sound of a bully’s voice might have this effect). For other people, the voices might not sound like anyone they know, or seem to link to any particular memories from the past – but it might still be helpful to think about how trauma plays a role in our feelings and emotions.
Many different kinds of therapy can be “trauma-focused” or be relevant to understanding trauma. The distress of an upsetting and traumatic event may never go away, but trauma-focused therapies tend to share the aim of helping someone deal with the shock, memories, and emotions of a trauma in a way that makes it easier to manage and think about. One important distinction between trauma therapies and talking therapies is the fact that an individual does not have to talk about the trauma they have experienced. This makes them particularly useful for people who aren’t yet ready to discuss what has happened to them. A number of techniques have been designed – usually they have been initially developed to help people with post-traumatic stress disorder (PTSD).
Two examples of trauma-focused approaches are EDMR and Prolonged Exposure:
What is EMDR?
EMDR stands for Eye Movement Desensitization and Reprocessing. The aim of EMDR is to allow people to access and change the way they remember traumatic memories. In a typical EMDR session, the therapist might encourage someone to move their eyes in particular patterns in response to the therapist’s hand. At the same time, the participant holds a particular memory, thought, or image in their mind relating to the traumatic event. The feeling of the process is that it or the eye movement allows people to think and talk about such events in a way that keeps stress levels down. Over time, this might make the memories themselves easier to manage and less frequent and distressing.
What is prolonged exposure?
Prolonged exposure therapy is a kind of CBT that was originally designed for managing PTSD. The general idea is that traumatic or unpleasant memories can become more manageable by gradually building up exposure to imagery and triggers that link to the experience. Often participants will be encouraged to imagine the experience while using things like breathing techniques to control feelings of anxiety and fear. It might also involve homework such as trying to visit people or places linked to the original trauma.
Techniques like EMDR and prolonged exposure have only recently been used to help people with voices or other unusual experiences, so some people think more research is needed to show that they are OK. EMDR is also a technique that seems to be helpful for some people but can be hard to explain scientifically (so some people are still skeptical about how and why it might work). However, some people who find these techniques useful for their voices. Here’s an example from ‘Helen’ in an article for Psychosis:
In my experience, EMDR appears to work on a number of different levels – unlocking, unblocking and processing the trauma, re-connecting us with the parts of ourselves which we have dissociated from, resulting in greater integration and a much more adaptive resolution…. Prior to beginning EMDR the voices I heard were an almost constant backdrop to my life. There was no escape. I had had to resign myself to living a life tormented by abusive voices, although I had not entirely given up hope of finding some sort of reprieve. Through EMDR I have experienced a number of significant changes. With respect to the voice hearing, I do still hear voices, but these are now occasional.
Whether or not someone chooses a trauma-focused approach, it might be a key part of how they understand their experience with voices. Many facilitators of voice dialogue or practitioners of CBT use ideas and techniques from our current understanding of how trauma can affect the mind and body.
Find out more
Sue (2015). How EMDR helped me. MIND.
Robin Logie (2014). EMDR – more than just a therapy for PTSD. The Psychologist.
Rachel Brand (2015). Trauma-focused psychotherapies for PTSD in people with experiences of psychosis. Nationalelfservice.net. A blog post from Mental Elf on research testing EMDR and Prolonged Exposure treatment for psychosis
Craig Steel (2017). Working with trauma and distressing voices. Frontiers. A comment piece from Craig Steel on using EMDR for voices.