Treating And Managing Schizophrenia Audio Hallucinations

Audio hallucinations, sometimes called paracusias, are a symptom of schizophrenia (and some other mental illnesses) in which individuals hear voices or noises without an external stimulus. While they’re most often experienced as a symptom of schizophrenia spectrum disorders, auditory hallucinations are sometimes present in other conditions, such as substance use disorder, neurological conditions, bipolar and anxiety disorders, post-traumatic stress disorder (PTSD), and borderline personality disorder. 

Audio hallucinations can be a common schizophrenia symptom

Online therapy can help you manage them

Types of auditory hallucinations

There are several types of auditory hallucinations categorized by what an individual hears and how it relates to their experience. Types of auditory hallucinations can include, but aren’t limited to, the following:

• The individual hears one or more voices speaking to each other (hearing voices can be referred to as “auditory verbal hallucinations”).
• The voice(s) narrate the individual’s actions. 
• The voice(s) speak the individual’s thoughts.
• The patient hears music with which they may be familiar or unfamiliar. (This isn’t the same as what’s known colloquially as an “earworm” or “getting a song stuck in one’s head.”)

Although not usually associated with schizophrenia, exploding head syndrome is another type of auditory hallucination typically characterized by imagined loud sounds and/or flashes of light during the period between sleep and waking. The syndrome is not necessarily associated with any psychotic disorder, but is considered a parasomnia sleep disorder and is not dangerous.

Etiology of auditory hallucinations in schizophrenia

A definitive explanation for how and why auditory hallucinations emerge isn’t yet available. Some people may experience them due to a medical issue, like a brain tumor or head trauma. Others may experience them due to factors like heredity. A growing body of research investigating the potential origins of auditory hallucinations reveals a few possible candidates:

• Neurobiological mechanisms:Studies using magnetic resonance imaging reveal several potential causes for auditory hallucinations, including those stemming from brain structure and function alterations in areas that process auditory information, such as the primary auditory cortex located in the left superior temporal gyrus. 
• Genes: Research suggests there could be a strong connection between genetics and auditory hallucinations in people with schizophrenia.
• Genetics and environmental factors: Some genes have been associated with the introduction of auditory hallucinations only when paired with specific environmental stimuli. For example, certain gene mutations may cause auditory hallucinations only when individuals have been exposed to certain environmental factors, such as childhood abuse.

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• Psychological factors: Exposure to trauma and the co-occurrence of mental illnesses associated with trauma spectrum disorders like PTSD and dissociative disorders may play a significant role in developing auditory hallucinations in people with schizophrenia. 
• Psychosocial factors: While not typically considered a direct cause, some experts believe that auditory hallucinations with negative content may be driven by factors like physical or social threats and cultural influences.

Schizophrenia symptoms, stages, and diagnostic criteria

Auditory hallucinations are one of many symptoms associated with schizophrenia. Schizophrenia symptoms are normally classified into two groups: positive and negative. 

Positive symptoms of schizophrenia

Positive symptoms of schizophrenia generally refer to those that present outwardly in individuals as changes in thoughts and behaviors, such as the following: 

• Hallucinations: Auditory hallucinations tend to be the most common type, but individuals may also experience visual and other sensory hallucinations involving seeing, smelling, tasting, and feeling stimuli that aren’t there.
• Delusions: These can be defined as false beliefs that aren’t reality-based. They’re often odd, and individuals typically believe them despite evidence to the contrary. For example, one may believe that external forces are controlling them, that they are being monitored in their home, or that they have special powers. 
• Disorganized thoughts and speech patterns: People with schizophrenia often have difficulty organizing their thoughts and expressing them coherently. This may emerge as incoherent or jumbled speech, sometimes referred to colloquially as “word salad.”
• Disorganized behaviors: People with schizophrenia sometimes exhibit bizarre behaviors, such as agitated, spontaneous, or disjointed movements. Catatonia, in which the individual becomes verbally and physically unresponsive to external stimuli and engagement, may be present in some cases. 

Negative symptoms of schizophrenia

Negative symptoms are often present in people with schizophrenia as well. These symptoms typically manifest within the context of diminished affect and engagement with the outside world. They can include those listed below:

• Asociality: A reluctance toward or aversion to social interaction
• Blunted affect: Lack of or diminished ability to display emotions through facial expressions, physical gestures, or tone of voice
• Avolition: An uncharacteristic lack of motivation or significant inability to handle everyday tasks and responsibilities
• Anhedonia: Lack of or diminished ability to experience pleasure
• Alogia: Reduced ability to communicate through speech

Factors like positive symptoms of schizophrenia, social isolation, antipsychotic side effects, substance use, and comorbid disorders like depression and anxiety can also cause secondary negative symptoms.

Stages of schizophrenic episodes

An episode of schizophrenia is when a person is actively experiencing psychotic symptoms. While schizophrenic episodes may present differently between people, they typically involve three phases. These phases are the prodromal phase, the active phase, and the residual phase. 

The prodromal phase

Symptoms of this phase usually emerge before more intense psychotic symptoms, like delusions and hallucinations. They often mirror those of other conditions, such as depressive and anxiety disorders. For this reason, it can be challenging to identify them as being associated with the prodromal phase of a schizophrenic episode.

The active phase

The active phase is the main phase of an episode where the primary symptoms occur. Positive symptoms like hallucinations, delusions, paranoia, and disorganized speech and behavior often emerge during this stage.

Residual phase

Though not considered an official stage in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the residual phase is often acknowledged by clinicians as a significant part of a schizophrenic episode featuring symptoms like those in the prodromal stage. These may include apathy, social withdrawal, and reduced affect. 

Diagnostic criteria for schizophrenia

Diagnosing schizophrenia normally requires a comprehensive evaluation by a qualified mental health professional (typically a psychiatrist or clinical psychologist) who can assess the individual’s symptoms, medical history, and the duration and impact of symptoms on functioning. To qualify for a diagnosis of schizophrenia, individuals must meet the following criteria listed in the DSM-5:

• The presence of two or more core symptoms, such as delusions, hallucinations, disorganized speech and behaviors, and negative symptoms for a significant portion of time over one month (or less with successful treatment)
• Symptoms must cause a significant disturbance in the individual’s social or occupational functioning, such as at work, in relationships, or in practicing self-care
• Continuous signs of the disturbance must persist for at least six months (or less with successful treatment)
• The disturbance isn’t attributed to another medical condition or the psychological effects of medications or substances like alcohol

Diagnosing schizophrenia normally requires a comprehensive evaluation by a qualified mental health professional (typically a psychiatrist or clinical psychologist) who can assess the individual’s symptoms, medical history, and the duration and impact of symptoms on functioning.

Treatment and management

Schizophrenia treatments generally involve a combination of approaches that focus on managing symptoms and improving relationships and functioning in daily life. An individual’s experiences, environment, and coping strategies often play a prominent role in the therapeutic approach. Treatments for schizophrenia usually include the following:

• Medications: Pharmaceutical intervention is often a first-line strategy for schizophrenia treatment. Antipsychotics tend to be the most prescribed medications for schizophrenia. However, mood stabilizers or antidepressants may be recommended in some cases. Always consult your doctor or psychiatrist before starting, stopping, or changing the way you take medication.
• Individual therapy: Evidence-based methods like cognitive behavioral therapy (CBT) can be an integral part of managing schizophrenia symptoms, including hallucinations. 

CBT may be attended in person or online. Some individuals may prefer the convenience and flexible scheduling options offered by online therapy. Others may appreciate that many online therapy platforms provide more affordable options than in-person treatment without insurance. 

Studies suggest that online therapy can produce the same results as in-person therapy, although individuals experiencing acute psychosis may require in-person care. For instance, a 2018 study suggested that internet-based interventions could be helpful for individuals living with psychotic disorders. 

• Family therapy: Educating and involving family members in the treatment process can improve communication, empathy, support, and familial relationships. Individual counseling is also often encouraged for family members to learn how to manage and cope with challenges that can arise when caring for a loved one with schizophrenia. 
• Peer support groups: This type of intervention can provide an opportunity for individuals to share experiences, offer mutual support, and connect with others diagnosed with schizophrenia.
• Other psychosocial interventions: Rehabilitation programs offering vocational training, educational opportunities, housing assistance, and social skills training can support individuals in daily life. 

Hallucination-focused integrative treatment (HIT)

HIT can be defined as a specialized, targeted intervention for auditory verbal hallucinations emphasizing active family involvement and psychoeducation as a supplement to medication, CBT, and rehabilitative services. HIT generally aims to improve symptoms and the ability to manage crisis situations caused by auditory hallucinations.

Audio hallucinations can be a common schizophrenia symptom

Online therapy can help you manage them

HIT is usually seen as an integrative approach, recognizing that success in treating auditory hallucinations often depends on the consideration of an individual’s unique circumstances, such as age, heredity, history of trauma, learning difficulties, or suicidal thoughts or attempts.

If you or a loved one are experiencing thoughts of suicide, please know that help is available. You can call the National Suicide Prevention Lifeline anytime, 24/7, at 988.

Clinical trials indicate that people with auditory hallucinations treated with HIT usually experience “longer lasting and broader ranging effects than other therapies, higher satisfaction, and lower drop-out rates.”