Hearing Voices (Auditory Hallucinations) in Schizophrenia

Auditory hallucinations, or hearing voices, is a common symptom in people living with schizophrenia. In fact, an estimated 70% to 80% of people with schizophrenia hear voices. These voices can call your name, argue with you, threaten you, come from inside your head or from outside sources, and can begin suddenly as well as grow stronger over time.

People living with other mental illnesses, including bipolar disorder, borderline personality disorder, major depressive disorder, post-traumatic stress disorder, and schizoaffective disorder, may also experience hearing voices.

Auditory perceptual illusions are not as uncommon as was once thought. In fact, up to 10% of the general population have had the experience of hearing one’s name called, especially during the twilight times of falling asleep (hypnagogic) or waking up (hypnopompic).

This article discusses the different types of auditory hallucinations that may occur when someone has schizophrenia. It also covers common treatments, how loved ones can help, and effective coping tactics.

Types of Auditory Hallucinations in Schizophrenia

For some, auditory hallucinations appear suddenly. Tanya Luhrmann, PhD, a professor of anthropology at Stanford and author of the article "Living With Voices," described the experience of a young man who started hearing the sound of rats scratching behind his ears. His auditory hallucinations began rapidly and soon after, he destroyed a number of rats' nests.

Another young man started to suddenly hear a voice coming from outside his apartment that sounded like a woman screaming she was raped and begging for help. Many times the voices can start gradually and are often described as a vague or fleeting impression of hearing your name called or people talking about you.

A few examples of the type sounds that might be heard:

• Repetitive, screeching sounds suggestive of rats
• Painfully loud, thumping music themes
• Voices of people whispering or yelling mean orders or comments
• People talking about you as if you were not even present

Nonsensical Voices

As Eleanor Longden, a research psychologist with a diagnosis of schizophrenia explains, the voices can order you to do completely nonsensical things, such as taking a glass of water and pouring it over your head.

Self-Harm Voices

Voices giving orders to harm oneself or others need to be approached with great caution. This type of auditory hallucination can be extremely frightening as the orders tend to be screamed non-stop.

Threatening Voices

Some people hear persuasive, repetitive voices by a secret organization, for example, that threaten death or harm. Again, these voices are frightening and increase a person's risk of self-harm or violence.

Treatment for Schizophrenia

Treatment for auditory hallucinations in schizophrenia typically requires a combination of medications, therapy, and other procedures for people whose symptoms are treatment-resistant.

• Medication: Antipsychotic medications are often the first line of treatment for schizophrenia and have been proven to rapidly decrease the severity of auditory hallucinations.
• Cognitive behavioral therapy (CBT): When used in combination with medication, CBT can help reduce the emotional distress of hearing voices and help people develop skills to cope with and quiet the voices. For example, humming the "Happy Birthday" song or reading a paragraph backward when the voices begin.
• Repetitive transcranial magnetic stimulation (rTMS): Also known as repetitive TMS, this relatively non-invasive procedure involves placing a small magnetic device directly on the skull. It has been shown to reduce the frequency and severity of auditory hallucinations in people with schizophrenia.
• Electroconvulsive therapy (ECT): Considered a last-resort treatment for reducing the severity of auditory hallucinations, ECT involves the application of a brief electrical pulse to the scalp in order to produce a seizure.

Helping a Loved One With Schizophrenia

Coping with a loved one who is struggling with schizophrenia and hearing voices can take a toll—but try not to lose hope. With the right treatment, your loved one may be able to control the frequency and severity of these voices.

You also may consider family therapy, which can help you and your loved one recognize these auditory hallucinations and develop strategies to better cope. In order to support both yourself and your loved one you can:

• Educate yourself about their condition. Learn as much as you can about schizophrenia in order to understand how it affects your loved one. This can help you recognize when symptoms are worsening and know more about what you can do to help.
• Help them stick to their treatment. If you are in a caregiving role, it is important to work with your loved one's treatment team to make sure that they are getting the help that they need. You can encourage them to take their medication and assist them in getting to and from therapy and doctor's appointments.
• Write down the details. Keep a journal where you can record upcoming appointments and any information provided by your loved one's doctor or medical team. Also, be sure to make notes about symptoms including their frequency, type, and severity. Jot down any major life changes or sources of stress your loved one might be experiencing.
• Manage your stress. Caring for yourself is also important. Practice good self-care and find ways to cope with stress. Relaxation strategies such as mindfulness, yoga, and deep breathing can be helpful.

You might also find it helpful to join a support group where you can talk to other people who have similar experiences. The National Alliance on Mental Illness (NAMI) and The Schizophrenia and Psychosis Action Alliance list options that you might consider.

How to Cope With Auditory Hallucinations

While auditory hallucinations often respond to treatment with antipsychotic medications, it is possible that a person might continue to hear voices despite treatment.

Coping mechanisms that people often try include attempting to drown out the hallucinations by listening to loud music, shouting back at the voices, or focusing on the voices. Unfortunately, research suggests these tactics are ineffective and often backfire.

According to one article published in the journal BJPsych Advances, effective distraction techniques that can help people cope with hearing voices include:

• Periodically listening to lyrical, harmonic, slow-paced music at a low volume
• Playing an instrument
• Spending time with an animal
• Watching non-distressing TV shows and paying attention to the voices of the performers
• Making art, which can help induce a flow state
• Reading either quietly or aloud (or switching between the two)

Breathing exercises may also be helpful. However, the authors note that this activity needs to be carefully modeled and practiced with the help of a therapist before you try it on your own.

A Word From Verywell

If your loved one is experiencing an auditory hallucination, you should not respond by arguing or insisting that it is not real. The best approach is to remain calm, try to be respectful, and contact your loved one's doctor. If your loved one is experiencing a psychotic episode or engaging in potentially dangerous behaviors, contact emergency services.

Auditory hallucinations can be distressing, but antipsychotic medications can often help reduce their frequency and severity. In addition to getting appropriate treatment, there are also distraction tactics that can help such as reading, watching tv, and making art.