Download Hearing Voices Workshop: training and simulated experience

August 2016 I Indian Health Services Conference
Hearing Voices Workshop:
training and simulated
experience
“As a nation, it is up to all of us
to know the signs of mental
health issues and lend a hand
to those who are struggling,. . .
Shame and stigma too often
leave people feeling like there is
no place to turn. We need to
make sure they know that
asking for help is not a sign of
weakness –
it is a sign of strength.”
PRESIDENT OBAMA
Objectives
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Discuss what is voice hearing
Learning about the subjective experience of
hearing voices and those that are distressing
Understand the day to day challenges that
people with psychiatric disabilities experience
Changing practices to better address the needs
of people who hear distressing voices
Describe support networks and coping
strategies for voice hearers
Has this ever happened to you?
You are in a crowd when you hear your name.
You turn, looking for the speaker.
No one meets your gaze.
It dawns on you that the voice you heard must
have sprung from your own mind.
Studies have found that between
4% and 10% of people across
the world hear voices
It is estimated that between
5% and 28% of the general
population hears voices that other
people do not
part I: hearing
voices
Hearing Voices
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Voices can be critical, complimentary or neutral
It's difficult to explain what it is like to hear voices,
particularly if you've never heard voices yourself
May give commands that are potentially harmful
Engage a person in conversations
Mahatma Gandhi
Saint Joan of Arc
Saint Patrick
Paul McCartney
Anthony Hopkins
Brian Wilson
Carlos Santana
Charles Dickens
John Forbes Nash
Sigmund Freud
Socrates
ALL HEARD VOICES…
Hearing Voices
Don’t assume that means schizophrenia
Voices can be male, female,
without gender, child, adult,
human or non-human
What are voices and
who hears them?
§  Hearing voices is often thought of as a symptom
of a serious mental illness
§  Research on the experiences of the general
population shows that lots of people hear voices,
and the majority of them are not mentally unwell
§  It is a common human experience
Between 70% and 90% of
people who hear voices do so
following traumatic events
Why do people hear voices?
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Voices as you fall asleep or wake up
Lack of sleep
Hunger
Physical illness
Drugs
Bereavement
Abuse or bullying
Other traumatic experiences
Spiritual experiences
Mental health problems: depression, anxiety, & stress
Different Experiences
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People can experience unkind and threatening voices
Voices can tell people to do dangerous or unacceptable
things or try to control them
People may hear a kind supportive voice
Sometimes there may be more than one voice and they
may talk or argue with each other
People may believe that they are hearing other people’s
thoughts
The voices may be louder or more frequent if they are
feeling stressed
They may hear or see things as they are falling asleep
They may experience the voices as being in their head,
or they may feel that they are coming from outside and
heard through their ears like other sounds
However, there are clearly voice
hearing experiences that can be
very distressing and can
disrupt our lives and ability to work,
make friends, reach our
personal goals…
part II: mental
health
causes of mental illness are
COMPLICATED
genetics
environment
physical
strange or grandiose ideas
Inability to cope with problems and daily activities
Excessive anger, hostility, or violent behavior
Marked
changes in
eating or
sleeping
patterns
Marked personalities changes
Excessive anxieties
warning signs for
mental illness
Thinking or talking about
suicide
or harming oneself
prolonged depression and apathy
abuse of alcohol or drugs
biopsychosocial
model:
integrating
perspectives
not one perspective is
“correct”
most disorders are a
result of biological,
psychological, and social
factors
not one single
“cause”
schizophrenia
exact cause is
unknown
3 factors believed
important:
•  brain structure/
function
*increased dopamine levels
•  hereditary factors
•  environmental
stressors
research
…showing abnormalities in the ventricles,
prefrontal cortex, limbic region, and
communication pathways of the brains of
people who have schizophrenia.
Neurotransmitters, including dopamine, and
to a lesser extent serotonin and glutamine
appear to be involved, although no causal
relationships have been identified.
symptoms of schizophrenia
•  positive symptoms
•  hallucinations
•  delusions
•  disorganized thoughts
•  suspiciousness
•  Hostility
•  negative symptoms
•  blunted/flat affect
•  social/emotional withdrawal
•  difficulty in abstract thinking
•  lack of ability to experience pleasure
medications
§ common medications:
§ Haldol
§ Zyprexa
§ Risperdal
§ Thorazine
§ side effects include: blurred vision,
tremors, stiffness, drowsiness, muscle
spasms, uncontrolled muscle
movements, lip smacking, jerking and
twisting movements
This foray into the uncanny is as close as
most people come to experiencing auditory
hallucinations or hearing voices, a condition
that affects 70% of people
diagnosed with schizophrenia and
15% of people diagnosed with
mood disorders - such as mania or
depression
bipolar disorder
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bipolar I disorder
§  characterized by one or more manic
episodes, mixed episodes (rapid cycling),
one or more major depressive episodes
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bipolar II disorder
§  characterized by one or more major
depressive episodes with at least one
hypomanic episode
mood disorders
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causes
§  exact cause not known
§  related to neurotransmitters and genetic factors
manic symptoms
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elevated/expansive mood
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grandiosity/delusions of grandeur
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decreased need for sleep
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pressured speech
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flight of ideas
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distractibility
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irritability/intrusiveness
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increased involvement in goal directed activity
major depression
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depressed mood
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disturbance in appetite
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weight loss/gain
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sleep problems
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decreased energy
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feelings of worthlessness/guilt
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difficulty concentrating
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suicidal thoughts/attempts
loss of interest or pleasure in activities for at least 2
weeks
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mania and psychosis
TOXICICTY
impaired or unstable coordination
Strokeorheart
problems
weight gain/
obesity
involuntary movements or movement disorders
blurred vision
sensitivity to the sun
drowsiness
warning signs for
side effects prescription
medications
CAN CAUSE CONVULSIONS, SEIZURES OR TREMORS
sexual dysfunction
diabetes
Strong taste of metal
cognitive decline or impairment
psychotropic medications
do not cure the illness,
but can help treat the
symptoms
pills don’t give skills
but you can teach skills…
part III: symptoms
& experiences
Voices can be experienced
in the head, in the ears, outside
the head, in some other part of
the body, or in the environment...
Possible Voices
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You did a bad job!
You are a bad person!
Overtime, you begin to have difficultly
discerning between the statements
You stink!
You’re ugly!
You should hurt yourself!
You are the chosen one!
hallucinations
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Auditory: Hearing things (e.g. sounds of footsteps or
voices)
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Olfactory: Smelling things
Gustatory: Having unusual tastes in the mouth
Tactile: Feeling sensations on the skin (e.g.
something is crawling over them)
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Somatic: These are feeling sensations deep within
the body and can be very unpleasant
Visual: Seeing things that aren't really there (e.g.
seeing people or shadows)
Voices often reflect important
aspects of the hearer’s emotional
state – emotions
that are
often unexpressed by the
hearer
Recent Discoveries…
3 Factors
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Reduced brain integration, social isolation,
and high levels of emotionality
This view has become the focus of efforts
to understand and help people with
mental illness quiet their minds
Coping skills such as; listening to music,
talking on an inactive mobile phone,
combating negative voices with positive
responses
Cast Away
WILSON
part IV: hearing
voices activity
Patricia Deegan, PhD
National Empowerment Center
simulated experience
Simulation Experience
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Should have volume at a
reasonable level
There is foul language on the
recording. If this will be upsetting
to you then please DO NOT listen
Do not drive or operate any
machinery while listening to the
content
Anyone who has experienced
auditory hallucinations or has a
history of hearing voices should
NOT listen to this recording
If the voices become distressing
or upsetting TURN OFF THE
PLAYER!
This is not a marathon
Simulation Experience
A few more important guidelines:
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Do not communicate with each
other about the content of the MP3
Player during the simulation.
You can communicate with each
other about general topics, just not
what is on the player.
It’s important to try and complete
the tasks not just sit back and
listen.
You do not have to “role play” being
“crazy” during the simulation.
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Just be yourself.
Again if the content becomes
disturbing you may turn it off
and continue with the
simulation with the player off
or cease your participation.
At times, the audio will just
be “white noise” just let it
continue and the voices will
come back.
SanDisk MP3 Players
Volume control
Turn on and off press and hold center button
Discussion
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Howdidyoubest“deal”
withthevoices?
Wereyouabletoblock
themoutsuccessfullyif
youwantedto?
Whatwasitlike
comple;ngthemini
mentalstatusexam?
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Didyouhaveany
physicalresponsetothe
experience?
Willthiseffectyour
approachinworking
withthosehearing
voices?
Whatwillyoutakeaway
fromthisexperience?
You get to take off your headsets…
Voice hearers don’t have that option!
part V: path to
wellness
is not about getting rid of
voices but about:
§  The person understanding their voices in
relation to their life experiences
§  The person changing their relationship with
their voices so that the voices become
harmless and/or helpful
People may hear one voice or
many. Some people report
hearing hundreds, although in
almost all reported cases, one
dominates above the others…
what CAN you
do to help?
delusions and hallucinations
§  recognize and acknowledge that their delusions
or hallucinations are real to them
§ don’t tell them there is no one there
§ don’t tell them you see or hear something that you don’t
§  ask what the voices are saying to get an idea of
what the person is going through and messages
they are hearing
§  realize that they may be overwhelmed What can you do to help?
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undivided attention
summarize/paraphrase/restate
non-judgmental
silence
listen for real message
empathic listening
avoid becoming a precipitating factor
don’t take it take personally
be proactive
1.  Don't isolate
2.  Try some music
3.  Keep a record
4.  Some research suggests that if you put a
rubber band around your wrist
5.  Some people have found it particularly
helpful to use "I statements”
self-help intervention strategies
§ slow yourself down and take a deep breath
§ eye contact
§ be clear, specific and firm
§ display patience and empathy
§ remain calm & keep on discussion topic
ways to
de-escalate
people
§ repetition is the key learning
§ consult with and/or refer to behavioral health services
Crisis Development Model
Verbal or Physical
Attitudes/
Crisis Development/
Staff
Behavioral Levels Approaches
defensive
ac$ngoutperson
tensionreduc$on
CRISIS PREVENTION INSTITUTE
direc$ve
non-harmfulcontrol
therapeu$crapport
reduce
stigma by
leading by
example
don’t call the person by
their diagnosis
a person with mental illness
be
patient
have empathy
treat with
respect and dignity
in case of an emergency
§  crisis line/crisis team
§  first responders
§  certified crisis intervention
police officers
suicide hotline: 1-800-273-talk
teen hotline: 1-800-248-teen
Resources
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Intervoice: The International community for hearing voices
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New USA hearing voices network: Support groups for voice hearers and also
trainings for leaders of support groups. www.hearingvoicesusa.org
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Hearing Voices Network, Manchester, UK (has links to other hearing
voices networks and online groups): www.hearingvoices.org
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Voice-Hearers Support Group: http://groups.yahoo.com/group/voicehearers
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Hearing Voices Movement:
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Hearing Voices Info Booklet: http://hvna.net.au/upfile/HVNA_Info_Booklet.pdf
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National Alliance of Mentally Ill: http://NAMI.org
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Mental Health Foundation https://www.mentalhealth.org.uk/a-to-z/h/hearing-
www.intervoiceonline.org
http://en.wikipedia.org/wiki/Hearing_Voices_Movement
voices
Homework
Be sure to take care of yourself or let
someone else take care of you tonight!
contact info
[email protected]