The power and omnipotence of voices: subordination and entrapment by voices and significant others

TLDR

Cognitive therapy for psychotic symptoms often incorporates self‑evaluative beliefs such as self‑worth, yet the link between these beliefs and delusions remains unclear. The study aimed to determine whether the relationship with voices reflects a broader paradigm of social relationships by applying the new social‑cognition framework of ranking theory. Researchers measured power and social‑rank differences between voices and 59 voice hearers, alongside comparable power and rank metrics in wider social relationships. They found that subordination to voices closely mirrors subordination and marginalization in other social contexts, that voice‑related distress arises from social and interpersonal cognition rather than voice content, and that perceived power imbalances are rooted in appraisals of social rank and group belonging, suggesting novel treatment implications.

Abstract

Cognitive therapy for psychotic symptoms often embraces self-evaluative beliefs (e.g. self-worth) but whether and how such beliefs are related to delusions remains uncertain. In previous research we demonstrated that distress arising from voices was linked to beliefs about voices and not voice content alone. In this study we examine whether the relationship with the voice is a paradigm of social relationships in general, using a new framework of social cognition, 'ranking' theory.In a sample of 59 voice hearers, measures of power and social rank difference between voice and voice hearer are taken in addition to parallel measures of power and rank in wider social relationships.As predicted, subordination to voices was closely linked to subordination and marginalization in other social relationships. This was not the result of a mood-linked appraisal. Distress arising from voices was linked not to voice characteristics but social and interpersonal cognition.This study suggests that the power imbalance between the individual and his persecutor(s) may have origins in an appraisal by the individual of his social rank and sense of group identification and belonging. The results also raise the possibility that the appraisal of voice frequency and volume are the result of the appraisal of voices' rank and power. Theoretical and novel treatment implications are discussed.