Date of Submission

2002

Degree Type

Dissertation

Degree Name

Doctor of Psychology (PsyD)

Department

Psychology

Department Chair

Arthur Freeman, Ed.D., ABPP

First Advisor

Robert A. DiTomasso, Ph.D., ABPP, Chairperson

Second Advisor

Dr. Kathy Miller

Third Advisor

David Castro-Blanco Ph.D., ABPP

Abstract

Refractory auditory hallucinations are a continuing problem in the treatment of schizophrenic, schizoaffective and psychotically depressed patient populations as well as patients with psychotic disorder, not otherwise specified. To date, little is known about the assessment of such hallucinatory states. Currently there are only a few instruments designed to examine the characteristics of auditory hallucinations. The study examined the reliability and validity of the Beliefs About Voices Questionnaire-Revised (BAVQ-R) in a sample of psychotic outpatients experiencing refractory auditory hallucinations. The present study consisted of 91 subjects; 57 men and 34 women selected from four separate community outpatient settings, who experienced active auditory hallucinations for at least 5 years. The subjects ranged between age 25-50 years of age and were represented by the following ethnic groups: White: 82 subjects, (90.1 %); African American: 7 subjects, (7.7%) and Hispanic: 2 subjects, (2.2%). The sample included: (1) patients who were experiencing both active benevolent and malevolent hallucinations and patients who were experiencing only malevolent hallucinations; (2) those diagnosed according to DSM IV criteria (APA, 1994) with schizophrenia (63.7%), schizoaffective disorder, (24.2%), and psychotic depression, (12.1%) and (3) those considered refractory defined as chronic and drug resistant and corroborated by their treating psychiatrist. Number of self reported hospitalizations ranged from 4-60. Exclusion criteria included those patients suffering from either a drug or alcohol induced psychosis and/or dementia. The goals of this study were: (1) To better define the construct being measured by the Beliefs About Voices Questionnaire-Revised (BAVQ-R) through correlation with measures of anxiety, depression and hopelessness; (2) to test the internal consistency of the content of the Beliefs About Voices Questionnaire-Revised (BAVQ-R); and (3) to study the properties of the BAVQ-R and its constructvalidity and reliability. Measures included the Beliefs About Voices Questionnaire-R (BAVQ-R); Beck Anxiety Inventory (BAI); Beck Depression Inventory II (BDI-II); Beck Hopelessness Scale (BHS). The present study provides support for the validity and reliability of the BAVQ-R suggesting that it measures constructs that are potentially useful and relevant to understanding and treating patients suffering from chronic refractory hallucinations. The measure is a valid and reliable one with the sub-scale scores being stable and measuring homogenous constructs. The BAVQ-R exhibits test-retest reliability and internal consistency reliability. Test-retest reliability is lower than coefficient alpha. There is support for this measure's construct validity. These subscales correlate with measures of emotional distress. Coefficient Alpha reliabilities were calculated with alpha values ranging from .75 to .88. Corrected item subscale total score correlations were calculated and found to be significant at p < .01. The findings of this study are theoretically consistent with Chadwick's theoretical underpinnings, except that there was no statistical relationship observed between the Benevolent subscale of the BAVQ-R and the BAl. The results of this study have some interesting implications for treatment of patients suffering from refractory auditory hallucinations. In the current study a very high correlation was found between the BAVQ-R subscales of malevolence and omnipotence and scores on the Beck Depression Inventory-II (BDI-II) and the Beck Hopelessness Scale (BHS). The researchers found a statistically significant positive correlation between the scores on the Malevolence sub-scale of the BAVQ-R and the BDI-II (r = .605, p < .01). As scores on the Malevolent sub-scale increased subjects evidenced higher scores on the BDI-II. In support of hypothesis 2 the correlation between the Omnipotence sub-scale and the BDI -II was .565, (p < .01) suggesting that the more the subjects attributed power and omnipotence to the hallucination, the more depression the subject reported. There was a statistically significant positive correlation between the Malevolent sub-scale of the BAVQ-R and the BAI (r = .458, p < .01) suggesting that the more malevolent the subjects hallucination the higher was the subject's anxiety level. There was also a statistically significant positive correlation (r =.461, p. < .01) between the Omnipotence sub-scale and the BAI suggesting that the more power and omnipotence that was attributed to the hallucination, the more anxious the subject was. In support of our third hypothesis there was a statistically significant positive correlation observed between the Malevolence sub-scale of the BAVQ-R and the BHS (r = .450, p < .01) suggesting that the more malevolent a subject's hallucination the higher the subject's endorsement of hopelessness items on the BHS. There was an inverse correlation between the Benevolence sub-scale and the BHS (r = -.319, p < .01) which also supported our third hypothesis suggesting that the more benevolent the subject's hallucinations the lower the scores on the BHS. Again in support of the third hypothesis there was a statistically significant positive correlation between the Omnipotence sub-scale and the BHS (r =.387, p < .01) suggesting that the more omnipotent subjects rated their hallucination, the higher the endorsement of hopelessness items on the BHS. It is important to note that the relationships between administration 2 of the BAVQ-R and the Beck measures replicated those observed on administration 1. There appears to be some higher order factor on this scale having to do with aversive hallucinatory experience and pleasurable hallucinatory experience. Those who would score high on the aversive factor might be more likely to comply with a treatment modality that would remove the hallucination and lessen their discomfort. On the other hand, those patients high on the pleasurable factor might be less likely to comply since they do not see their hallucination as distressing. Utilization of the BAVQ-R in the assessment of hallucinatory states may be effective in alerting clinicians' to those patients who may represent potential treatment resistance.

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