Can You Hear What I Hear: Exploring ability and perspective when matching loudness of auditory verbal hallucinations to audio volume
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Introduction
Auditory verbal hallucinations (AVH) affect 60-80% of people with schizophrenia, yet existing assessment tools inadequately capture their phenomenological complexity.
Aim
To determine whether individuals with schizophrenia spectrum disorders could accurately match auditory verbal hallucination loudness to an external audio track, and to explore participant perspectives on this approach.
Methods
Eight participants with schizophrenia spectrum disorders and active AVHs rated loudness via a Likert scale and by adjusting a headphone audio track to match their experience. Structured interviews and thematic analysis captured participant viewpoints.
Results
No significant correlation was found between audio tool and Likert scale scores. Seven of eight participants reported the audio tool provided greater precision in quantifying AVH loudness and better enabled them to convey their internal experience to others.
Discussion
Audio-matching tools may offer meaningful advantages over traditional scales for quantifying AVH loudness, even where statistical convergence with existing measures is absent.
Limitations
Small sample size; loudness alone cannot fully capture the qualitative experience of hearing voices.
Implications
This tool shows promise for longitudinal tracking of AVH loudness.
Recommendations
Further investigation of digital approaches to AVH assessment is warranted.
Relevance Statement
Mental health nurses are often the clinicians who assess and monitor auditory verbal hallucinations, yet they rely on rating scales that ask patients to score or describe their voices. This study explores an approach that enables patients to demonstrate the loudness of their voices rather than describe it. For nursing practice, it may offer a concrete, patient-led way to quantify symptom severity, track change over time, and communicate that experience with others. With development and validation, the approach may support improved clinical assessment, strengthen rapport and inform how mental health nurses evaluate and plan care for people with psychosis.
Accessible Summary
What is known on the subject
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Many people living with psychotic conditions such as schizophrenia hear voices that others cannot hear, known as auditory verbal hallucinations (AVH).
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Voices vary in how loud they seem, and louder voices can be more distressing.
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Clinicians usually measure loudness using rating scales that ask people to score their voice hearing experiences.
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Prior research has called for the development of new approaches in the area of AVH assessment.
Originality
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This study tested a new approach: participants adjusted the volume of a sound played through headphones until it matched how loud their voices were.
Significance
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Most participants (seven of eight) felt the headphone method captured their experience better than a rating scale and helped them explain it to others.
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The tool could help mental health nurses and other clinicians track whether voices are getting louder or quieter over time, including in response to treatment.
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Larger studies are needed, but this study suggests that simple technology could improve how voice-hearing is understood and discussed.
