Hearing voices

Brain-scan research shows changes in the brain’s speech areas when people hear voices. The NHS describes it as the brain mistaking thoughts for real voices.

So the experience is genuinely happening, even if no one else can hear it. That is why telling someone “it’s not real” rarely helps.

Some people see voices as a symptom of a health condition. Others understand them through their life story, their faith or their culture. The Hearing Voices movement accepts all of these explanations.

What matters most is what helps you live well. You have the right to form your own understanding of your experiences.

Some people find their voices helpful or comforting. Others find them upsetting. Many people have a mix.

This guide is for everyone, whether your voices feel like company, a challenge, or something you are still trying to understand.

Hearing or seeing something while falling asleep or waking up is very common and usually not a concern. Lack of sleep can also bring on unusual experiences.

Extreme stress and grief can bring on voices. Bereavement, divorce or separation are among the life events linked with hearing voices.

Some grieving people hear the voice of the person who died. For many, this is comforting rather than frightening. The Grief: understanding loss guide has more support.

Trauma, including abuse, is one of the life experiences most often linked with hearing voices. Around 40% of people with PTSD hear voices.

The Hearing Voices movement encourages people to explore how voices may connect to life events and relationships. Sometimes what a voice says, or whose voice it sounds like, holds meaning.

About 16% of adults with hearing loss hear sounds or voices that aren’t there, and the more severe the hearing loss, the more likely it becomes.

A hearing check can be a helpful first step, especially for older adults who start hearing music or voices.

Examples include

• Brain changes, such as after a stroke
• Extreme hunger
• High fever or infections, such as urinary infections in older adults
• Migraine
• Parkinson’s disease
• Recovering from anaesthesia
• Sleep conditions, such as narcolepsy

This is one reason a full check-up matters. A clinical provider can look for physical causes first.

Alcohol and recreational drugs can bring on voices. Stress, anger and anxiety can make voices louder too.

Voices are common in schizophrenia, and also happen with bipolar disorder, PTSD, anxiety and depression.

Even then, voices are only one part of a bigger picture. The Schizophrenia: understanding it and Psychosis & schizophrenia guides explain more.

The founders of the Hearing Voices movement interviewed voice hearers who had never been psychiatric patients. Their work showed that many people cope well and live full lives alongside their voices.

In a large international survey, most people who had these experiences had them only a few times, and about a third only once.

It may help to talk to a clinical provider if

• Beliefs feel certain, frightening and hard to question
• It is getting hard to tell what’s real
• School, work or self-care is slipping
• Sleep has changed a lot
• Thinking or speech feels jumbled
• You feel watched, followed or plotted against

These are not a checklist. They are signs that some support could help, whatever the cause.

Whether voices are part of psychosis or not, the person hearing them deserves to be believed about their experience and treated with dignity.

Stigma, not voices, is often what stops people asking for help. The Stigma & talking about mental health guide explores this further.

Some voices give a running commentary on what a person is doing, or talk to each other about them.

This can feel very exposing. It makes sense that someone might start to wonder if they are being watched.

Some voices are friendly, but often they are critical, rude or bossy.

Critical voices can sound a lot like the worst things a person has been told, or tells themselves. Many people find it helps to remember: what a voice says about you is not the truth about you.

Some voices tell a person what to do. You don’t have to obey a voice. Many voice hearers learn to say no, or to stand up to them.

Some people hear voices that are supportive, wise or comforting. Focusing on the voices you like is one coping strategy people use.

Not every voice needs to go away. For some people, the goal is a calmer relationship with their voices rather than silence.

Some people hear music or background sounds rather than speech. Others see, smell, taste or feel things that others don’t.

Hearing Voices groups welcome people with all of these experiences, not only voices.

Ideas people use

• Calling or texting a friend
• Humming or singing quietly
• Listening to music or a podcast with headphones
• Reading out loud
• Taking a walk or doing something with your hands

Distraction is one of the strategies Rethink Mental Illness lists for taking control of voices. Some people also use a phone app.

Some people set a time each day to give their voices attention. Outside that time, they can say, “Not now, I’ll listen later.”

This can help a person feel more in charge, instead of the voices running the whole day.

Talking back to voices, or standing up to them, is a strategy many people use.

Others prefer to ignore voices. Both are valid. Notice which one leaves you feeling calmer.

Keeping a diary can help you understand your voices: when they get louder, what they say, and what calms them down.

If some voices are helpful, giving them more attention can make the harder ones feel smaller.

Some people ask a kinder voice for support when a critical one gets loud.

Everyday supports

• A regular sleep pattern
• Exercise you enjoy
• Mindfulness or relaxation
• Time with people who make you feel safe

Voices often get louder with stress. Anything that lowers stress can help. The Breathing basics and Coping strategies guides have ideas.

The movement’s key values include

• Accepting and understanding voices may help recovery more than fighting them
• Many explanations for voices are accepted
• Peer support and working together are empowering
• Voice hearers own and define their own experiences
• Voices can often be understood through life events
• Voice hearing is a natural part of human experience

Hearing Voices groups aim to be spaces of trust, respect, equality, acceptance and mutuality. Members shape what the group talks about.

Groups don’t try to persuade, teach, fix or change anyone’s ideas. They are connection-focused, not treatment.

Hearing Voices Network USA supports groups for people who hear voices or have similar experiences, and separate groups for family members and friends.

Visit hearingvoicesusa.org to learn about groups, including online options.

England alone had more than 180 groups by 2014, and national networks exist in many countries.

Searching “Hearing Voices Network” with your country’s name is a good way to find one near you.

CBT helps people notice triggers and patterns and build coping skills. A version made for voices and unusual beliefs is called CBT for psychosis (CBTp).

In the UK, NICE recommends offering CBTp to people with psychosis. It can help a person look at what voices say and feel less ruled by them.

Family intervention brings the person and their family together with professionals. Rethink notes it usually lasts 3 months to a year, with at least 10 planned sessions.

It can help everyone talk more calmly and solve problems together.

Because voices are often linked to trauma, some people find counselling or psychotherapy that explores root causes helpful.

It’s okay to ask your provider whether trauma-focused care is right for you.

Art therapy, usually in groups, can be especially helpful when low mood is part of the picture.

The Creative & body-based therapies guide explains more.

In AVATAR therapy, a person creates a computer avatar that looks and sounds like their most distressing voice. With a therapist, they practise talking to it and gaining confidence.

In a trial of 150 people in the UK, voices improved more with AVATAR therapy than with supportive counselling at 12 weeks. Researchers say it needs more testing and isn’t widely available yet.

Things worth sharing

• Anything that seems to set voices off
• How much the voices upset you
• What the voices say, if you feel able
• What you already do to cope
• When the voices started and how often you hear them

A provider will usually check for physical causes, such as sleep problems or hearing loss, as part of the picture.

You might say

• “I’d like to tell you something, and I just need you to listen.”
• “Sometimes I hear voices. I’m working on ways to cope.”
• “What helps me most is…”

You decide how much to share. Your experience is yours.

The Hearing Voices movement works to challenge stigma and the idea that voices are always a sign of illness.

Meeting other voice hearers, in person or online, is one of the strongest antidotes to shame.

Try

• “Thank you for telling me.”
• “What are the voices like for you?”
• “Is there anything that helps when they’re loud?”
• “I don’t hear them, but I believe it’s real for you.”

Arguing about whether voices are real usually backfires. Focus on the feeling behind the experience.

Voice hearers often know what calms things down: quiet, music, company, or time alone. Ask, and support their own coping plan.

Families and friends can join their own Hearing Voices groups to learn and share.

If voices are part of schizophrenia or psychosis, the Supporting someone with schizophrenia guide covers communication, crisis planning and caring for yourself.