Mediators of negative content and voice‐related distress in a diverse sample of clinical and non‐clinical voice‐hearers

Objectives: Negative content in hearing voices (i.e., auditory verbal hallucinations) has been associated with adverse clinical outcomes including voice‐related distress. Voice appraisals and responding mindfully to voices are theorized to reduce voice‐related distress. This study aimed in examine mediators of the negative content voice‐related distress relationship in clinical (those who recently received input from mental health services) and non‐clinical voice‐hearers. Methods: One hundred and twenty‐one adults (71.9% female; 35.5% mixed or non‐white ethnic background) who hear voices were recruited online and completed self‐report measures of negative content of voices, voice‐related distress, mindfulness of voices, interpretation of loss of control, thought suppression and intrusion. Results: Clinical voice‐hearers had significantly higher levels of negative content, voice‐related distress and interpretation of loss of control than non‐clinical voice‐hearers. A mindful approach to voices and interpretation of loss of control mediated the relationship between negative content and voice‐related distress across the whole sample. Thought suppression and intrusion did not mediate the relationship. Conclusions: The results support the use of mindfulness‐based psychological intervention to reduce voice‐related distress. Further development of valid and reliable measures specifically relating to constructs of voice content, voice‐related distress and voice suppression will support further research in this area.