Hearing voices can be an intrusive and distressing experience for people living with a psychotic illness.
Developing personalised interventions and strategies, preferably with health professionals, can help alleviate the impact.
This may be achieved by focusing on a specific problem, such as voices that wake you at night, or focusing on an element, like a particularly distressing voice.
Being prepared and understanding the warning signs and triggers will help you manage your hallucinations.
Some helpful self-care strategies include:
Structure and routine
Planning, combined with self-awareness, can be very helpful. If you tend to hear voices in the afternoon plan to complete your daily chores in the morning and rest in the afternoon. Try planning your day to ensure you do not have long periods of inactivity.
If you work, plan to complete the more taxing aspects of your role in the morning. Or you may prefer to work part-time to suit your needs. Consider speaking with your employer if you need workplace modifications.
For more information read the SANE Guide to Getting Back to Work.
Build a network of support people who reassure you when the voices become overwhelming. A partner, family member, healthy professional or helpline can encourage social interaction, provide a listening ear and redirect you to your coping strategies. Stay in regular contact, even if you feel okay.
Keeping a diary of what the voices say and your feelings can help you develop self-awareness. It may help you find patterns, identify what makes you feel bad and what triggers your voices. Perhaps share your journal with your health professional to help them understand your experience.
Distraction, concentration and keeping busy
Staying busy is a helpful way to distract you from your voices. Puzzles or games are two effective options.
Another option is to get artistic with craft, writing, drawing or sculpting. Some people find incorporating their voices into their craft helps them understand their experiences.
Computer games, household tasks or joining a common interest group can be useful. Experiment and find what works for you.
Try being more assertive with your voices. This can involve making a contract with the voices. For example, saying 'I am too busy to talk just now', 'I will listen to you if you come back at 7 pm when I have finished my dinner', or 'I will only talk to you if you are respectful'.
The voices may stick to these contracts.
You may hear positive and negative, helpful and unhelpful voices. Selective listening involves taking what is useful from the voices and ignoring the rest.
For example, 'I need to get to the shops before they close'. There is a difference between this speech pattern and 'We want you to go to the shops before they close'.
It can be the subtle switch between reminding yourself of something and interacting with the voices.
Try changing statements from 'We want you to…' to 'I'm going to…'.
Ignoring what the voices tell you
This can be difficult and takes determination, particularly if the voices become nasty and persistent. Ensure you utilise your self-care strategies and stay connected with supports.
Evidence suggests people use their vocal cords when hearing voices. So the physical act of making a sound can interfere with this process.
Any vocal activity may be helpful, such as singing, humming, counting, talking, reading out loud, talking quietly so others cannot hear, or simply holding the mouth open.
You may find shouting and swearing at your voices helps. But doing this in public may be embarrassing. Perhaps try shouting into a mobile phone so you don't attract the attention of others.
Different strategies will be suitable for different people in different situations.
TV and radio
TV or radio can be a useful distraction, but avoid adrenalin packed movies. If voices make it hard to concentrate, try children's programs or books to build your concentration.
This is a popular coping strategy, particularly when wearing headphones. The more relaxing or pleasant you find the music, the greater the benefit.
Wearing an earplug in one ear (monaural occlusion) has shown to reduce voice activity by nearly 50 per cent. By wearing one earplug you can continue with normal social activities. Earplugs also work well at night.
Try creative or positive visualisation and imagining how you would like to be in various scenarios. By constructing a room in your head that only you hold the key you can try to lock up your voices.
Listening to a relaxation tape, particularly at bed time, can help. Using a heavy doona can relieve anxiety, as can cuddling a teddy bear. Try aromatherapy, massage, a bath, or mindfulness relaxation (body scan).
Exercise can also be invigorating and relaxing, but don't exercise before bedtime. For ideas on good sleep hygiene read, Counting sheep for adults - 10 tips for sleep hygiene.
Anti-psychotic medication, and psychological therapy are considered most helpful in reducing or sometimes eliminating voices. Finding the right medication and dose to suit is not always easy, so persistence is important.
Always speak with your doctor before stopping medication. For more information read, Thinking about stopping your medication?
Avoiding drugs and alcohol
Avoid recreational drugs or alcohol as they have a negative impact on voices. They can also interfere with prescribed medication.
Reward yourself each time you take control. When voices become less frequent you may find you are left with a void to fill. This may result in anxiety, which can invite voices back. Be aware of these times, think positively, stay in control and use your social supports.
Unfortunately there is no easy solution to managing voices, particularly the nasty ones. But by understanding the way voices work, and by taking responsibility for managing them, you may find a way to limit their influence.
For information, advice and support for mental health issues call the SANE Help Centre on 1800 18 7263, open 10am to 10pm, Monday to Friday.