Posted: 06.21.2014 | by AMRA

As a rule, a high level of experiential avoidance, that is, deliberate inattention towards unwanted and unpleasant thoughts and feelings, is usually associated with higher levels of distress, while high levels of non-judgmental acceptance of those thoughts and feelings are usually associated with lower levels of distress.

Morris et al. [Australian & New Zealand Journal of Psychiatry] explored whether this commonly observed pattern also applies to the avoidance or acceptance of auditory hallucinations. They administered a battery of self-report measures including the Kentucky Inventory of Mindfulness Skills, the Acceptance and Action Questionnaire, the Belief About Voices Questionnaire-Revised, the Thought Control Questionnaire, and the Beck Anxiety and Depression Inventories, to 50 people who were experiencing persistent distressing auditory hallucinations.

The authors were interested in whether dispositional mindfulness and acceptance affected how voices were appraised (e.g., were they experienced as malevolent, benevolent, or omnipotent), and the degree to which the patients experienced distress and disability, were engaged with the voices or resisted them, and relied on thought-control strategies such as distraction, self-punishment or cognitive reappraisal.

“Psychological flexibility” (present-moment awareness coupled with a sustained ability to act in accord with one’s values — a variable derived from Acceptance and Commitment Therapy) and nonjudgmental acceptance partially behaved as predicted. Both had significant negative correlations with measures of depression (-.66 and -.40), anxiety (-.57 and -.38), maladaptive efforts at thought-control through self-punishment (-.38 and -.59), appraisals of the voices as being “omnipotent” (-.34 and -.41) and actions (-.37 and -.42) and emotions (-.28 and -.48) centered on resisting the voices.

On the other hand, neither psychological flexibility nor nonjudgmental acceptance were correlated with distress and disruption caused by the voices or the patients’ emotional and behavioral engagement with them. This may be due in part to the lack of variance on both the distress/disruption and behavioral engagement measures. By excluding patients who viewed their voices positively, the authors may also have limited the magnitude of some of these correlations.

This study underscores the importance of mindfulness and nonjudgmental acceptance as factors influencing the way in which individuals who hear voices interpret and respond to their hallucinations, and suggests a pathway through which MBIs may successfully influence clinical outcomes.


Morris, E. M., Garety, P., & Peters, E. (2014). Psychological flexibility and nonjudgemental acceptance in voice hearers: Relationships with omnipotence and distress. Australian and New Zealand Journal of Psychiatry. [PMID: 24835207]

[Link to abstract]