Developing a codebook for assessing auditory hallucination complexity using mixed methods

Area of Science:

• Psychiatry
• Psychology
• Clinical Assessment

Background:

• Auditory verbal hallucinations (AVH) are increasingly treated with psychotherapy, often conceptualizing voices as dissociative parts.
• Limited research exists on AVH from a dissociation perspective, highlighting a need for better assessment tools.
• Voices in dissociative identity disorder (DID) are complex, necessitating tools to measure voice complexity (VC) across clinical groups.

Purpose of the Study:

• To operationalize the concept of voice complexity (VC) by identifying its dimensions and indicators.
• To develop an assessment tool for VC that can be used with the Structured Clinical Interview for Voice-Hearers.
• To facilitate the identification of patients who may benefit from dissociation-based therapy approaches.

Main Methods:

• Concept mapping procedures involved 12 healthcare professionals and 2 voice-hearers for brainstorming.
• Sorting and rating tasks were performed by 24 individuals with clinical backgrounds.
• Inter-rater reliability was assessed using Kendall's Coefficient on two interview transcripts.

Main Results:

• Seven dimensions of VC were identified: System Complexity, Content Complexity, Voice's Interest Complexity, Interaction Complexity with Voice-Hearer, Voice's Own Life, Voice Influence, and Voice's Vocal Characteristics.
• A codebook for assessing VC was developed, providing indicators for varying complexity levels.
• Substantial (W = .613) and almost perfect (W = .805) inter-rater agreement was achieved.

Conclusions:

• The developed instrument shows promise for comparative studies of VC in various populations.
• This tool has potential implications for clinical practice and future research in AVH and dissociation.
• Operationalizing VC provides a framework for understanding complex voice experiences and guiding therapeutic interventions.