Investigating the network structure of voice-related appraisals, distress, and responses in psychosis: an experience sampling methodology and network analysis study

Student thesis: Doctoral ThesisDoctor of Clinical Psychology


Auditory hallucinations in the form of voices can have a negative impact on a range of outcomes, including social functioning. As a social experience, auditory hallucinations activate processes implicated in interpersonal relationships, such as perceptions of social rank. Although previous studies and reviews have reported on the role of social rank in voice hearing and the impact of voices on social functioning, to our knowledge this is the first systematic review exploring the direct relationship between voice hearing, social rank and social functioning in voice hearing in the context of psychosis. Four databases were systematically reviewed resulting in 13 studies from an initial screen of 3,131. Six studies which directly investigated the relationship between social rank and social functioning indicated that lower social rank was typically associated with greater difficulties in social functioning, though this relationship is likely to be bi-directional. Seven studies investigated the relationship between voice-related distress and measures of social rank and functioning, and reported that lower social rank and difficulties in social functioning were often associated with greater voice-related distress. These findings extend those of previous studies by highlighting the relationship between social rank perceptions and social functioning. This identifies social rank as a potential target for treatment approaches to support positive social functioning among people who
experience voices.
Date of Award1 Oct 2023
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorThomas Ward (Supervisor) & Katharine Rimes (Supervisor)

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