Reimagining Voices: A Case-Based Exploration of Imagery-Enhanced Cognitive Behavioural Therapy for Distressing Voices (IE-CBTv).

Distressing voices (auditory verbal hallucinations) are frequently accompanied by emotional mental imagery, the nature of which often amplifies the associated distress. Mental imagery can be experienced across any of the sensory modalities and can reflect memories of past events or be fictional. Often, the themes for the content of distressing voices and associated mental imagery are driven by underlying core beliefs, or schemas, that the individual holds. Imagery-Enhanced Cognitive Behavioural Therapy for distressing voices (IE-CBTv) builds on the traditional first-line CBT approach by incorporating targeted work with associated mental imagery and using imagery techniques to address the underlying themes and core beliefs linked to the voices. This paper presents the case of a 25-year-old male voice hearer, Leo, who worked collaboratively with their therapist across ten sessions of IE-CBTv. Leo reported distressing voices with core themes of being unloved, abandoned, and not belonging. His distressing voices were associated with a clear mental image of Leo being cast aside in a social group situation. This case presentation will discuss how the therapist supported the client to make sense of his voices, using a formulation-based approach. The rationale for different imagery techniques, how they were collaboratively designed, implemented, and received, will be discussed; alongside challenges and therapist reflections. Implications for clinical practice for working with distressing voices using an IE-CBTv framework will also be discussed.