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Abstract. Auditory hallucinations are foundin patients with schizophrenia. For some patientswith persistent psychotic symptoms, hallucina-tions are unresponsive to medications.

We report three cases with schizophrenia andpersistent auditory hallucinations. In this studythree types of tapes were used: pure music, mu-

sic and speech, blank tapes. The patients wereasked to record the duration and severity oftheir auditory hallucinations when they were lis-tening to tapes. Audiotape therapy led to a sig-nificant decrease in the duration and severity ofthe hallucinations (p < 0.05).

This study supports treating persistent audito-ry hallucination by altering external stimulation.Therefore, audiotape therapy could be helpful.

Key Words:Auditory hallucinations, Audiotape therapy, Schizo-

phrenia.

Introduction

Schizophrenia is a complex phenomenon with dif-ferent symptoms and functional deficits. Hence, it isoften difficult to determine the effectiveness of any in-tervention strategy by focusing on a specific type ofsymptom such as auditory hallucinations. The thera-pist may better determine the type of intervention re-quired when the hallucinations are problematic. Theclinician may introduce specific tasks for the purposeof minimizing the influence of the hallucinations1.

The persistent hallucinations affect a persons abilityto engage in work, leisure and self care task but theeffects are highly variable and individualistic2.

For some patients with persistent psychotic symp-toms, hallucinations are directly responsible for pro-found dysfunction in all aspects of daily life. The tra-ditional medical approach for controlling hallucina-tions is the administration of antipsychotic drugs butsome patients continue to experience persistent hallu-cinations in spite of treatment with psychotropicmedication3. There are several methods that havebeen evaluated for controlling hallucinations. At-

tempted techniques have included increasing audito-

Control of persistent auditory hallucinationsthrough Audiotape therapy (three case reports)

M. ZARGHAMI, F. SHEIKH MOONESI, M. KHADEMLOO

Psychiatry and Behavioral Sciences Research Center, Mazandan University of Medical Sciences, Sari, Iran

Corresponding Author:Fatemeh Sheikh Moonesi, MD; e-mail: fmoonesi@mazums.ac.ir

ry input and aversion therapy and use of earplugs5.All these techniques have met with some success butresults have not been consistently replicated. This ar-ticle presents preliminary findings from three partici-pants to evaluating the efficacy of the audiotape ther-apy in treating auditory hallucination.

Cases Presentation and TreatmentIn this study, we assessed three people with di-

agnosis of schizophrenia according to DSM-IV-TR. These patients include a 32 year old womanwith three near fatal suicidal attempts (case 1)and 38 year old man (case 2) and a 20 year oldman (case 3). All of them were suffering fromhearing voices discussed them in third personand made critical comment about them. Treat-ment with typical and atypical anti psychotics

(including clozapine), augmentation with lithiumand anti convulsants failed to suppress voices.All of them had normal hearing.

The patients were asked to record the durationand severity of their auditory hallucinations overa baseline period of a week. Three experimentalconditions were assessed in random order on al-ternate weeks, each condition was applied fortwo hours between 10 am and 2 pm for a week.

Ratings were made during the interventiontoo. Intervention conditions were audiotapes ofpure music (classical), speech and music (PayamRadio, Iran) and a blank tape (control). The

portable audiotape cassette players with intra-au-ral headphones were also used. When these con-ditions were investigated no other changes weremade to their previous treatment.

Statistical AnalysisData were analyzed using t test in SPSS soft-

ware (version 16) (SPSS Inc., Chicago, IL, USA).

OutcomeFigure 1 shows tapes of pure music and music

and speech reduced the severity of hallucinations

whereas the blank tape had little effect.

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Control of persistent auditory hallucinations through Audiotape therapy (three case report)

The hallucinatory episodes lasted for an aver-age of 13.5 min while listening to the pure musicand 10.1 min for music and speech tape and 16.1min for listening to blank tape and 17.9 minwhen not listening to audiotape (baseline). Dura-tion of hallucination significantly reduced whenpatients listening to the pure music, music andspeech (p < 0.05), but its not significantly re-duced with blank tape (control).

Discussion

This article presents preliminary findings aboutefficacy of the audiotape therapy in treating persis-tent auditory hallucinations. Previous studies indi-cated the effectiveness of counter stimulation treat-ments for auditory hallucinations5,6 which is in lineof our study. McInnis and Marks7 reported a pa-tient with psychotic depression who used audio-tape therapy. They referred duration of hallucina-tion was reduced but they had not measured severi-

ty of hallucination. They used the tape that thevoice of patient was recorded on and it was aboutpleasant memories. Collins et al8 compared the ef-ficacy of music tape, music and speech tape, bor-ing tape, and blank tape in treating persistent audi-tory hallucination in a patient with schizophrenia.They found that both music tape and speech andmusic tape can reduce severity of hallucinationsbut they didnt evaluate effect of auditory input onduration of auditory hallucination. Our study is thefirst study that evaluates the effect of audiotapetherapy with different tapes on duration and severi-

ty of hallucinations in three cases simultaneously.

Previous studies and the present one underlinethe possibilities of treating persistent auditoryhallucination by altering external stimulation.Audiotape therapy may be helpful. Using aportable cassette player has the advantages of be-ing simple, safe and socially acceptable and thepatients are given a degree of personal controlover symptoms.

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Figure 1. Rating of hallucinations (0 = none, 5 = continuous) during and after of four conditions applied between 10 am and2 pm. Series 1: Baseline; Series 2: music tape; Series 3: music and speech tape; Series 4: blanktape.

Severity

Time

am 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10