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Yale Researchers Develop First Tool to Measure the Amount and Types of Control Voice-hearers Exhibit

January 26, 2022

From hearing your name to full sentences, hearing voices that others don’t is more common than many know, occurring in up to 15% of the general population. Auditory hallucinations can be part of schizophrenia and other psychotic illnesses, causing significant distress and impairment. However, many voice-hearers never feel the need to seek help and function well anyway. Yale researchers sought to understand how.

The answer may lie in control. Albert Powers, MD, PhD, assistant professor of psychiatry and senior author of this study, defined voluntary control over voices “as the ability to intentionally influence the timing, frequency, or intensity of voice hearing experiences.” Although not recognized by psychiatry for many decades, voluntary control over voice-hearing has been the focus of a growing number of studies. This work has increasingly shown that voluntary control over voice-hearing experiences may protect against the distress and functional impairment often associated with these experiences.

“When a voice-hearer told me for the first time that they had learned to turn their voices on and off at will, I was floored,” Powers said. “Now we’ve developed a way to measure that ability so that we can enhance it and help people function.”

In the new study, published in Schizophrenia Bulletin, the researchers developed and validated the first tool to measure the amount and types of control voice-hearers exhibit: the Yale Control Over Perceptual Experiences (COPE) Scales. Powers’s laboratory worked with a large team of voice-hearers and advocates to develop the COPE Scales. The team interviewed and piloted individual scale items in over 50 voice-hearers, honing them to reflect experiences of control in voice-hearers both with and without a need for psychiatric care. The final COPE Scales, which use 18 questions to measure control over voices and how that control is exerted, were then validated in over 318 voice-hearers internationally through the ongoing online COPE Project (

In addition to validating the Yale COPE Scales, the new study showed that some methods of exerting control may be better than others. The most effective methods involved engagement with the voices. Engagement included listening, talking with, and establishing boundaries for when voice-hearers would hear voices.

“Very few people were born with the ability to control their voice-hearing experiences,” said Dr. Catalina Mourgues, lead author of the study. “But many of them gained that ability by engaging with their voices.”

However, not all voice-hearers control their voices through engagement. Some try listening to music, meditating, or hanging out with other people to stop the voices or distract themselves. However, ignoring your problems (or voices) is not nearly as effective as facing them. Those who employ engagement strategies tend to have greater control.

“We know from groups like the Hearing Voices Movement and spiritual groups across the world that getting to know and understand these experiences is extremely important for being able to function,” said Brittany Quagan, co-director of the COPE Project, self-identified voice-hearer, and co-author on the study.

The Yale COPE Scales are a self-report tool and don’t require lengthy structured interviews and clinician ratings. As a result, patients can complete the scales multiple times over the course of treatment so that their control development can be tracked and helped by clinicians. This may be most impactful in the earliest phases of psychosis, such as the so-called prodromal phase of the illness that precedes the onset of frank psychosis. Quagan and Powers are both clinicians at the PRIME Clinic, which treats patients who may be experiencing the psychosis prodrome.

“We want to help people develop control over their voice-hearing experiences, whether through therapy or more brain-based methods like neurofeedback,” Powers said. “But the first step is being able to measure control. We now have the ability to do that.”

Submitted by Christopher Gardner on January 26, 2022