• Development of an Instrument for Assessment of Auditory Hallucinations in Schizophrenia

      Frederick, Jane A; Department of Physiological and Technological Nursing (2000-03)
      The purpose of this study was to develop and assess the psychometrics of an instrument for the assessment of auditory hallucinations in schizophrenia and other psychiatric disorders. Development of the Auditory Hallucination Assessment Scale (AHAS) was guided by Albert Ellis’ reformulated model of Rational Emotive Behavior Therapy, the ABCD model. Applied to auditory hallucinations, the ABCD model asserts that distress and maladaptive coping behaviors are consequences not of the hallucination itself, but of the individual’s beliefs about the hallucination. An initial draft of the AHAS was submitted to an expert panel for assessment of content validity. The revised version of the AHAS is a 32 item self-report. Likert scale items describe characteristics, beliefs and attitudes about hallucinations and consequences of hallucinations. The psychometric properties of the AHAS were studied in a convenience sample of 151 clients in psychosocial rehabilitation outpatient day programs in two Georgia counties. Participants also completed two other hallucination scales, and one depression scale. Exploratory factor analysis was used to determine the underlying factor structure of the items and to assess the construct validity of the AHAS. The factor analysis resulted in a three-factor model which delineated three differing clinical symptom patterns of auditory hallucinations. The factors were labeled Troublesome Voices, Dangerous Voices, and Nurturing Voices. Rather than dividing the hallucinatory experience into three cognitive components as in the theoretical model, the factors reflected connections between the characteristics, beliefs, and consequences of auditory hallucinations. Thus, each of the constructs of the theoretical model operates within each of the resulting factors. The Troublesome Voices Factor consists of items indicating distressing auditory hallucinations and attempts to cope with them. The items on this factor indicate self-awareness and reflect behavioral or emotional reactions to the voices. The items on the Dangerous Voices Factor reflect beliefs that the voices are bad, hostile and powerful. The Nurturing Voices Factor items indicate that the individual experiences soothing and comforting voices. Finally, it is clinically significant that all participants in the sample, ninety-one percent of whom had schizophrenia or schizoaffective disorder, were able to complete the AHAS without difficulty.