{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T06:00:11Z","timestamp":1779256811313,"version":"3.51.4"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,12,12]],"date-time":"2024-12-12T00:00:00Z","timestamp":1733961600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>In recent years there has been a notable expansion of psychotherapeutic approaches to treat people experiencing auditory verbal hallucinations (AVH). While many psychotherapists conceptualize voices as \u201cdissociative parts\u201d and apply therapeutic techniques derived from the field of dissociation, research investigating AVH from this perspective is limited. Despite the acknowledgment that voices encountered in dissociative identity disorder (DID) often exhibit high complexity and autonomy, there is a critical need for assessment tools capable of exploring voice complexity across different clinical groups. Such tools hold significant potential for aiding clinicians to identify patients who may benefit more from dissociation-based therapy approaches. This study aims to operationalize the concept of voice complexity (VC) by identifying its different dimensions and indicators. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using concept mapping procedures, 12 healthcare professionals and two voice-hearers participated in brainstorming, and 24 people with clinical backgrounds performed sorting and rating tasks. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seven dimensions of VC were identified: System Complexity, Content Complexity, Voice\u2019s Interest Complexity, Interaction Complexity with Voice-Hearer, Voice\u2019s Own Life, Voice Influence, and Voice\u2019s Vocal Characteristics. A\u00a0codebook for assessing VC with indicators for varying levels of complexity across these dimensions was developed and can be used with the Structured Clinical Interview for Voice-Hearers. Inter-rater reliability, measured by comparing the assessments of two interview transcripts by seven raters using Kendall\u2019s Coefficient, indicated substantial agreement in one interview (W = .613) and almost perfect agreement in the second (W = .805). <\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>The new instrument has promise as an effective tool for comparative studies exploring VC in diverse clinical and non-clinical populations, with potential implications for clinical practice and future research.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyt.2024.1441919","type":"journal-article","created":{"date-parts":[[2024,12,12]],"date-time":"2024-12-12T06:25:44Z","timestamp":1733984744000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Developing a codebook for assessing auditory hallucination complexity using mixed methods"],"prefix":"10.3389","volume":"15","author":[{"given":"Igor J.","family":"Pietkiewicz","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rados\u0142aw","family":"Tomalski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna M.","family":"He\u0142ka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,12,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291717002203","article-title":"Auditory hallucinations, not necessarily a hallmark of psychotic disorder","volume":"48","author":"Waters","year":"2018","journal-title":"psychol Med"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291712000165","article-title":"Auditory verbal hallucinations in patients with borderline personality disorder are similar to those in schizophrenia","volume":"42","author":"Slotema","year":"2012","journal-title":"psychol Med"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1080\/17522439.2013.796402","article-title":"A final common pathway to hearing voices: examining differences and similarities in clinical and non-clinical individuals","volume":"5","author":"Daalman","year":"2013","journal-title":"Psychosis"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbaa037","article-title":"The relationship between dissociation and symptoms of psychosis: a meta-analysis","volume":"46","author":"Longden","year":"2020","journal-title":"Schizophr Bull"},{"key":"B5","volume-title":"The haunted self: Structural dissociation and the treatment of chronic traumatization","author":"Van der Hart","year":"2006"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(15)00006-1","article-title":"Experiences of hearing voices: analysis of a novel phenomenological survey","volume":"2","author":"Woods","year":"2015","journal-title":"Lancet Psychiatry"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbaa095","article-title":"Voice-hearing and personification: characterizing social qualities of auditory verbal hallucinations in early psychosis","volume":"47","author":"Alderson-Day","year":"2021","journal-title":"Schizophr Bull"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.cpr.2004.08.006","article-title":"Are there two qualitatively distinct forms of dissociation? 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