Coping with voices: selective attention training for persistent auditory hallucinations in treatment refractory schizophrenia.

Attentional difficulties in people with schizophrenia are common and can be disabling. A number of cognitive rehabilitation interventions aim to improve attention span by having patients practice paying attention to various types of stimuli for increasing lengths of time. However, such interventions typically assume that the attention deficit is a form of negative symptom, reflecting a reduced ability to maintain an attentional focus. In the following case study, we describe a cognitive intervention for a patient whose inability to pay attention was the result of persistent, distracting, and disabling auditory hallucinations. The dichotic listening paradigm was modified to enable the patient to repeatedly practice attending to a source of relevant information, while ignoring irrelevant information that was gradually introduced to one, two, and then three spatial locations. A graded technique was used wherein difficulty level (i.e., number of stimulus sources and stimulus intensity) was increased only after near perfect performance was achieved on prior trials. Embedding this intervention within the context of a therapeutic relationship led to clear improvement in task performance over time, with concomitant better attentiveness on the inpatient unit, and an improved ability to engage in interviews at residential settings, leading to subsequent hospital discharge.