Abstract
Background: Studies of both clinical and non-clinical voice hearers suggest that distress is rather inconsistently associated with the perceived relationship between voice and hearer. It is also not clear if their beliefs about voices are relevant. Aims: This study investigated the links between attachment anxiety/avoidance, interpersonal aspects of the voice relationship, and distress whilst considering the impact of beliefs about voices and paranoia. Method: Forty-four voice-hearing participants completed a number of self-report measures tapping attachment, interpersonal processes in the voice relationship, beliefs about voices, paranoia, distress and depression. Results: Attachment avoidance was related to voice intrusiveness, hearer distance and distress. Attachment anxiety was related to voice intrusiveness, hearer dependence and distress. A series of simple mediation analyses were conducted that suggest that the relationship between attachment and voice related distress may be mediated by interpersonal dynamics in the voice-hearer relationship, beliefs about voices and paranoia. Conclusions: Beliefs about voices, the hearer's relationship with their voices, and the distress voices sometimes engender appear to be meaningfully related to their attachment style. This may be important to consider in therapeutic work.