Study data published in Psychiatry Research outline the clinical characteristics and treatment outcomes of patients with multimodal vs unimodal auditory hallucinations. In a cohort study of patients with verbal hallucinations (AVH), post-traumatic stress symptoms were more severe in patients reporting multimodal hallucinations. However, outcomes following outpatient care were similar between patient groups.

This study enrolled patients from an AVH treatment clinic in Western Australia. Sociodemographic information and clinical history were captured at baseline, including psychiatric diagnosis, medication use, and time of AVH onset. Patients completed a series of questionnaires assessing psychotic symptoms, past traumatic experiences, post-traumatic stress disorder (PTSD) symptoms, self-esteem, social and occupational functioning, and depression and anxiety symptoms.

Following the baseline visit, patients underwent Coping Strategy Enhancement, a therapy modality that incorporates a series of cognitive and behavioral workshops. Clinical questionnaires were re-administered after completion of treatment. Outcomes were compared between patients with unimodal and multimodal AVH.

Continue Reading

The study enrolled 111 adults, among whom 31 (27.9%) reported unimodal and 80 (72.1%) reported multimodal auditory hallucinations. Mean age in the total cohort was 34.3 (±12.73) years. Patients with multimodal hallucinations had a significantly younger age at onset compared with patients with unimodal hallucinations (20.2 vs 27.3 years; P =.007).

At baseline, clinical characteristics were not significantly different between groups. However, in a subgroup analysis of patients with prior traumatic experiences (n=65), those with multimodal hallucinations had significantly higher scores on the Post-Traumatic Stress Disorder Symptom Scale (PSS) compared to those with unimodal hallucinations.

At follow-up, both patient groups displayed significant improvements on the Psychotic Symptoms Rating Scale. The mean score was numerically lower in the unimodal group, but the difference was not statistically significant.

In this study of patients with AVH, Coping Strategy Enhancement appeared comparably effective for unimodal and multimodal hallucinations. Baseline characteristics were similar between patient groups, although multimodal hallucinations appeared to be more strongly associated with post-traumatic stress symptoms.

Study limitations include the small cohort size and relative demographic homogeneity. Replication in larger cohorts is necessary to better understand treatment outcomes in AVH.

“[Our] findings suggest that brief Coping Strategy Enhancement is comparably effective…and suitable for use with people seeking help for distressing unimodal hallucinations (AVH) or multimodal hallucinatory experiences,” the investigators wrote.


Badcock JC, Brand R, Thomas N, Hayward M, Paulik G. Multimodal versus unimodal auditory hallucinations in clinical practice: clinical characteristics and treatment outcomes. Published online January 23, 2021. Psychiatry Res. doi:10.1016/j.psychres.2021.113754