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University of Iowa News Release

Nov. 17, 2004

UI Studies Treatments For Auditory Hallucinations

For nearly one in four people with schizophrenia, auditory hallucinations - unwanted sounds or "voices" that others cannot hear - don't go away even when medications treat other symptoms of the illness.

Researchers in the University of Iowa Roy J. and Lucille A. Carver College of Medicine are studying whether these individuals can find relief in two therapies used alone or in combination.

Led by Del Miller, Pharm.D., M.D., UI professor of psychiatry and a practitioner with UI Hospitals and Clinics, and Scott Temple, Ph.D., UI associate professor (clinical) of psychiatry, the team is studying the use of cognitive behavioral therapy (CBT) and repetitive transcranial magnetic stimulation (rTMS). People age 18 and older with schizophrenia or schizoaffective disorder who currently have auditory hallucinations on a daily basis are eligible for the study (contact information is provided below).

The investigators will see if they can replicate previous rTMS findings by Ralph Hoffman, M.D., associate professor of psychiatry at Yale University, whose studies showed a significant decrease in auditory hallucinations, and to extend that work by also studying CBT. The UI study will examine whether each treatment used alone can help those not aided by medications and whether using CBT followed by rTMS might "keep voices away" for longer periods of time.

"We believe that auditory hallucinations occur secondary to an abnormality in the part of the brain that perceives speech and sounds," Miller said. "We think that in people with schizophrenia who experience auditory hallucinations this area of the brain is overactive. rTMS is believed to slow down this neuronal area that is abnormally sped up in individuals with schizophrenia who hear voices."

rTMS uses a figure-eight-shaped paddle held to the head to non-invasively direct an electromagnetic force to a specific area of the brain. Patients are completely awake during the pain-free procedure. The procedure was used initially to help individuals with depression by treating the frontal region of the brain with 10 to 15 pulses per second. In the UI study on auditory hallucinations, the rTMS is being used to treat a different area of the brain - the temporal parietal region - and at a lower frequency of one pulse per second.

CBT, which also has been used extensively to treat depression and anxiety, focuses on getting patients to understand, recognize and appropriately respond to their auditory symptoms rather than on actually decreasing the symptoms.

"CBT involves having the patient understand the symptoms better and decreasing the emotional reaction to them," Miller said. "This helps decrease the overall stress associated with auditory hallucinations."

When patients with auditory hallucinations are asked where they believe the voices are coming from, some may say it is a higher power or strangers. "We try to help the patients think of alternative reasons for the symptoms of their mental illness and educate the patients that what is happening is due to an abnormality of their brain," Miller said.

He added, "Our study may show that if a person goes through CBT, which helps manage feelings about hearing voices, and then has rTMS, which can actually decrease the incidence of hearing voices, then it will really enforce to the patient that there is an abnormality in the brain and that the treatments can help."

It is estimated that between 60 and 70 percent of the 2.8 million people with schizophrenia in the United States experience auditory hallucinations, although for some people antipsychotic medications can control symptoms.

"For some people, hearing voices is constant. It may be a single clear audible voice or more like the background noise you hear when walking into a large room where many people are talking at once," Miller explained.

A minority of people report that the voices can be "comforting" or "good" voices, but more commonly people say the voices are negative, such as saying negative things about the person.

There will be four groups of patients in the study. Half of the patients will receive CBT for four weeks and then will be randomly assigned either to rTMS or inactive rTMS (placebo) for two weeks. The other half of the patients will be assigned to receive only rTMS or the inactive rTMS for two weeks.

The treatments are not a substitute for the use of currently prescribed medication. People with schizophrenia who have auditory hallucinations must be stable on their medications for the past month and continue on their medication regime throughout the study. Individuals who have a pacemaker or other metal assistive devices in their body and those who have had seizures or head trauma are not eligible to participate.

The study is funded by the Essel Foundation through the National Alliance for Research on Schizophrenia and Depression.

For more information contact the study coordinators, Tim Holman at 319-335-6769 or or Jane Kerr at 319-353-4955 or Toll-free inquiries may be made through UI Health Access at 800-777-8442.

University of Iowa Health Care describes the partnership between the UI Roy J. and Lucille A. Carver College of Medicine and UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide. Visit UI Health Care online at

STORY SOURCE: University of Iowa Health Science Relations, 5137 Westlawn, Iowa City, Iowa 5224-1178

MEDIA CONTACT: Becky Soglin, 319 335-6660

STUDY CONTACTS: Tim Holman at 319-335-6769 or or Jane Kerr at 319-353-4955 or Toll-free inquiries through UI Health Access at 800-777-8442.