Schizophrenia: Hearing Voices and How to Manage Them

Medically Reviewed by Jennifer Casarella, MD on May 13, 2022
5 min read

If you have schizophrenia and you hear voices, know that it’s not uncommon for people with the condition. Up to 80% of people diagnosed with schizophrenia have this symptom, too.

Doctors call them auditory hallucinations. It’s as if someone is speaking to you, but they’re not actually there. The voices feel very real and can be distracting and stressful. This can affect your overall quality of life. In severe cases, these voices may trigger thoughts of suicide or violence.

While the voices go away for some, for many, they never completely fade. But it’s possible to learn to manage them and take back some control in your day-to-day life.

Prescription medications and talk therapy can help.

Medications. Antipsychotic medications are commonly prescribed for schizophrenia and can help in a number of ways. The drugs can:

  • Lessen the urge to interact with voices or listen to them
  • Help you ignore some of the criticism you may hear
  • Make the voices less frightening
  • Make the voices less intrusive or “in your face”

Drugs work differently for everyone. Tell your doctor if you don’t think your medication is helping. They may switch you to another one or change the dose. They might also try a combination of drugs.

It’s also important to give whatever medication you’re on a chance to do its job. If our doctor says it may take 2 weeks, 3 months, or whatever time frame to work, allow that much time to pass before deciding to try something else.

Cognitive behavioral therapy (CBT). This is when a mental health professional helps you work through what the voices mean, how they make you feel, and how they control what you think about yourself.

CBT can:

  • Lessen anxiety about hearing voices
  • Help you stand up to them
  • Help you build control over the voices

If you can’t go in person, look into telehealth options. This way, you can get help from the comfort of your own home. If you’re not sure how to get started, ask your doctor about it.

Avatar therapy. This is a newer form of talk therapy where computer technology is used to make an avatar, or animated version, of the voices you hear. The avatar can be human or nonhuman. It can also be built to mimic the gender, tone, and accent of the voices you hear. The goal of avatar therapy is to use the computer-generated form of your voices to learn ways to resist them and gain more self-control. The therapist usually sits in another room and is there for support if you need it.

A few small-scale studies have shown that avatar therapy may help make the voices appear less often and ease overall stress. But more research is needed to learn about how effective it is and the long-term effects. This type of therapy may be right for you if you’re still hearing voices even with medication. It usually lasts 6 weeks, with 30-minute sessions once a week.

Support groups. This can help you connect with others who also hear voices or live with similar schizophrenia-related issues. You can build community and find support, while also sharing what works for you to manage your day-to-day life with this condition. The National Alliance on Mental Illness (NAMI) is a good support resource.

Repetitive transcranial magnetic stimulation (RTMS). It’s a painless, noninvasive procedure in which an electromagnetic coil is placed on your scalp near your forehead. The coil sends magnetic pulses that stimulate nerve cells in this area. Experts are not entirely sure how it works, but they think it affects the regions of your brain that control mood and depression. Research suggests RTMS sessions can help make the voices appear less often and make them less intense. It may even keep voices at bay for up to 3 months after treatment. More research is needed.

Ways you can try to control the effects of voices include:

Find distractions. Staying busy or focusing on something else to keep your mind occupied may help. This might drown out the voices or distract you from them.

Options include:

  • Puzzles or games
  • Listening to music
  • Reading a book
  • Watching TV
  • Writing
  • Household chores

Try out a few different things to see what works best for you.

Vocalization. Talking out loud might help keep the voices from flooding your thoughts and causing trouble. Besides talking, you can hum tunes, sing, or read out loud.

Keep a diary. Write down each time you hear voices, how they make you feel, and what effect they have on your mental and physical health. Try to write down the date, time, and place. Make a note of what you were doing right before the voices started. This can help you:

  • Recognize a pattern if there is one
  • Build self-awareness
  • Find what triggers the voices

Sharing it with your doctor or therapist can also give them a better idea of the help you need.

Avoid drugs and alcohol. They can worsen symptoms and may trigger paranoia or visual hallucinations (when you see things that aren’t there). Drugs and alcohol can also affect how well your antipsychotic medication works.

Find ways to relax. Schizophrenia symptoms tend to get worse if you’re stressed. Try relaxation techniques like yoga, meditation, or mindful breathing to manage stress and lower anxiety.

Be assertive. If the voices are gaining control over your actions and thoughts, try to confidently speak back. For example, you can say out loud, “I’m too busy to talk right now” or “I can talk after 7 p.m.” This may help you gain some control and “negotiate” or set boundaries with the voices.

Practice selective listening. Voices can often range from positive to negative. Try to pay attention or engage only when the voices are positive. This may take time and practice. Talk to your doctor or therapist if you’re not sure how to do this.

Call 911 or head to the nearest hospital If the voices get too strong, mean, or dangerous.