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Noticing the context and meaning of voices

Notice the setting, meaning and effects of one voice-hearing experience with your therapist.

Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed

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Use brief notes and your own words; voice-hearing experiences vary. Leave out detailed harmful commands. If voices tell you to harm yourself or others, or distress rises, pause, follow your safety plan and contact your team through the agreed route. If unavailable and help is urgent, use your agreed urgent-care contact. If a voice tells you to hurt yourself or someone else, tell your therapist or care team. If you feel you might act on it, call 999 or go to A&E. Your therapist will agree when to review your notes with you. This record is not monitored for urgent help. If you need help now, contact your team through the agreed route rather than waiting for someone to read an entry. Therapist note: Agree the review arrangements and complete the first entry together.

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When to use ‘Noticing the context and meaning of voices’

‘Noticing the context and meaning of voices’ is an interactive cognitive behavioural therapy (CBT) worksheet, most often used in CBT for psychosis.

It is designed to be used within therapy rather than as a standalone self-help tool: a therapist introduces it, works through it collaboratively, and helps make sense of what it surfaces. You can preview the full worksheet above, then assign it digitally for clients to complete between sessions on any device or download it as a print-ready PDF.

How it works

Most people work through it in around 10 minutes. It centres on one focused exercise:

  1. One experience

Completed on the Formulate platform, your client's answers are saved automatically and shared straight back to you, so you can review them before the next session rather than waiting for a paper copy to come back.

The CBT approach behind it

In common with other CBT methods, ‘Noticing the context and meaning of voices’ works by noticing the links between situations, thoughts, feelings, physical sensations and behaviour and finding practical ways to change unhelpful patterns. The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going and practical, testable ways to change it.

Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.

Evidence & sources

This worksheet is grounded in established cognitive behavioural therapy theory and practice. Key sources include:

  • Kingdon, D. G., & Turkington, D. (2005). Cognitive Therapy of Schizophrenia. Guilford Press.
  • Chadwick, P. (2006). Person-Based Cognitive Therapy for Distressing Psychosis. Wiley.

For use alongside professional support

Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.

If you need urgent help now:

  • Emergency services: 999 — if you or someone else is in immediate danger
  • NHS 111 (NHS 24 in Scotland): 111 — choose the mental health option for urgent help, in England, Scotland and Wales (in Wales, press 2)
  • Lifeline: 0808 808 8000 — for urgent help in Northern Ireland, free, day or night
  • Samaritans: 116 123 — free, day or night, 365 days a year
  • Shout: 85258 — text SHOUT, free, day or night
  • SANEline: 0300 304 7000 — 4pm–10pm, every day

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