One of the first things a good CBT for psychosis therapist does is hand the patient a piece of unexpected information: experiences like yours are more common than you think. Not exactly the same as everyone else's, not necessarily benign, but on a continuum with experiences that ordinary people have throughout their lives. This move is called normalising, and it sits near the heart of the CBTp approach. It is also one of the most misunderstood techniques in the field — both by patients who fear it dismisses what they are going through and by clinicians who confuse it with telling people their symptoms are "fine."
Normalising is the deliberate use of facts about how common psychotic-like experiences are in the general population to reduce the secondary suffering — the sense of being uniquely broken — that psychosis often produces.
Where the technique came from
Normalising was developed within the early CBTp work of David Kingdon and Douglas Turkington in the 1990s, and is described in detail in their textbook Cognitive Therapy of Schizophrenia. Around the same time, the Dutch psychiatrist Marius Romme and his colleague Patsy Hage launched the Hearing Voices movement after Romme realised that a substantial number of people in the general population heard voices and never came near a psychiatric service. Their book Accepting Voices made the case that voice-hearing is part of the human range of experience, not exclusively a sign of illness.
The technique was later embedded in the British NICE CG178 guideline as part of standard CBTp practice and is taught in essentially every CBTp training programme worldwide.
What the data say about commonness
Some illustrative findings:
- Population studies suggest 5 to 15% of people will hear a voice at some point in life that no one else hears, often briefly
- Hypnopompic and hypnagogic hallucinations (around sleep onset and waking) are reported by roughly 30% of people
- Bereaved people frequently report sensing or hearing the deceased; estimates range from 30 to 60%
- Sleep deprivation reliably produces brief hallucinations after 24 to 48 hours
- Sensory deprivation (think long-distance solo sailors) can produce vivid hallucinations
- Up to 1 in 10 people endorse some form of unusual belief that does not impair function
None of this means that the experiences of someone with schizophrenia are "the same" as those of someone with a brief hypnopompic voice. The intensity, frequency, distress, and behavioural impact are usually very different. But the existence of a continuum is real — and recognising it changes the meaning of one's own experience.
How normalising is delivered in session
The therapist does not lecture. The information is offered tentatively and personalised to what the patient describes:
- "You mentioned that you hear voices when you are very tired. Did you know that even people without any mental health diagnosis often start to have brief hallucinations after long periods without sleep?"
- "You said you sometimes feel that strangers are looking at you with significance. That kind of experience — feeling that things are personally meaningful — is something many people report after a stressful event or under pressure. It tends to fade as the stress fades."
- "What you are describing about your grandfather's voice happens for a lot of people after a death. It does not necessarily mean what you fear it means."
The aim is not to convince the patient there is nothing wrong. The aim is to remove the additional layer of suffering that comes from believing one's experiences are uniquely alien, monstrous, or evidence of being beyond help.
What normalising is not
- Not minimising — the experiences are real and often debilitating; the technique respects that
- Not dismissing — "everyone hears voices sometimes" said carelessly is harmful; said carefully and with personalisation, it can be liberating
- Not denying the diagnosis — schizophrenia is a real condition with biological underpinnings; normalising does not contradict this
- Not arguing the patient out of their distress — the work runs alongside acknowledgment of how hard the experiences are
Why it works
Several mechanisms have been proposed:
- Reduced shame — the sense of being uniquely broken often drives social withdrawal and hopelessness
- Reduced catastrophic appraisal — if voices do not necessarily mean "I am losing my mind," they can be approached more flexibly
- Increased openness to therapy — patients who feel less alien are more willing to engage with treatment
- Better engagement with self-help strategies — peer-led groups like the Hearing Voices Network offer powerful normalising experiences
The continuum of psychotic experience
The continuum framing has gone from controversial to mainstream over the past two decades. Researchers including Jim van Os, Richard Bentall, and Ron Kessler have argued that psychosis-spectrum experiences are distributed across the population, with diagnosis representing the more severe and impairing end. This view does not eliminate the diagnostic category — schizophrenia involves a constellation that goes beyond isolated experiences — but it reframes those experiences as variations rather than as a categorical break from normal.
What patients say after normalising
Common reactions, drawn from clinical experience:
- "I had no idea other people hear things too. I assumed it was just me."
- "I thought meaning the voice was a sign I was going to be locked up."
- "I have been hiding this for ten years. I cannot believe how much energy that took."
- "It does not make my voices easier — but I feel less afraid of myself."
Connections to peer support
The Hearing Voices Network, NAMI peer support groups (nami.org), and similar organisations all use normalising as a foundational principle. For many people, the experience of sitting in a room with others who hear voices accomplishes in an hour what individual therapy may take months to do. CBTp and peer support are complementary rather than competing.
For people considering this work
If your clinician has never offered any of this kind of context, it is reasonable to ask. "Are experiences like mine more common than I think?" is a fair question and a good clinician will answer it honestly. The answer often opens the door to the rest of CBTp.
This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.