Construction and validation of the Approve questionnaires - Measures of relating to voices and other people.

Background: The effectiveness of psychological treatments for auditory hallucinations ('voices') needs to be enhanced. Some forms of novel treatment are working within relational frameworks to support patients to relate assertively to distressing voices. Yet, no measure of assertive relating to voices is available to assess the extent to which this skill is developed during therapy. This study aimed to assess the factor structure and validity of two new questionnaires: a measure of relating to voices and a measure of social relating.

Methods: The relating measures were developed in consultation with members of the international research community and validated in a large sample (N = 402) of voice hearing patients within the UK. The measures were subjected to factor analysis and compared to measures of voice hearing, mental health and well-being to evaluate construct, convergent, discriminant, and criterion validity.

Results: Factor analysis confirmed a three-dimensional set of items that measure assertive and non-assertive (passive and aggressive) relating. This resulted in the validation of the 'Approve' questionnaires - two 15-item measures of relating to voices and other people.

Conclusion: The Approve questionnaires can be used to assess a patient's suitability for relationally-based psychological therapies for distressing voices and the extent to which assertive relating skills are developed during the therapy.