Can You Hear What I Hear: Exploring ability and perspective when matching loudness of auditory verbal hallucinations to audio volume

Introduction: Auditory verbal hallucinations (AVH) affect 60-80% of people with schizophrenia, yet existing assessment tools inadequately capture their phenomenological complexity. Aim: To determine whether individuals with schizophrenia spectrum disorders could accurately match auditory verbal hallucination loudness to an external audio track, and to explore participant perspectives on this approach. Methods: Eight participants with schizophrenia spectrum disorders and active AVHs rated loudness via a Likert scale and by adjusting a headphone audio track to match their experience. Structured interviews and thematic analysis captured participant viewpoints. Results: No significant correlation was found between audio tool and Likert scale scores. Seven of eight participants reported the audio tool provided greater precision in quantifying AVH loudness and better enabled them to convey their internal experience to others. Discussion: Audio-matching tools may offer meaningful advantages over traditional scales for quantifying AVH loudness, even where statistical convergence with existing measures is absent. Limitations: Small sample size; loudness alone cannot fully capture the qualitative experience of hearing voices. Implications: This tool shows promise for longitudinal tracking of AVH loudness. Recommendations: Further investigation of digital approaches to AVH assessment is warranted.