The Auditory Vocal Hallucination Rating Scale (AVHRS) is a 16-item structured interview that rates how a person experiences auditory verbal hallucinations, commonly called hearing voices. Developed by Jenner and van de Willige, it captures the frequency, duration, loudness, distress, and daily interference of voices over a defined period, supporting a consistent clinical assessment of severity.
Why healthcare providers use the AVHRS
- Structured consistency. The interview guides each rater through the same questions and anchors, which reduces variation between clinicians and across visits.
- Multidimensional picture. It looks beyond how often voices occur to include distress, content, control, and interference with daily life, which single-item ratings miss.
- Change over time. Repeating the interview lets a team track whether voice-related distress and impact are improving or worsening over a treatment course.
- Shared language. Standardized ratings give clinicians, patients, and researchers a common way to describe voice-hearing and to guide clinical decision-making.
Which settings use the AVHRS?
- Community mental health teams. Outpatient psychiatry and psychology services use it to characterize voice-hearing and monitor it across appointments.
- Early psychosis services. Programs for first-episode and at-risk presentations use it to profile hallucinations at intake and follow-up.
- Inpatient psychiatric units. Ward teams use structured ratings to document severity and support continuity across staff and shifts.
- Research and specialist voices clinics. Studies and hearing-voices clinics use it as a validated outcome measure for auditory hallucinations.
What does the AVHRS measure?
The AVHRS evaluates the character and burden of auditory verbal hallucinations experienced during a set reference period, such as the past week or month. Rather than a single symptom count, it maps several dimensions of the voice-hearing experience so a clinician can describe both how present the voices are and how much they affect the person. Because the instrument is copyrighted by its authors, the domains are summarized below without reproducing the interview items.
- Phenomenology. Number, frequency, duration, loudness, and location of the voices.
- Content and form of address. Negative or positive content and whether voices speak in the first, second, or third person.
- Distress and interference. Anxiety, suffering, and disruption of thinking and daily functioning caused by the voices.
- Control and command content. Perceived ability to manage the voices and whether they instruct the person to act.
Scoring the AVHRS
- Number of items: 16 items delivered as a structured interview.
- Per-item scale: most items are rated 0 to 4 with descriptive anchors, with additional administrative codes for unclear or unasked items.
- Total score range: a severity score from 0 to 13 is derived from the most severe item ratings in the validation studies.
- Score direction: higher scores indicate more severe and more burdensome voice-hearing.
The AVHRS does not define official severity bands or a diagnostic cutoff. Item ratings and the derived severity score describe the current picture and support monitoring, but they do not replace clinical judgment. Interpret any score alongside history, risk, and the broader presentation, and consider further assessment when distress, control, or command content raises concern.
Best practices for administration
- Set the reference period. Agree on the window being rated, such as the past week or month, so ratings stay comparable over time.
- Use the anchors. Rate each item against its descriptive definitions rather than a general impression to keep scoring reliable.
- Probe before coding. Follow up unclear answers so each rating reflects what the person actually experiences.
- Attend to risk. When responses point to command voices or acting on them, follow your service's safety and escalation process.
- Repeat consistently. Re-administer at planned intervals with the same method to make change over time meaningful.
How Zentake helps with the AVHRS
- Automatic scoring. Zentake totals responses on submit, so there is no hand-tallying and no arithmetic errors.
- Longitudinal tracking. Re-send the form on a schedule and view change over time to see whether voice-related distress is shifting.
- Risk flagging. Concerning responses, such as command content, can be surfaced to staff so they are reviewed promptly.
- Before the visit. For mental health practices, patients can complete a self-report version from home on any device, with results ready before the appointment.
- HIPAA compliant. Responses are encrypted, and a signed BAA is included on every plan.
References
Jenner JA, van de Willige G. AVHRS: Auditory Vocal Hallucination Rating Scale. University Medical Center Groningen, University Center for Psychiatry, 2002. The instrument and manual are available from the Rob Giel Onderzoekcentrum.
Bartels-Velthuis AA, van de Willige G, Jenner JA, Wiersma D. Consistency and reliability of the auditory vocal hallucination rating scale (AVHRS). Epidemiology and Psychiatric Sciences, 2012, reporting the 16-item structure and the 0 to 13 severity score.
Steenhuis LA and colleagues. The development, validity, and reliability of the auditory vocal hallucination rating scale questionnaire (AVHRS-Q). Social Psychiatry and Psychiatric Epidemiology, 2019, describing the self-report questionnaire version.
Last updated: August 2026