*2.1.8. The social rank theory of auditory hallucinations*

The social rank theory was generally used for depression and anxiety disorders but considering the parallel mechanisms within the scope of "attack the weaker and submit to the stronger," it was finally modified for hallucinations. Different from other cognitive theories, this theory considers *the patient's relationship with voices as well as with his significant others.* This approach uses the ABC framework. ABC model for auditory hallucinations of psychosis can be summarized as follows:


Activating events can be categorized into three types including symptoms and internal events (e.g., hallucinations), descriptions of interactions with significant others like parents or siblings, and significant life events (diagnosis, hospitalization, and social stigma). According to this theory, the hallucinations demonstrate *a core self-perception of low social rank*, so the person perceives that he/she is in control of his/her parents or peers and community. The emotional consequences of these evaluations can be shame, humiliation, and depression. In this context, the distress and behavior are related to patients' perceived relationship with voices, their appraisal of voices power and omnipotence, as a result they evaluate the voice as benevolent or malevolent [33, 36–38].

The explanations mentioned earlier would help to understand the occurrence of psychotic episodes. The following passages will also address the maintenance of these psychotic symptoms.
