The Auditory Vocal Hallucination Rating Scale (AVHRS) is a structured 16-item clinical interview developed by Jenner and van de Willige (1996, University Medical Center Groningen) that assesses the multidimensional characteristics of auditory vocal hallucinations (AVH). Items are rated on 4- and 5-point scales covering frequency, duration, loudness, negative content, distress, anxiety, perceived control, and interference with thinking and daily functioning. The AVHRS demonstrates excellent inter-rater reliability and good internal consistency (Bartels-Velthuis et al., 2012). Zentake's digital version enables secure, HIPAA-compliant administration with automated scoring and longitudinal tracking.
The AVHRS uses a structured interview format in which a trained clinician rates 16 items across multiple dimensions of auditory vocal hallucinations. Each item is scored on a 4- or 5-point scale depending on the dimension being assessed. Dimensions include the number of voices heard, frequency of occurrence, duration of episodes, loudness, location of voices, negative content, level of distress, degree of anxiety, sense of control over the voices, and interference with thinking and daily life activities.
Total severity scores are calculated by summing individual item ratings. Higher scores indicate more severe hallucination experiences. The AVHRS does not use a single clinical cutoff threshold; instead, clinicians interpret the severity profile across dimensions to guide treatment planning and monitor change over time.
Zentake automatically calculates the AVHRS severity score upon form submission, eliminating manual computation and allowing clinicians to focus on clinical interpretation and treatment decisions.
Step 1: Prepare the clinical environment. Ensure a private, quiet setting suitable for a structured clinical interview. Using Zentake, you can pre-load the AVHRS template and have it ready on a tablet or computer before the session begins.
Step 2: Introduce the assessment. Explain to the patient that the interview will cover their experiences with hearing voices over the past month. Emphasize that there are no right or wrong answers and that the goal is to understand their experiences as accurately as possible.
Step 3: Conduct the structured interview. Work through each of the 16 items systematically, asking about specific dimensions of the patient's auditory hallucination experience. Use Zentake's digital form to record responses in real time, reducing transcription errors and ensuring data completeness.
Step 4: Rate each dimension. Based on the patient's responses, rate each item on the appropriate 4- or 5-point scale. Zentake's form guides you through each dimension with clear anchoring descriptions for each rating level.
Step 5: Review results and plan treatment. After completing all items, review the automatically generated severity profile. Zentake stores historical AVHRS results, making it easy to track changes in hallucination severity across sessions and evaluate treatment effectiveness over time.
Scoring: Paper AVHRS requires manual addition of item ratings and hand-calculation of severity scores, increasing the risk of arithmetic errors. Zentake automatically computes total severity and dimension-level scores upon submission.
Completion: Paper administration takes approximately 20 minutes plus additional time for scoring and documentation. Zentake's guided digital format maintains the same 20-minute interview while eliminating post-interview paperwork.
Delivery: Paper forms must be printed, organized, and physically distributed to clinicians. Zentake delivers the AVHRS digitally to any device, ready for immediate use in any clinical setting.
Data Storage: Paper AVHRS forms require physical filing, are vulnerable to loss or damage, and must be stored in locked cabinets for compliance. Zentake stores all data in encrypted, HIPAA-compliant cloud infrastructure.
Longitudinal Tracking: Comparing paper AVHRS results over time requires manually retrieving and reviewing previous forms. Zentake displays severity trends across all historical administrations in a single dashboard view.
Security: Paper forms can be misplaced, accessed by unauthorized individuals, or damaged. Zentake uses encryption at rest and in transit, role-based access controls, and comprehensive audit logging.
Integration: Paper results must be manually entered into electronic health records. Zentake integrates directly with EMR systems, pushing completed assessment data without manual re-entry.
Cost: Paper administration involves ongoing printing, storage, and administrative labor costs. Zentake reduces per-assessment costs through digital automation and eliminates physical supply expenses.
What does the AVHRS measure?
The AVHRS measures the multidimensional characteristics of auditory vocal hallucinations, including frequency, duration, loudness, location, negative content, distress, anxiety, perceived control, and interference with daily functioning. It provides a comprehensive severity profile rather than a single score, helping clinicians understand the specific nature and impact of a patient's voice-hearing experiences. Zentake digitizes this assessment for efficient clinical use.
How do you score the AVHRS?
Each of the 16 items is rated on a 4- or 5-point scale by a trained clinician during a structured interview. Scores are summed to produce a total severity score, with higher scores indicating more severe hallucination experiences. Individual dimension scores can also be examined to identify specific areas of concern. Zentake automates all scoring calculations upon form completion.
How long does the AVHRS take to administer?
The AVHRS structured interview typically takes approximately 20 minutes to complete. This includes time for the clinician to ask about each dimension and rate responses. With Zentake's digital format, the interview duration remains the same, but post-interview documentation time is eliminated through automated scoring and EMR integration.
Is the AVHRS free to use?
The AVHRS is freely available for clinical and research use. The original scale can be obtained from the developers at the University Medical Center Groningen. Zentake offers a digital version of the AVHRS as part of its template library, available through a free trial with no setup fees.
What population is the AVHRS designed for?
The AVHRS was originally developed for adults experiencing auditory vocal hallucinations, most commonly in the context of schizophrenia and related psychotic disorders. It has also been validated for use with children and adolescents who report voice-hearing experiences (Bartels-Velthuis et al., 2012). The scale is appropriate for any clinical population where auditory hallucinations are present.
Who should administer the AVHRS?
The AVHRS should be administered by a trained mental health professional, such as a psychiatrist, psychologist, psychiatric nurse, or clinical researcher. The interviewer needs clinical experience with psychotic symptoms to accurately rate the hallucination dimensions. Zentake's guided digital format provides clear anchoring descriptions to support consistent rating across clinicians.
How is the AVHRS different from the AVHRS-Q?
The AVHRS is a clinician-administered structured interview, while the AVHRS-Q (Auditory Vocal Hallucination Rating Scale Questionnaire) is a self-report version developed by Bartels-Velthuis et al. (2019). The AVHRS-Q severity scores correlate strongly with the original AVHRS (r = 0.90), making it suitable for settings where clinician-administered interviews are not feasible. Both versions are available on Zentake.
Can the AVHRS track treatment progress?
Yes. The AVHRS is designed to be administered repeatedly over time to monitor changes in hallucination severity and characteristics. Zentake's longitudinal tracking feature automatically graphs AVHRS scores across administrations, making it easy to visualize treatment response and share progress data with patients and care teams.
1. Jenner, J. A., & van de Willige, G. (2002). Auditory Vocal Hallucination Rating Scale (AVHRS). University Medical Center Groningen.
2. Bartels-Velthuis, A. A., van de Willige, G., Jenner, J. A., & Wiersma, D. (2012). Consistency and reliability of the Auditory Vocal Hallucination Rating Scale (AVHRS). Epidemiology and Psychiatric Sciences, 21(3), 305–310.
3. Bartels-Velthuis, A. A., van de Willige, G., Jenner, J. A., Brilman, E., & Wiersma, D. (2019). The development, validity, and reliability of the Auditory Vocal Hallucination Rating Scale Questionnaire (AVHRS-Q). Social Psychiatry and Psychiatric Epidemiology, 54(8), 985–993.
Last updated: March 2026
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