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Luhrmann TM, Chen XA, Baumeister D, Peters E. When Spirit Calls: A Phenomenological Approach to Healthy Voice-Hearers. SCHIZOPHRENIA BULLETIN OPEN 2023; 4:sgad025. [PMID: 39145340 PMCID: PMC11207670 DOI: 10.1093/schizbullopen/sgad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
We present a mixed-methods study, from an anthropological perspective, of 22 healthy voice-hearers ie, people who report hearing voices but have no need for clinical care. They were interviewed using the Varieties Of Individual Voice-Experiences Scale (VOICES), a new scale assessing phenomenology, beliefs and relationships with voices, and their emotional and behavioral impact. Despite in many cases hearing voices daily, they report remarkably little distress, with almost all mentioning a positive impact on their life. Most interpreted their voices as spirits, and spoke of learning to understand, to manage, and even to train their experience of communicating with spirits productively. There was, however, considerable diversity in their voice experiences. Some described experiences they seemed to have discovered after starting a practice. Others described reaching for a practice to make sense of unusual experiences. This raises the possibility that cultural ideas about spirit communication may have two effects. On the one hand, they may help those who begin to hear voices involuntarily to interpret and manage their experience in a non-threatening way, through a meaning framework imposed on experiences. On the other hand, it also suggests that cultural ideas about spirit communication may lead some people to identify some thoughts as voices, and to come to feel that those thoughts are generated outside of themselves, through a meaning-framework shaping experiences. This should remind us that the culture-mind relationship is complex. There may be different kinds of phenomena described by individuals as "voices," with practice and interpretation changing how these phenomena are experienced.
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Affiliation(s)
| | | | - David Baumeister
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Emmanuelle Peters
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London SE5, UK
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Buck B, Munson J, Chander A, Wang W, Brenner CJ, Campbell AT, Ben-Zeev D. The relationship between appraisals of auditory verbal hallucinations and real-time affect and social functioning. Schizophr Res 2022; 250:112-119. [PMID: 36399900 PMCID: PMC9750498 DOI: 10.1016/j.schres.2022.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 09/03/2022] [Accepted: 10/30/2022] [Indexed: 11/18/2022]
Abstract
In addition to being a hallmark symptom of schizophrenia-spectrum disorders, auditory verbal hallucinations (AVH) are present in a range of psychiatric disorders as well as among individuals who are otherwise healthy. People who experience AVH are heterogeneous, and research has aimed to better understand what characteristics distinguish, among those who experience AVH, those who experience significant disruption and distress from those who do not. The cognitive model of AVH suggests that appraisals of voices determine the extent to which voices cause distress and social dysfunction. Previous work has relied largely on comparisons of "clinical" and "non-clinical" voice hearers, and few studies have been able to provide insight into the moment-to-moment relationships between appraisals and outcomes. The current study examines longitudinal data provided through ecological momentary assessment and passive sensors of 465 individuals who experience cross-diagnostic AVH. Results demonstrated associations of AVH appraisals to negative affect and social functioning. Above and beyond within-individual averages, when a participant reported increased appraisals of their voices as powerful and difficult to control, they were more likely to feel increased negative affect and reduced feelings of safety. AVH power appraisals were also associated with next-day number and duration of phone calls placed, and AVH controllability appraisals were associated with increased time near speech and reduced next-day time away from primary location. These results suggest that appraisals are state-like characteristics linked with day-to-day and moment-to-moment changes in impactful affective and behavioral outcomes; intervention approaches should aim to address these domains in real-time.
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Affiliation(s)
- Benjamin Buck
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States of America.
| | - Jeffrey Munson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States of America
| | - Ayesha Chander
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States of America
| | - Weichen Wang
- Department of Computer Science, Dartmouth College, Hanover, NH, United States of America
| | - Carolyn J Brenner
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States of America
| | - Andrew T Campbell
- Department of Computer Science, Dartmouth College, Hanover, NH, United States of America
| | - Dror Ben-Zeev
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States of America
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Dave B, O'Connor C. A systematic review of the antecedents, correlates, and consequences of continuum beliefs about depression. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kusztrits I, Toh WL, Thomas N, Larøi F, Meyers D, Hirnstein M, Rossell S. From core schemas about the self and others to voice phenomenology: Anxiety and depression affect voice hearers differently. Psychol Psychother 2022; 95:493-507. [PMID: 35157776 PMCID: PMC9305789 DOI: 10.1111/papt.12384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/16/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Auditory verbal hallucinations (AVHs) occur as a symptom in various mental disorders, and show different phenomenological aspects, depending on their underlying psychopathology. Anxiety and depression, which are known to be involved in the development of AVHs, are suggested to amplify a vicious cycle in which negative interpretations of daily experiences feed into the formation of negative core schemas about the self and others. However, the way in which these variables interrelate is still unknown. Therefore, our aim was to determine the specific roles of anxiety and depression in the relationship between core schemas and emotional aspects of AVHs for three groups (non-clinical voice hearers, affective voice hearers and non-affective voice hearers). METHODS Positive and negative core schemas of the self and others were tested as predictors of emotional distress due to AVHs, examining anxiety and depression separately as potential mediators. RESULTS Results showed full mediating effects of depression in non-affective voice hearers in the relationship between negative core schemas and AVH distress, but not in affective voice hearers. Anxiety was not a mediator in any of the groups. CONCLUSIONS These findings suggest different emotional mechanisms depending on the underlying psychopathology.
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Affiliation(s)
- Isabella Kusztrits
- Department of Biological and Medical PsychologyUniversity of BergenBergenNorway,NORMENT Norwegian Centre for Mental Disorders ResearchUniversity of Bergen & Haukeland University HospitalBergenNorway
| | - Wei Lin Toh
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Neil Thomas
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Frank Larøi
- Department of Biological and Medical PsychologyUniversity of BergenBergenNorway,NORMENT Norwegian Centre for Mental Disorders ResearchUniversity of Bergen & Haukeland University HospitalBergenNorway,Psychology and Neuroscience of Cognition Research UnitUniversity of LiègeLiègeBelgium
| | - Denny Meyers
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Marco Hirnstein
- Department of Biological and Medical PsychologyUniversity of BergenBergenNorway,NORMENT Norwegian Centre for Mental Disorders ResearchUniversity of Bergen & Haukeland University HospitalBergenNorway
| | - Susan Rossell
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia,PsychiatrySt Vincent’s HospitalMelbourneVictoriaAustralia
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5
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Mourgues C, Hammer A, Fisher V, Kafadar E, Quagan B, Bien C, Jaeger H, Thomas R, Sibarium E, Negreira AM, Sarisik E, Polisetty V, Nur Eken H, Imtiaz A, Niles H, Sheldon AD, Powers AR. Measuring Voluntary Control Over Hallucinations: The Yale Control Over Perceptual Experiences (COPE) Scales. Schizophr Bull 2022; 48:673-683. [PMID: 35089361 PMCID: PMC9077437 DOI: 10.1093/schbul/sbab144] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Auditory verbal hallucinations (AVH) frequently cause significant distress and dysfunction, and may be unresponsive to conventional treatments. Some voice-hearers report an ability to fully control the onset and offset of their AVH, making them significantly less disruptive. Measuring and understanding these abilities may lead to novel interventions to enhance control over AVH. Fifty-two voice-hearers participated in the pilot study. 318 participants with frequent AVH participated in the validation study. A pool of 59 items was developed by a diverse team including voice-hearers and clinicians. After the pilot study, 35 items were retained. Factorial structure was assessed with exploratory (EFA, n = 148) and confirmatory (CFA, n = 170) factor analyses. Reliability and convergent validity were assessed using a comprehensive battery of validated phenomenological and clinical scales. CFA on the final 18 items supported two factors for a Methods of Control Scale (5 items each, average ω = .87), and one factor for a Degree of Control Scale (8 items, average ω = .95). Correlation with clinical measures supported convergent validity. Degree of control was associated with positive clinical outcomes in voice-hearers both with and without a psychosis-spectrum diagnosis. Degree of control also varied with quality of life independently of symptom severity and AVH content. The Yale control over perceptual experiences (COPE) Scales robustly measure voice-hearers' control over AVH and exhibit sound psychometric properties. Results demonstrate that the capacity to voluntarily control AVH is independently associated with positive clinical outcomes. Reliable measurement of control over AVH will enable future development of interventions meant to bolster that control.
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Affiliation(s)
| | | | | | - Eren Kafadar
- Yale University School of Medicine, New Haven, CT,USA
| | | | - Claire Bien
- Yale University School of Medicine, New Haven, CT,USA
| | - Hale Jaeger
- Yale University School of Medicine, New Haven, CT,USA
| | - Rigi Thomas
- Southwest College of Naturopathic Medicine, Tempe, AZ, USA
| | - Ely Sibarium
- Yale University School of Medicine, New Haven, CT,USA
| | | | - Elif Sarisik
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Vasishta Polisetty
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Hatice Nur Eken
- School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Ayyub Imtiaz
- Faculty of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
| | - Halsey Niles
- Yale University School of Medicine, New Haven, CT,USA
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Reddyhough C, Locke V, Badcock JC, Paulik G. Changing Attitudes Towards Voice Hearers: A Literature Review. Community Ment Health J 2021; 57:1032-1044. [PMID: 33068204 DOI: 10.1007/s10597-020-00727-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 10/06/2020] [Indexed: 01/11/2023]
Abstract
Auditory verbal hallucinations, or voice hearing, is increasingly understood as a common experience. Despite this, voice hearers still experience a great deal of stigma, which can have serious negative impacts on the person's experience of their voices, and their recovery. Research has demonstrated that healthcare professionals may be a major source of the stigma surrounding voice hearing, with service-level implications for the development and delivery of evidence-based interventions. Therefore, reducing this stigma is a critical intervention target. The purpose of this narrative review is to examine evidence for interventions aimed at reducing stigma towards people who hear voices, in populations of healthcare professionals, students, and the general public. The available evidence supports the use of anti-stigma interventions based around direct contact with voice hearers and education about voice hearing. However, further research is necessary in this area to confirm these findings.
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Affiliation(s)
- Caitlin Reddyhough
- Discipline of Psychology, Murdoch University, Building 440, 90 South Street, Murdoch, WA, 6150, Australia.
| | - Vance Locke
- Discipline of Psychology, Murdoch University, Building 440, 90 South Street, Murdoch, WA, 6150, Australia
| | - Johanna C Badcock
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
- Perth Voices Clinic, Murdoch, WA, Australia
| | - Georgie Paulik
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
- Perth Voices Clinic, Murdoch, WA, Australia
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7
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Ben-Zeev D, Buck B, Chander A, Brian R, Wang W, Atkins D, Brenner CJ, Cohen T, Campbell A, Munson J. Mobile RDoC: Using Smartphones to Understand the Relationship Between Auditory Verbal Hallucinations and Need for Care. ACTA ACUST UNITED AC 2020; 1:sgaa060. [PMID: 33937774 PMCID: PMC8061119 DOI: 10.1093/schizbullopen/sgaa060] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objective Auditory verbal hallucinations (AVH) are common in multiple clinical populations but also occur in individuals who are otherwise considered healthy. Adopting the National Institute of Mental Health's Research Domain Criteria (RDoC) framework, the aim of the current study was to integrate a variety of measures to evaluate whether AVH experience varies across clinical and nonclinical individuals. Methods A total of 384 people with AVH from 41 US states participated in the study; 295 participants (77%) who received inpatient, outpatient, or combination treatments for AVH and 89 participants (23%) who never received care. Participants used a multi-modal smartphone data collection system to report on their AVH experiences and co-occurring psychological states multiple times daily, over 30 days. In parallel, smartphone sensors recorded their physical activity, geolocation, and calling and texting behavior continuously. Results The clinical sample experienced AVH more frequently than the nonclinical group and rated their AVH as significantly louder and more powerful. They experienced more co-occurring negative affect and were more socially withdrawn, spending significantly more time at home and significantly less time near other people. Participants with a history of inpatient care also rated their AVH as infused with significantly more negative content. The groups did not differ in their physical activity or use of their smartphones for digital communication. Conclusion Smartphone-assisted remote data collection revealed real-time/real-place phenomenological, affective, and behavioral differences between clinical and nonclinical samples of people who experience AVH. The study provided strong support for the application of RDoC-informed approaches in psychosis research.
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Affiliation(s)
- Dror Ben-Zeev
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Benjamin Buck
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Ayesha Chander
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Rachel Brian
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Weichen Wang
- Department of Computer Science, Dartmouth College, Hanover, NH
| | - David Atkins
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Carolyn J Brenner
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Trevor Cohen
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.,Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA
| | - Andrew Campbell
- Department of Computer Science, Dartmouth College, Hanover, NH
| | - Jeffrey Munson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
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Schizotypy but not Cannabis Use Modestly Predicts Psychotogenic Experiences: A Cross-Sectional Study Using the Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE). JOURNAL OF ADDICTION 2020; 2020:5961275. [PMID: 33123406 PMCID: PMC7582076 DOI: 10.1155/2020/5961275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/14/2020] [Accepted: 09/26/2020] [Indexed: 11/25/2022]
Abstract
Objective Cannabis use predicts psychosis in longitudinal studies, but it is difficult to infer causation. Some precursor variables predict both, including childhood trauma and adversity. Additionally, some of the desired effects of cannabis use resemble the symptoms of psychosis. It would be preferable to assess psychotomimetic or “unusual” experiences that include psychotic symptoms but without assuming pathology. Finally, it is possible that similar people are prone to psychosis and drawn to cannabis use, perhaps, because they are sensitive or attracted to unusual experiences. Schizotypy provides a trait measure of proneness to unusual experiences. The study aimed to examine cross-sectionally relationships between cannabis use, schizotypy, and unusual experiences whilst controlling for current trauma symptoms. Method A volunteer online sample (n = 129, 64% women, predominantly students) who had used cannabis at least once was recruited. People who reported active effects of past trauma were excluded with a brief primary care posttraumatic stress disorder screen. Participants completed the Oxford-Liverpool Inventory of Feelings and Experience, the Cognitive Failures Questionnaire, and measures of substance use and sociodemographics. Results The majority of respondents recounted unusual experiences after cannabis use, and many of these might have been considered symptoms of psychosis if they had received medical attention. In regression analysis, the only predictor of the unusual experiences scale of O-LIFE was schizotypy (measured by the remaining subscales; 4% of variance). There were no correlations between cannabis use frequency and schizotypy or unusual experiences. Conclusions These findings suggest that, after controlling for schizotypy and excluding people who are actively experiencing the effects of past trauma, frequency of cannabis use does not predict unusual experiences. However, individuals with schizotypal personality traits may have more unusual experiences when using cannabis.
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Swyer A, Powers AR. Voluntary control of auditory hallucinations: phenomenology to therapeutic implications. NPJ SCHIZOPHRENIA 2020; 6:19. [PMID: 32753641 PMCID: PMC7403299 DOI: 10.1038/s41537-020-0106-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/04/2020] [Indexed: 12/11/2022]
Abstract
Auditory verbal hallucinations (AVH) have traditionally been thought to be outside the influence of conscious control. However, recent work with voice hearers makes clear that both treatment-seeking and non-treatment-seeking voice hearers may exert varying degrees of control over their voices. Evidence suggests that this ability may be a key factor in determining health status, but little systematic examination of control in AVH has been carried out. This review provides an overview of the research examining control over AVH in both treatment-seeking and non-treatment-seeking populations. We first examine the relationship between control over AVH and health status as well as the psychosocial factors that may influence control and functioning. We then link control to various cognitive constructs that appear to be important for voice hearing. Finally, we reconcile the possibility of control with the field’s current understanding of the proposed cognitive, computational, and neural underpinnings of hallucinations and perception more broadly. Established relationships between control, health status, and functioning suggest that the development of control over AVH could increase functioning and reduce distress. A more detailed understanding of the discrete types of control, their development, and their neural underpinnings is essential for translating this knowledge into new therapeutic approaches.
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Affiliation(s)
- Ariel Swyer
- Department of Behavioral Sciences, York College/CUNY, Jamaica, NY, USA
| | - Albert R Powers
- Department of Psychiatry and the Connecticut Mental Health Center, Yale University, New Haven, CT, USA.
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Laloyaux J, Collazzoni A, Hirnstein M, Kusztrits I, Larøi F. Personal resilience factors protect against distressing auditory hallucinations: A study comparing psychotic patients with auditory hallucinations, non-patients with auditory hallucinations, and healthy controls. Psychiatry Res 2020; 290:113058. [PMID: 32480117 DOI: 10.1016/j.psychres.2020.113058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 01/23/2023]
Abstract
Although studies have identified several risk factors for the development of psychotic disorders, potential protective factors - such as resilience - have rarely been examined. Studies suggest that the negative beliefs people hold about their Auditory Hallucinations (AH) may be an indicator of a need for care. However, the reason why certain people do not develop negative beliefs is unclear but may be related to resilience. The present study aimed to examine the role of resilience in AH by comparing psychotic patients with AH, non-patients with AH, and healthy controls without AH. Another aim was to explore whether resilience is related to the beliefs people hold about their AH. Results revealed that patients with AH and non-patients with AH had similarly weak interpersonal resilience factors compared to healthy controls without AH. In contrast, patients with AH showed weak personal factors of resilience compared to both non-patients with AH and healthy controls without AH. Patients with AH had more negative and fewer positive beliefs about their AH than non-patients with AH. Finally, the personal factors of resilience were related to the beliefs about AH. These results showed that personal factors of resilience are decisive variables influencing the need for care in people experiencing AH and thus represent an important treatment target.
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Affiliation(s)
- Julien Laloyaux
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway; NORMENT - Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway; Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium.
| | - Alberto Collazzoni
- Renewed Freedom Center for Rapid Anxiety Relief, Division of Strategic Cognitive Behavioral Institute, Los Angeles, CA, USA
| | - Marco Hirnstein
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Isabella Kusztrits
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Frank Larøi
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway; NORMENT - Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway; Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
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11
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Carden LJ, Saini P, Seddon C, Evans E, Taylor PJ. Shame, social deprivation, and the quality of the voice-hearing relationship. Psychol Psychother 2020; 93:292-308. [PMID: 30729646 DOI: 10.1111/papt.12216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 12/05/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Many individuals hold different beliefs about the voices that they hear and have distinct relationships with them, the nature of which may determine the distress experienced. Understanding what factors contribute to these beliefs and relationships and consequently the resulting distress is important. The current research examined whether shame and social deprivation, in a sample of adult voice-hearers, were related to the relationships that individuals had with their voices or the beliefs that they held about them. DESIGN The study utilized a cross-sectional, Internet-based design. METHODS Eighty-seven adult voice-hearers from England were recruited to the online survey. Participants completed measures regarding shame, beliefs about voices, and relationships with voices and provided demographic information and postcodes that were used to refer to Index of Multiple Deprivation data. RESULTS Social deprivation and shame were not associated. Shame was positively associated with variables describing negative voice-hearing beliefs/relationships but not positive voice-hearing beliefs/relationships. Principal component analysis on the eight voice-hearing variables yielded two components related to positive and negative voice-hearing qualities. A multiple regression conducted on the two components identified that shame was only associated with negative voice-hearing qualities. CONCLUSIONS The results suggest that therapies that target shame may be helpful when working with negative voice-hearing beliefs and relationships. Future research should utilize experimental or longitudinal designs to examine the direction of the relationship. PRACTITIONER POINTS The results contribute to the limited research evidence available regarding the relationship between shame and voice-hearing. The results suggest the utility of psychological therapies that focus on shame such as compassion-focused therapy and that conceptualize voices interpersonally such as cognitive analytic therapy. No conclusions can be made regarding causation. The sample size was relatively small, and results cannot be generalized to other areas of the United Kingdom. Future research should utilize experimental and longitudinal designs to examine the impact of shame on voice-hearing experiences and to examine other factors that may predict shame.
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Affiliation(s)
- Louise J Carden
- Single Point of Access, Mersey Care NHS Trust, Liverpool, UK
| | - Pooja Saini
- Institute of Psychology, Health and Society, NIHR CLAHRC NWC, University of Liverpool, UK.,Natural Sciences and Psychology, Liverpool John Moores University, UK
| | - Claire Seddon
- Liverpool Early Intervention Service, Mersey Care NHS Trust, UK
| | - Emma Evans
- Bootle Community Mental Health Team, Mersey Care NHS Trust, UK
| | - Peter James Taylor
- Division of Psychology and Mental Health, Manchester Academic Health Sciences Centre, University of Manchester, UK
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12
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The Phenomenon of "Hearing Voices": Not Just Psychotic Hallucinations-A Psychological Literature Review and a Reflection on Clinical and Social Health. Community Ment Health J 2019; 55:811-818. [PMID: 30535890 DOI: 10.1007/s10597-018-0359-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 12/04/2018] [Indexed: 10/27/2022]
Abstract
The phenomenon of hearing voices is currently a much-discussed topic, both in the field of research and in the field of care services. The majority of people who report "hearing voices" do not subsequently receive services or receive a diagnosis of psychopathology. This topic raises questions for professionals in the health field about the lack of tools that can help illuminate the phenomenon. The purposes of this work are (a) to highlight the psychological studies that approach the phenomenon in a non-psychopathological way and (b) to determine which concepts could aid the comprehension of the phenomenon. The method consists of a systematic review of the literature that characterizes the phenomenon of hearing voices from a non-pathological perspective. The literature offers different theoretical approaches to interpret the phenomenon in a way that is not necessarily pathological and presents new tools for examining the phenomenon. For example, a few studies state that it is possible to coexist with voices, while others indicate that it is necessary to know how to manage voices. We highlighted and discussed several concepts that can support doctors, psychiatrists and practitioners in understanding "hearer" patients, particularly attention to the context of belonging, attention to language, and the role of the sense-making process.
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Facco E, Mendozzi L, Bona A, Motta A, Garegnani M, Costantini I, Dipasquale O, Cecconi P, Menotti R, Coscioli E, Lipari S. Dissociative identity as a continuum from healthy mind to psychiatric disorders: Epistemological and neurophenomenological implications approached through hypnosis. Med Hypotheses 2019; 130:109274. [PMID: 31383343 DOI: 10.1016/j.mehy.2019.109274] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 06/05/2019] [Accepted: 06/10/2019] [Indexed: 12/19/2022]
Abstract
The topic of multiple personality, redefined as Dissociative Identity Disorders (DIDs) in the DSM-5, is an intriguing and still debated disorder with a long history and deep cultural and epistemological implications, extending up to the idea of possession. Hypnosis is an appealing and valuable model to manipulate subjective experience and get an insight on both the physiology and the pathophysiology of the mind-brain functioning; it and has been closely connected with DIDs and possession since its origin in 18th century and as recently proved the capacity to yield a loss of sense of agency, mimicking delusions of alien control and spirit possession. In this study we report on five very uncommon "hypnotic virtuosos" (HVs) free from any psychiatric disorder, spontaneously undergoing the emergence of multiple identities during neutral hypnosis; this allowed us to check the relationship between their experience and fMRI data. During hypnosis the subjects underwent spontaneous non-intrusive experiences of other selves which were not recalled after the end of the session, due to post-hypnotic amnesia. The fMRI showed a significant decrease of connectivity in the Default Mode Network (DMN) especially between the posterior cingulate cortex and the medial prefrontal cortex. Our results and their contrast with the available data on fMRI in DIDs allows to draw the hypothesis of a continuum between healthy mind - where multiple identities may coexist at unconscious level and may sometimes emerge to the consciousness - and DIDs, where multiple personalities emerge as dissociated, ostensibly autonomous components yielding impaired functioning, subject's loss of control and suffering. If this is the case, it seems more reasonable to refrain from seeking for a clear-cut limit between normality (anyway a conventional, statistical concept) and pathology, and accept a grey area in between, where ostensibly odd but non-pathological experiences may occur (including so-called non-ordinary mental expressions) without calling for treatment but, rather, for being properly understood.
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Affiliation(s)
- Enrico Facco
- Studium Patavinum - Dept. of Neurosciences, University of Padua, Italy; Science of Consciousness Research Group, Dept. of General Psychology, University of Padua, Italy; Inst. F. Granone - Italian Center of Clinical and Experimental Hypnosis (CIICS), Turin, Italy.
| | - Laura Mendozzi
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, via Capecelatro 66, 20148 Milan, Italy
| | - Angelo Bona
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Achille Motta
- Department of Clinical Neurosciences, Villa San Benedetto Hospital, Hermanas Hospitalarias, Albese con Cassano, via Roma 16, Como, Italy
| | - Massimo Garegnani
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, via Capecelatro 66, 20148 Milan, Italy
| | - Isa Costantini
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, via Capecelatro 66, 20148 Milan, Italy; INRIA, Sophia-Antipolis, France
| | - Ottavia Dipasquale
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, via Capecelatro 66, 20148 Milan, Italy; Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, United Kingdom
| | - Pietro Cecconi
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, via Capecelatro 66, 20148 Milan, Italy
| | - Roberta Menotti
- Department of Clinical Neurosciences, Villa San Benedetto Hospital, Hermanas Hospitalarias, Albese con Cassano, via Roma 16, Como, Italy
| | | | - Susanna Lipari
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, via Capecelatro 66, 20148 Milan, Italy
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14
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Garrison JR, Fernyhough C, McCarthy-Jones S, Simons JS, Sommer IEC. Paracingulate Sulcus Morphology and Hallucinations in Clinical and Nonclinical Groups. Schizophr Bull 2019; 45:733-741. [PMID: 30380115 PMCID: PMC6581129 DOI: 10.1093/schbul/sby157] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hallucinations are a characteristic symptom of psychotic mental health conditions that are also experienced by many individuals without a clinical diagnosis. Hallucinations in schizophrenia have been linked to differences in the length of the paracingulate sulcus (PCS), a structure in the medial prefrontal cortex which has previously been associated with the ability to differentiate perceived and imagined information. We investigated whether this putative morphological basis for hallucinations extends to individuals without a clinical diagnosis, by examining whether nonclinical individuals with hallucinations have shorter PCS than nonclinical individuals without hallucinations. Structural MRI scans were examined from 3 demographically matched groups of individuals: 50 patients with psychotic diagnoses who experienced auditory verbal hallucinations (AVHs), 50 nonclinical individuals with AVHs, and 50 healthy control subjects with no life-time history of hallucinations. Results were verified using automated data-driven gyrification analyses. Patients with hallucinations had shorter PCS than both healthy controls and nonclinical individuals with hallucinations, with no difference between nonclinical individuals with hallucinations and healthy controls. These findings suggest that the association of shorter PCS length with hallucinations is specific to patients with a psychotic disorder. This presents challenges for full-continuum models of psychosis and suggests possible differences in the mechanisms underlying hallucinations in clinical and nonclinical groups.
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Affiliation(s)
- Jane R Garrison
- Department of Psychology, University of Cambridge, Cambridge, UK,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK,To whom correspondence should be addressed; Department of Psychology, University of Cambridge, Downing Street, Cambridge CB2 3EB, UK; tel: +44-1223-333535, e-mail:
| | | | | | - Jon S Simons
- Department of Psychology, University of Cambridge, Cambridge, UK,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Iris E C Sommer
- Department of Neuroscience, Rijks Universiteit Groningen (RUG), University Medical Center Groningen, Groningen, Netherlands,Department of Medical and Biological Psychology, University of Bergen, Bergen, Norway
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15
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How many bereaved people hallucinate about their loved one? A systematic review and meta-analysis of bereavement hallucinations. J Affect Disord 2019; 243:463-476. [PMID: 30273885 DOI: 10.1016/j.jad.2018.09.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 08/15/2018] [Accepted: 09/15/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Bereavement hallucinations (BHs) entail a perception of a deceased in any sense modality or as a quasi-sensory sense of presence. BHs are an associated feature of the proposed Persistent Complex Bereavement Disorder (PCBD) in DSM-5. The goals of this review are to estimate the prevalence of BHs, identify possible moderators, and review the methodological status of this research field. METHODS A systematic literature search was conducted through the databases PubMed, PsycINFO, and CINAHL. Studies systematically assessing the prevalence of BHs of a relative or friend were included. RESULTS Twenty-one eligible studies were identified and 8 meta-analyses of BHs in different sense modalities were conducted. The prevalence of having one or more BHs was estimated to be 56.6% (95% CI 49.9-63.2), and the estimated prevalence of BHs in specific sense modalities ranged within 7.0-39.7%. Meta-regression analyses revealed associations to age and conjugal bereavement, but results are tentative and dependent on the type of BH in question. LIMITATIONS The included studies were methodologically heterogeneous. Limitations included the lack of a valid measure of BHs and low sample generalizability. CONCLUSION This first systematic review and meta-analysis of BHs suggests that more than half of the bereaved people experience some kind of BH. However, there are considerable methodological limitations in the research of BHs, which is of pertinent interest as BHs have been linked to the development of a future diagnosis of clinically impairing grief. A valid measure of BHs needs to be developed and used in high-quality epidemiological research using population-based designs.
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16
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Couto MLDO, Kantorski LP. Ouvidores de vozes: uma revisão sobre o sentido e a relação com as vozes. PSICOLOGIA USP 2018. [DOI: 10.1590/0103-656420180077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Este estudo se trata de uma revisão sistematizada da literatura e teve como objetivo revisar os achados sobre o tema ouvidores de vozes, enfatizando a relação deles com suas vozes. A investigação foi realizada em duas bases de dados, PubMed e Lilacs, sem limite temporal e com os seguintes termos em inglês: “voice hearing” OR “auditory verbal hallucination”. A busca resultou no total de 2.464 títulos de artigos que foram examinados quanto à adequação ao objetivo. Identificaram-se 126 artigos para análise de texto completo, dos quais 35 preencheram critérios para inclusão. Evidenciou-se que o sentido que o ouvidor atribui às vozes está atrelado a sua história de vida, fazendo ele as considerar ameaçadoras, intrusivas, controladoras, ou gentis, amigáveis e positivas. Portanto, o sentido atribuído às vozes se mostrou determinante na relação que o ouvidor estabelecerá com elas mesmas, bem como a forma como ele se relaciona socialmente.
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17
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Cole ER, Strauss C, Fife-Schaw C, McCarthy-Jones S. Echoes of others: A path analytic examination of an interpersonal-cognitive model of voice-related distress. Psychol Psychother 2017; 90:617-632. [PMID: 28497892 DOI: 10.1111/papt.12129] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 03/31/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Cognitive models propose that levels of distress associated with auditory verbal hallucinations ('voices') are influenced by the hearers' beliefs about their voices (perceived malevolence and omnipotence), their negative beliefs about themselves and others and their attachment style. This study aims to test a comprehensive model of the relationship between these variables in order to identify distal and proximal interpersonal and cognitive factors contributing to voice-related distress. This interpersonal-cognitive model of voices proposes that attachment anxiety/avoidance drive negative beliefs about self and others, which in turn lead to persecutory (malevolent/omnipotent) beliefs about voices, which in turn increase levels of voice-related distress. DESIGN/METHODS Path analysis was used to test the interpersonal-cognitive model in a sample of 180 people currently hearing voices (57% self-reported schizophrenia-spectrum diagnoses; 90% some form of self-reported mental health diagnosis). RESULTS Path analysis provided support for a model in which there were direct pathways from attachment anxiety and avoidance to negative beliefs about self and others; direct pathways from negative beliefs about self and others to persecutory beliefs about voices; and a direct path from persecutory beliefs about voices, and negative beliefs about self, to voice distress. CONCLUSIONS Findings add support to the suggestion that voice-related distress occurs in the context of an insecure attachment style and negative core beliefs about self/others. A therapeutic focus on beliefs about voices, attachment style and core beliefs about self/others may be important to minimize voice-related distress. Further tests of this model that can establish causal relationships between variables are now needed. PRACTITIONER POINTS Distress associated with auditory verbal hallucinations ('voices') is highly variable. This study tests a comprehensive interpersonal-cognitive model of voice distress using path analysis with 180 participants. The model tested in the current paper shows that attachment style predicts negative beliefs about self and others, which in turn predicts negative beliefs about voices, which in turn predicts voice-related distress. Findings support the suggestion that voice-related distress occurs in the context of an insecure attachment style and negative core beliefs about self and others. In addition to focusing on beliefs about voices, a therapeutic focus on attachment style and core beliefs about self and others may be important in order to minimize voice-related distress.
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Affiliation(s)
- Esther R Cole
- South West London and St George's NHS Trust, London, UK
| | - Clara Strauss
- School of Psychology, University of Sussex, Brighton, UK.,Sussex Partnership NHS Foundation Trust, Worthing, UK
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18
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Iudici A, Faccio E, Quarato M, Neri J, Castelnuovo G. Getting Better Acquainted with Auditory Voice Hallucinations (AVHs): A Need for Clinical and Social Change. Front Psychol 2017; 8:1978. [PMID: 29184521 PMCID: PMC5694460 DOI: 10.3389/fpsyg.2017.01978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/30/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Antonio Iudici
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padua, Italy
| | - Elena Faccio
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padua, Italy
| | - Maria Quarato
- Interactionist School of Padova, Istituto di Psicologia e Psicoterapia, Padua, Italy
| | - Jessica Neri
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padua, Italy
| | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy.,Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Ospedale San Giuseppe, Verbania, Italy
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19
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Abstract
BACKGROUND Voice hearing experiences, or auditory verbal hallucinations, occur in healthy individuals as well as in individuals who need clinical care, but news media depict voice hearing primarily as a symptom of mental illness, particularly schizophrenia. AIMS This article explores whether, and how, public perception of an exaggerated association between voice hearing and mental illness might influence individuals' need for clinical care. METHOD A narrative literature review was conducted, using relevant peer-reviewed research published in the English language. RESULTS Stigma may prevent disclosure of voice hearing experiences. Non-disclosure can prevent access to sources of normalizing information and lead to isolation, loss of social support and distress. Internalization of stigma and concomitantly decreased self-esteem could potentially affect features of voices such as perceived voice power, controllability, negativity and frequency, as well as distress. Increased distress may result in a decrease in functioning and increased need for clinical care. CONCLUSION The literature reviewed suggests that stigma has the potential to increase need for care through many interrelated pathways. However, the ability to draw definitive conclusions was constrained by the designs of the studies reviewed. Further research is needed to confirm the findings of this review.
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20
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Baumeister D, Sedgwick O, Howes O, Peters E. Auditory verbal hallucinations and continuum models of psychosis: A systematic review of the healthy voice-hearer literature. Clin Psychol Rev 2016; 51:125-141. [PMID: 27866082 PMCID: PMC5240854 DOI: 10.1016/j.cpr.2016.10.010] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 09/05/2016] [Accepted: 10/29/2016] [Indexed: 12/22/2022]
Abstract
Recent decades have seen a surge of research interest in the phenomenon of healthy individuals who experience auditory verbal hallucinations, yet do not exhibit distress or need for care. The aims of the present systematic review are to provide a comprehensive overview of this research and examine how healthy voice-hearers may best be conceptualised in relation to the diagnostic versus ‘quasi-‘ and ‘fully-dimensional’ continuum models of psychosis. A systematic literature search was conducted, resulting in a total of 398 article titles and abstracts that were scrutinised for appropriateness to the present objective. Seventy articles were identified for full-text analysis, of which 36 met criteria for inclusion. Subjective perceptual experience of voices, such as loudness or location (i.e., inside/outside head), is similar in clinical and non-clinical groups, although clinical voice-hearers have more frequent voices, more negative voice content, and an older age of onset. Groups differ significantly in beliefs about voices, control over voices, voice-related distress, and affective difficulties. Cognitive biases, reduced global functioning, and psychiatric symptoms such as delusions, appear more prevalent in healthy voice-hearers than in healthy controls, yet less than in clinical samples. Transition to mental health difficulties is increased in HVHs, yet only occurs in a minority and is predicted by previous mood problems and voice distress. Whilst healthy voice-hearers show similar brain activity during hallucinatory experiences to clinical voice-hearers, other neuroimaging measures, such as mismatch negativity, have been inconclusive. Risk factors such as familial and childhood trauma appear similar between clinical and non-clinical voice-hearers. Overall the results of the present systematic review support a continuum view rather than a diagnostic model, but cannot distinguish between ‘quasi’ and ‘fully’ dimensional models. Healthy voice-hearers may be a key resource in informing transdiagnostic approaches to research of auditory hallucinations. Subjective perceptual experiences of voices appear similar in clinical and non-clinical groups. Healthy voice-hearers hear voices less frequently, with less negative content, more perceived control and from an earlier age. Healthy and clinical voice-hearers differ in beliefs about voices, voice-related distress, and affective difficulties. Healthy voice-hearers show more cognitive biases, psychiatric symptoms and functional impairments than healthy controls. Risk factors such as familial and childhood trauma appear similar between clinical and non-clinical voice-hearers.
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Affiliation(s)
- David Baumeister
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Department of Psychology, London, UK.
| | - Ottilie Sedgwick
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Department of Psychology, London, UK; NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - Oliver Howes
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK; Institute of Psychiatry, Psychology & Neuroscience, King's College London, Department of Psychosis Studies, London, UK
| | - Emmanuelle Peters
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Department of Psychology, London, UK; NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
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21
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Relationship between neuroticism, childhood trauma and cognitive-affective responses to auditory verbal hallucinations. Sci Rep 2016; 6:34401. [PMID: 27698407 PMCID: PMC5048145 DOI: 10.1038/srep34401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 09/12/2016] [Indexed: 11/23/2022] Open
Abstract
Neuroticism has been shown to adversely influence the development and outcome of psychosis. However, how this personality trait associates with the individual’s responses to psychotic symptoms is less well known. Auditory verbal hallucinations (AVHs) have been reported by patients with psychosis and non-clinical individuals. There is evidence that voice-hearers who are more distressed by and resistant against the voices, as well as those who appraise the voices as malevolent and powerful, have poorer outcome. This study aimed to examine the mechanistic association of neuroticism with the cognitive-affective reactions to AVH. We assessed 40 psychotic patients experiencing frequent AVHs, 135 non-clinical participants experiencing frequent AVHs, and 126 healthy individuals. In both clinical and non-clinical voice-hearers alike, a higher level of neuroticism was associated with more distress and behavioral resistance in response to AVHs, as well as a stronger tendency to perceive voices as malevolent and powerful. Neuroticism fully mediated the found associations between childhood trauma and the individuals’ cognitive-affective reactions to voices. Our results supported the role of neurotic personality in shaping maladaptive reactions to voices. Neuroticism may also serve as a putative mechanism linking childhood trauma and psychological reactions to voices. Implications for psychological models of hallucinations are discussed.
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22
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Boumans J, Baart I, Widdershoven G, Kroon H. Coping with psychotic-like experiences without receiving help from mental health care. A qualitative study. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2016. [DOI: 10.1080/17522439.2016.1178798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jenny Boumans
- Netherlands Institute of Mental Health and Addiction, Trimbos Institute, Utrecht, The Netherlands
| | - Ingrid Baart
- Department of medical humanities, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Guy Widdershoven
- Department of medical humanities, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Hans Kroon
- Netherlands Institute of Mental Health and Addiction, Trimbos Institute, Utrecht, The Netherlands
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23
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Alsawy S, Wood L, Taylor PJ, Morrison AP. Psychotic experiences and PTSD: exploring associations in a population survey. Psychol Med 2015; 45:2849-2859. [PMID: 25990802 DOI: 10.1017/s003329171500080x] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Extensive evidence has shown that experiencing a traumatic event and post-traumatic stress disorder (PTSD) are associated with experiences of psychosis. However, less is known about specific PTSD symptoms and their relationship with psychotic experiences. This study aimed to examine the relationship between symptoms of PTSD with paranoia and auditory hallucinations in a large-scale sample. METHOD The Adult Psychiatric Morbidity Survey (APMS) was utilized to examine the prevalence of lifetime trauma, symptoms of PTSD, and experiences of paranoia and auditory hallucinations (n = 7403). RESULTS There were significant bivariate associations between symptoms of PTSD and psychotic experiences. Multiple logistic regression analyses indicated that reliving and arousal symptoms were significant predictors for paranoia while reliving, but not arousal symptoms, also significantly predicted auditory hallucinations. A dose-response relationship was found, the greater the number of PTSD symptoms, the greater the odds were of experiencing both paranoia and hallucinations. CONCLUSIONS These findings illustrate that symptoms of PTSD are associated with increased odds of experiencing auditory hallucinations and paranoia. Overlaps appear to be present between the symptoms of PTSD and psychotic experiences. Increasing awareness of this association may advance work in clinical practice.
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Affiliation(s)
- S Alsawy
- University of Manchester,School of Psychological Sciences,Manchester,UK
| | - L Wood
- University of Manchester,School of Psychological Sciences,Manchester,UK
| | - P J Taylor
- University of Liverpool,Institute of Psychology,Health & Society,Liverpool,UK
| | - A P Morrison
- University of Manchester,School of Psychological Sciences,Manchester,UK
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24
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Toh WL, Thomas N, Rossell SL. Auditory verbal hallucinations in bipolar disorder (BD) and major depressive disorder (MDD): A systematic review. J Affect Disord 2015; 184:18-28. [PMID: 26066781 DOI: 10.1016/j.jad.2015.05.040] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 05/20/2015] [Accepted: 05/20/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Auditory verbal hallucinations (AVHs) are not uncommon in bipolar disorder (BD) and major depressive disorder (MDD), but there has been scant research in the area. The current paper aims to draw together and provide a critical overview of existing studies of AVHs in BD and MDD. METHODS A systematic review was undertaken using the search terms 'hallucinations' or 'hearing voices' in conjunction with 'bipolar disorder', 'mania' or 'manic-depressive' or 'major depressive disorder' or 'depression' or 'affective disorder' or 'mood disorder'. After applying a pre-defined set of inclusion criteria, 14 eligible peer-reviewed publications were accepted for further analysis. RESULTS Prevalence rates of AVHs in BD (11.3-62.8%) and MDD (5.4-40.6%) varied. When psychotic features were examined, persecutory and grandiose delusions were especially common in BD (though the latter did not necessarily occur in conjunction with AVHs). A single known neuroimaging study has suggested increased fronto-temporal connectivity relating to AVHs in BD. LIMITATIONS Methodological challenges relating to fluctuations in mood states and limited use of validated instruments, coupled with post-episode recall bias, pose as specific barriers to the collection of meaningful phenomenological information. CONCLUSIONS AVHs remains a central but largely understudied symptom in BD and MDD. Future research examining its phenomenology and clinical/neural correlates could bring about positive clinical implications as well as adapted therapeutic applications.
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Affiliation(s)
- Wei Lin Toh
- Brain and Psychological Sciences Research Centre (BPsyC), Swinburne University of Technology, Melbourne, VIC, Australia; Monash Alfred Psychiatry Research Centre (MAPrc), The Alfred Hospital and Monash University School of Psychology and Psychiatry, Melbourne, VIC, Australia.
| | - Neil Thomas
- Brain and Psychological Sciences Research Centre (BPsyC), Swinburne University of Technology, Melbourne, VIC, Australia; Monash Alfred Psychiatry Research Centre (MAPrc), The Alfred Hospital and Monash University School of Psychology and Psychiatry, Melbourne, VIC, Australia
| | - Susan L Rossell
- Brain and Psychological Sciences Research Centre (BPsyC), Swinburne University of Technology, Melbourne, VIC, Australia; Monash Alfred Psychiatry Research Centre (MAPrc), The Alfred Hospital and Monash University School of Psychology and Psychiatry, Melbourne, VIC, Australia; Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia
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25
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Kråkvik B, Larøi F, Kalhovde AM, Hugdahl K, Kompus K, Salvesen Ø, Stiles TC, Vedul-Kjelsås E. Prevalence of auditory verbal hallucinations in a general population: A group comparison study. Scand J Psychol 2015; 56:508-15. [PMID: 26079977 PMCID: PMC4744794 DOI: 10.1111/sjop.12236] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/22/2015] [Indexed: 11/28/2022]
Abstract
The present study was specifically designed to investigate the prevalence of auditory verbal hallucinations (AVH) in the general population, and sought to compare similarities and differences regarding socio-demographics, mental health and severe life events between individuals who have never experienced AVH with those who had. The study also aimed to compare those who sought professional help for their experience of AVH with those who had not sought help. Through a postal questionnaire, 2,533 participants ages 18 and over from a national survey completed the Launay-Slade Hallucinations Scale and other measures examining AVH characteristics and other areas related to AVH. In total, 7.3% of the sample reported a life-time prevalence of AVH. Those with AVH were more likely to be single and unemployed, reported higher levels of depression and anxiety, and experienced a higher number of severe life events compared with those without AVH. Only 16% of those who experienced AVH in the general population sought professional help for these experiences. Compared to those who did not seek professional help, participants that had were more likely to experience AVH with a negative content, experience them on a daily basis, undergo negative reactions when experiencing AVH, and resist AVH. In conclusion, the prevalence of AVH was found to be relatively high. The results also revealed higher levels of reduced mental health for individuals who sought professional help, followed by those who did not, compared with those who had never experienced AVH.
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Affiliation(s)
- Bodil Kråkvik
- Nidaros District Psychiatric Center, Department of Research and Development, St. Olavs University Hospital, Trondheim, Norway.,Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Frank Larøi
- Department of Psychology: Cognition and Behaviour, University of Liège, Liège, Belgium.,Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | | | - Kenneth Hugdahl
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Radiology, Haukeland University Hospital, Bergen, Norway.,NORMENT Center of Excellence, University of Bergen, Bergen, Norway.,KG Jebsen Center of Neuropsychiatric Disorders, University of Bergen, Bergen, Norway
| | - Kristiina Kompus
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Øyvind Salvesen
- Unit for Applied Clinical Research, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tore C Stiles
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Einar Vedul-Kjelsås
- Department of Research and Development, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway.,Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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26
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Abstract
BACKGROUND The characterization of auditory verbal hallucinations (AVH) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), diverges from recent research literature, which demonstrates the occurrence of AVH in individuals who are psychologically healthy. This discrepancy raises the question of how the public perceives AVH. Public perceptions are important because they could potentially affect how individuals with AVH interpret these experiences and how people view voice hearers. AIMS Because media portrayals can provide a window into how phenomena are viewed by the public, an archival study of newspaper articles was carried out to examine depictions of AVH. METHODS A sample of 181 newspaper articles originating in the United States was analyzed using a content analysis approach. RESULTS The majority of articles examined contained no suggestion that AVH are possible in psychologically healthy individuals. Most articles suggested that AVH were a symptom of mental illness, and many suggested that AVH were associated with criminal behavior, violence and suicidality. CONCLUSION The news media examined tended to present a misleading and largely pathologizing view of AVH. More research is needed to shed light on how, and to what extent, public perceptions may influence those who experience AVH.
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27
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Johns LC, Kompus K, Connell M, Humpston C, Lincoln TM, Longden E, Preti A, Alderson-Day B, Badcock JC, Cella M, Fernyhough C, McCarthy-Jones S, Peters E, Raballo A, Scott J, Siddi S, Sommer IE, Larøi F. Auditory verbal hallucinations in persons with and without a need for care. Schizophr Bull 2014; 40 Suppl 4:S255-64. [PMID: 24936085 PMCID: PMC4141313 DOI: 10.1093/schbul/sbu005] [Citation(s) in RCA: 196] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Auditory verbal hallucinations (AVH) are complex experiences that occur in the context of various clinical disorders. AVH also occur in individuals from the general population who have no identifiable psychiatric or neurological diagnoses. This article reviews research on AVH in nonclinical individuals and provides a cross-disciplinary view of the clinical relevance of these experiences in defining the risk of mental illness and need for care. Prevalence rates of AVH vary according to measurement tool and indicate a continuum of experience in the general population. Cross-sectional comparisons of individuals with AVH with and without need for care reveal similarities in phenomenology and some underlying mechanisms but also highlight key differences in emotional valence of AVH, appraisals, and behavioral response. Longitudinal studies suggest that AVH are an antecedent of clinical disorders when combined with negative emotional states, specific cognitive difficulties and poor coping, plus family history of psychosis, and environmental exposures such as childhood adversity. However, their predictive value for specific psychiatric disorders is not entirely clear. The theoretical and clinical implications of the reviewed findings are discussed, together with directions for future research.
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Affiliation(s)
- Louise C. Johns
- King’s College London, Institute of Psychiatry, Department of Psychology, London, UK;,South London and Maudsley NHS Foundation Trust, London, UK
| | - Kristiina Kompus
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway;
| | - Melissa Connell
- The University of Queensland Centre for Clinical Research, Metro North Mental Health, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Clara Humpston
- King’s College London, Institute of Psychiatry, Department of Psychosis Studies, London, UK
| | | | - Eleanor Longden
- Institute of Psychological Sciences, University of Leeds, Leeds, UK
| | - Antonio Preti
- Department of Education, Psychology, Philosophy, University of Cagliari, Cagliari, Italy
| | | | - Johanna C. Badcock
- School of Psychology, University of Western Australia, Crawley, Australia
| | - Matteo Cella
- King’s College London, Institute of Psychiatry, Department of Psychology, London, UK;,National Institute for Health Research (NIHR), Biomedical Research Centre for Mental Health at South London and Maudsley, NHS Foundation Trust, London, UK
| | | | - Simon McCarthy-Jones
- ARC Centre of Excellence in Cognition and Its Disorders, Department of Cognitive Science, Macquarie University, Sydney, Australia
| | - Emmanuelle Peters
- King’s College London, Institute of Psychiatry, Department of Psychology, London, UK;,National Institute for Health Research (NIHR), Biomedical Research Centre for Mental Health at South London and Maudsley, NHS Foundation Trust, London, UK
| | - Andrea Raballo
- Department of Mental Health and Pathological Addiction, AUSL Reggio Emilia, Reggio Emilia, Italy
| | - James Scott
- The University of Queensland Centre for Clinical Research, Metro North Mental Health, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Sara Siddi
- Department of Education, Psychology, Philosophy, University of Cagliari, Cagliari, Italy
| | - Iris E. Sommer
- Psychiatry Department, University of Utrecht, Utrecht, The Netherlands
| | - Frank Larøi
- Department of Psychology, University of Liège, Liège, Belgium
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Evrard R, Le Malefan P. Que changent les « entendeurs de voix » à l’écoute des hallucinations ? II. Recherches sur l’entente de voix. ANNALES MEDICO-PSYCHOLOGIQUES 2013. [DOI: 10.1016/j.amp.2013.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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de Leede-Smith S, Barkus E. A comprehensive review of auditory verbal hallucinations: lifetime prevalence, correlates and mechanisms in healthy and clinical individuals. Front Hum Neurosci 2013; 7:367. [PMID: 23882203 PMCID: PMC3712258 DOI: 10.3389/fnhum.2013.00367] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 06/25/2013] [Indexed: 12/27/2022] Open
Abstract
Over the years, the prevalence of auditory verbal hallucinations (AVHs) have been documented across the lifespan in varied contexts, and with a range of potential long-term outcomes. Initially the emphasis focused on whether AVHs conferred risk for psychosis. However, recent research has identified significant differences in the presentation and outcomes of AVH in patients compared to those in non-clinical populations. For this reason, it has been suggested that auditory hallucinations are an entity by themselves and not necessarily indicative of transition along the psychosis continuum. This review will examine the presentation of auditory hallucinations across the life span, as well as in various clinical groups. The stages described include childhood, adolescence, adult non-clinical populations, hypnagogic/hypnopompic experiences, high schizotypal traits, schizophrenia, substance induced AVH, AVH in epilepsy, and AVH in the elderly. In children, need for care depends upon whether the child associates the voice with negative beliefs, appraisals and other symptoms of psychosis. This theme appears to carry right through to healthy voice hearers in adulthood, in which a negative impact of the voice usually only exists if the individual has negative experiences as a result of their voice(s). This includes features of the voices such as the negative content, frequency, and emotional valence as well as anxiety and depression, independently or caused by voices presence. It seems possible that the mechanisms which maintain AVH in non-clinical populations are different from those which are behind AVH presentations in psychotic illness. For example, the existence of maladaptive coping strategies in patient populations is one significant difference between clinical and non-clinical groups which is associated with a need for care. Whether or not these mechanisms start out the same and have differential trajectories is not yet evidenced. Future research needs to focus on the comparison of underlying factors and mechanisms that lead to the onset of AVH in both patient and non-clinical populations.
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Badcock JC, Chhabra S. Voices to reckon with: perceptions of voice identity in clinical and non-clinical voice hearers. Front Hum Neurosci 2013; 7:114. [PMID: 23565088 PMCID: PMC3615181 DOI: 10.3389/fnhum.2013.00114] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 03/15/2013] [Indexed: 01/13/2023] Open
Abstract
The current review focuses on the perception of voice identity in clinical and non-clinical voice hearers. Identity perception in auditory verbal hallucinations (AVH) is grounded in the mechanisms of human (i.e., real, external) voice perception, and shapes the emotional (distress) and behavioral (help-seeking) response to the experience. Yet, the phenomenological assessment of voice identity is often limited, for example to the gender of the voice, and has failed to take advantage of recent models and evidence on human voice perception. In this paper we aim to synthesize the literature on identity in real and hallucinated voices and begin by providing a comprehensive overview of the features used to judge voice identity in healthy individuals and in people with schizophrenia. The findings suggest some subtle, but possibly systematic biases across different levels of voice identity in clinical hallucinators that are associated with higher levels of distress. Next we provide a critical evaluation of voice processing abilities in clinical and non-clinical voice hearers, including recent data collected in our laboratory. Our studies used diverse methods, assessing recognition and binding of words and voices in memory as well as multidimensional scaling of voice dissimilarity judgments. The findings overall point to significant difficulties recognizing familiar speakers and discriminating between unfamiliar speakers in people with schizophrenia, both with and without AVH. In contrast, these voice processing abilities appear to be generally intact in non-clinical hallucinators. The review highlights some important avenues for future research and treatment of AVH associated with a need for care, and suggests some novel insights into other symptoms of psychosis.
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Affiliation(s)
- Johanna C. Badcock
- School of Psychology, The University of Western AustraliaPerth, WA, Australia
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, University of Western AustraliaPerth, WA, Australia
| | - Saruchi Chhabra
- School of Psychology, The University of Western AustraliaPerth, WA, Australia
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García-Ptacek S, García Azorín D, Sanchez Salmador R, Cuadrado M, Porta-Etessam J. Hallucinations and aberrant perceptions are prevalent among the young healthy adult population. NEUROLOGÍA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.nrleng.2012.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Auditory hallucinations in a cross-diagnostic sample of psychotic disorder patients: a descriptive, cross-sectional study. Compr Psychiatry 2012; 53:718-26. [PMID: 22197213 PMCID: PMC3314103 DOI: 10.1016/j.comppsych.2011.11.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 10/24/2011] [Accepted: 11/08/2011] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Auditory hallucinations (AH) are a cardinal feature of schizophrenia spectrum disorders. They are not disease specific, however, and can occur in other conditions, including affective psychoses. METHODS In this descriptive, cross-sectional study, we examined AH in relation to other psychotic symptoms, mood symptoms, illness severity, and functional status in 569 patients with psychosis (n = 172 schizophrenia, n = 153 schizoaffective disorder, n = 244 bipolar disorder with psychotic features). RESULTS A total of 323 (56.7%) patients reported a lifetime history of AH (75.6% of patients with schizophrenia, 71.9% schizoaffective disorder, and 34.0% bipolar disorder). The mean score for the hallucinations item (P3) of the Positive and Negative Syndrome Scale in the AH group was 3.66 ± 1.79, indicating mild to moderate state hallucinations severity. Auditory hallucinations were strongly associated with hallucinations in other sensory modalities and with the first-rank symptoms of delusions of control, thought insertion, and thought broadcasting. Multivariate analysis showed that AH were associated with lower education even after controlling for diagnosis, age, and sex. There was no association between AH and functional status as measured by the Multnomah Community Ability Scale. CONCLUSIONS Auditory hallucinations are associated with specific clinical features across the continuum of both schizophrenic and affective psychoses independent of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis.
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Hallucinations and aberrant perceptions are prevalent among the young healthy adult population. Neurologia 2012; 28:19-23. [PMID: 22608537 DOI: 10.1016/j.nrl.2012.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 02/18/2012] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Hallucinations are frequent in clinical practice, with an incidence of up to 38.7% in the general population. We aim to determine the prevalence of hallucinations among healthy young adults in our environment. SUBJECTS AND METHODS We designed an observational study, using as subjects 3rd to 6th year medical students at the Universidad Complutense de Madrid who complete clinical rotations in the Hospital Clínico San Carlos. After a screening questionnaire, an individual interview was conducted via telephone or e-mail to those students who reported hallucinations. We obtained clinical and epidemiological data through a semi-structured clinical interview performed by a third year neurology resident. RESULTS N=134 (average age was 22.1 years; 77.6% were women). 74 respondents answered affirmatively to one or more screening questions, and 54 completed the follow-up interview. 22.2% described visual phenomena and 64.8%, auditory. The majority reported sleep-related experiences and auditory perceptions related to hyper vigilance, such as hearing the telephone or the doorbell ring when in fact it had not (38.8%). All subjects had good insight into their experiences and none had psychotic symptoms. Two cases were associated with substance abuse. CONCLUSIONS Hallucinations are frequent among the general population. Traditionally, auditory phenomena have been associated with psychotic pathology, and other studies show a low population incidence (0.6%). However, in our sample, short auditory perceptions with immediate analysis were frequent and not pathological.
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Varese F, Barkus E, Bentall RP. Dissociation mediates the relationship between childhood trauma and hallucination-proneness. Psychol Med 2012; 42:1025-1036. [PMID: 21896238 DOI: 10.1017/s0033291711001826] [Citation(s) in RCA: 179] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND It has been proposed that the relationship between childhood trauma and hallucinations can be explained by dissociative processes. The present study examined whether the effect of childhood trauma on hallucination-proneness is mediated by dissociative tendencies. In addition, the influence of dissociative symptoms on a cognitive process believed to underlie hallucinatory experiences (i.e. reality discrimination; the capacity to discriminate between internal and external cognitive events) was also investigated. METHOD Patients with schizophrenia spectrum disorders (n=45) and healthy controls (with no history of hallucinations; n=20) completed questionnaire measures of hallucination-proneness, dissociative tendencies and childhood trauma, as well as performing an auditory signal detection task. RESULTS Compared to both healthy and non-hallucinating clinical controls, hallucinating patients reported both significantly higher dissociative tendencies and childhood sexual abuse. Dissociation positively mediated the effect of childhood trauma on hallucination-proneness. This mediational role was particularly robust for sexual abuse over other types of trauma. Signal detection abnormalities were evident in hallucinating patients and patients with a history of hallucinations, but were not associated with pathological dissociative symptoms. CONCLUSIONS These results are consistent with dissociative accounts of the trauma-hallucinations link. Dissociation, however, does not affect reality discrimination. Future research should examine whether other cognitive processes associated with both dissociative states and hallucinations (e.g. deficits in cognitive inhibition) may explain the relationship between dissociation and hallucinatory experiences.
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Affiliation(s)
- F Varese
- School of Psychology, Bangor University, Bangor, Gwynedd, UK.
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Cottam S, Paul SN, Doughty OJ, Carpenter L, Al-Mousawi A, Karvounis S, Done DJ. Does religious belief enable positive interpretation of auditory hallucinations?: a comparison of religious voice hearers with and without psychosis. Cogn Neuropsychiatry 2011; 16:403-21. [PMID: 21390926 DOI: 10.1080/13546805.2010.548543] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Introduction. Hearing voices occurs in people without psychosis. Why hearing voices is such a key pathological feature of psychosis whilst remaining a manageable experience in nonpsychotic people is yet to be understood. We hypothesised that religious voice hearers would interpret voices in accordance with their beliefs and therefore experience less distress. Methods. Three voice hearing groups, which comprised: 20 mentally healthy Christians, 15 Christian patients with psychosis, and 14 nonreligious patients with psychosis. All completed (1) questionnaires with rating scales measuring the perceptual and emotional aspects of hallucinated voices, and (2) a semistructured interview to explore whether religious belief is used to make sense of the voice hearing experience. Results. The three groups had perceptually similar experiences when hearing the voices. Mentally healthy Christians appeared to assimilate the experience with their religious beliefs (schematic processing) resulting in positive interpretations. Christian patients tended not to assimilate the experience with their religious beliefs, frequently reporting nonreligious interpretations that were predominantly negative. Nearly all participants experienced voices as powerful, but mentally healthy Christians reported the power of voices positively. Conclusion. Religious belief appeared to have a profound, beneficial influence on the mentally healthy Christians' interpretation of hearing voices, but had little or no influence in the case of Christian patients.
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Badcock JC, Hugdahl K. Cognitive mechanisms of auditory verbal hallucinations in psychotic and non-psychotic groups. Neurosci Biobehav Rev 2011; 36:431-8. [PMID: 21827786 DOI: 10.1016/j.neubiorev.2011.07.010] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 07/07/2011] [Accepted: 07/23/2011] [Indexed: 12/29/2022]
Abstract
The continuum model of psychosis has been extremely influential. It assumes that psychotic symptoms, such as auditory verbal hallucinations (AVH), are not limited to patients with psychosis but also occur in healthy, non-clinical individuals - suggesting similar mechanisms of origin. Recent debate surrounding this model has highlighted certain differences, as well as similarities, in the phenomenology of AVH in clinical and non-clinical populations. These findings imply that there may, in fact, be only partial overlap of the mechanism(s) involved in generating AVH in these groups. We review evidence of continuity or similarity, and dissimilarity, in cognitive, and related neural processes, underlying AVH in clinical and non-clinical samples. The results reveal some shared (intrusive cognitions, inhibitory deficits) and some distinct (aspects of source memory and cerebral lateralization) mechanisms in these groups. The evidence, therefore, supports both continuous and categorical models of positive psychotic symptoms. The review considers potential risks of uncritical acceptance of the continuum model and highlights some important methodological issues for future research.
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Affiliation(s)
- Johanna C Badcock
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia.
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Heriot-Maitland C, Knight M, Peters E. A qualitative comparison of psychotic-like phenomena in clinical and non-clinical populations. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2011; 51:37-53. [PMID: 22268540 DOI: 10.1111/j.2044-8260.2011.02011.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To explore the nature and context of psychotic-like phenomena in clinical (C) and non-clinical (NC) participants, and to investigate whether the factors involved with triggering a psychotic-like 'out-of-the-ordinary' experience (OOE) can be distinguished from those determining its clinical consequences. DESIGN AND METHODS Qualitative data were collected by semi-structured interviews, and analysed using interpretative phenomenological analysis (IPA). Twelve participants, who reported OOEs starting in the last 5 years, were split into C and NC groups depending on whether they were involved with mental-health services as a result of their experiences. Inter-group comparisons of emergent themes were made. RESULTS Inter-group similarities were found in the triggers and subjective nature of experiences, with clearer group differences in the inter-personal and background personal contexts, and how the experiences were incorporated into their lives. In particular, the inter-personal theme of validation was identified as important in distinguishing the clinical consequences of OOEs. CONCLUSIONS It is not the OOE itself that determines the development of a clinical condition, but rather the wider personal and interpersonal contexts that influence how this experience is subsequently integrated. Theoretical implications for the refinement of psychosis models are outlined, and clinical implications for the validation and normalization of psychotic-like phenomena are proposed.
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Bowins B. A cognitive regulatory control model of schizophrenia. Brain Res Bull 2011; 85:36-41. [PMID: 21329746 DOI: 10.1016/j.brainresbull.2011.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 12/28/2010] [Accepted: 02/07/2011] [Indexed: 01/15/2023]
Abstract
A puzzling aspect of schizophrenia concerns the relationship between negative and positive symptoms. Perspectives suggesting that they arise from the same pathophysiological process are not consistent with the numerous differences such as treatment response, and the underlying neurochemistry relevant to treatment. Explanations viewing negative and positive symptoms as independent processes or diseases cannot readily account for the typical developmental course of schizophrenia, consisting of a lengthy prodromal phase of negative followed by positive symptoms. A model of schizophrenia is presented positing that negative and positive symptoms are distinct but interrelated processes, with the former bringing forth the latter due to damaged or impaired cognitive regulatory control processes. The extensive cognitive distortions, thought form variants, and sensory perceptual experiences comprising psychosis represent a natural propensity derived from the evolution of human intelligence. To facilitate reality congruency typically necessary for adaptive functioning, cognitive regulatory control processes normally prevent these extreme variants from entering the conscious and awake state. During sleep when there is no need for reality congruency the cognitive regulatory control processes are deactivated and psychotic equivalents are expressed. Psychological defensive functioning can also deactivate these processes and allow psychosis to manifest. The negative symptoms of schizophrenia are seen as arising from diverse neural deficits that impair to varying degrees the cognitive regulatory control processes, thus producing psychosis. The pattern of neural damage determines the negative symptom profile, and the impact on cognitive regulatory control processes influences whether negative or positive symptoms dominate or exist in relatively equal proportions.
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Varese F, Udachina A, Myin‐Germeys I, Oorschot M, Bentall RP. The relationship between dissociation and auditory verbal hallucinations in the flow of daily life of patients with psychosis. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2011. [DOI: 10.1080/17522439.2010.548564] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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