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Iudici A, Alecu G, Quarato M, Neri J. Early Support for People Who Hear Voices: Exploratory Research on Family Medicine Physicians' Clinical Practice and Beliefs. Behav Sci (Basel) 2024; 14:357. [PMID: 38785848 PMCID: PMC11117472 DOI: 10.3390/bs14050357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/25/2024] Open
Abstract
Nowadays the phenomenon of hearing voices represents a very fertile and discussed field of research. In psychological and psychiatric fields, the phenomenon has been described as a normal phenomenon, but also as a prodromal stage and as a symptom of psychosis. Through a qualitative research methodology, the aim was to explore how family medicine physicians configure the phenomenon and its clinical and interactive implications. The present research involved 35 family medicine physicians as figures of primary importance in the approach toward people who start to hear voices. Semi-structured interviews have been used and they have been analyzed by the method of discourse analysis. The results show a remarkable difficulty in understanding the phenomenon in all its complexity and the tendency to consider it a symptom or a prodromal stage of psychopathology. Increasing the knowledge of doctors on the subject is necessary so that their evaluation and choice of intervention match the needs of each patient. We also discuss the importance of promoting the knowledge of the potential meanings taken on by the voices in the context of the personal and family background of the individual hearer, and of collaboration with other relevant professionals and services.
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Affiliation(s)
- Antonio Iudici
- Department of Philosophy, Education, Sociology and Applied Psychology of Padua (FISPPA), University of Padua, 35139 Padua, Italy;
| | - Giulia Alecu
- Institute of Psychology and Psychotherapy (Scuola Interazionista), 35100 Padua, Italy; (G.A.); (M.Q.)
| | - Maria Quarato
- Institute of Psychology and Psychotherapy (Scuola Interazionista), 35100 Padua, Italy; (G.A.); (M.Q.)
- Ediveria Center, Zentagasse 18 top ¾, 1050 Vienna, Austria
| | - Jessica Neri
- Department of Philosophy, Education, Sociology and Applied Psychology of Padua (FISPPA), University of Padua, 35139 Padua, Italy;
- Institute of Psychology and Psychotherapy (Scuola Interazionista), 35100 Padua, Italy; (G.A.); (M.Q.)
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Wright AC, Palmer-Cooper E, Cella M, McGuire N, Montagnese M, Dlugunovych V, Liu CWJ, Wykes T, Cather C. Experiencing hallucinations in daily life: The role of metacognition. Schizophr Res 2024; 265:74-82. [PMID: 36623979 DOI: 10.1016/j.schres.2022.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Hallucinations have been linked to failures in metacognitive reflection suggesting an association between hallucinations and overestimation of performance, although the cross-sectional findings are inconsistent. This inconsistency may relate to the fluctuating hallucinatory experiences that are not captured in cross-sectional studies. Ecological Momentary Assessment (EMA) captures in-the-moment experiences over time so can identify causal relationships between variables such as the associations between metacognition and hallucinatory experience in daily life and overcome problems in cross-sectional designs. METHODS Participants (N = 41) experiencing daily hallucinations completed baseline questionnaires and smartphone surveys 7 times per day for 14 days. They were prompted to identify a task they would complete in the next 4 h and to make metacognitive predictions around the likelihood of completing the task, the difficulty of the task, and how well they would complete it (standard of completion). RESULTS 76 % finished the 14-days of assessment with an average of 42.2 % survey completion. Less accurate metacognition was associated with more hallucinations, but less accurate likelihood and standard of completion was associated with fewer hallucinations. Using a cross-lagged analysis, metacognitive predictions around the likelihood of completion (p < .001) and standard of completion (p = .01) predicted hallucination intensity at the following timepoint, and metacognitive predictions regarding likelihood of completion (p = .02) predicted hallucination control at the following timepoint. DISCUSSION Interventions that aim to improve metacognitive ability in-the-moment may serve to reduce the intensity and increase the control of hallucinations.
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Affiliation(s)
- Abigail C Wright
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Emma Palmer-Cooper
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, UK
| | - Matteo Cella
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Nicola McGuire
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Marcella Montagnese
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Chih-Wei Joshua Liu
- Physics of Living Systems Group, Department of Physics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Corinne Cather
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Panikratova YR, Lebedeva IS, Akhutina TV, Tikhonov DV, Kaleda VG, Vlasova RM. Executive control of language in schizophrenia patients with history of auditory verbal hallucinations: A neuropsychological and resting-state fMRI study. Schizophr Res 2023; 262:201-210. [PMID: 37923596 DOI: 10.1016/j.schres.2023.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND As demonstrated by a plethora of studies, compromised executive functions (EF) and language are implicated in mechanisms of auditory verbal hallucinations (AVH), but the contribution of their interaction to AVH remains unclear. We hypothesized that schizophrenia patients with history of AVH (AVHh+) vs. without history of AVH (AVHh-) have a specific deficit of executive control of language and alterations in functional connectivity (FC) between the brain regions involved in EF and language, and these neuropsychological and neurophysiological traits are associated with each other. METHODS To explore the executive control of language and its contribution to AVH, we used an integrative approach involving analysis of neuropsychological and resting-state fMRI data of 34 AVHh+, 16 AVHh-, and 40 healthy controls. We identified the neuropsychological and FC measures that differentiated between AVHh+, AVHh-, and HC, and tested the associations between them. RESULTS AVHh+ were characterized by decreased category and phonological verbal fluency, utterance length, productivity in the planning tasks, and poorer retelling. AVHh+ had decreased FC between the left inferior frontal gyrus and the anterior cingulate cortex. Productivity in category verbal fluency was associated with the FC between these regions. CONCLUSIONS Poor executive control of word retrieval and deficient programming of sentence and narrative related to more general deficits of planning may be the neuropsychological traits specific for AVHh+. A neurophysiological trait specific for AVHh+ may be a decreased FC between regions involved in language production and differentiation between alien- vs. self-generated speech and between language production vs. comprehension.
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Affiliation(s)
- Yana R Panikratova
- Laboratory of Neuroimaging and Multimodal Analysis, Mental Health Research Center, 115522, 34 Kashirskoye shosse, Moscow, Russia.
| | - Irina S Lebedeva
- Laboratory of Neuroimaging and Multimodal Analysis, Mental Health Research Center, 115522, 34 Kashirskoye shosse, Moscow, Russia
| | - Tatiana V Akhutina
- Laboratory of Neuropsychology, Faculty of Psychology, Lomonosov Moscow State University, 125009, 11/9 Mokhovaya street, Moscow, Russia
| | - Denis V Tikhonov
- Department of Youth Psychiatry, Mental Health Research Center, 115522, 34 Kashirskoye shosse, Moscow, Russia
| | - Vasilii G Kaleda
- Department of Youth Psychiatry, Mental Health Research Center, 115522, 34 Kashirskoye shosse, Moscow, Russia
| | - Roza M Vlasova
- Department of Psychiatry, University of North Carolina, 101 Manning Dr # 1, Chapel Hill, NC 27514, United States of America
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Farrugia P, Grech P. The Experience of Hearing Voices: Challenges and Coping Mechanisms. Issues Ment Health Nurs 2023; 44:1254-1264. [PMID: 37832155 DOI: 10.1080/01612840.2023.2262569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
Auditory hallucinations or hearing voices are often associated with schizophrenia and other psychotic disorders. However, several voice-hearers do not have any mental health issues or diagnoses. The study presented in this paper aimed to explore how voice-hearers understand and react to their concerns by reflecting on and exploring their experiences and interpretations of these experiences. The participants were nine individuals - three females, four males and two others, all experiencing auditory hallucinations for at least five years, residing either at their home or at one of the Hostels run by Richmond Foundation (Malta). A qualitative approach following the principles of Interpretative Phenomenological Analysis was used. In-depth interviews were conducted to explore how the participants perceive their voices, what coping strategies are used, and how their experiences affect their lives. Four super-ordinate themes related to the participants' perceptions and their interpretation of the experience of hearing voices were identified: 'A tough experience', 'Methods used to cope with voices', 'Factors linked to recovery' and 'Relationships'. Furthermore, the study elicited the voice-hearers' recommendations (both for other voice-hearers and mental health professionals).
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Affiliation(s)
- Patrick Farrugia
- Department of Mental Health, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Paulann Grech
- Department of Mental Health, Faculty of Health Sciences, University of Malta, Msida, Malta
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Gold JM, Corlett PR, Erickson M, Waltz JA, August S, Dutterer J, Bansal S. Phenomenological and Cognitive Features Associated With Auditory Hallucinations in Clinical and Nonclinical Voice Hearers. Schizophr Bull 2023; 49:1591-1601. [PMID: 37350507 PMCID: PMC10686332 DOI: 10.1093/schbul/sbad083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND AND HYPOTHESES Auditory verbal hallucinations (AVH) are central features of schizophrenia (SZ). However, AVH also occur in a small percentage of the general population who do not have a need for care, termed nonclinical voice hearers (NCVH). We sought to determine the degree to which the experience of AVH was similar in NCVH and in people with schizophrenia (PSZ) and evaluate the degree to which NCVH shared other features of SZ such as delusional beliefs, cognitive impairment, and negative symptoms. STUDY DESIGN We recruited 76 people with a DSM-V diagnosis of SZ/schizoaffective disorder (PSZ; 49 with current AVH, 27 without), 48 NCVH, and 51 healthy controls. Participants received a broad battery of clinician-administered and self-report symptom assessments and a focused cognitive assessment. STUDY RESULTS The AVH of NCVH and PSZ shared very similar sensory features. NCVH experienced less distress, had greater control over their AVH, and, unlike PSZ, rarely heard 2 voices speaking to each other. NCVH demonstrated a wide range of deeply held unusual beliefs, but reported less paranoia, and fewer first-rank symptoms such as passivity and alterations in self-experience. NCVH showed no evidence of cognitive deficits or negative symptoms. CONCLUSIONS The AVH in NCVH and PSZ demonstrate important similarities as well as clear differences. Specific features, rather than the presence, of AVH appear to determine the need for care. NCVH do not share the cognitive and motivational deficits seen in PSZ. These results suggest that AVH and unusual beliefs can be separated from the broader phenotype of SZ.
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Affiliation(s)
- James M Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Philip R Corlett
- Department of Psychiatry, Connecticut Mental Health Center, Yale University, New Haven, CT and Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Molly Erickson
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - James A Waltz
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sharon August
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jenna Dutterer
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sonia Bansal
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
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Beaudoin M, Potvin S, Phraxayavong K, Dumais A. Changes in Quality of Life in Treatment-Resistant Schizophrenia Patients Undergoing Avatar Therapy: A Content Analysis. J Pers Med 2023; 13:jpm13030522. [PMID: 36983704 PMCID: PMC10058174 DOI: 10.3390/jpm13030522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/15/2023] Open
Abstract
Avatar Therapy has a significant impact on symptoms, beliefs, and quality of life of patients with treatment-resistant schizophrenia. However, little is known about how these changes are implemented into their lives and to which aspects of their lives these improvements relate. Ten consecutive patients enrolled in an ongoing clinical trial were assessed using semi-guided interviews before as well as three months after Avatar Therapy. These encounters have been recorded and transcribed so that the discourse could be thoroughly analyzed, leading to the generation of an extensive theme grid. As the cases were analyzed, the grid was adapted in a back-and-forth manner until data saturation occurred. The content analysis allowed the identification of nine main themes representing different aspects of the patients’ lives, each of which was subdivided into more specific codes. By analyzing the evolution of their frequency, it was observed that, following therapy, patients presented with fewer psychotic symptoms, better self-esteem, more hobbies and projects, and an overall improved lifestyle and mood. Finally, investigating the impact of Avatar Therapy on quality of life allows for a deeper understanding of how people with treatment-resistant schizophrenia can achieve meaningful changes and move towards a certain recovery process.
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Affiliation(s)
- Mélissa Beaudoin
- Department of Psychiatry and Addictology, University of Montreal, Montreal, QC H3T 1J4, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3G 2M1, Canada
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada
- Correspondence: (M.B.); (A.D.); Tel.: +1-514-251-4015 (A.D.)
| | - Stephane Potvin
- Department of Psychiatry and Addictology, University of Montreal, Montreal, QC H3T 1J4, Canada
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada
| | - Kingsada Phraxayavong
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada
- Services et Recherches Psychiatriques AD, Montreal, QC H1N 3V2, Canada
| | - Alexandre Dumais
- Department of Psychiatry and Addictology, University of Montreal, Montreal, QC H3T 1J4, Canada
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada
- Services et Recherches Psychiatriques AD, Montreal, QC H1N 3V2, Canada
- Institut National de Psychiatrie Légale Philippe-Pinel, Montreal, QC H1C 1H1, Canada
- Correspondence: (M.B.); (A.D.); Tel.: +1-514-251-4015 (A.D.)
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Sheldon AD, Kafadar E, Fisher V, Greenwald MS, Aitken F, Negreira AM, Woods SW, Powers AR. Perceptual pathways to hallucinogenesis. Schizophr Res 2022; 245:77-89. [PMID: 35216865 PMCID: PMC9232894 DOI: 10.1016/j.schres.2022.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 12/22/2022]
Abstract
Recent advances in computational psychiatry have provided unique insights into the neural and cognitive underpinnings of psychotic symptoms. In particular, a host of new data has demonstrated the utility of computational frameworks for understanding how hallucinations might arise from alterations in typical perceptual processing. Of particular promise are models based in Bayesian inference that link hallucinatory perceptual experiences to latent states that may drive them. In this piece, we move beyond these findings to ask: how and why do these latent states arise, and how might we take advantage of heterogeneity in that process to develop precision approaches to the treatment of hallucinations? We leverage specific models of Bayesian inference to discuss components that might lead to the development of hallucinations. Using the unifying power of our model, we attempt to place disparate findings in the study of psychotic symptoms within a common framework. Finally, we suggest directions for future elaboration of these models in the service of a more refined psychiatric nosology based on predictable, testable, and ultimately treatable information processing derangements.
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Affiliation(s)
- Andrew D Sheldon
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, United States of America
| | - Eren Kafadar
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, United States of America
| | - Victoria Fisher
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, United States of America
| | - Maximillian S Greenwald
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, United States of America
| | - Fraser Aitken
- School of Biomedical and Imaging Sciences, Kings College, London, UK
| | | | - Scott W Woods
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, United States of America
| | - Albert R Powers
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, United States of America.
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Moseley P, Powell A, Woods A, Fernyhough C, Alderson-Day B. Voice-Hearing Across The Continuum: A Phenomenology of Spiritual Voices. Schizophr Bull 2022; 48:1066-1074. [PMID: 35733238 PMCID: PMC9434432 DOI: 10.1093/schbul/sbac054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND HYPOTHESIS Voice-hearing in clinical and nonclinical groups has previously been compared using standardized assessments of psychotic experiences. Findings from several studies suggest that nonclinical voice-hearing is distinguished by reduced distress and increased control. However, symptom-rating scales developed for clinical populations may be limited in their ability to elucidate subtle aspects of nonclinical voices. Moreover, such experiences often occur within specific contexts and belief systems, such as spiritualism. We investigated similarities and differences in the phenomenology of clinical voice-hearing and nonclinical voice-hearer (NCVH). STUDY DESIGN We conducted a comparative interdisciplinary study which administered a semi-structured interview to NCVH individuals (N = 26) and psychosis patients (N = 40). The nonclinical group was recruited from spiritualist communities. We used content analysis and inductive thematic analysis to create a coding frame which was used across both spiritual and patient groups to compare phenomenological features of voice-hearing. STUDY RESULTS The findings were consistent with previous results regarding distress and control. Additionally, in the NCVH group, multiple modalities were often integrated into 1 entity, and there were high levels of associated visual imagery, and subtle differences in the location of voices relating to perceptual boundaries. Most NCVHs reported voices before encountering spiritualism, suggesting that their onset was not solely due to deliberate practice. CONCLUSIONS Nonclinical spiritual voice-hearing has important similarities and differences to voices in psychosis. Future research should aim to understand how spiritual voice-hearers cultivate and control voice-hearing after its onset, which may inform interventions for people with psychosis with distressing voices.
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Affiliation(s)
- Peter Moseley
- To whom correspondence to be addressed; tel: 0191 227 4976, e-mail:
| | - Adam Powell
- Department of Theology & Religion, Durham University, Durham, UK
| | - Angela Woods
- Department of English Studies, Durham University, Durham, UK
| | - Charles Fernyhough
- Department of Psychology, Durham University, Science Laboratories, Durham, UK
| | - Ben Alderson-Day
- Department of Psychology, Durham University, Science Laboratories, Durham, UK
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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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Moseley P, Alderson-Day B, Common S, Dodgson G, Lee R, Mitrenga K, Moffatt J, Fernyhough C. Continuities and Discontinuities in the Cognitive Mechanisms Associated With Clinical and Nonclinical Auditory Verbal Hallucinations. Clin Psychol Sci 2022; 10:752-766. [PMID: 35846173 PMCID: PMC9280701 DOI: 10.1177/21677026211059802] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 10/01/2021] [Indexed: 11/15/2022]
Abstract
Auditory verbal hallucinations (AVHs) are typically associated with schizophrenia but also occur in individuals without any need for care (nonclinical voice hearers [NCVHs]). Cognitive models of AVHs posit potential biases in source monitoring, top-down processes, or a failure to inhibit intrusive memories. However, research across clinical/nonclinical groups is limited, and the extent to which there may be continuity in cognitive mechanism across groups, as predicted by the psychosis-continuum hypothesis, is unclear. We report two studies in which voice hearers with psychosis ( n = 31) and NCVH participants reporting regular spiritual voices ( n = 26) completed a battery of cognitive tasks. Compared with non-voice-hearing groups ( ns = 33 and 28), voice hearers with psychosis showed atypical performance on signal detection, dichotic listening, and memory-inhibition tasks but intact performance on the source-monitoring task. NCVH participants, however, showed only atypical signal detection, which suggests differences between clinical and nonclinical voice hearers potentially related to attentional control and inhibition. These findings suggest that at the level of cognition, continuum models of hallucinations may need to take into account continuity but also discontinuity between clinical and nonclinical groups.
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Affiliation(s)
- Peter Moseley
- Department of Psychology, Northumbria University
- Peter Moseley, Department of Psychology, Northumbria University
| | | | - Stephanie Common
- Tees, Esk, & Wear Valley National Health Service (NHS) Foundation Trust, West Park Hospital, Darlington, England
| | - Guy Dodgson
- Cumbria, Northumberland, Tyne, & Wear NHS Foundation Trust, St. Nicholas Hospital, Newcastle upon Tyne, England
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Abstract
PURPOSE OF REVIEW To provide recent evidence on real-time neurofeedback (NFB) training for auditory verbal hallucinations (AVH) in schizophrenia patients. RECENT FINDINGS NFB is a promising technique that allows patients to gain control over their AVH by modulating their own speech-related/language-related networks including superior temporal gyrus (STG) and anterior cingulate cortex (ACC) using fMRI, fNIRS and EEG/MEG. A recent limited number of studies showed that while an EEG-based NFB study failed to regulate auditory-evoked potentials and reduce AVH, downregulation of STG hyperactivity and upregulation of ACC activity with fMRI-based NFB appear to alleviate treatment-resistant AVH in schizophrenia patients. A deeper understanding of AVH and development of more effective methodologies are still needed. SUMMARY Despite recent innovations in antipsychotics, many schizophrenia patients continue to suffer from treatment-resistant AVH and social dysfunctions. Recent studies suggested that real-time NFB shows promise in enabling patients to gain control over AVH by regulating their own speech-related/language-related networks. Although fMRI-NFB is suitable for regulating localized activity, EEG/MEG-NFB are ideal for regulating the ever-changing AVH. Although there are still many challenges including logistic complexity and burden on patients, we hope that such innovative real-time NFB trainings will help patients to alleviate severe symptoms and improve social functioning.
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12
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Thakkar KN, Mathalon DH, Ford JM. Reconciling competing mechanisms posited to underlie auditory verbal hallucinations. Philos Trans R Soc Lond B Biol Sci 2021; 376:20190702. [PMID: 33308062 PMCID: PMC7741078 DOI: 10.1098/rstb.2019.0702] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 01/21/2023] Open
Abstract
Perception is not the passive registration of incoming sensory data. Rather, it involves some analysis by synthesis, based on past experiences and context. One adaptive consequence of this arrangement is imagination-the ability to richly simulate sensory experiences, interrogate and manipulate those simulations, in service of action and decision making. In this paper, we will discuss one possible cost of this adaptation, namely hallucinations-perceptions without sensory stimulation, which characterize serious mental illnesses like schizophrenia, but which also occur in neurological illnesses, and-crucially for the present piece-are common also in the non-treatment-seeking population. We will draw upon a framework for imagination that distinguishes voluntary from non-voluntary experiences and explore the extent to which the varieties and features of hallucinations map onto this distinction, with a focus on auditory-verbal hallucinations (AVHs)-colloquially, hearing voices. We will propose that sense of agency for the act of imagining is key to meaningfully dissecting different forms and features of AVHs, and we will outline the neural, cognitive and phenomenological sequelae of this sense. We will conclude that a compelling unifying framework for action, perception and belief-predictive processing-can incorporate observations regarding sense of agency, imagination and hallucination. This article is part of the theme issue 'Offline perception: voluntary and spontaneous perceptual experiences without matching external stimulation'.
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Affiliation(s)
- Katharine N. Thakkar
- Department of Psychology, Michigan State University, East Lansing, MI, USA
- Department of Psychiatry and Behavioral Medicine, Michigan State University, East Lansing, MI, USA
| | - Daniel H. Mathalon
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (UCSF), San Francisco, CA, USA
- Mental Health Service, Veterans Affairs San Francisco Healthcare System, San Francisco, CA, USA
| | - Judith M. Ford
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (UCSF), San Francisco, CA, USA
- Mental Health Service, Veterans Affairs San Francisco Healthcare System, San Francisco, CA, USA
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A case study of the feasibility of weekly tACS for the treatment of auditory hallucinations in schizophrenia. Brain Stimul 2021; 14:361-363. [PMID: 33515747 PMCID: PMC9332123 DOI: 10.1016/j.brs.2021.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/18/2020] [Accepted: 01/14/2021] [Indexed: 12/28/2022] Open
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