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Salt E, Skeffington P, Reddyhough C, Paulik G. Assessment of Voice Content for Voice Hearers: Psychometric Evaluation of the Perth Voice Content Questionnaire. Clin Psychol Psychother 2024; 31:e2991. [PMID: 38706173 DOI: 10.1002/cpp.2991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/11/2024] [Accepted: 04/09/2024] [Indexed: 05/07/2024]
Abstract
The experience of hearing voices is common to an estimated 7% of the general population, with the presence of negative content being the best predictor of whether individuals will require clinical support. Whilst largely neglected in the literature to date, there are calls to consider the significance of voice content for reducing voice-related distress. However, no quantitative and comprehensive measure of voice content with suitability for research and clinical use exists. This pilot study aimed to demonstrate preliminary psychometric properties of a newly developed measure, the Perth Voice Content Questionnaire (PVCQ), designed to measure the intensity and themes of positively and negatively valenced voice content, primarily of the dominant voice. The PVCQ and measures of voice severity and related beliefs were completed by 47 voice-hearing participants. The measure was found to be internally consistent, loaded onto two distinct factors of positive and negative content, and these factors were associated with voice-related distress and negative beliefs about voices and positive beliefs about voices, respectively, indicating good validity. The PVCQ offers the first self-report measure of voice content, with preliminary psychometric properties indicating its suitability for clinical and research use.
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Affiliation(s)
- Erica Salt
- School of Psychology, Murdoch University, Murdoch, Western Australia, Australia
| | - Petra Skeffington
- School of Psychology, Murdoch University, Murdoch, Western Australia, Australia
| | - Caitlin Reddyhough
- School of Psychology, Murdoch University, Murdoch, Western Australia, Australia
- Translational Research Division, Perth Voices Clinic, Murdoch, Western Australia, Australia
| | - Georgie Paulik
- School of Psychology, Murdoch University, Murdoch, Western Australia, Australia
- Translational Research Division, Perth Voices Clinic, Murdoch, Western Australia, Australia
- School of Psychology, Curtin University, Perth, Western Australia, Australia
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Conring F, Gangl N, Derome M, Wiest R, Federspiel A, Walther S, Stegmayer K. Associations of resting-state perfusion and auditory verbal hallucinations with and without emotional content in schizophrenia. Neuroimage Clin 2023; 40:103527. [PMID: 37871539 PMCID: PMC10598456 DOI: 10.1016/j.nicl.2023.103527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/21/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
Auditory Verbal Hallucinations (AVH) are highly prevalent in patients with schizophrenia. AVH with high emotional content lead to particularly poor functional outcome. Increasing evidence shows that AVH are associated with alterations in structure and function in language and memory related brain regions. However, neural correlates of AVH with emotional content remain unclear. In our study (n = 91), we related resting-state cerebral perfusion to AVH and emotional content, comparing four groups: patients with AVH with emotional content (n = 13), without emotional content (n = 14), without hallucinations (n = 20) and healthy controls (n = 44). Patients with AVH and emotional content presented with increased perfusion within the amygdala and the ventromedial and dorsomedial prefrontal cortex (vmPFC/ dmPFC) compared to patients with AVH without emotional content. In addition, patients with any AVH showed hyperperfusion within the anterior cingulate gyrus, the vmPFC/dmPFC, the right hippocampus, and the left pre- and postcentral gyrus compared to patients without AVH. Our results indicate metabolic alterations in brain areas critical for the processing of emotions as key for the pathophysiology of AVH with emotional content. Particularly, hyperperfusion of the amygdala may reflect and even trigger emotional content of AVH, while hyperperfusion of the vmPFC/dmPFC cluster may indicate insufficient top-down amygdala regulation in patients with schizophrenia.
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Affiliation(s)
- Frauke Conring
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
| | - Nicole Gangl
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Melodie Derome
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Roland Wiest
- Support Center of Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern, Switzerland
| | - Andrea Federspiel
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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Mak O, Couth S, Plack CJ, Kotz SA, Yao B. Investigating the lateralisation of experimentally induced auditory verbal hallucinations. Front Neurosci 2023; 17:1193402. [PMID: 37483346 PMCID: PMC10359906 DOI: 10.3389/fnins.2023.1193402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/16/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Auditory verbal hallucinations (AVHs), or hearing non-existent voices, are a common symptom in psychosis. Recent research suggests that AVHs are also experienced by neurotypical individuals. Individuals with schizophrenia experiencing AVHs and neurotypicals who are highly prone to hallucinate both produce false positive responses in auditory signal detection. These findings suggest that voice-hearing may lie on a continuum with similar mechanisms underlying AVHs in both populations. Methods The current study used a monaural auditory stimulus in a signal detection task to test to what extent experimentally induced verbal hallucinations are (1) left-lateralised (i.e., more likely to occur when presented to the right ear compared to the left ear due to the left-hemisphere dominance for language processing), and (2) predicted by self-reported hallucination proneness and auditory imagery tendencies. In a conditioning task, fifty neurotypical participants associated a negative word on-screen with the same word being played via headphones through successive simultaneous audio-visual presentations. A signal detection task followed where participants were presented with a target word on-screen and indicated whether they heard the word being played concurrently amongst white noise. Results Results showed that Pavlovian audio-visual conditioning reliably elicited a significant number of false positives (FPs). However, FP rates, perceptual sensitivities, and response biases did not differ between either ear. They were neither predicted by hallucination proneness nor auditory imagery. Discussion The results show that experimentally induced FPs in neurotypicals are not left-lateralised, adding further weight to the argument that lateralisation may not be a defining feature of hallucinations in clinical or non-clinical populations. The findings also support the idea that AVHs may be a continuous phenomenon that varies in severity and frequency across the population. Studying induced AVHs in neurotypicals may help identify the underlying cognitive and neural mechanisms contributing to AVHs in individuals with psychotic disorders.
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Affiliation(s)
- Olivia Mak
- Division of Human Communication, Development & Hearing, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Samuel Couth
- Division of Human Communication, Development & Hearing, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Christopher J. Plack
- Division of Human Communication, Development & Hearing, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
- Department of Psychology, Lancaster University, Lancaster, United Kingdom
| | - Sonja A. Kotz
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Bo Yao
- Department of Psychology, Lancaster University, Lancaster, United Kingdom
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El-Ashry AM, Abd Elhay ES, El-Sayed MM. The phenomenology of auditory verbal hallucinations among clients with schizophrenia: The association with acceptance and autonomous action responses. Arch Psychiatr Nurs 2023; 44:114-121. [PMID: 37197855 DOI: 10.1016/j.apnu.2023.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 04/11/2023] [Accepted: 04/30/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Living with the experience of hearing voices without trying to ignore or suppress them is referred to as accepting auditory verbal hallucinations (AVH). It varies depending on the phenomenology of AVH itself; some clients may find it challenging to acquire new coping mechanisms with the voices. AIM Examine the association between the phenomenology of AVH and acceptance or autonomous action among clients with schizophrenia. DESIGN A descriptive correlational study was conducted on 200 clients with schizophrenia using the following instruments; Sociodemographic and clinical data tools, Psychotic Symptom Rating Scales (PSYRATS-AH), and Voices Acceptance and Action Scale (VAAS). RESULTS Most patients have moderate to severe levels of AVH (95.5 %), with a mean score of 25.34. The emotional characteristics reflected the high mean score (11.24). A highly statistically negative correlation was found between the total Voices Acceptance and Action Scale and severity of AVH (P = -0.448, sig = 0.000). A predictable significant effect of user acceptance and autonomous actions response coping with decreasing the severity of AVH was found (adjusted r square = 0.196, sig = 0.000) and model equation = Severity of Verbal auditory hallucinations = 31.990-0.257 X Total of Voice Acceptance and Autonomous Action Scale (VAAS). CONCLUSION The severity of all phenomenological characteristics of AVH can be successfully reduced by using voice acceptance and autonomous action responses rather than resistance or engagement responses. Subsequently, it must be improved and learned by psychiatric nurses the patients with schizophrenia in the hospitals by applying Acceptance and Commitment Therapy as a crucial intervention.
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Affiliation(s)
- Ayman Mohamed El-Ashry
- Psychiatric and Mental Health Nursing, Faculty of Nursing, Alexandria University, Egypt.
| | - Eman Sameh Abd Elhay
- Psychiatric and Mental Health Nursing, Faculty of Nursing, Mansoura University, Egypt.
| | - Mona Metwally El-Sayed
- Psychiatric and Mental Health Nursing, Faculty of Nursing, Alexandria University, Egypt.
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How to reap the benefits of language for psychiatry. Psychiatry Res 2022; 318:114932. [PMID: 36332505 DOI: 10.1016/j.psychres.2022.114932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 11/19/2022]
Abstract
Our aim is to find accurate and valid markers for diagnosis, prognosis, and the monitoring of treatment to improve outcome for patients with schizophrenia-spectrum disorders. This search has led us into the disciplines of computational linguistics and artificial intelligence, as automatic analysis of spoken language may provide useful markers for psychiatry. Together with our language team at UMC Groningen and with great colleagues around the globe, we intend to push this field forward and provide tools that can support service users in self-monitoring and help clinicians with diagnosis, treatment monitoring and risk prediction.
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Brand RM, Badcock JC, Paulik G. Changes in positive and negative voice content in cognitive-behavioural therapy for distressing voices. Psychol Psychother 2022; 95:807-819. [PMID: 35523677 PMCID: PMC9542164 DOI: 10.1111/papt.12399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/19/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE People who experience distressing voices frequently report negative (e.g. abusive or threatening) voice content and this is a key driver of distress. There has also been recognition that positive (e.g. reassuring, or guiding) voice content contributes to better outcomes. Despite this, voice content has been neglected as a standalone outcome in evaluations of psychological therapies for distressing voices. We aimed to examine whether a modular cognitive-behavioural therapy (CBT) intervention for voices led to changes in negative and positive voice content. DESIGN/METHODS In a naturalistic, uncontrolled pre- and post- service evaluation study, 32 clients at an outpatient psychology service for distressing voices received eight sessions of CBT for distressing voices and completed self-report measures of negative and positive voice content at pre-, mid- and post- therapy. RESULTS There was no significant change in positive voice content. There was no significant change in negative voice content from pre- to post-therapy; however, there was a significant change in negative voice content between mid and post-treatment in which the cognitive therapy component was delivered. The CBT treatment was also associated with significant changes in routinely reported outcomes of voice-related distress and voice severity. CONCLUSIONS The cognitive component of CBT for distressing voices may be associated with changes in negative, but not positive, voice content. There may be benefit to enhancing these effects by developing treatments targeting specific processes involved in negative and positive voice content and further exploring efficacy in well-powered, controlled trials with more comprehensive measures of voice content.
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Affiliation(s)
- Rachel M. Brand
- School of Health and Behavioural SciencesUniversity of the Sunshine CoastSippy DownsQueenslandAustralia
| | - Johanna C. Badcock
- Perth Voices ClinicMurdochWestern AustraliaAustralia,School of Psychological ScienceUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Georgie Paulik
- Perth Voices ClinicMurdochWestern AustraliaAustralia,School of Psychological ScienceUniversity of Western AustraliaPerthWestern AustraliaAustralia,Discipline of PsychologyMurdoch UniversityMurdochWestern AustraliaAustralia
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Urwyler P, Begemann M, Bell V. Editorial: new directions in hallucination research. Cogn Neuropsychiatry 2022; 27:83-85. [PMID: 35403572 DOI: 10.1080/13546805.2022.2057845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Prabitha Urwyler
- Gerontechnology and Rehabilitation, ARTORG Center for Biomedical Engineering, University of Bern, Switzerland
| | - Marieke Begemann
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, the Netherlands
| | - Vaughan Bell
- Department Of Clinical, Educational and Health Psychology, University College London, UK
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Jacobsen P, Choksi T, Sawyer K, Maximen C, Harding E, Richardson M. Home practice in mindfulness-based interventions for psychosis groups: a systematic review and qualitative study. BMC Psychol 2022; 10:9. [PMID: 35022085 PMCID: PMC8756717 DOI: 10.1186/s40359-021-00694-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Regular home practice is considered a core component of mindfulness groups and may be associated with better treatment outcomes. This study aimed to (1) review the existing evidence on how much home practice people do in mindfulness-based interventions for psychosis groups, and (2) explore participants' experiences of the barriers and facilitators to completing home practice in a mindfulness for psychosis group using a qualitative study. METHODS In study 1, we conducted a systematic review of mindfulness-based interventions for psychosis studies and extracted data on home practice rates. In study 2, we conducted semi-structured interviews with people who had completed a mindfulness for psychosis group (N = 5) as part of their routine community care, specifically focusing on experiences of home practice. RESULTS Out of 43 studies included in the systematic review, only 5 reported any data on amount of home practice, and none examined the relationship between completion of home practice and treatment outcomes. In the qualitative study, participants described home practice as being difficult but important. Arising themes were similar to findings from previous (non-psychosis) studies suggesting that generic challenges are common, rather than being specific to psychosis. CONCLUSIONS We recommend that future mindfulness-based interventions for psychosis studies record data on home practice rates, in order to investigate any association between home practice and treatment outcome. Our qualitative findings suggest home practice can be a valued part of mindfulness for psychosis group, and a normalising approach could be taken when and if participants encounter common challenges.
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Affiliation(s)
- Pamela Jacobsen
- Department of Psychology, University of Bath, Bath, BA2 7AY, UK.
| | - Twinkle Choksi
- Department of Psychology, University of Bath, Bath, BA2 7AY, UK
| | | | - Cassia Maximen
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Emma Harding
- South London and Maudsley NHS Foundation Trust, London, UK
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