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Duggirala SX, Schwartze M, Goller LK, Linden DEJ, Pinheiro AP, Kotz SA. Hallucination Proneness Alters Sensory Feedback Processing in Self-voice Production. Schizophr Bull 2024; 50:1147-1158. [PMID: 38824450 PMCID: PMC11349023 DOI: 10.1093/schbul/sbae095] [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: 06/03/2024]
Abstract
BACKGROUND Sensory suppression occurs when hearing one's self-generated voice, as opposed to passively listening to one's own voice. Quality changes in sensory feedback to the self-generated voice can increase attentional control. These changes affect the self-other voice distinction and might lead to hearing voices in the absence of an external source (ie, auditory verbal hallucinations). However, it is unclear how changes in sensory feedback processing and attention allocation interact and how this interaction might relate to hallucination proneness (HP). STUDY DESIGN Participants varying in HP self-generated (via a button-press) and passively listened to their voice that varied in emotional quality and certainty of recognition-100% neutral, 60%-40% neutral-angry, 50%-50% neutral-angry, 40%-60% neutral-angry, 100% angry, during electroencephalography (EEG) recordings. STUDY RESULTS The N1 auditory evoked potential was more suppressed for self-generated than externally generated voices. Increased HP was associated with (1) an increased N1 response to the self- compared with externally generated voices, (2) a reduced N1 response for angry compared with neutral voices, and (3) a reduced N2 response to unexpected voice quality in sensory feedback (60%-40% neutral-angry) compared with neutral voices. CONCLUSIONS The current study highlights an association between increased HP and systematic changes in the emotional quality and certainty in sensory feedback processing (N1) and attentional control (N2) in self-voice production in a nonclinical population. Considering that voice hearers also display these changes, these findings support the continuum hypothesis.
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Affiliation(s)
- Suvarnalata Xanthate Duggirala
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
- Department of Psychology, Faculty of Psychology, University of Lisbon, Lisbon, Portugal
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Faculty of Health and Medical Sciences, Maastricht University, Maastricht, Netherlands
| | - Michael Schwartze
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Lisa K Goller
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - David E J Linden
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Faculty of Health and Medical Sciences, Maastricht University, Maastricht, Netherlands
- Maastricht University Medical Center, Maastricht, Netherlands
| | - Ana P Pinheiro
- Department of Psychology, Faculty of Psychology, University of Lisbon, Lisbon, Portugal
| | - Sonja A Kotz
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
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Bassi D, Orrù L, Moro C, Salvarani D, Turchi GP. Investigating AVHs narratives through text analysis: the proposal of Dialogic Science for tackling stigmatization. BMC Psychol 2024; 12:434. [PMID: 39127739 DOI: 10.1186/s40359-024-01936-x] [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: 04/04/2024] [Accepted: 08/02/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Auditory verbal hallucinations (AVHs) are a significant symptom of various psychological conditions, often stigmatized and misunderstood. Moving beyond traditional psychological, psychotherapeutic and psychiatric approaches, recent research shifts focus on understanding AVHs through community perspectives and the resulting stigmatization. This research approach is crucial for better support and understanding of AVHs, however it still suffers from the lack of a rigorous and shared methodology for studying and reducing stigma. METHODS Our study, part of the Italian "PsicoVoice" project, aims to investigate community discourses on AVHs, in order to observe whether and to what extent they are drivers of stigmatisation processes. Engaging 268 participants with direct (hearers) and indirect (such as relatives and professionals) experiences of AVHs, the research analyzes a corpus of 54,320 instances using MADIT: a text analysis methodology which is both qualitative and quantitative. MADIT allows for an innovative examination of the rhetorical-argumentative structures within narratives, producing an index for measuring the narratives' practical impact on people' interactions around AVHs. RESULTS The analysis revealed that the overall community discourses are predominantly shaped by absolute and personal belief-driven modalities. This way of conveying sense, even with non-necessarily-judgmental words, contributes to a stigmatizing environment for individuals with AVHs, cementing a static representation dominated by personal opinions and reducing the potential for more nuanced, diverse interactions about AVHs. CONCLUSION The study's findings underscore the importance of addressing the narrative structures within community discourses. By intervening in these narratives, there is potential to shift towards a less stigmatizing social construction of AVHs. Thus, the article concludes using the results to provide some insights on how to generate these interventions. This approach could significantly impact how communities understand and interact with individuals experiencing AVHs, promoting more inclusive and supportive environments and interventions.
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Affiliation(s)
- Davide Bassi
- Centro Singular de Investigacion en Tecnoloxìas Intelixentes (CiTIUS), University of Santiago de Compostela, Rúa de Jenaro de la Fuente Domínguez, Santiago de Compostela, 15782, Spain
| | - Luisa Orrù
- Dipartimento di Filosofia, Sociologia, Pedagogia e Psicologia Applicata (FISPPA), University Of Padua, Via Venezia, 14, Padova, 35131, Italy
| | - Christian Moro
- Dipartimento di Filosofia, Sociologia, Pedagogia e Psicologia Applicata (FISPPA), University Of Padua, Via Venezia, 14, Padova, 35131, Italy
| | - Davide Salvarani
- Associazione Nazionale "Sentire le Voci", Via Fratelli Manfredi, 6, Reggio Emilia, 42124, Italy
| | - Gian Piero Turchi
- Dipartimento di Filosofia, Sociologia, Pedagogia e Psicologia Applicata (FISPPA), University Of Padua, Via Venezia, 14, Padova, 35131, Italy.
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Honcamp H, Schwartze M, Amorim M, Linden DEJ, Pinheiro AP, Kotz SA. Revisiting alpha resting state dynamics underlying hallucinatory vulnerability: Insights from Hidden semi-Markov Modeling. J Neurosci Methods 2024; 407:110138. [PMID: 38648892 DOI: 10.1016/j.jneumeth.2024.110138] [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: 12/13/2023] [Revised: 03/22/2024] [Accepted: 04/12/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Resting state (RS) brain activity is inherently non-stationary. Hidden semi-Markov Models (HsMM) can characterize continuous RS data as a sequence of recurring and distinct brain states along with their spatio-temporal dynamics. NEW METHOD Recent explorations suggest that HsMM state dynamics in the alpha frequency band link to auditory hallucination proneness (HP) in non-clinical individuals. The present study aimed to replicate these findings to elucidate robust neural correlates of hallucinatory vulnerability. Specifically, we aimed to investigate the reproducibility of HsMM states across different data sets and within-data set variants as well as the replicability of the association between alpha brain state dynamics and HP. RESULTS We found that most brain states are reproducible in different data sets, confirming that the HsMM characterized robust and generalizable EEG RS dynamics on a sub-second timescale. Brain state topographies and temporal dynamics of different within-data set variants showed substantial similarities and were robust against reduced data length and number of electrodes. However, the association with HP was not directly reproducible across data sets. COMPARISON WITH EXISTING METHODS The HsMM optimally leverages the high temporal resolution of EEG data and overcomes time-domain restrictions of other state allocation methods. CONCLUSION The results indicate that the sensitivity of brain state dynamics to capture individual variability in HP may depend on the data recording characteristics and individual variability in RS cognition, such as mind wandering. Future studies should consider that the order in which eyes-open and eyes-closed RS data are acquired directly influences an individual's attentional state and generation of spontaneous thoughts, and thereby might mediate the link to hallucinatory vulnerability.
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Affiliation(s)
- Hanna Honcamp
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands.
| | - Michael Schwartze
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands
| | - Maria Amorim
- Centro de Investigação em Ciência Psicológica, Faculdade de Psicologia, Universidade de Lisboa, Lisboa, Portugal
| | - David E J Linden
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ana P Pinheiro
- Centro de Investigação em Ciência Psicológica, Faculdade de Psicologia, Universidade de Lisboa, Lisboa, Portugal
| | - Sonja A Kotz
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands
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Farina EA, Mourgues-Codern C, Sibarium E, Powers AR. Recent social stress and severity of auditory hallucinations. Schizophr Res 2024; 269:64-70. [PMID: 38733801 PMCID: PMC11180583 DOI: 10.1016/j.schres.2024.04.024] [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] [Received: 11/07/2023] [Accepted: 04/27/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND AND HYPOTHESIS Hearing voices is a common and often distressing experience for people with psychosis, and many individuals experience medication-resistant auditory verbal hallucinations (AVH). Psychosocial interventions are often employed to address distress over hearing voices. However, although links have been made between adverse social experiences and psychosis broadly, no work has yet delineated the relationship between day-to-day social stress and hallucination severity. We aimed to define that relationship in both clinical and non-clinical voice-hearers. STUDY DESIGN A sample of 278 participants with a history of hearing voices was selected from the Yale Control Over Perceptual Experiences (COPE) Project. They were administered self-report measures of recent stress and recent auditory experiences within a cross-sectional design. Regression models were used to evaluate whether self-reported aspects of recent stress-and social stress in particular-were related to recent frequency of and distress over hearing voices. Related demographics and clinical characteristics were included as covariates. STUDY RESULTS A significant relationship was observed between recent social stress and both recent frequency of and distress over hearing voices. While other aspects of recent stress were also related to recent distress over voices, social stressors uniquely predicted distress over voice-hearing, beyond the influence of other stressors. Depressive symptom severity was also related to distress over voices. CONCLUSIONS Results suggest that daily social stress may be an important consideration and a potential treatment target for individuals experiencing clinical distress over auditory hallucinations.
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Affiliation(s)
- Emily A Farina
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, USA
| | | | - Ely Sibarium
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, USA
| | - Albert R Powers
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, USA.
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Aversa S, Ghanem J, Grunfeld G, Lemonde AC, Malla A, Iyer S, Joober R, Lepage M, Shah J. Sociodemographic and clinical correlates of hallucinations in patients entering an early intervention program for first episode psychosis. Schizophr Res 2024; 269:86-92. [PMID: 38754313 DOI: 10.1016/j.schres.2024.04.026] [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: 11/18/2023] [Revised: 03/28/2024] [Accepted: 04/27/2024] [Indexed: 05/18/2024]
Abstract
Hallucinations are a core feature of psychosis, and their severity during the acute phase of illness is associated with a range of poor outcomes. Various clinical and sociodemographic factors may predict hallucinations and other positive psychotic symptoms in first episode psychosis (FEP). Despite this, the precise factors associated with hallucinations at first presentation to an early intervention service have not been extensively researched. Through detailed interviews and chart reviews, we investigated sociodemographic and clinical predictors in 636 minimally-medicated patients who entered PEPP-Montréal, an early intervention service for FEP, between 2003 and 2018. Hallucinations were measured using the Scale for the Assessment of Positive Symptoms (SAPS), while negative symptoms were assessed using the Scale for the Assessment of Negative symptoms (SANS). Depressive symptoms were evaluated through the Calgary Depression Scale for Schizophrenia (CDSS), and anxiety symptoms via the Hamilton Rating Scale for Anxiety (HAS). A majority (n = 381, 59.9 %) of the sample presented with clinically significant hallucinations (SAPS global hallucinations score ≥ 3) at program entry. These patients had an earlier age at onset, fewer years of education, and a higher severity of delusions, depression and negative symptoms than those without clinical-level hallucinations. These results suggest that individuals with clinically significant hallucinations at admission tend to be younger and have a greater overall symptom burden. This makes it especially important to monitor hallucinations alongside delusions, depression and negative symptoms in order to identify who might benefit from targeted interventions. The implications of these findings for early intervention and person-centered care are discussed.
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Affiliation(s)
- Samantha Aversa
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, 7070 Champlain Blvd, Verdun, Montreal, Quebec H4H 1A8, Canada.
| | - Joseph Ghanem
- Douglas Mental Health University Institute, 6875 Bd LaSalle, Verdun, Montreal, QC H4H 1R3, Canada; Department of Psychology, Faculty of Science, McGill University, 2001 Av. McGill College, Montréal, QC H3A 1G1, Canada.
| | - Gili Grunfeld
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, 7070 Champlain Blvd, Verdun, Montreal, Quebec H4H 1A8, Canada; Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, 1033 Pine Ave W, Montreal, Quebec H3A 1A1, Canada.
| | - Ann-Catherine Lemonde
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, 7070 Champlain Blvd, Verdun, Montreal, Quebec H4H 1A8, Canada; Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, 1033 Pine Ave W, Montreal, Quebec H3A 1A1, Canada.
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, 7070 Champlain Blvd, Verdun, Montreal, Quebec H4H 1A8, Canada; Douglas Mental Health University Institute, 6875 Bd LaSalle, Verdun, Montreal, QC H4H 1R3, Canada; Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, 1033 Pine Ave W, Montreal, Quebec H3A 1A1, Canada.
| | - Srividya Iyer
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, 7070 Champlain Blvd, Verdun, Montreal, Quebec H4H 1A8, Canada; Douglas Mental Health University Institute, 6875 Bd LaSalle, Verdun, Montreal, QC H4H 1R3, Canada; Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, 1033 Pine Ave W, Montreal, Quebec H3A 1A1, Canada.
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, 7070 Champlain Blvd, Verdun, Montreal, Quebec H4H 1A8, Canada; Douglas Mental Health University Institute, 6875 Bd LaSalle, Verdun, Montreal, QC H4H 1R3, Canada; Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, 1033 Pine Ave W, Montreal, Quebec H3A 1A1, Canada.
| | - Martin Lepage
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, 7070 Champlain Blvd, Verdun, Montreal, Quebec H4H 1A8, Canada; Douglas Mental Health University Institute, 6875 Bd LaSalle, Verdun, Montreal, QC H4H 1R3, Canada; Department of Psychology, Faculty of Science, McGill University, 2001 Av. McGill College, Montréal, QC H3A 1G1, Canada; Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, 1033 Pine Ave W, Montreal, Quebec H3A 1A1, Canada.
| | - Jai Shah
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, 7070 Champlain Blvd, Verdun, Montreal, Quebec H4H 1A8, Canada; Douglas Mental Health University Institute, 6875 Bd LaSalle, Verdun, Montreal, QC H4H 1R3, Canada; Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, 1033 Pine Ave W, Montreal, Quebec H3A 1A1, Canada.
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6
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Renaud E, Arthur B, Typhaine K, Clémentine R, Juan-Pablo RDC. Representation of Voice Hearing Groups by French Mental Health Professionals. Community Ment Health J 2024; 60:572-580. [PMID: 37976007 DOI: 10.1007/s10597-023-01209-8] [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] [Received: 08/05/2023] [Accepted: 11/04/2023] [Indexed: 11/19/2023]
Abstract
Hearing voices groups (HVGs) are an alternative way of treating acoustic-verbal hallucinations. Although they have been developing in France for the last decade, they have lagged behind their international expansion. The representations that circulate about their functioning and their effects are likely to influence the referral to these groups by mental health professionals. We created and used a questionnaire to survey mental health professionals' representations of voice hearing groups. We surveyed 79 French health professionals using a questionnaire with 19 closed items. 7 additional items allowed us to specify the professional status and familiarity of the participants with the HVGs. Professionals generally shared positive representations of HVGs but had very approximate knowledge of them. The subgroup of the most familiar professionals (N = 45) differed significantly on 7 items from the subgroup of non-familiars (N = 35). HVGs are represented as one medical offer among others, of little clinical use and indicated only for psychotic voice-hearing patients, which seems to be a misunderstanding in every case. However, our study also shows that these opinions evolve with the degree of familiarity with HVGs. Certain representations need to be corrected so that quality information can be circulated about HVGs and improve their integration into their ecosystem.
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Affiliation(s)
- Evrard Renaud
- Clinical Psychologist, University of Lorraine, Interpsy Laboratory, Co-Founder of the Center for Information, Research and Counseling on Exceptional Experiences. Campus Lettres et Sciences Humaines, 23 boulevard Albert 1er, Nancy, 54015, France.
| | - Braun Arthur
- Clinical Psychologist and Psychotherapist at the Centre Médico-Psychologique Pour Adolescents of Epinal, Centre Hospitalier Ravenel, University of Lorraine, Laboratory Interpsy, Nancy, 54015, France
| | - Krebs Typhaine
- Clinical Psychologist, University of Lorraine, Interpsy Laboratory, Co-Founder of the Center for Information, Research and Counseling on Exceptional Experiences. Campus Lettres et Sciences Humaines, 23 boulevard Albert 1er, Nancy, 54015, France
- University of Lorraine, Interpsy Laboratory, Nancy, France
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7
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Park SW, Lee NY, Jeong HY, Chung IW, Kim YS, Jeong SH. The Mediating Role of Anxiety/Depression Between Auditory Verbal Hallucinations and the Level of Insight in Schizophrenia. Psychiatry Investig 2024; 21:403-414. [PMID: 38695048 PMCID: PMC11065532 DOI: 10.30773/pi.2023.0396] [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: 11/16/2023] [Revised: 01/17/2024] [Accepted: 01/31/2024] [Indexed: 05/04/2024] Open
Abstract
OBJECTIVE Auditory verbal hallucination (AVH) is a prominent symptom of schizophrenia causing profound distress. The influence of AVHs on insight appears to be intricate and contingent on other accompanying symptoms. This study investigated the relationship and possible mediators between AVHs and the degree of insight. METHODS One hundred patients with schizophrenia participated in the study. Scales were used to evaluate the hallucinatory experience, the level of insight and other psychopathology. Complex relationships between variables were envisaged as a path model, whose initial structure was constructed via Gaussian Graphical Model. The validity of the final model was verified by Structural Equation Modeling. Separate analyses were performed for self-reported and clinician-rated data to enhance the model's robustness. RESULTS The greater the severity of the physical aspects of AVHs, the lower the level of insight observed. Conversely, higher emotional distress was associated with increased insight. These relationships were only evident in the self-reported results and were not reflected in the clinician-rated results. The path model suggested that the Positive and Negative Syndrome Scale (PANSS) anxiety/depression factor was an important mediator that linked the found association. Notably, the PANSS negative symptom had the opposite effect on the PANSS anxiety/depression factor and insight, making it difficult to define its overall effect. CONCLUSION The findings of this study provided one possible route for the positive influence of AVH experience in gaining insight. The mediating role of anxiety/depression modified by negative symptoms emerged as a valuable concept for clarifying this intricate relationship.
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Affiliation(s)
- Sang Won Park
- Inarae Psychiatry Clinic, Cheongju, Republic of Korea
| | - Nam Young Lee
- Department of Psychiatry, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Goyang, Republic of Korea
| | - Hee Yeon Jeong
- Department of Psychiatry, SNU SMG Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - In Won Chung
- Department of Psychiatry and Yong-In Psychiatric Institute Yong-In Mental Hospital, Yongin, Republic of Korea
| | - Yong Sik Kim
- Department of Psychiatry, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Seong Hoon Jeong
- Department of Psychiatry, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
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8
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Aldhafeeri FM. Altered brain responses to emotional auditory stimuli in AVH subjects: an fMRI study. Int J Neurosci 2024; 134:333-340. [PMID: 35849653 DOI: 10.1080/00207454.2022.2102977] [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: 07/10/2021] [Revised: 03/07/2022] [Accepted: 06/30/2022] [Indexed: 10/17/2022]
Abstract
Purpose: Auditory verbal hallucinations (AVH) are a frequently occurring phenomenon in which subjects hear verbal sounds in the absence of any external stimuli. The prevalence of auditory hallucinations in schizophrenia has been revealed in many studies. Healthy subjects may also experience auditory hallucinations without accompanying psychological or neurological disorders, and in rare cases they seek clinical assistance for this emotionally disturbing condition. The aim of this study was to investigate the neural basis of emotional disturbance in auditory hallucinating subjects who do not suffer from any psychological or neurological disorder. Materials and Methods: Fourteen subjects suffering from auditory hallucinations and 15 age- and sex-matched healthy controls were recruited in this study. All participants underwent fMRI in two experimental sessions. In the first experimental session, all participants from both groups listened to pleasant auditory stimuli. In the second session, both groups listened to unpleasant auditory stimuli. The auditory stimuli were obtained from the International Affective Digitized Sounds (IADS). Results: Compared with the healthy control group, AVH subjects exhibited significantly increased activation in limbic, auditory, and frontal regions. Conclusion: Current results suggest that AVH may induce functional reorganization in emotion-related brain regions.
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Affiliation(s)
- Faten Mane Aldhafeeri
- Department of Radiology, College of Applied Medical Sciences, University of Hafr Albatin, Hafr Albatin, Saudi Arabia
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9
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Næss JØ, Hirnstein M, Kusztrits I, Larøi F. An online survey on clinical and healthy individuals with auditory verbal hallucinations: Abuse did not lead to more negative voice content. Schizophr Res 2024; 265:39-45. [PMID: 36435717 DOI: 10.1016/j.schres.2022.11.020] [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: 07/11/2022] [Revised: 10/21/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022]
Abstract
Despite the clinical and theoretical importance of the negative content in auditory verbal hallucinations (AVHs), little research has been conducted on the topic. A handful of studies suggest that trauma or adverse life events contribute to negative content. The findings are somewhat inconsistent, however, possibly due to methodological limitations. Moreover, only trauma occurring in childhood has been investigated so far. In the present study, we studied the effect of abuse, experienced in either child- or adulthood, and clinical status on negative content of AVHs in four groups of participants that were assessed as part of a large, previously published online survey: Individuals with a psychotic disorder and AVHs (total n = 33), who had experienced abuse (n = 21) or not (n = 12) as well as a group of healthy individuals with AVHs (total n = 53), who had experienced abuse (n = 31) or not (n = 22). We hypothesized that having experienced abuse was associated with a higher degree of negative content. The clinical group collectively reported significantly higher degrees of negative AVHs content compared to the healthy group, but there was no effect of abuse on the degree of negative AVHs content. The presence of AVHs was more common amongst individuals who reported a history of abuse compared to individuals with no history of abuse, both in clinical and healthy participants with AVHs. This implies that at group level, being subjected to traumatic events increases an individual's vulnerability to experiencing AVHs. However, it does not necessarily account for negative content in AVHs.
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Affiliation(s)
- Julie Øverbø Næss
- Department of Biological and Medical Psychology, University of Bergen, Norway
| | - Marco Hirnstein
- Department of Biological and Medical Psychology, University of Bergen, Norway; NORMENT - Norwegian Centre of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
| | - Isabella Kusztrits
- Department of Biological and Medical Psychology, University of Bergen, Norway; NORMENT - Norwegian Centre of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Frank Larøi
- Department of Psychology, University of Oslo, Oslo, Norway; Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium.
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10
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Kubera KM, Rashidi M, Schmitgen MM, Barth A, Hirjak D, Otte ML, Sambataro F, Calhoun VD, Wolf RC. Functional network interactions in patients with schizophrenia with persistent auditory verbal hallucinations: A multimodal MRI fusion approach using three-way pICA. Schizophr Res 2024; 265:20-29. [PMID: 37024417 DOI: 10.1016/j.schres.2023.03.001] [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: 10/23/2022] [Revised: 02/18/2023] [Accepted: 03/03/2023] [Indexed: 04/08/2023]
Abstract
Over the last decade, there have been an increasing number of functional magnetic resonance imaging (fMRI) studies examining brain activity in schizophrenia (SZ) patients with persistent auditory verbal hallucinations (AVH) using either task-based or resting-state fMRI (rs-fMRI) paradigms. Such data have been conventionally collected and analyzed as distinct modalities, disregarding putative crossmodal interactions. Recently, it has become possible to incorporate two or more modalities in one comprehensive analysis to uncover hidden patterns of neural dysfunction not sufficiently captured by separate analysis. A novel multivariate fusion approach to multimodal data analysis, i.e., parallel independent component analysis (pICA), has been previously shown to be a powerful tool in this regard. We utilized three-way pICA to study covarying components among fractional amplitude of low-frequency fluctuations (fALFF) for rs-MRI and task-based activation computed from an alertness and a working memory (WM) paradigm of 15 SZ patients with AVH, 16 non-hallucinating SZ patients (nAVH), and 19 healthy controls (HC). The strongest connected triplet (false discovery rate (FDR)-corrected pairwise correlations) comprised a frontostriatal/temporal network (fALFF), a temporal/sensorimotor network (alertness task), and a frontoparietal network (WM task). Frontoparietal and frontostriatal/temporal network strength significantly differed between AVH patients and HC. Phenomenological features such as omnipotence and malevolence of AVH were associated with temporal/sensorimotor and frontoparietal network strength. The transmodal data confirm a complex interplay of neural systems subserving attentional processes and cognitive control interacting with speech and language processing networks. In addition, the data emphasize the importance of sensorimotor regions modulating specific symptom dimensions of AVH.
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Affiliation(s)
- Katharina M Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany
| | - Mahmoud Rashidi
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany
| | - Mike M Schmitgen
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany
| | - Anja Barth
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marie-Luise Otte
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany
| | - Fabio Sambataro
- Department of Neuroscience (DNS), University of Padua, Padua, Italy; Padua Neuroscience Center, University of Padua, Padua, Italy
| | - Vince D Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
| | - Robert C Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany.
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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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Mosqueiro BP, Costa MDA, Caribé AC, Oliveira e Oliveira FH, Pizutti L, Zimpel RR, Baldaçara L, da Silva AG, Moreira-Almeida A. Brazilian Psychiatric Association guidelines on the integration of spirituality into mental health clinical practice: Part 1. Spiritual history and differential diagnosis. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2023; 45:506-517. [PMID: 37718460 PMCID: PMC10897776 DOI: 10.47626/1516-4446-2023-3056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/25/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVES To present evidence-based guidelines for clinical practice regarding religiosity and spirituality in mental health care in Brazil. METHODS A systematic review was conducted to identify potentially eligible articles indexed in the PubMed, PsycINFO, SciELO, LILACS, and Cochrane databases. A summary of recommendations and their levels of evidence was produced in accordance with Oxford Centre for Evidence-Based Medicine guidelines. RESULTS The systematic review identified 6,609 articles, 41 of which satisfied all inclusion criteria. Taking a spiritual history was found to be an essential part of a compassionate and culturally sensitive approach to care. It represents a way of obtaining relevant information about the patient's religiosity/spirituality, potential conflicts that could impact treatment adherence, and improve patient satisfaction. Consistent evidence shows that reported perceptual experiences are unreliable for differentiating between anomalous experiences and psychopathology. Negative symptoms, cognitive and behavioral disorganization, and functional impairment are more helpful for distinguishing pathological and non-pathological anomalous experiences. CONCLUSION Considering the importance of religiosity/spirituality for many patients, a spiritual history should be routinely included in mental health care. Anomalous experiences are highly prevalent, requiring a sensitive and evidence-based approach to differential diagnosis.
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Affiliation(s)
- Bruno Paz Mosqueiro
- Departamento de Psiquiatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil
- Comissão de Estudos e Pesquisas em Espiritualidade e Saúde Mental, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
| | - Marianna de Abreu Costa
- Comissão de Estudos e Pesquisas em Espiritualidade e Saúde Mental, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Núcleo de Pesquisas em Espiritualidade e Saúde (NUPES), Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - André C. Caribé
- Comissão de Estudos e Pesquisas em Espiritualidade e Saúde Mental, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil
- Hospital Universitário Professor Edgar Santos, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Fabrício H.A. Oliveira e Oliveira
- Comissão de Estudos e Pesquisas em Espiritualidade e Saúde Mental, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Núcleo de Pesquisas em Espiritualidade e Saúde (NUPES), Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Leandro Pizutti
- Departamento de Psiquiatria e Espiritualidade, Associação de Psiquiatria do Rio Grande do Sul (APRS), Porto Alegre, RS, Brazil
| | - Rogério R. Zimpel
- Departamento de Psiquiatria e Espiritualidade, Associação de Psiquiatria do Rio Grande do Sul (APRS), Porto Alegre, RS, Brazil
| | - Leonardo Baldaçara
- Universidade Federal do Tocantins, Palmas, TO, Brazil
- ABP, Rio de Janeiro, RJ, Brazil
| | - Antônio Geraldo da Silva
- ABP, Rio de Janeiro, RJ, Brazil
- Asociación Psiquiátrica de América Latina, Santo Domingo, Dominican Republic
| | - Alexander Moreira-Almeida
- Comissão de Estudos e Pesquisas em Espiritualidade e Saúde Mental, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Núcleo de Pesquisas em Espiritualidade e Saúde (NUPES), Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
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Butter S, Shevlin M, McBride O, Bentall RP, Hyland P, Leavey G, Murphy J. Functioning, symptom expression and risk along the psychosis continuum. Psychol Med 2023; 53:7407-7417. [PMID: 37092866 PMCID: PMC10719677 DOI: 10.1017/s0033291723001046] [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: 08/22/2022] [Revised: 03/25/2023] [Accepted: 03/31/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND The psychosis continuum implies that subclinical psychotic experiences (PEs) can be differentiated from clinically relevant expressions since they are not accompanied by a 'need for care'. METHODS Using data from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 34 653), the current study examined variation in functioning, symptomology and aetiological risk across the psychosis phenotype [i.e. variation from (i) no PEs, 'No PEs' to (ii) non-distressing PEs, 'PE-Experienced Only' to (iii) distressing PEs, 'PE-Impaired' to (iv) clinically defined psychotic disorder, 'Diagnosed']. RESULTS A graded trend was present such that, compared to those with no PEs, the Diagnosed group had the poorest functioning, followed by the PE-Impaired then PE-Experienced Only groups. In relation to symptom expression, the PE-Impaired group were more likely than the PE-Experienced Only and the Diagnosed groups to endorse most PEs. Predictors of group membership tended to vary quantitatively rather than qualitatively. Trauma, current mental health diagnoses (anxiety and depression) and drug use variables differentiated between all levels of the continuum, with the exception of the extreme end (PE-Impaired v. Diagnosed). Only a few variables distinguished groups at the upper end of the continuum: female sex, older age, unemployment, parental mental health hospitalisation and lower likelihood of having experienced physical assault. CONCLUSIONS The findings highlight the importance of continuum-based interpretations of the psychosis phenotype and afford valuable opportunities to consider if and how impairment, symptom expression and risk change along the continuum.
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Affiliation(s)
- Sarah Butter
- School of Psychology, Ulster University, Coleraine, Northern Ireland
- Bamford Centre for Mental Health & Wellbeing, Ulster University, Coleraine, Northern Ireland
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Orla McBride
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Richard P. Bentall
- Department of Psychology, The University of Sheffield, Sheffield, England
| | - Philip Hyland
- Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Gerard Leavey
- School of Psychology, Ulster University, Coleraine, Northern Ireland
- Bamford Centre for Mental Health & Wellbeing, Ulster University, Coleraine, Northern Ireland
| | - Jamie Murphy
- School of Psychology, Ulster University, Coleraine, Northern Ireland
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Bortolon C, Baeyens C, Raffard S. Hooked on a memory: How rumination about past positive events might contribute to grandiose ideas? BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2023; 62:556-572. [PMID: 37089072 DOI: 10.1111/bjc.12425] [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: 10/28/2022] [Revised: 03/03/2023] [Accepted: 04/05/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVES Dwelling about positive experiences has been found to be positively related to mania and grandiose ideas. Nevertheless, besides some important limitations, past research has also neglected the nature (or characteristics) of memories individuals dwell on, and that might be specifically associated with grandiose ideas. Thus, the present study aimed to replicate previous studies while considering the role of specificity and the importance of memory used to increase grandiose feelings. METHOD In total, 219 participants were included and, after completing the memory induction, were randomized to either the rumination condition or the distraction condition. They also completed different questionnaires assessing positive rumination and grandiose ideas. RESULTS Overall, rumination, compared to the distraction condition, led to the maintenance of grandiose ideas and positive affect from T2 to T3. Regression analysis showed that the specificity of memory was associated with grandiose ideas at T2, which predicted grandiose ideas at T3. CONCLUSIONS Our results confirm rumination's causal role in forming grandiose ideas. We also found that autobiographical memory and, more specifically, the capacity to recall past positive experiences coupled with repeatedly thinking about them might constitute a fundamental pathway leading to the persistence of such beliefs. The use of a non-clinical sample limits the results and needs replication in clinical samples.
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Affiliation(s)
- Catherine Bortolon
- Université Grenoble Alpes, Université Savoie Mont Blanc, LIP/PC2S, Grenoble, France
- C3R - Réhabilitation Psychosociale et Remédiation Cognitive, Centre Hospitalier Alpes Isère, Grenoble, France
- Institut Universitaire de France (IUF), Paris, France
| | - Céline Baeyens
- Université Grenoble Alpes, Université Savoie Mont Blanc, LIP/PC2S, Grenoble, France
| | - Stéphane Raffard
- Université Paul Valéry Montpellier 3, Montpellier, France
- University Department of Adult Psychiatry, CHU Montpellier, Montpellier, France
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15
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Jones B, Muddle S, Jenkins T, Kitapci N, Jacobsen P. Mindfulness for voices: An experimental analogue study of the effect of manipulating response style to simulated voices in a non-clinical population. Psychol Psychother 2023; 96:778-792. [PMID: 37102493 DOI: 10.1111/papt.12468] [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: 12/11/2019] [Revised: 02/07/2023] [Accepted: 04/05/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVES We aimed to investigate the effects of directly manipulating response style to simulated voice hearing on emotional and cognitive outcomes in a non-clinical population. DESIGN A between-subjects design with one independent variable, response style (with two levels: mindful acceptance vs attentional avoidance). The dependent variables were subjective distress and anxiety (primary outcomes) and performance on a sustained attention task (secondary outcomes). METHODS Participants were randomly assigned to one of two response styles (mindful acceptance vs. attentional avoidance). They completed a computerised attention task (continuous performance task) whilst listening to a simulation of voice hearing. Participants rated their experience of anxiety and distress before and after completing the sustained attention task which was used to measure their accuracy and response times. RESULTS One hundred and one participants took part (mindful acceptance (n = 54); attentional avoidance (n = 47)). There were no statistically significant group differences on post-test distress and anxiety scores, correct response rate or response times on the computerised attention task. Participants reported a range of different response styles along the spectrum of avoidance to acceptance, but this had no association with their assigned experimental condition. Adherence to task instructions was therefore low. CONCLUSIONS We are unable to conclude from this study whether experimentally inducing people to respond to voices under cognitively demanding conditions in an avoidant or accepting way has an impact on their emotional or cognitive outcomes. Further research should focus on the development of more robust and reliable procedures for inducing differences in response style under experimental conditions.
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Affiliation(s)
- Bradley Jones
- Department of Psychology, University of Bath, Bath, UK
| | - Sarah Muddle
- Department of Psychology, University of Bath, Bath, UK
| | - Tom Jenkins
- Department of Psychology, University of Bath, Bath, UK
| | - Nice Kitapci
- Department of Psychology, University of Bath, Bath, UK
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16
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Abalo-Rodríguez I, Santos-Mayo A, Moratti S. Pavlovian conditioning-induced hallucinations reduce MMN amplitudes for duration but not frequency deviants. Schizophr Res 2023; 256:63-71. [PMID: 37156071 DOI: 10.1016/j.schres.2023.04.017] [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: 09/09/2022] [Revised: 04/12/2023] [Accepted: 04/30/2023] [Indexed: 05/10/2023]
Abstract
The mismatch negativity (MMN) is an evoked potential that indexes auditory regularity violations. Since the 90's, a reduced amplitude of this brain activity in patients with schizophrenia has been consistently reported. Recently, this alteration has been related to the presence of auditory hallucinations (AHs) rather than the schizophrenia diagnostic per se. However, making this attribution is rather problematic due to the high heterogeneity of symptoms in schizophrenia. In an attempt to isolate the AHs influence on the MMN amplitude from other cofounding variables, we artificially induced AHs in a non-clinical population by Pavlovian conditioning. Before and after conditioning, volunteers (N = 31) participated in an oddball paradigm that elicited an MMN. Two different types of deviants were presented: a frequency and a duration deviant, as the MMN alteration seems to be especially present in schizophrenia with the latter type of deviant. Hence, this pre-post design allowed us to compare whether experiencing conditioning-induced AHs exert any influence on MMN amplitudes. Our results show that duration-deviant related MMN reductions significantly correlate with the number of AHs experienced. Moreover, we found a significant correlation between AHs proneness (measured with the Launay-Slade Hallucination Extended Scale) and the number of AHs experienced during the paradigm. In sum, our study shows that AHs can be conditioned and exert similar effects on MMN modulation in healthy participants as has been reported for patients with schizophrenia. Thus, conditioning paradigms offer the possibility to study the association between hallucinations and MMN reductions without the confounding variables present in schizophrenia patients.
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Affiliation(s)
- Inés Abalo-Rodríguez
- Department of Experimental Psychology, Complutense University of Madrid, Spain; Center of Cognitive and Computational Neuroscience, Complutense University of Madrid, Spain
| | - Alejandro Santos-Mayo
- Department of Experimental Psychology, Complutense University of Madrid, Spain; Center of Cognitive and Computational Neuroscience, Complutense University of Madrid, Spain
| | - Stephan Moratti
- Department of Experimental Psychology, Complutense University of Madrid, Spain; Center of Cognitive and Computational Neuroscience, Complutense University of Madrid, Spain.
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17
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Pratt DN, Bridgwater M, Schiffman J, Ellman LM, Mittal VA. Do the Components of Attenuated Positive Symptoms Truly Represent One Construct? Schizophr Bull 2023; 49:788-798. [PMID: 36454660 PMCID: PMC10154719 DOI: 10.1093/schbul/sbac182] [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: 12/03/2022]
Abstract
BACKGROUND AND HYPOTHESES Psychosis-risk inventories, like the Structured Interview for Psychosis-Risk Syndromes (SIPS), utilize symptom components and coalesce the information into a single-severity rating. These components include frequency, duration, in-the-moment conviction, retrospective insight, distress, and effect on social/role functioning. While combining components distills a great deal of important information into one practical symptom rating, this approach may mask important details of the greater clinical picture. STUDY DESIGN Individuals at clinical high risk for psychosis (n = 115) were assessed with the SIPS Score Separable Components (SSSC) scale, created to accompany the SIPS positive items by dividing each item into the 7 components identified above. The latent structure of the SSSC was identified with an exploratory factor analysis (EFA). The factors were followed up with validation analyses including hypothesized cognitive, functioning, and symptom measures. Finally, clinical utility analyses were conducted to understand relationships between psychosis risk and common comorbidities. STUDY RESULTS EFA revealed that the SSSC had 3 interpretable factors with the appropriate fit (rmsr = 0.018, TLI = 0.921): Conviction (in-the-moment conviction, retrospective insight), Distress-Impairment (distress, social/role functioning), and Frequency/Duration (frequency, duration). Conviction was minimally valid, Distress-Impairment had excellent validity, and Frequency/Duration was not related to any of the candidate validators. Conviction significantly predicted elevated psychosis risk. Distress-Impairment was related to common comorbid symptoms. Notably, the factors associated more strongly with clinical features than the traditional SIPS scores. CONCLUSIONS The SSSC offers a supplemental approach to single-severity ratings, providing useful clinical insight, mechanistic understanding, and the potential for better capturing heterogeneity in this population.
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Affiliation(s)
- Danielle N Pratt
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Miranda Bridgwater
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Jason Schiffman
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Department of Psychiatry, Northwestern University, Chicago, IL, USA
- Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Institute for Policy Research (IPR), Northwestern University, Chicago, IL, USA
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18
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Stephan-Otto C, Núñez C, Lombardini F, Cambra-Martí MR, Ochoa S, Senior C, Brébion G. Neurocognitive bases of self-monitoring of inner speech in hallucination prone individuals. Sci Rep 2023; 13:6251. [PMID: 37069194 PMCID: PMC10110610 DOI: 10.1038/s41598-023-32042-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/20/2023] [Indexed: 04/19/2023] Open
Abstract
Verbal hallucinations in schizophrenia patients might be seen as internal verbal productions mistaken for perceptions as a result of over-salient inner speech and/or defective self-monitoring processes. Similar cognitive mechanisms might underpin verbal hallucination proneness in the general population. We investigated, in a non-clinical sample, the cerebral activity associated with verbal hallucinatory predisposition during false recognition of familiar words -assumed to stem from poor monitoring of inner speech-vs. uncommon words. Thirty-seven healthy participants underwent a verbal recognition task. High- and low-frequency words were presented outside the scanner. In the scanner, the participants were then required to recognize the target words among equivalent distractors. Results showed that verbal hallucination proneness was associated with higher rates of false recognition of high-frequency words. It was further associated with activation of language and decisional brain areas during false recognitions of low-, but not high-, frequency words, and with activation of a recollective brain area during correct recognitions of low-, but not high-, frequency words. The increased tendency to report familiar words as targets, along with a lack of activation of the language, recollective, and decisional brain areas necessary for their judgement, suggests failure in the self-monitoring of inner speech in verbal hallucination-prone individuals.
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Affiliation(s)
- Christian Stephan-Otto
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Christian Núñez
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | | | | | - Susana Ochoa
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Carl Senior
- School of Life & Health Sciences, Aston University, Birmingham, UK.
- University of Gibraltar, Gibraltar, UK.
| | - Gildas Brébion
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
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Ngo HVV, Oster H, Andreou C, Obleser J. Circadian rhythms in auditory hallucinations and psychosis. Acta Physiol (Oxf) 2023; 237:e13944. [PMID: 36744985 DOI: 10.1111/apha.13944] [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: 09/23/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/07/2023]
Abstract
Circadian rhythms are imprinted in all organisms and influence virtually all aspects of physiology and behavior in adaptation to the 24-h day-night cycle. This recognition of a circadian timekeeping system permeating essentially all healthy functioning of body and mind quickly leads to the realization that, in turn, human ailments should be probed for the degree to which they are rooted in or marked by disruptions and dysregulations of circadian clock functions in the human body. In this review, we will focus on psychosis as a key mental illness and foremost one of its cardinal symptoms: auditory hallucinations. We will discuss recent empirical evidence and conceptual advances probing the potential role of circadian disruption in auditory hallucinations. Moreover, a dysbalance in excitation and inhibition within cortical networks, which in turn drive a disinhibition of dopaminergic signaling, will be highlighted as central physiological mechanism. Finally, we will propose two avenues for experimentally intervening on the circadian influences to potentially alleviate hallucinations in psychotic disorders.
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Affiliation(s)
- Hong-Viet V Ngo
- Department of Psychology, University of Lübeck, Lübeck, Germany
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
| | - Henrik Oster
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
- Institute of Neurobiology, University of Lübeck, Lübeck, Germany
| | - Christina Andreou
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Jonas Obleser
- Department of Psychology, University of Lübeck, Lübeck, Germany
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
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20
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Silver JH, Lewton M, Lewis HW. Mediators of negative content and voice-related distress in a diverse sample of clinical and non-clinical voice-hearers. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2023; 62:96-111. [PMID: 36205115 PMCID: PMC10092889 DOI: 10.1111/bjc.12396] [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: 11/09/2021] [Revised: 07/29/2022] [Accepted: 09/08/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Negative content in hearing voices (i.e., auditory verbal hallucinations) has been associated with adverse clinical outcomes including voice-related distress. Voice appraisals and responding mindfully to voices are theorized to reduce voice-related distress. This study aimed in examine mediators of the negative content voice-related distress relationship in clinical (those who recently received input from mental health services) and non-clinical voice-hearers. METHODS One hundred and twenty-one adults (71.9% female; 35.5% mixed or non-white ethnic background) who hear voices were recruited online and completed self-report measures of negative content of voices, voice-related distress, mindfulness of voices, interpretation of loss of control, thought suppression and intrusion. RESULTS Clinical voice-hearers had significantly higher levels of negative content, voice-related distress and interpretation of loss of control than non-clinical voice-hearers. A mindful approach to voices and interpretation of loss of control mediated the relationship between negative content and voice-related distress across the whole sample. Thought suppression and intrusion did not mediate the relationship. CONCLUSIONS The results support the use of mindfulness-based psychological intervention to reduce voice-related distress. Further development of valid and reliable measures specifically relating to constructs of voice content, voice-related distress and voice suppression will support further research in this area.
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Affiliation(s)
- Jessica Helen Silver
- Older Persons Mental Health Psychology Service, Cwm Taf Morgannwg University Health Board, Pontypridd, UK
| | - Marcus Lewton
- Child and Adolescent Mental Health Service, Cwm Taf Morgannwg University Health Board, Pontypridd, UK
| | - Heledd Wyn Lewis
- South Wales Doctoral Programme in Clinical Psychology, Cardiff University, Cardiff, UK
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21
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Bortolon C, Chen S, Bonanno GA. Components of emotion regulation flexibility and psychosis: The association between psychosis-proneness and context sensitivity. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2023; 62:82-95. [PMID: 36172993 DOI: 10.1111/bjc.12395] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/26/2022] [Accepted: 09/02/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Emotion regulation flexibility has been conceptualized as a multi-componential construct involving context sensitivity, repertoire and feedback responsiveness. Psychosis research has yet to incorporate these new developments in the study of emotion regulation. Thus, we sought to advance even further the knowledge on emotion regulation in psychosis by adopting the emotion regulation flexibility approach as proposed by Bonanno and Burton (Perspectives on Psychological Science, 2013, 8, 591). METHOD In total, 401 participants completed 4 scales assessing the multi-components of emotion regulation flexibility and psychosis-proneness. RESULTS Our results indicated that Context Sensitivity (i.e., Cue Absence) and Feedback Responsiveness (i.e., Evaluation) were associated with psychosis-proneness. Cue absence was specifically associated with the positive dimension, while both Cue Absence and Enhancement ability were associated with the negative dimension. CONCLUSIONS Overall, our results suggest that emotional context insensitivity is the most relevant component of regulatory flexibility in the case of psychosis-proneness. Thus, the disruption in this first step of flexible emotion regulation might be already present in those prone to psychosis. Difficulties in decoding appropriately the contextual cues might further disrupt the other steps of emotion regulation contributing to the psychotic (-like) experiences. This study needs replication in clinical and non-clinical samples.
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Affiliation(s)
- Catherine Bortolon
- Université Grenoble Alpes, Université Savoie Mont Blanc, Grenoble, France.,C3R - Réhabilitation Psychosociale et Remédiation Cognitive, Centre Hospitalier Alpes Isère, Grenoble, France
| | - Shuquan Chen
- Teachers College, Columbia University, New York, New York, USA
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22
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Luhrmann TM, Alderson-Day B, Chen A, Corlett P, Deeley Q, Dupuis D, Lifshitz M, Moseley P, Peters E, Powell A, Powers A. Learning to Discern the Voices of Gods, Spirits, Tulpas, and the Dead. Schizophr Bull 2023; 49:S3-S12. [PMID: 36840538 PMCID: PMC9959996 DOI: 10.1093/schbul/sbac005] [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: 11/12/2022]
Abstract
There are communities in which hearing voices frequently is common and expected, and in which participants are not expected to have a need for care. This paper compares the ideas and practices of these communities. We observe that these communities utilize cultural models to identify and to explain voice-like events-and that there are some common features to these models across communities. All communities teach participants to "discern," or identify accurately, the legitimate voice of the spirit or being who speaks. We also observe that there are roughly two methods taught to participants to enable them to experience spirits (or other invisible beings): trained attention to inner experience, and repeated speech to the invisible other. We also observe that all of these communities model a learning process in which the ability to hear spirit (or invisible others) becomes more skilled with practice, and in which what they hear becomes clearer over time. Practice-including the practice of discernment-is presumed to change experience. We also note that despite these shared cultural ideas and practices, there is considerable individual variation in experience-some of which may reflect psychotic process, and some perhaps not. We suggest that voice-like events in this context may be shaped by cognitive expectation and trained practice as well as an experiential pathway. We also suggest that researchers could explore these common features both as a way to help those struggling with psychosis, and to consider the possibility that expectations and practice may affect the voice-hearing experience.
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Affiliation(s)
- Tanya M Luhrmann
- Department of Anthropology, Stanford University, Stanford, CA, USA
| | | | - Ann Chen
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Philip Corlett
- Department of Psychiatry, Yale School of Medicine, Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Quinton Deeley
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, Department of Forensic & Neurodevelopmental Sciences, London, UK
| | - David Dupuis
- Quai Branly Museum (Paris), Research Department, Paris, France
| | - Michael Lifshitz
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, Canada
| | - Peter Moseley
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Emmanuelle Peters
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, Department of Psychology, London, UK
| | - Adam Powell
- Department of Theology and Religion, Durham University, Durham, UK
| | - Albert Powers
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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23
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Hallucinations and Hallucinogens: Psychopathology or Wisdom? Cult Med Psychiatry 2023; 47:576-604. [PMID: 36633720 PMCID: PMC9838303 DOI: 10.1007/s11013-022-09814-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 01/13/2023]
Abstract
Hallucinations are currently associated almost exclusively with psychopathological states. While it is evident that hallucinations can indicate psychopathology or neurological disorders, we should remember that hallucinations also commonly occur in people without any signs of psychopathology. A similar case occurs in the case of hallucinogenic drugs, which have been long associated with psychopathology and insanity. However, during the last decades a huge body of research has shown that certain kinds of hallucinations, exerted by hallucinogenic drugs, may serve to improve mental health. We propose that, in light of historical, epidemiological, and scientific research, hallucinations can be better characterized as a common phenomenon associated sometimes with psychopathology but also with functional and even beneficial outcomes. In the last sections of the manuscript, we extend our argument, suggesting that hallucinations can offer a via regia to knowledge of the mind and the world. This radical shift in the cultural interpretation of hallucinations could have several implications for fields such as drug policy, civil law, and psychiatry, as well as for the stigma associated with mental disorders.
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Echoes of shame: a comparison of the characteristics and psychological sequelae of recalled shame experiences across the voice hearing continuum. Behav Cogn Psychother 2023; 51:61-73. [PMID: 36285429 DOI: 10.1017/s1352465822000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Voice hearing occurs across a number of psychiatric diagnoses and appears to be present on a continuum within the general population. Previous research has highlighted the potential role of past experiences of shame in proneness to voice hearing in the general population. AIMS This study aimed to extend this past research and compare people with distressing voices, people with voices but no distress, and a non-voice hearing control group, on various dimensions of shame and shame memory characteristics. METHOD In a cross-sectional, online study 39 distressed voice hearers, 31 non-distressed voice hearers and 50 non-voice hearers undertook a shame memory priming task in which they were prompted to recall a memory of a shaming experience from their past. They then completed questionnaires assessing the characteristics of the recalled shame event and the psychological sequalae of this event (i.e. intrusions, hyperarousal, avoidance, the centrality of shame memories, external shame, and self-criticism). RESULTS The majority of recalled shame memories involved experiences such as interpersonal criticism or experiences of being devalued. Univariate analyses found no significant differences between the three groups with regard to the shame events that were recalled, but the distressed voice hearer group reported significantly more hyperarousal, intrusions, self-criticism, and external shame in relation to their experience. CONCLUSIONS The findings suggest that voice hearers recall similar types of shame experiences to non-voice hearers, but that problematic psychological sequelae of these shame experiences (in the form of intrusive memories, hyperarousal, external shame, and self-criticism) may specifically contribute to distressing voice hearing.
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25
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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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26
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Aynsworth C, Rolinson J, Pervez M, Collerton D, Dudley R. What is the frequency and nature of visual hallucinations in non-clinical participants? Psychol Psychother 2022; 96:281-295. [PMID: 36504251 DOI: 10.1111/papt.12440] [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: 07/05/2021] [Accepted: 11/14/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES There is a paucity of psychological treatments for visual hallucinations (VH). A key aspect in the psychological treatment of hallucination-related distress is normalisation to explain that these experiences are commonplace and can be non-distressing. In order to normalise VH, it is vital that more is known about VH in non-clinical populations. This study investigated the prevalence, content, context, appraisals, distress, and behavioural reactions to VH in a non-clinical sample. DESIGN A cross-sectional study was conducted. METHODS 466 students completed the Multi-Modality Unusual Sensory Experiences Questionnaire-VH subscale with additional contextual follow-up questions. RESULTS Of the 466 participants, 395 (84.8%) reported anomalous visual experiences. 176 (37.77%) participants reported VH similar to the content seen in psychosis. Of the overall sample, 17.38% felt their experience met the VH definition. Participants mainly saw figures, when alone and in the evening. Participants endorsed normalising appraisals: 112 out of 176 (78.87%) believed their mind was playing tricks on them and 83 (58.45%) believed they were tired. However, many also believed the VH was a threat to their mental (66, 46.48%) or physical well-being (41, 28.87%). These negative appraisals were associated with distress. CONCLUSION VH are seemingly common in non-clinical populations and are similar in a number of ways to those of people with psychosis. Awareness that VH occur on a continuum could normalise people's experiences and reduce their negative appraisals and related distress.
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Affiliation(s)
- Charlotte Aynsworth
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Julie Rolinson
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - Maryam Pervez
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Daniel Collerton
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - Robert Dudley
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.,School of Psychology, Newcastle University, Newcastle upon Tyne, UK
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27
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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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28
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Rammou A, Berry C, Fowler D, Hayward M. Distress factors of voice-hearing in young people and social relating: Exploring a cognitive-interpersonal voice-hearing model. Psychol Psychother 2022; 95:939-957. [PMID: 35773751 PMCID: PMC9795969 DOI: 10.1111/papt.12411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/22/2022] [Accepted: 06/13/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Little is known about the factors that can maintain the distress related to voice-hearing experiences in youth. Building upon understandings developed with adults, this study aimed to explore the associations between negative relating between hearer and voices, persecutory beliefs about voices and voice-related distress in a clinical sample of adolescents. The study also aimed to investigate associations between relating to voices and wider patterns of social relating. DESIGN This was an observational, cross-sectional, survey study. METHODS Thirty-four young people (age 14-18 years) who were hearing voices completed measures about voices (characteristics, relating and beliefs) and relating to social others (negative relating styles, social connectedness and belongingness). Participants were patients of NHS mental health services. Bivariate correlations explored associations between relating to voices and distress, beliefs about voices and distress, and between relating to voices and social relating variables. RESULTS Perceiving the voices as dominant, intrusive, and persecutory and resisting them was significantly associated with distress. Adjusting for loudness and negative content rendered the association between persecutory beliefs and distress non-significant. Fear of separation and of being alone in relation to social others was associated with distancing from voices. Being suspicious, uncommunicative and self-reliant and/or being sadistic and intimidating towards social others was significantly associated with dependence towards the voices. Greater hearer-to-voice dependence was associated with lower perceived social belongingness and connectedness. CONCLUSIONS Beliefs about voices being persecutory, dominant, intrusive and resisting voices seem to be significant contributors of distress in young people. In terms of proximity and power, relating to voices and social others appears to be contrasting.
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Affiliation(s)
- Aikaterini Rammou
- School of PsychologyUniversity of SussexBrightonUK,Research & Development DepartmentSussex Partnership NHS Foundation TrustBrightonUK
| | - Clio Berry
- School of PsychologyUniversity of SussexBrightonUK,Brighton and Sussex Medical SchoolUniversity of SussexBrightonUK
| | - David Fowler
- School of PsychologyUniversity of SussexBrightonUK,Research & Development DepartmentSussex Partnership NHS Foundation TrustBrightonUK
| | - Mark Hayward
- School of PsychologyUniversity of SussexBrightonUK,Research & Development DepartmentSussex Partnership NHS Foundation TrustBrightonUK
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29
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Harris O, Andrews C, Broome MR, Kustner C, Jacobsen P. Epistemic injustice amongst clinical and non-clinical voice-hearers: A qualitative thematic analysis study. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:947-963. [PMID: 35466414 PMCID: PMC9790593 DOI: 10.1111/bjc.12368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Research has suggested people who hear voices may be at risk of epistemic injustice. This is a form of discrimination whereby someone is unfairly judged to be an unreliable knower (testimonial injustice) or is unable to contribute to, and therefore access, concepts that make sense of their experience within mainstream society (hermeneutical injustice). Voice-hearing occurs both in people who are mental health service users and in the general population (clinical and non-clinical voice-hearers, respectively). The degree of distress and impairment associated with voices has been shown to relate to how individuals make sense of their experiences and how others respond to their identity as a voice-hearer. The aim of this study was to explore people's experiences of epistemic injustice in relation to voice-hearing and to understand how these may differ between clinical and non-clinical voice-hearers. DESIGN A qualitative design was used. METHOD Eight clinical and nine non-clinical voice-hearers partook in semi-structured interviews, which were analysed using thematic analysis. RESULTS Three pairs of themes related to (i) identity, (ii) relationships and (iii) power and position were constructed across the clinical and non-clinical groups, and two shared themes within both groups were created relating to testimonial and hermeneutical injustice. CONCLUSION Both clinical and non-clinical voice-hearers described experiencing epistemic injustice in wider society. The presence of a 'safe haven' (e.g. spiritualist churches) for non-clinical voice-hearers ameliorated the impact of this to some degree, by allowing people to make connections with others with similar experiences within a non-judgemental and accepting community.
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Affiliation(s)
| | | | - Matthew R. Broome
- Institute for Mental HealthSchool of PsychologyUniversity of BirminghamBirminghamUK
- Birmingham Women's and Children's NHS Foundation TrustBirminghamUK
| | - Claudia Kustner
- Berkshire Healthcare NHS Foundation Trust, Prospect Park HospitalReadingUK
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30
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Momentary effects of Temstem, an app for voice-hearing individuals: Results from naturalistic data from 1048 users. Internet Interv 2022; 30:100580. [PMID: 36277314 PMCID: PMC9582699 DOI: 10.1016/j.invent.2022.100580] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 09/13/2022] [Accepted: 10/04/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Temstem is a mobile application developed in cooperation with voice-hearing persons to help them cope with distressing voices. After psychoeducation about voice hearing, Temstem offers two functions: Silencing is a mode designed to inhibit voice activity through the processing of incompatible language; the Challenging mode introduces dual tasking (as used in eye movement desensitisation and reprocessing) designed to reduce the emotionality and vividness of a voice memory. Two different language games, Lingo Tapper and Word Link, are provided, containing both functions. This study aimed to explore the momentary effects of Temstem on voice-hearing distress, emotionality and vividness in a naturalistic sample of voice-hearing app users. METHOD Temstem is freely available in the Netherlands. We collected data through the app from 1048 individual users who had given informed consent for the study. We assessed changes in pre- and post-session scores on distress, emotionality and vividness, and we evaluated differences in outcomes between the games and whether effects remained stable over multiple sessions. RESULTS Users had been hearing voices for an average of 4.95 years; 79 % had been informed about Temstem by a mental health therapist or coach. After a Silencing session, voice-hearing distress was reduced, t(958) = 27.12, p < .001, d = 0.49; the degree of reduction remained stable after repeated use, F(1, 7905.57) = 1.91, p = .167. After a Challenging session, emotionality, t(651) = 23.16, p < .001, d = 0.74, and the vividness of voice memories were reduced, t(651) = 22.20, p < .001, d = 0.71; both diminished slightly with frequent use, F(1, 2222.86) = 7.21, p < .05; F(1, 2289.92) = 4.25, p < .05. In comparison with Lingo Tapper, larger reductions were seen for a Word Link game: emotionality t(226) = 2.88, p < .005, d = 0.21; vividness t(226) = 2.29, p < .05, d = 0.17. DISCUSSION In this heterogeneous sample of voice-hearing individuals, Temstem appeared to be a promising coping tool; momentary voice-hearing distress and the emotionality and vividness of voice statements were reduced after a Temstem session. Despite important limitations and the need for more research, naturalistic studies of user app data may yield interesting and generalisable findings.
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31
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Isaksson J, Angenfelt M, Frick MA, Olofsdotter S, Vadlin S. Psychotic-like experiences from adolescence to adulthood: A longitudinal study. Schizophr Res 2022; 248:1-7. [PMID: 35907346 DOI: 10.1016/j.schres.2022.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 04/05/2022] [Accepted: 07/10/2022] [Indexed: 11/18/2022]
Abstract
Psychotic-like experiences (PLEs), such as delusions and hallucinations, are regarded to occur along a spectrum and to be present also in non-help-seeking individuals from the general population. However, it remains unclear whether the occurrence of PLEs is a unique risk factor for future PLEs or a symptom of general psychopathology. In this study, we investigated whether PLEs during adolescence predict future PLEs in adulthood. A community-based cohort of 1146 young adolescents (mean age, 14.38 years) were assessed and then reassessed 6 years later (mean age, 20.15 years). Participants reported PLEs experienced in the past year, as well as symptoms of depression, anxiety, attention-deficit/hyperactivity disorder, and conduct problems. We adjusted the analysis for other forms of psychopathology and sex differences. Participants who reported PLEs in adulthood had higher ratings for all preceding and co-occurring symptoms of psychopathology. In the adjusted logistic regression model, having PLEs and, to a smaller degree, anxiety during adolescence predicted PLEs in early adulthood. The association between baseline and future PLEs did not differ between males and females, although females were more likely to report PLEs during adolescence. Participants with persistent PLEs reported more hallucinations during adolescence than those with transient symptoms. Our findings suggest that the early occurrence of PLEs is an important and independent predictor of future PLEs and should be monitored to identify individuals with a high risk of future psychopathology and to enable early interventions.
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Affiliation(s)
- Johan Isaksson
- Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden; Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Max Angenfelt
- Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden
| | - Matilda A Frick
- Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden; Emotion Division, Department of Psychology, Uppsala University, Sweden
| | - Susanne Olofsdotter
- Centre for Clinical Research, Västmanland County Hospital Västerås, Uppsala University, Sweden
| | - Sofia Vadlin
- Centre for Clinical Research, Västmanland County Hospital Västerås, Uppsala University, Sweden.
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32
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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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33
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Staines L, Healy C, Coughlan H, Clarke M, Kelleher I, Cotter D, Cannon M. Psychotic experiences in the general population, a review; definition, risk factors, outcomes and interventions. Psychol Med 2022; 52:1-12. [PMID: 36004805 PMCID: PMC9772919 DOI: 10.1017/s0033291722002550] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 12/31/2022]
Abstract
Psychotic experiences (PE) are common in the general population, in particular in childhood, adolescence and young adulthood. PE have been shown to be associated with an increased risk for later psychotic disorders, mental disorders, and poorer functioning. Recent findings have highlighted the relevance of PE to many fields of healthcare, including treatment response in clinical services for anxiety & depression treatment, healthcare costs and service use. Despite PE relevance to many areas of mental health, and healthcare research, there remains a gap of information between PE researchers and experts in other fields. With this review, we aim to bridge this gap by providing a broad overview of the current state of PE research, and future directions. This narrative review aims to provide an broad overview of the literature on psychotic experiences, under the following headings: (1) Definition and Measurement of PE; (2) Risk Factors for PE; (3) PE and Health; (4) PE and Psychosocial Functioning; (5) Interventions for PE, (6) Future Directions.
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Affiliation(s)
- Lorna Staines
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Colm Healy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Helen Coughlan
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Mary Clarke
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Department Psychology, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Department Psychiatry Beaumont Hospital, Dublin 9, Ireland
| | - Ian Kelleher
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- School of Medicine, University College, Dublin 4, Ireland
- Lucena Clinic Child and Adolescent Mental Health Service, Rathgar, Dublin 6, Ireland
| | - David Cotter
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Department Psychiatry Beaumont Hospital, Dublin 9, Ireland
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Department Psychiatry Beaumont Hospital, Dublin 9, Ireland
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Loizou S, Fowler D, Hayward M. Measuring the longitudinal course of voice hearing under psychological interventions: A systematic review. Clin Psychol Rev 2022; 97:102191. [PMID: 35995024 DOI: 10.1016/j.cpr.2022.102191] [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: 11/23/2021] [Revised: 06/10/2022] [Accepted: 08/04/2022] [Indexed: 11/30/2022]
Abstract
Trials of psychological interventions targeting distressing voices have used a range of variables to measure outcomes. This has complicated attempts to compare outcomes across trials and to evaluate the effectiveness of these interventions. Therefore, this review aimed to identify the variables that have been used to measure the longitudinal course and impact of voice hearing under these interventions and to evaluate how these variables change over time. Inclusion and exclusion criteria were applied, resulting in a total of 66 articles. Of these, 60 studies (28 RCTs, 23 uncontrolled, 9 non-randomised) were published in peer-reviewed journals, whilst 6 were recently completed or currently ongoing. The findings of this review suggest that a range of variables that are not directly relevant to psychological interventions have been used (e.g., depression, characteristics of voice hearing experience), whilst those directly impacted by psychological interventions (e.g., voice-related distress), broader concepts of outcome (e.g., functioning) and specific associated processes (e.g., self-schema) have received less attention. Findings also showed that the majority of variables demonstrated improvements, but effect sizes varied considerably across trials. This may be attributed to methodological differences such as statistical power, blinding, control groups and different methods of measurement. Our review highlights the importance of determining a set of outcomes that are directly targeted and should change under psychological interventions. Recommendations include the use of voice-related distress as a primary outcome. This can ultimately facilitate comparisons across studies and inform the development of psychological interventions.
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Affiliation(s)
- Sofia Loizou
- School of Psychology, University of Sussex, Falmer BN1 9QH, UK.
| | - David Fowler
- School of Psychology, University of Sussex, Falmer BN1 9QH, UK
| | - Mark Hayward
- School of Psychology, University of Sussex, Falmer BN1 9QH, UK; Research & Development Department, Sussex Partnership NHS Foundation Trust, Nevill Avenue, Hove BN7 3HZ, UK
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35
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Myers N, Mollel EL, Pauselli L, Chacon M, Compton M. Maasai women hearing voices: Implications for global mental health. Transcult Psychiatry 2022:13634615221111628. [PMID: 35912508 DOI: 10.1177/13634615221111628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is a sparse literature on women who hear voices globally, even though there are documented gendered dimensions of distress in the context of globalization and climate change and research indicates that trauma and psychosocial stress may be related to an increased prevalence of voice-hearing or auditory verbal hallucinations (AVHs). There is also a gap in the cultural phenomenology of voice-hearing in general, as well as idioms of distress for non-western peoples. This article presents results of a mixed methods study that: 1) estimated community prevalence of voice-hearing among Maasai women in northern Tanzania; 2) examined any demographic correlates and two specific hypothesized correlates (i.e., psychological stress and potentially traumatic events); and 3) engaged women in semi-structured interviews about their everyday lives and the phenomenological experience of voice-hearing. The prevalence of voice-hearing (39.4%) in this nonclinical sample (n = 71) was quite high compared to other studies in sub-Saharan Africa. Most women also reported high psychosocial stress and traumatic life events. They also talked about gendered conditions of social adversity in a context of rapid social, economic, and climate change. Women who reported hearing voices had a statistically significantly higher level of psychological distress, met criteria for severe psychological distress, and reported more potentially traumatic life events. In a logistic regression model, psychosocial stress predicted voice-hearing. The presence of distressing voices may offer a straightforward way to quickly identify people in the community experiencing the most extreme levels of psychosocial stress and traumatic events-a potentially simple but effective screening tool for health workers on the ground.
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Affiliation(s)
- Neely Myers
- Southern Methodist University, Department of Anthropology, Dallas, Texas
- University of Texas-Southwestern Medical School, Department of Psychiatry, Dallas, Texas
| | | | - Luca Pauselli
- Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside/West, Department of Psychiatry, New York, New York
| | - Marne Chacon
- Southern Methodist University, Department of Anthropology, Dallas, Texas
| | - Michael Compton
- Columbia University Vagelos College of Physicians and Surgeons
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Johnson JF, Belyk M, Schwartze M, Pinheiro AP, Kotz SA. Hypersensitivity to passive voice hearing in hallucination proneness. Front Hum Neurosci 2022; 16:859731. [PMID: 35966990 PMCID: PMC9366353 DOI: 10.3389/fnhum.2022.859731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/29/2022] [Indexed: 11/21/2022] Open
Abstract
Voices are a complex and rich acoustic signal processed in an extensive cortical brain network. Specialized regions within this network support voice perception and production and may be differentially affected in pathological voice processing. For example, the experience of hallucinating voices has been linked to hyperactivity in temporal and extra-temporal voice areas, possibly extending into regions associated with vocalization. Predominant self-monitoring hypotheses ascribe a primary role of voice production regions to auditory verbal hallucinations (AVH). Alternative postulations view a generalized perceptual salience bias as causal to AVH. These theories are not mutually exclusive as both ascribe the emergence and phenomenology of AVH to unbalanced top-down and bottom-up signal processing. The focus of the current study was to investigate the neurocognitive mechanisms underlying predisposition brain states for emergent hallucinations, detached from the effects of inner speech. Using the temporal voice area (TVA) localizer task, we explored putative hypersalient responses to passively presented sounds in relation to hallucination proneness (HP). Furthermore, to avoid confounds commonly found in in clinical samples, we employed the Launay-Slade Hallucination Scale (LSHS) for the quantification of HP levels in healthy people across an experiential continuum spanning the general population. We report increased activation in the right posterior superior temporal gyrus (pSTG) during the perception of voice features that positively correlates with increased HP scores. In line with prior results, we propose that this right-lateralized pSTG activation might indicate early hypersensitivity to acoustic features coding speaker identity that extends beyond own voice production to perception in healthy participants prone to experience AVH.
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Affiliation(s)
- Joseph F. Johnson
- Department of Neuropsychology and Psychopharmacology, University of Maastricht, Maastricht, Netherlands
| | - Michel Belyk
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - Michael Schwartze
- Department of Neuropsychology and Psychopharmacology, University of Maastricht, Maastricht, Netherlands
| | - Ana P. Pinheiro
- Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
| | - Sonja A. Kotz
- Department of Neuropsychology and Psychopharmacology, University of Maastricht, Maastricht, Netherlands
- Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
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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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Baumeister D, Peters E, Pruessner J, Howes O, Chadwick P. The effects of voice content on stress reactivity: A simulation paradigm of auditory verbal hallucinations. Schizophr Res 2022; 243:225-231. [PMID: 31377050 PMCID: PMC9205337 DOI: 10.1016/j.schres.2019.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 05/27/2019] [Accepted: 07/11/2019] [Indexed: 12/02/2022]
Abstract
OBJECTIVES Psychosis is associated with increased subjective and altered endocrine and autonomic nervous system stress-reactivity. Psychosis patients often experience auditory verbal hallucinations, with negative voice content being particularly associated with distress. The present study developed a voice-simulation paradigm and investigated the effect of simulated voices with neutral and negative content on psychophysiological stress-reactivity, and the effect of mindful voice-appraisals on stress-reactivity. METHOD Eighty-four healthy participants completed the Montreal Imaging Stress Task with simultaneous presentation of one of three randomly allocated auditory stimuli conditions: negative voices, neutral voices or non-voice ambient sounds. Subjective stress-levels and mindful voice-appraisals were assessed using questionnaire measures, and cortisol and α-amylase levels were measured using saliva samples. RESULTS ANOVA revealed a significant effect of condition on subjective stress-levels (p = .002), but not cortisol (p = .63) or α-amylase (p = .73). Post-hoc analyses showed that negative voices increased subjective stress-levels relative to neutral voices (p = .002) and ambient sounds (p = .01), which did not differ from each other (p = .41). Mindful voice-appraisals were associated with less distress across conditions (p = .003), although negative voices were also associated with less mindful appraisals (p < .001). CONCLUSIONS Negative voice content, rather than voices or auditory stimuli per se, is linked to greater subjective but not physiological stress-reactivity. Mindful appraisals may partially moderate this effect. These findings highlight the importance of voice content for the impact of voice-hearing, and highlight the potential value of mindfulness training to treat voice distress in psychosis.
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Affiliation(s)
- David Baumeister
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Department of Psychology, London, UK; Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Germany.
| | - Emmanuelle Peters
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Department of Psychology, London, UK,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, Kent, UK
| | - Jens Pruessner
- Department of Psychology, University of Constance, Constance, Germany
| | - Oliver Howes
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, Kent, UK,Institute of Psychiatry, Psychology & Neuroscience, King's College London, Department of Psychosis Studies, London, UK
| | - Paul Chadwick
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Department of Psychology, London, UK,Department of Psychology, University of Bath, Bath, UK
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39
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Volpato E, Cavalera C, Castelnuovo G, Molinari E, Pagnini F. The "common" experience of voice-hearing and its relationship with shame and guilt: a systematic review. BMC Psychiatry 2022; 22:281. [PMID: 35443637 PMCID: PMC9022353 DOI: 10.1186/s12888-022-03902-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite Auditory Verbal Hallucinations (AVHs) having been long associated with mental illness, they represent a common experience also in the non-clinical population, yet do not exhibit distress or need for care. Shame and guilt are emotions related to one's perception of oneself and one's responsibility. As such, they direct our attention to aspects of AVHs that are under-researched and elusive, particularly about the status of voices as others, their social implications and the constitution and conceptualisation of the self. OBJECTIVES This paper aims to provide a systematic review of studies that investigated the relationship between auditory hallucinations, shame, and guilt in people without relevant signs of psychiatric issues. METHODS We searched studies reporting information about voices characteristics, the relationship between voices and hearers, hearer's reactions, and beliefs, paying peculiar attention to shame and guilt issues. Included papers were evaluated for risk of bias. RESULTS Eleven studies that explored the relationship between AVHs, shame and guilt, were extracted. Phenomenological, pragmatic, as well as neuropsychological features of hearing voices in non-clinical populations, allowed us to note a dynamic relationship and the constellation of subjective experiences that can occur. The role of guilt was characterized by few studies and mixed results, while shame was mainly common. CONCLUSIONS Due to the high heterogeneity detected and the scarce sources available, further studies should focus on both the aetiology and the bidirectional relationship between hearing voices, shame, and guilt in non-clinical people. This can be helpful in therapies for non-clinical populations who are distressed by their voices (e.g., psychotherapy), and for whom shame, and guilt may contribute to negative consequences such as isolation, anxiety or future depression. Moreover, it might favour the development and implication of different treatments considering emotion regulation, distress tolerance and interpersonal sensitivity on the clinical populations.
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Affiliation(s)
- E Volpato
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123, Milan, Italy.
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.
| | - C Cavalera
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123, Milan, Italy
| | - G Castelnuovo
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123, Milan, Italy
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory , Verbania , Italy
| | - E Molinari
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123, Milan, Italy
- Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - F Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123, Milan, Italy
- Department of Psychology, Harvard University, Cambridge, MA, USA
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40
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Uncovering hidden resting state dynamics: A new perspective on auditory verbal hallucinations. Neuroimage 2022; 255:119188. [PMID: 35398281 DOI: 10.1016/j.neuroimage.2022.119188] [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: 12/01/2021] [Revised: 02/25/2022] [Accepted: 03/13/2022] [Indexed: 11/24/2022] Open
Abstract
In the absence of sensory stimulation, the brain transits between distinct functional networks. Network dynamics such as transition patterns and the time the brain stays in each network link to cognition and behavior and are subject to much investigation. Auditory verbal hallucinations (AVH), the temporally fluctuating unprovoked experience of hearing voices, are associated with aberrant resting state network activity. However, we lack a clear understanding of how different networks contribute to aberrant activity over time. An accurate characterization of latent network dynamics and their relation to neurocognitive changes necessitates methods that capture the sub-second temporal fluctuations of the networks' functional connectivity signatures. Here, we critically evaluate the assumptions and sensitivity of several approaches commonly used to assess temporal dynamics of brain connectivity states in M/EEG and fMRI research, highlighting methodological constraints and their clinical relevance to AVH. Identifying altered brain connectivity states linked to AVH can facilitate the detection of predictive disease markers and ultimately be valuable for generating individual risk profiles, differential diagnosis, targeted intervention, and treatment strategies.
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41
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Amorim M, Roberto MS, Kotz SA, Pinheiro AP. The perceived salience of vocal emotions is dampened in non-clinical auditory verbal hallucinations. Cogn Neuropsychiatry 2022; 27:169-182. [PMID: 34261424 DOI: 10.1080/13546805.2021.1949972] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Introduction: Auditory verbal hallucinations (AVH) are a cardinal symptom of schizophrenia but are also reported in the general population without need for psychiatric care. Previous evidence suggests that AVH may reflect an imbalance of prior expectation and sensory information, and that altered salience processing is characteristic of both psychotic and non-clinical voice hearers. However, it remains to be shown how such an imbalance affects the categorisation of vocal emotions in perceptual ambiguity.Methods: Neutral and emotional nonverbal vocalisations were morphed along two continua differing in valence (anger; pleasure), each including 11 morphing steps at intervals of 10%. College students (N = 234) differing in AVH proneness (measured with the Launay-Slade Hallucination Scale) evaluated the emotional quality of the vocalisations.Results: Increased AVH proneness was associated with more frequent categorisation of ambiguous vocalisations as 'neutral', irrespective of valence. Similarly, the perceptual boundary for emotional classification was shifted by AVH proneness: participants needed more emotional information to categorise a voice as emotional.Conclusions: These findings suggest that emotional salience in vocalisations is dampened as a function of increased AVH proneness. This could be related to changes in the acoustic representations of emotions or reflect top-down expectations of less salient information in the social environment.
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Affiliation(s)
- Maria Amorim
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisboa, Portugal
| | - Magda S Roberto
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisboa, Portugal
| | - Sonja A Kotz
- Faculty of Psychology and Neuroscience, University of Maastricht, Maastricht, The Netherlands.,Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Ana P Pinheiro
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisboa, Portugal.,Faculty of Psychology and Neuroscience, University of Maastricht, Maastricht, The Netherlands
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Begemann MJH, Sommer IE, Brand RM, Oomen PP, Jongeneel A, Berkhout J, Molenaar RE, Wielage NN, Toh WL, Rossell SL, Bell IH. Auditory verbal hallucinations and childhood trauma subtypes across the psychosis continuum: a cluster analysis. Cogn Neuropsychiatry 2022; 27:150-168. [PMID: 33980128 DOI: 10.1080/13546805.2021.1925235] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: A strong link between voice-hearing experience and childhood trauma has been established. The aim of this study was to identify whether there were unique clusters of childhood trauma subtypes in a sample across the clinical spectrum of auditory verbal hallucinations (AVH) and to examine clinical and phenomenological features across these clusters.Methods: Combining two independent international datasets (the Netherlands and Australia), childhood trauma subtypes were examined using hierarchical cluster analysis. Clinical and phenomenological characteristics were compared across emerging clusters using MANOVA and chi-squared analyses.Results: The total sample (n = 413) included 166 clinical individuals with a psychotic disorder and AVH, 122 non-clinical individuals with AVH and 125 non-clinical individuals without AVH. Three clusters emerged: (1) low trauma (n = 299); (2) emotion-focused trauma (n = 71); (3) multi-trauma (n = 43). The three clusters differed significantly on their AVH ratings of amount of negative content, with trend-level effects for loudness, degree of negative content and degree of experienced distress. Furthermore, perceptions of voices being malevolent, benevolent and resistance towards voices differed significantly.Conclusion: The data revealed different types of childhood trauma had different relationships between clinical and phenomenological features of voice-hearing experiences. Thus, implicating different mechanistic pathways and a need for tailored treatment approaches.
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Affiliation(s)
- M J H Begemann
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - I E Sommer
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - R M Brand
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia
| | - P P Oomen
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - A Jongeneel
- Department of Clinical Psychology, Amsterdam UMCAmsterdam Public Health research institute, Amsterdam, the Netherlands.,Department of Psychosis Research and Innovation, Parnassia Psychiatric Institute, Den Haag, the Netherlands
| | - J Berkhout
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - R E Molenaar
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - N N Wielage
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - W L Toh
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - S L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.,Department of Mental Health, St Vincent's Hospital, Melbourne, Australia
| | - I H Bell
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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Hogg LI, Smith LGE, Morrison AP, Prosser AMB, Kurz T. The nuances of “the social cure” for people who experience psychosis. EUROPEAN JOURNAL OF SOCIAL PSYCHOLOGY 2022. [DOI: 10.1002/ejsp.2848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lorna I. Hogg
- Department of Psychology University of Bath
- Oxford Health NHS Foundation Trust
- Harris Manchester College University of Oxford
| | | | | | | | - Tim Kurz
- Department of Psychology University of Bath
- School of Psychological Science University of Western Australia
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Alderson-Day B, Moffatt J, Lima CF, Krishnan S, Fernyhough C, Scott SK, Denton S, Leong IYT, Oncel AD, Wu YL, Gurbuz Z, Evans S. Susceptibility to auditory hallucinations is associated with spontaneous but not directed modulation of top-down expectations for speech. Neurosci Conscious 2022; 2022:niac002. [PMID: 35145758 PMCID: PMC8824703 DOI: 10.1093/nc/niac002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/13/2022] [Indexed: 11/29/2022] Open
Abstract
Auditory verbal hallucinations (AVHs)-or hearing voices-occur in clinical and non-clinical populations, but their mechanisms remain unclear. Predictive processing models of psychosis have proposed that hallucinations arise from an over-weighting of prior expectations in perception. It is unknown, however, whether this reflects (i) a sensitivity to explicit modulation of prior knowledge or (ii) a pre-existing tendency to spontaneously use such knowledge in ambiguous contexts. Four experiments were conducted to examine this question in healthy participants listening to ambiguous speech stimuli. In experiments 1a (n = 60) and 1b (n = 60), participants discriminated intelligible and unintelligible sine-wave speech before and after exposure to the original language templates (i.e. a modulation of expectation). No relationship was observed between top-down modulation and two common measures of hallucination-proneness. Experiment 2 (n = 99) confirmed this pattern with a different stimulus-sine-vocoded speech (SVS)-that was designed to minimize ceiling effects in discrimination and more closely model previous top-down effects reported in psychosis. In Experiment 3 (n = 134), participants were exposed to SVS without prior knowledge that it contained speech (i.e. naïve listening). AVH-proneness significantly predicted both pre-exposure identification of speech and successful recall for words hidden in SVS, indicating that participants could actually decode the hidden signal spontaneously. Altogether, these findings support a pre-existing tendency to spontaneously draw upon prior knowledge in healthy people prone to AVH, rather than a sensitivity to temporary modulations of expectation. We propose a model of clinical and non-clinical hallucinations, across auditory and visual modalities, with testable predictions for future research.
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Affiliation(s)
| | - Jamie Moffatt
- Department of Psychology, Durham University, Durham, UK
- Department of Psychology, University of Sussex, Brighton, UK
| | - César F Lima
- Centro de Investigação e Intervenção Social, Instituto Universitário de Lisboa (ISCTE-IUL), Lisbon, Portugal
| | - Saloni Krishnan
- Department of Psychology, Royal Holloway, University of London, London, UK
| | | | - Sophie K Scott
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Sophie Denton
- Department of Psychology, Durham University, Durham, UK
| | | | - Alena D Oncel
- Department of Psychology, Durham University, Durham, UK
| | - Yu-Lin Wu
- Department of Psychology, Durham University, Durham, UK
| | - Zehra Gurbuz
- Department of Psychology, Durham University, Durham, UK
| | - Samuel Evans
- Department of Psychology, University of Westminster, London, UK
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Quijada Y, Saldivia S, Bustos C, Preti A, Ochoa S, Castro-Alzate E, Siddi S. Measurement invariance between online and paper-and-pencil formats of the Launay-Slade Hallucinations scale-extended (LSHS-E) in the Chilean population: Invariance between LSHS-E formats. CURRENT PSYCHOLOGY 2022; 42:1-12. [PMID: 35068905 PMCID: PMC8761522 DOI: 10.1007/s12144-021-02497-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 11/28/2022]
Abstract
Research on the multidimensionality of hallucination-like experiences (HLEs) can contribute to the study of psychotic risk. The Launay-Slade Hallucinations Scale-Extended (LSHS-E) is one of the most widely used tools for research in HLEs, but the correspondence of its paper and online formats has not been established yet. Therefore, we studied the factorial structure and measurement invariance between online and paper-and-pencil versions of LSHS-E in a Chilean population. Two thousand eighty-six completed the online version, and 578 students completed the original paper-and-pencil version. After matching by sex, age, civil status, alcohol and cannabis consumption, and psychiatric treatment received, we selected 543 students from each group. We conducted a confirmatory factor analysis of a four-factor model and a hierarchical model that included a general predisposition to hallucination, explaining the strong relationship between the different types of hallucinations. Both models showed a good fit to the data and were invariant between paper-and-pencil and online versions. Also, the LSHS-E has good reliability in both online and paper-and-pencil formats. This study shows that the online LSHS-E possesses psychometric properties equivalent to the paper-and-pencil version. It should be considered a valuable tool for research of psychosis determinants in the COVID-19 era. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s12144-021-02497-7.
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Affiliation(s)
- Yanet Quijada
- Facultad de Psicología, Universidad San Sebastián, Concepción, Chile
| | - Sandra Saldivia
- Departamento de Psiquiatría y Salud mental, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Claudio Bustos
- Departamento de Psiquiatría y Salud mental, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Antonio Preti
- Dipartimento di neuroscienze, Università degli studi di Torino, Torino, Italy
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu. CIBERSAM, Parc Sanitari Sant Joan de Déu. Dr. Antoni Pujadas, 42, 08830 Sant Boi de Llobregat, Barcelona Spain
| | - Elvis Castro-Alzate
- Departamento de Psiquiatría y Salud mental, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
- Escuela de Rehabilitación Humana, Facultad de Salud, Universidad del Valle, Cali, Colombia
| | - Sara Siddi
- Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu. CIBERSAM, Parc Sanitari Sant Joan de Déu. Dr. Antoni Pujadas, 42, 08830 Sant Boi de Llobregat, Barcelona Spain
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López-Silva P, Cavieres Á, Humpston C. The phenomenology of auditory verbal hallucinations in schizophrenia and the challenge from pseudohallucinations. Front Psychiatry 2022; 13:826654. [PMID: 36051554 PMCID: PMC9424625 DOI: 10.3389/fpsyt.2022.826654] [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: 12/01/2021] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
In trying to make sense of the extensive phenomenological variation of first-personal reports on auditory verbal hallucinations, the concept of pseudohallucination is originally introduced to designate any hallucinatory-like phenomena not exhibiting some of the paradigmatic features of "genuine" hallucinations. After its introduction, Karl Jaspers locates the notion of pseudohallucinations into the auditory domain, appealing to a distinction between hallucinatory voices heard within the subjective inner space (pseudohallucination) and voices heard in the outer external space (real hallucinations) with differences in their sensory richness. Jaspers' characterization of the term has been the target of a number of phenomenological, conceptual and empirically-based criticisms. From this latter point of view, it has been claimed that the concept cannot capture distinct phenomena at the neurobiological level. Over the last years, the notion of pseudohallucination seems to be falling into disuse as no major diagnostic system seems to refer to it. In this paper, we propose that even if the concept of pseudohallucination is not helpful to differentiate distinct phenomena at the neurobiological level, the inner/outer distinction highlighted by Jaspers' characterization of the term still remains an open explanatory challenge for dominant theories about the neurocognitive origin of auditory verbal hallucinations. We call this, "the challenge from pseudohallucinations". After exploring this issue in detail, we propose some phenomenological, conceptual, and empirical paths for future research that might help to build up a more contextualized and dynamic view of auditory verbal hallucinatory phenomena.
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Affiliation(s)
- Pablo López-Silva
- School of Psychology, Faculty of Social Sciences, Universidad de Valparaíso, Valparaíso, Chile.,Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile
| | - Álvaro Cavieres
- Department of Psychiatry, School of Medicine, Faculty of Medicine, Universidad de Valparaíso, Valparaíso, Chile
| | - Clara Humpston
- School of Psychology, University of York, York, United Kingdom.,School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
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Formulating psychosis: a thematic analysis of CBTp trainees’ experiences. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Abstract
The NICE guidance states that cognitive behavioural therapy (CBT) should now be offered to everyone with psychosis in the UK. This has rightly resulted in an increased demand for adherent therapy from qualified clinicians. Individualised formulation is a key component of CBT for psychosis, yet many trainees struggle to make sense of and apply the theoretical models on which these are based. This study explored trainee and recently qualified therapists’ experience of formulating CBT for psychosis, to help us understand how best to guide training and clinical practice. We ran focus groups with trainees who were completing, or had recently completed, postgraduate training in CBT for psychosis. We then analysed verbatim transcripts of the semi-structured interviews. and completed a thematic analysis of the data using inductive open coding. Three over-arching themes were generated: (1) purpose of formulation, (2) formulation in practice, and (3) (reflection on) learning to formulate. Training programmes and clinical supervisors should focus on fostering trainees’ and newly qualified therapists’ ability to develop simple, targeted formulations. These will draw on maintenance and developmental models of psychosis, depending on the person’s needs and goals. Opportunities for procedural learning are likely to improve skilful formulation, and use as the basis for therapeutic change.
Key learning aims
(1)
CBT for psychosis is best guided by individualised formulation.
(2)
The range and complexity of current theoretical models is challenging.
(3)
A qualitative analysis of trainee and recently qualified therapists’ experiences highlights means of facilitating understanding and application of these models.
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Morais G, Vinne L, Santos D, Stefanello S. As vozes dos usuários participantes de grupos de ouvidores de vozes. REVISTA LATINOAMERICANA DE PSICOPATOLOGIA FUNDAMENTAL 2022. [DOI: 10.1590/1415-4714.2022v25n1p140.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O objetivo deste artigo é investigar as vivências e possíveis efeitos da participação em grupos de Ouvidores de Vozes. Trata-se de um estudo qualitativo com participantes acima de 18 anos, que concordaram em fazer parte do estudo e frequentaram os grupos por um período mínimo de três meses. Foram realizadas 14 entrevistas até obtenção de saturação em grupos de Centros de Atenção Psicossocial, em seguida transcritas e analisadas usando a hermenêutica Gadameriana. A análise evidenciou cinco núcleos argumentais: a chegada no grupo; modo de funcionamento; uso de medicamentos; sentidos e efeitos. Demonstrou-se que os grupos podem ser uma das estratégias de cuidado e recuperação dos indivíduos, permitindo com que as suas experiências sejam reconhecidas e ressignificadas, promovendo, além da melhora clínica, acolhimento, compartilhamento entre pares e socialização.
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Underwood R, Mason L, O'Daly O, Dalton J, Simmons A, Barker GJ, Peters E, Kumari V. You read my mind: fMRI markers of threatening appraisals in people with persistent psychotic experiences. NPJ SCHIZOPHRENIA 2021; 7:49. [PMID: 34635671 PMCID: PMC8505497 DOI: 10.1038/s41537-021-00173-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 08/06/2021] [Indexed: 11/09/2022]
Abstract
Anomalous perceptual experiences are relatively common in the general population. Evidence indicates that the key to distinguishing individuals with persistent psychotic experiences (PEs) with a need for care from those without is how they appraise their anomalous experiences. Here, we aimed to characterise the neural circuits underlying threatening and non-threatening appraisals in people with and without a need for care for PEs, respectively. A total of 48 participants, consisting of patients with psychosis spectrum disorder (clinical group, n = 16), non-need-for-care participants with PEs (non-clinical group, n = 16), and no-PE healthy control participants (n = 16), underwent functional magnetic resonance imaging while completing the Telepath task, designed to induce an anomalous perceptual experience. Appraisals of the anomalous perceptual experiences were examined, as well as functional brain responses during this window, for significant group differences. We also examined whether activation co-varied with the subjective threat appraisals reported in-task by participants. The clinical group reported elevated subjective threat appraisals compared to both the non-clinical and no-PE control groups, with no differences between the two non-clinical groups. This pattern of results was accompanied by reduced activation in the superior and inferior frontal gyri in the clinical group as compared to the non-clinical and control groups. Precuneus activation scaled with threat appraisals reported in-task. Resilience in the context of persistent anomalous experiences may be explained by intact functioning of fronto-parietal regions, and may correspond to the ability to contextualise and flexibly evaluate psychotic experiences.
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Affiliation(s)
- Raphael Underwood
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, London, UK. .,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Kent, UK.
| | - Liam Mason
- University College London, Max Planck Centre for Computational Psychiatry and Ageing Research, London, UK.,University College London, Research Department of Clinical, Educational and Health Psychology, London, UK
| | - Owen O'Daly
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Neuroimaging, London, UK
| | - Jeffrey Dalton
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Neuroimaging, London, UK
| | - Andrew Simmons
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Neuroimaging, London, UK
| | - Gareth J Barker
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Neuroimaging, London, UK
| | - Emmanuelle Peters
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, London, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Kent, UK
| | - Veena Kumari
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, London, UK.,Brunel University London, College of Health, Medicine and Life Sciences, Centre for Cognitive Neuroscience, Uxbridge, UK
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50
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Olfactory hallucinations in a population-based sample. Psychiatry Res 2021; 304:114117. [PMID: 34391204 DOI: 10.1016/j.psychres.2021.114117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 11/21/2022]
Abstract
Olfactory hallucinations referring to olfactory perceptions in the absence of chemical stimuli, occur in non-clinical and clinical populations. Few studies have investigated their prevalence in the general population and little is known about factors triggering and maintaining them such as substance use, severe life events, and mood. We analyzed self-report data from 2500 community dwelling Norwegians, aged 18-96 years, for occurrence of olfactory hallucinations and co-occurring hallucinations in other modalities (auditory, visual, tactile). Analyses included age, sex, self-reported symptoms of depression and anxiety, mental health status, and experience of severe life-events. The results show that 4.2% (95% CI 3.5-5.1%) reported having experienced olfactory hallucinations, and 56% of individuals experiencing olfactory hallucinations also reported these in combination with hallucinations in other modalities. Prevalence varied significantly in terms of age and sex, in that olfactory hallucinations were most frequently reported by young individuals and females. Self-reported symptoms of anxiety and experience of stressful life events were significantly associated with olfactory hallucinations, suggesting that experiencing olfactory hallucinations may negatively affect functioning and may increase the likelihood of developing psychopathology. Findings underline the need to continue to examine olfactory hallucinations albeit with a more comprehensive assessment in order to increase knowledge on this experience.
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