Mental imagery and perception in hallucination-prone individuals

The positive dimension of schizotypy is associated with self-report measures of autobiographical memory and future thinking but not experimenter-scored indices

ABSTRACTThe ability to remember our past and to imagine the future are critical to our sense of self. Previous research has indicated that they are disrupted in schizophrenia. However, it is unclear (i) whether this is found when examining experimenter-scored indices of content and/or participants' self-report of phenomenological characteristics, and (ii) how these abilities might be related to symptoms. This study sought to address these questions by taking a dimensional approach and measuring positive and negative schizotypal experiences in healthy people (n = 90). Participants were given cue words. For some, they remembered an event from the past and for others they generated an event in the future. No significant relationships were found with any aspect of schizotypy when participants' descriptions were scored by the experimenter according to a standardised episodic content measure. In contrast, several significant positive correlations were observed for past memory and future thinking when examining the positive dimension of schizotypy and participants' ratings, particularly to sensory characteristics of the experience and mental pre- or reliving. These results indicate enhanced subjective experiences of autobiographical memory and future thinking in those who report delusional and hallucinatory-like occurrences, which might be linked to mental imagery or metacognitive alterations.

A novel model of divergent predictive perception

Predictive processing theories state that our subjective experience of reality is shaped by a balance of expectations based on previous knowledge about the world (i.e. priors) and confidence in sensory input from the environment. Divergent experiences (e.g. hallucinations and synaesthesia) are likely to occur when there is an imbalance between one's reliance on priors and sensory input. In a novel theoretical model, inspired by both predictive processing and psychological principles, we propose that predictable divergent experiences are associated with natural or environmentally induced prior/sensory imbalances: inappropriately strong or inflexible (i.e. maladaptive) high-level priors (beliefs) combined with low sensory confidence can result in reality discrimination issues, a characteristic of psychosis; maladaptive low-level priors (sensory expectations) combined with high sensory confidence can result in atypical sensory sensitivities and persistent divergent percepts, a characteristic of synaesthesia. Crucially, we propose that whether different divergent experiences manifest with dominantly sensory (e.g. hallucinations) or nonsensory characteristics (e.g. delusions) depends on mental imagery ability, which is a spectrum from aphantasia (absent or weak imagery) to hyperphantasia (extremely vivid imagery). We theorize that imagery is critically involved in shaping the sensory richness of divergent perceptual experience. In sum, to predict a range of divergent perceptual experiences in both clinical and general populations, three factors must be accounted for: a maladaptive use of priors, individual level of confidence in sensory input, and mental imagery ability. These ideas can be expressed formally using nonparametric regression modeling. We provide evidence for our theory from previous work and deliver predictions for future research.

Hallucinating visual structure: Individual differences in 'scaffolded attention'

Our percepts usually derive their structure from particular cues in the incoming sensory information, but this is not so in the phenomenon of scaffolded attention - where shifting patterns of attention give rise to 'everyday hallucinations' of visual structure even in the absence of sensory cues. When looking at a piece of graph paper, for example, the squares are all identical - yet many people see a shifting array of structured patterns such as lines, crosses, or even block-letters - something that doesn't occur when staring at a blank page. We have informally noted that scaffolded attention is a widely but not universally shared phenomenon - with some people spontaneously experiencing such percepts (even without instruction), others seeing such 'phantom' structures only when actively trying to so, and still others never having such experiences at all. Accordingly, the present study assessed the prevalence of scaffolded attention - both as an ability, and a spontaneous phenomenon. These results were then correlated with several measures of imagery and attention, in an attempt to explain the nature and origin of such individual differences. 40% of observers experienced scaffolded attention spontaneously, and 78% did so when trying - and these differences were uniquely modulated by certain measures of attention (such as attentional breadth, as measured by the 'functional field of view'), but not by measures of the vividness or spontaneity of mental imagery. These results inspire an explanation for scaffolded attention based on spontaneous perceptual grouping.

Anomalous visual experience is linked to perceptual uncertainty and visual imagery vividness

An imbalance between top-down and bottom-up processing on perception (specifically, over-reliance on top-down processing) can lead to anomalous perception, such as illusions. One factor that may be involved in anomalous perception is visual mental imagery, which is the experience of "seeing" with the mind's eye. There are vast individual differences in self-reported imagery vividness, and more vivid imagery is linked to a more sensory-like experience. We, therefore, hypothesized that susceptibility to anomalous perception is linked to individual imagery vividness. To investigate this, we adopted a paradigm that is known to elicit the perception of faces in pure visual noise (pareidolia). In four experiments, we explored how imagery vividness contributes to this experience under different response instructions and environments. We found strong evidence that people with more vivid imagery were more likely to see faces in the noise, although removing suggestive instructions weakened this relationship. Analyses from the first two experiments led us to explore confidence as another factor in pareidolia proneness. We, therefore, modulated environment noise and added a confidence rating in a novel design. We found strong evidence that pareidolia proneness is correlated with uncertainty about real percepts. Decreasing perceptual ambiguity abolished the relationship between pareidolia proneness and both imagery vividness and confidence. The results cannot be explained by incidental face-like patterns in the noise, individual variations in response bias, perceptual sensitivity, subjective perceptual thresholds, viewing distance, testing environments, motivation, gender, or prosopagnosia. This indicates a critical role of mental imagery vividness and perceptual uncertainty in anomalous perceptual experience.

The Ganzflicker experience: High probability of seeing vivid and complex pseudo-hallucinations with imagery but not aphantasia

There are considerable individual differences in visual mental imagery ability across the general population, including a "blind mind's eye", or aphantasia. Recent studies have shown that imagery is linked to differences in perception in the healthy population, and clinical work has found a connection between imagery and hallucinatory experiences in neurological disorders. However, whether imagery ability is associated with anomalous perception-including hallucinations-in the general population remains unclear. In the current study, we explored the relationship between imagery ability and the anomalous perception of pseudo-hallucinations (PH) using rhythmic flicker stimulation ("Ganzflicker"). Specifically, we investigated whether the ability to generate voluntary imagery is associated with susceptibility to flicker-induced PH. We additionally explored individual differences in observed features of PH. We recruited a sample of people with aphantasia (aphants) and imagery (imagers) to view a constant red-and-black flicker for approximately 10 min. We found that imagers were more susceptible to PH, and saw more complex and vivid PH, compared to aphants. This study provides the first evidence that the ability to generate visual imagery increases the likelihood of experiencing complex and vivid anomalous percepts.

Hallucinations as intensified forms of mind-wandering

This paper argues for a novel way of thinking about hallucinations as intensified forms of mind-wandering. Starting from the observation that hallucinations are associated with hyperactive sensory areas underlying the content of hallucinatory experiences and a confusion with regard to the reality of the source of these experiences, the paper first reviews the different factors that might contribute to the impairment of reality monitoring. The paper then focuses on the sensory characteristics determining the vividness of an experience, reviews their relationship to the sensory hyperactivity observed in hallucinations, and investigates under what circumstances they can drive reality judgements. Finally, based on these considerations, the paper presents its main proposal according to which hallucinations are intensified forms of mind-wandering that are amplified along their sensory characteristics, and sketches a possible model of what factors might determine if an internally and involuntarily generated perceptual representation is experienced as a hallucination or as an instance of mind-wandering. This article is part of the theme issue 'Offline perception: voluntary and spontaneous perceptual experiences without matching external stimulation'.

Mental imagery in animals: Learning, memory, and decision-making in the face of missing information

When we open our eyes, we see a world filled with objects and events. Yet, due to occlusion of some objects by others, we only have partial perceptual access to the events that transpire around us. I discuss the body of research on mental imagery in animals. I first cover prior studies of mental rotation in pigeons and imagery using working memory procedures first developed for human studies. Next, I discuss the seminal work on a type of learning called mediated conditioning in rats. I then provide more in-depth coverage of work from my lab suggesting that rats can use imagery to fill in missing details of the world that are expected but hidden from perception. We have found that rats make use of an active expectation (i.e., an image) of a hidden visual event. I describe the behavioral and neurobiological studies investigating the use of a mental image, its theoretical basis, and its connections to current human cognitive neuroscience research on episodic memory, imagination, and mental simulations. Collectively, the reviewed literature provides insight into the mechanisms that mediate the flexible use of an image during ambiguous situations. I position this work in the broader scientific and philosophical context surrounding the concept of mental imagery in human and nonhuman animals.

Reading characters in voices: Ratings of personality characteristics from voices predict proneness to auditory verbal hallucinations

People rapidly make first impressions of others, often based on very little information–minimal exposure to faces or voices is sufficient for humans to make up their mind about personality of others. While there has been considerable research on voice personality perception, much less is known about its relevance to hallucination-proneness, despite auditory hallucinations being frequently perceived as personified social agents. The present paper reports two studies investigating the relation between voice personality perception and hallucination-proneness in non-clinical samples. A voice personality perception task was created, in which participants rated short voice recordings on four personality characteristics, relating to dimensions of the voice’s perceived Valence and Dominance. Hierarchical regression was used to assess contributions of Valence and Dominance voice personality ratings to hallucination-proneness scores, controlling for paranoia-proneness and vividness of mental imagery. Results from Study 1 suggested that high ratings of voices as dominant might be related to high hallucination-proneness; however, this relation seemed to be dependent on reported levels of paranoid thinking. In Study 2, we show that hallucination-proneness was associated with high ratings of voice dominance, and this was independent of paranoia and imagery abilities scores, both of which were found to be significant predictors of hallucination-proneness. Results from Study 2 suggest an interaction between gender of participants and the gender of the voice actor, where only ratings of own gender voices on Dominance characteristics are related to hallucination-proneness scores. These results are important for understanding the perception of characterful features of voices and its significance for psychopathology.

Reality monitoring performance and the role of visual imagery in visual hallucinations

BACKGROUND

Auditory Hallucinations may arise from people confusing their own inner speech with external spoken speech. People with visual hallucinations (VH) may similarly confuse vivid mental imagery with external events. This paper reports two experiments exploring confusion between internal and external visual material.

METHOD

Experiment 1 examined reality monitoring in people with psychosis; those with visual hallucinations (n = 16) and those without (n = 15). Experiment 2 used two non-clinical groups of people with high or low predisposition to VH (HVH, n = 26, LVH, n = 21). All participants completed the same reality monitoring task. Participants in Experiment 2 also completed measures of imagery.

RESULTS

Psychosis patients with VH demonstrated biased reality monitoring, where they misremembered items that had been presented as words as having been presented as pictures. Patients without VH did not show this bias. In Experiment 2, the HVH group demonstrated the same bias in reality monitoring that psychosis patients with VH had shown. The LVH group did not show this bias. In addition, the HVH group reported more vivid imagery and particularly more negative imagery.

CONCLUSIONS

Both studies found that people with visual hallucinations or prone-ness to such experiences confused their inner visual experiences with external images. Vivid imagery was also related to proneness to VH. Hence, vivid imagery and reality monitoring confusion could be contributory factors to understanding VH.

Visual Imagery and False Memory for Pictures: A Functional Magnetic Resonance Imaging Study in Healthy Participants

Background

Visual mental imagery might be critical in the ability to discriminate imagined from perceived pictures. Our aim was to investigate the neural bases of this specific type of reality-monitoring process in individuals with high visual imagery abilities.

Methods

A reality-monitoring task was administered to twenty-six healthy participants using functional magnetic resonance imaging. During the encoding phase, 45 words designating common items, and 45 pictures of other common items, were presented in random order. During the recall phase, participants were required to remember whether a picture of the item had been presented, or only a word. Two subgroups of participants with a propensity for high vs. low visual imagery were contrasted.

Results

Activation of the amygdala, left inferior occipital gyrus, insula, and precuneus were observed when high visual imagers encoded words later remembered as pictures. At the recall phase, these same participants activated the middle frontal gyrus and inferior and superior parietal lobes when erroneously remembering pictures.

Conclusions

The formation of visual mental images might activate visual brain areas as well as structures involved in emotional processing. High visual imagers demonstrate increased activation of a fronto-parietal source-monitoring network that enables distinction between imagined and perceived pictures.

Individual differences shape the content of visual representations

Visually perceiving a stimulus activates a pictorial representation of that item in the brain, but how pictorial is the representation of a stimulus in the absence of visual stimulation? Here I address this question with a review of the literatures on visual imagery (VI), visual working memory (VWM), and visual preparatory templates, all of which require activating visual information in the absence of sensory stimulation. These processes have historically been studied separately, but I propose that they can provide complimentary evidence for the pictorial nature of their contents. One major challenge in studying the contents of visual representations is the discrepant findings concerning the extent of overlap (both cortical and behavioral) between externally and internally sourced visual representations. I argue that these discrepancies may in large part be due to individual differences in VI vividness and precision, the specific representative abilities required to perform a task, appropriateness of visual preparatory strategies, visual cortex anatomy, and level of expertise with a particular object category. Individual differences in visual representative abilities greatly impact task performance and may influence the likelihood of experiences such as intrusive VI and hallucinations, but research still predominantly focuses on uniformities in visual experience across individuals. In this paper I review the evidence for the pictorial content of visual representations activated for VI, VWM, and preparatory templates, and highlight the importance of accounting for various individual differences in conducting research on this topic.

Source memory errors in schizophrenia, hallucinations and negative symptoms: a synthesis of research findings

BACKGROUND

Previous research has shown associations between source memory errors and hallucinations in patients with schizophrenia. We bring together here findings from a broad memory investigation to specify better the type of source memory failure that is associated with auditory and visual hallucinations.

METHOD

Forty-one patients with schizophrenia and 43 healthy participants underwent a memory task involving recall and recognition of lists of words, recognition of pictures, memory for temporal and spatial context of presentation of the stimuli, and remembering whether target items were presented as words or pictures.

RESULTS

False recognition of words and pictures was associated with hallucination scores. The extra-list intrusions in free recall were associated with verbal hallucinations whereas the intra-list intrusions were associated with a global hallucination score. Errors in discriminating the temporal context of word presentation and the spatial context of picture presentation were associated with auditory hallucinations. The tendency to remember verbal labels of items as pictures of these items was associated with visual hallucinations. Several memory errors were also inversely associated with affective flattening and anhedonia.

CONCLUSIONS

Verbal and visual hallucinations are associated with confusion between internal verbal thoughts or internal visual images and perception. In addition, auditory hallucinations are associated with failure to process or remember the context of presentation of the events. Certain negative symptoms have an opposite effect on memory errors.

Can we harness computerised cognitive bias modification to treat anxiety in schizophrenia? A first step highlighting the role of mental imagery

A new wave of computerised therapy is under development which, rather than simulating talking therapies, uses bias modification techniques to target the core psychological process underlying anxiety. Such interventions are aimed at anxiety disorders, and are yet to be adapted for co-morbid anxiety in psychosis. The cognitive bias modification (CBM) paradigm delivers repeated exposure to stimuli in order to train individuals to resolve ambiguous information in a positive, rather than anxiety provoking, manner. The current study is the first to report data from a modified form of CBM which targets co-morbid anxiety within individuals diagnosed with schizophrenia. Our version of CBM involved exposure to one hundred vignettes presented over headphones. Participants were instructed to actively simulate the described scenarios via visual imagery. Twenty-one participants completed both a single session of CBM and a single control condition session in counter-balanced order. Within the whole sample, there was no significant improvement on interpretation bias of CBM or state anxiety, relative to the control condition. However, in line with previous research, those participants who engage in higher levels of visual imagery exhibited larger changes in interpretation bias. We discuss the implications for harnessing computerised CBM therapy developments for co-morbid anxiety in schizophrenia.

Visual hallucinations in consultation-liaison neuropsychiatry

BACKGROUND

In consultation-liaison settings, neuropsychiatrists are commonly asked to assess patients with hallucinatory syndromes and to differentiate 'functional' from 'organic' psychotic presentations.

METHODS

The occurrence and management of visual hallucinations (VH) in healthy individuals, lesion states, neurodegenerative disorders, intoxication/withdrawal states and delirium are reviewed.

RESULTS

The presence of VH has been shown to predict a secondary rather than primary psychotic illness and an understanding of the neurobiology of the visual system - including how and where underlying neurotransmitter systems interact in visual processing and how perturbations can result in VH - allows for appropriate clinical assessment and management.

Factorial structure of the hallucinatory experience: continuity of experience in psychotic and normal individuals

Examination of the distribution of the hallucinatory experience may aide in the determination of their continuity and the psychological mechanisms that mediate their occurrence. Past investigators have found that hallucinatory experiences are not limited to disordered individuals and can be induced in the laboratory and occur naturally in the general population. Few reports to date, however, have directly investigated the continuity of the experience by comparing hallucinatory behavior of psychotic patients with a nonclinical sample. In the present study, we examined the architecture of the hallucinatory experience by comparing the factorial structure of the Launay-Slade Hallucination Scale using psychotic patients with active hallucinations, psychotic inpatients without hallucinations, and a group of university students. In support of the continuum model of psychosis, a very similar factor-analytic solution was obtained for all three groups. Discriminant function analysis, however, revealed that all groups achieved a high classified rate by their item responses. These results are consistent with the notion that expression of hallucinatory behavior exists along a continuum, but at a certain level of symptom severity beyond a critical threshold, the behavior becomes discontinuous and dysfunctional.

Cognitive basis of hallucinations in schizophrenia: role of top-down information processing

Hallucinations in schizophrenia have been regarded to result from the erroneous attribution of internally generated information to an external source. Distortions in mental imagery may underlie such confusions. We investigated performance of 77 subjects on multiple behavioral measures of auditory and visual mental imagery and perception, and a measure of reality monitoring. Comparisons were made between performance of schizophrenia patients with (N=22) and without (N=35) hallucinations and matched normal comparison subjects (N=20), after controlling for attentional factors. No differences emerged on any of the mental imagery measures, nor on reality monitoring accuracy. This suggests that there is no stable disposition towards abnormal mental imagery associated with hallucinations. However, for patients with active hallucinations (N=12), hallucination severity correlated positively with a measure of imagery-perception interaction in the auditory modality, r=0.70, p=0.01. Although preliminary, this finding is consistent with recent theoretical proposals in which hallucinations have been suggested to result from an increased influence of top-down sensory expectations on conscious perception.

Source monitoring impairments in schizophrenia: characterisation and associations with positive and negative symptomatology

This article describes a consistent pattern of the associations between source monitoring failure and clinical symptomatology in schizophrenia. The associations with positive symptoms in this sample have been reported previously, but not the associations with negative symptoms. Forty patients with schizophrenia were administered several memory tasks including free recall of lists of words, recognition and source memory. Various memory errors assumed to stem from source monitoring failure were derived. They include intrusions and recall of words from previous lists in free recall, false recognitions, and confusion with regard to the source of the stimuli. We studied the associations of these memory errors with positive symptoms and with a broad range of negative symptoms. All the memory errors were positively associated with at least one positive symptom. On the other hand, these errors were inversely associated with certain negative symptoms reflecting lack of emotion or lack of social interactions. Thus positive and negative symptomatology appear to have opposite links to the source monitoring errors observed in patients with schizophrenia. Cognitive mechanisms leading to different types of source monitoring errors and possibly to the formation of positive symptoms are discussed.

Relationship between symptom dimensions and neurocognitive functioning in schizophrenia: a meta-analysis of WCST and CPT studies. Wisconsin Card Sorting Test. Continuous Performance Test

Cognitive deficits have been hypothesized to be differentially related to the negative, positive and disorganization dimensions of schizophrenia symptoms. In this article, we quantitatively review the published literature on the relationships between symptom dimensions in schizophrenia and performance on the two most widely applied tests of executive functioning and sustained attention, the Wisconsin Card Sorting Test (WCST) and the Continuous Performance Test (CPT). Meta-analyses were conducted on studies that reported correlational data for the relations between performance on these tests and scales of positive and negative symptoms. The more recent distinction between disorganization and reality distortion was also taken into account. The results showed statistically significant relationships of negative symptoms with worse performance on the WCST and the CPT. Disorganization symptoms showed a significant positive correlation with perseverations on the WCST, but not with CPT performance. In contrast, reality distortion symptoms and general scores for all positive symptoms did not correlate with either measure. Although some correlations were statistically significant, the observed associations between psychiatric symptoms and cognitive performance were typically weak, suggesting relative independence of these disease processes.