Editorial: Hallucinations: New Interventions Supporting People with Distressing Voices and/or Visions

The future of hallucination research: Can hallucinogens and psychedelic drugs teach us anything?

Hallucinations are one of the most interesting and least understood of all human experiences. This commentary addresses the ideas which most influenced my thinking in the past 20 years and what I believe to be the most currently promising area of enquiry. Interest in hallucinations reaches far back into antiquity and across cultures. The similarity of hallucinations in mental illness with the perceptual experiences reported by individuals who not mentally unwell has long been recognized. Early scientific research on hallucinogen drugs such as lysergic acid diethylamide (LSD) was criticized and then withdrawn, but its recent revival offers new opportunities to examine the mechanism and 'process' of hallucinating. Many psychedelic compounds can elicit intense and realistic hallucinations. The study of hallucinogens conducted in carefully controlled and supervised settings and with individuals who are not mentally unwell opens exciting new possibilities. For example, it may be possible to study the temporal shifts in perceptual awareness, decode what influences the contents, affect, meaning, and appraisals of hallucinations and guide novel psychotherapy techniques and drug therapy.

The link between self-compassion and psychotic-like experiences: A matter of distress?

OBJECTIVES

Self-shaming and self-criticism have been shown to contribute to the emergence of distressing psychotic symptoms and psychotic-like experiences (PLEs). In contrast, a self-compassionate mindset may protect against negative evaluations in response to PLEs leading to less distress. This study explores the association between self-compassion, the frequency of PLEs, and their associated distress.

DESIGN

The study used a correlational, cross-sectional design on a German community sample.

METHODS

A total of 234 participants completed the self-compassion scale (SCS), the Peters' Delusions Inventory, and a modified version of the Launay-Slade Hallucination Scale that measures frequency and distress of hallucinatory experiences. Pearson correlations between SCS and frequency of PLEs as well as between SCS and PLE-distress were compared. Additionally, network analyses of SCS and PLE-measures were calculated.

RESULTS

Self-compassion was associated with less-frequent PLEs and with less PLE-distress, with stronger correlations between self-compassion and PLE-distress. The network analysis showed the self-compassion facets isolation and overidentification to be the closest links to PLE-distress.

CONCLUSIONS

Self-compassion is associated with less PLE related distress. Prevention programmes and interventions that target the negative facets associated with lack of self-compassion may be promising. However, future studies need to explore the causal role of self-compassion facets in the formation of PLE-distress.

PRACTITIONER POINTS

Low levels of self-compassion are associated with being more distressed by psychotic experiences. As the self-compassion facets isolation and overidentification are most strongly related to distress, prevention and intervention programmes may benefit from focusing on these negative facets.

Toward personalized treatment of hallucinations

PURPOSE OF REVIEW

Hallucinations are common and often stressful experiences, occurring in all sensory modalities. They frequently complicate many disorders or situations, such as Parkinson's disease, schizophrenia, hearing or vision loss, intoxications and delirium. Although psychoeducation, coping techniques and psychotherapy may be broadly applicable, they do not address a specific underlying brain mechanism. Pharmacotherapy may effectively alleviate hallucinations if the corresponding mechanism is present, whereas in its absence, may only cause harmful side effects. Therefore, pharmacotherapy needs input about underlying brain mechanisms.

RECENT FINDINGS

Recent findings suggest new underlying neurobiological mechanisms as possible therapeutic targets in selected patients, for example increased glutamate levels. In addition, neuronavigation can guide repetitive transcranial magnetic stimulation treatment of auditory verbal hallucinations to target-specific cortical regions.

SUMMARY

We propose the use of neuroimaging methods to better understand the interaction of different mechanisms underlying hallucinations and to use this knowledge to guide pharmacotherapy or focal brain stimulation in a personalized manner. In addition, we suggest evidence from various imaging modalities should converge to answer a research question. We believe this 'convergence of evidence' avoids the problem of overreliance on single and isolated findings.