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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 DOI: 10.1016/j.schres.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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2
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Benrimoh D, Fisher VL, Seabury R, Sibarium E, Mourgues C, Chen D, Powers A. Evidence for Reduced Sensory Precision and Increased Reliance on Priors in Hallucination-Prone Individuals in a General Population Sample. Schizophr Bull 2024; 50:349-362. [PMID: 37830405 PMCID: PMC10919780 DOI: 10.1093/schbul/sbad136] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND There is increasing evidence that people with hallucinations overweight perceptual beliefs relative to incoming sensory evidence. Past work demonstrating prior overweighting has used simple, nonlinguistic stimuli. However, auditory hallucinations in psychosis are often complex and linguistic. There may be an interaction between the type of auditory information being processed and its perceived quality in engendering hallucinations. STUDY DESIGN We administered a linguistic version of the conditioned hallucinations (CH) task to an online sample of 88 general population participants. Metrics related to hallucination-proneness, hallucination severity, stimulus thresholds, and stimulus detection rates were collected. Data were used to fit parameters of a Hierarchical Gaussian Filter (HGF) model of perceptual inference to determine how latent perceptual states influenced task behavior. STUDY RESULTS Replicating past results, higher CH rates were observed both in those with recent hallucinatory experiences as well as participants with high hallucination-proneness; CH rates were positively correlated with increased prior weighting; and increased prior weighting was related to hallucination severity. Unlike past results, participants with recent hallucinatory experiences as well as those with higher hallucination-proneness had higher stimulus thresholds, lower sensitivity to stimuli presented at the highest threshold, and had lower response confidence, consistent with lower precision of sensory evidence. CONCLUSIONS We replicate the finding that increased CH rates and recent hallucinations correlate with increased prior weighting using a linguistic version of the CH task. Results support a role for reduced sensory precision in the interplay between prior weighting and hallucination-proneness.
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Affiliation(s)
- David Benrimoh
- Department of Psychiatry, McGill University School of Medicine, Montreal, Canada
| | - Victoria L Fisher
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, USA
| | - Rashina Seabury
- 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
| | - Catalina Mourgues
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, USA
| | - Doris Chen
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, USA
| | - Albert Powers
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, USA
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Kafadar E, Fisher VL, Quagan B, Hammer A, Jaeger H, Mourgues C, Thomas R, Chen L, Imtiaz A, Sibarium E, Negreira AM, Sarisik E, Polisetty V, Benrimoh D, Sheldon AD, Lim C, Mathys C, Powers AR. Conditioned Hallucinations and Prior Overweighting Are State-Sensitive Markers of Hallucination Susceptibility. Biol Psychiatry 2022; 92:772-780. [PMID: 35843743 PMCID: PMC10575690 DOI: 10.1016/j.biopsych.2022.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/08/2022] [Accepted: 05/02/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Recent advances in computational psychiatry have identified latent cognitive and perceptual states that predispose to psychotic symptoms. Behavioral data fit to Bayesian models have demonstrated an overreliance on priors (i.e., prior overweighting) during perception in select samples of individuals with hallucinations, corresponding to increased precision of prior expectations over incoming sensory evidence. However, the clinical utility of this observation depends on the extent to which it reflects static symptom risk or current symptom state. METHODS To determine whether task performance and estimated prior weighting relate to specific elements of symptom expression, a large, heterogeneous, and deeply phenotyped sample of hallucinators (n = 249) and nonhallucinators (n = 209) performed the conditioned hallucination (CH) task. RESULTS We found that CH rates predicted stable measures of hallucination status (i.e., peak frequency). However, CH rates were more sensitive to hallucination state (i.e., recent frequency), significantly correlating with recent hallucination severity and driven by heightened reliance on past experiences (priors). To further test the sensitivity of CH rate and prior weighting to symptom severity, a subset of participants with hallucinations (n = 40) performed a repeated-measures version of the CH task. Changes in both CH frequency and prior weighting varied with changes in auditory hallucination frequency on follow-up. CONCLUSIONS These results indicate that CH rate and prior overweighting are state markers of hallucination status, potentially useful in tracking disease development and treatment response.
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Affiliation(s)
- Eren Kafadar
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, Connecticut
| | - Victoria L Fisher
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, Connecticut
| | - Brittany Quagan
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, Connecticut
| | - Allison Hammer
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, Connecticut
| | - Hale Jaeger
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, Connecticut
| | - Catalina Mourgues
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, Connecticut
| | - Rigi Thomas
- School of Naturopathic Medicine, Southwest College of Naturopathic Medicine and Health Sciences, Tempe, Arizona
| | - Linda Chen
- Faculty of Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ayyub Imtiaz
- Department of Psychiatry, St Elizabeth's Hospital, Washington, DC
| | - Ely Sibarium
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, Connecticut
| | | | - Elif Sarisik
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; Max Planck Institute for Psychiatry, Munich, Germany
| | - Vasishta Polisetty
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - David Benrimoh
- McGill University School of Medicine, Montreal, Quebec, Canada
| | - Andrew D Sheldon
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, Connecticut
| | - Chris Lim
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, Connecticut
| | - Christoph Mathys
- Interacting Minds Centre, Aarhus University, Aarhus C, Denmark; Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zürich and ETH Zürich, Zurich, Switzerland; Neuroscience Area, Scuola Internazionale Superiore di Studi Avanzati, Trieste, Italy
| | - Albert R Powers
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, Connecticut.
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Mourgues C, Hammer A, Fisher V, Kafadar E, Quagan B, Bien C, Jaeger H, Thomas R, Sibarium E, Negreira AM, Sarisik E, Polisetty V, Nur Eken H, Imtiaz A, Niles H, Sheldon AD, Powers AR. Measuring Voluntary Control Over Hallucinations: The Yale Control Over Perceptual Experiences (COPE) Scales. Schizophr Bull 2022; 48:673-683. [PMID: 35089361 PMCID: PMC9077437 DOI: 10.1093/schbul/sbab144] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Auditory verbal hallucinations (AVH) frequently cause significant distress and dysfunction, and may be unresponsive to conventional treatments. Some voice-hearers report an ability to fully control the onset and offset of their AVH, making them significantly less disruptive. Measuring and understanding these abilities may lead to novel interventions to enhance control over AVH. Fifty-two voice-hearers participated in the pilot study. 318 participants with frequent AVH participated in the validation study. A pool of 59 items was developed by a diverse team including voice-hearers and clinicians. After the pilot study, 35 items were retained. Factorial structure was assessed with exploratory (EFA, n = 148) and confirmatory (CFA, n = 170) factor analyses. Reliability and convergent validity were assessed using a comprehensive battery of validated phenomenological and clinical scales. CFA on the final 18 items supported two factors for a Methods of Control Scale (5 items each, average ω = .87), and one factor for a Degree of Control Scale (8 items, average ω = .95). Correlation with clinical measures supported convergent validity. Degree of control was associated with positive clinical outcomes in voice-hearers both with and without a psychosis-spectrum diagnosis. Degree of control also varied with quality of life independently of symptom severity and AVH content. The Yale control over perceptual experiences (COPE) Scales robustly measure voice-hearers' control over AVH and exhibit sound psychometric properties. Results demonstrate that the capacity to voluntarily control AVH is independently associated with positive clinical outcomes. Reliable measurement of control over AVH will enable future development of interventions meant to bolster that control.
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Affiliation(s)
| | | | | | - Eren Kafadar
- Yale University School of Medicine, New Haven, CT,USA
| | | | - Claire Bien
- Yale University School of Medicine, New Haven, CT,USA
| | - Hale Jaeger
- Yale University School of Medicine, New Haven, CT,USA
| | - Rigi Thomas
- Southwest College of Naturopathic Medicine, Tempe, AZ, USA
| | - Ely Sibarium
- Yale University School of Medicine, New Haven, CT,USA
| | | | - Elif Sarisik
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Vasishta Polisetty
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Hatice Nur Eken
- School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Ayyub Imtiaz
- Faculty of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
| | - Halsey Niles
- Yale University School of Medicine, New Haven, CT,USA
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Benrimoh D, Sheldon A, Sibarium E, Powers AR. Computational Mechanism for the Effect of Psychosis Community Treatment: A Conceptual Review From Neurobiology to Social Interaction. Front Psychiatry 2021; 12:685390. [PMID: 34385938 PMCID: PMC8353084 DOI: 10.3389/fpsyt.2021.685390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/18/2021] [Indexed: 11/13/2022] Open
Abstract
The computational underpinnings of positive psychotic symptoms have recently received significant attention. Candidate mechanisms include some combination of maladaptive priors and reduced updating of these priors during perception. A potential benefit of models with such mechanisms is their ability to link multiple levels of explanation, from the neurobiological to the social, allowing us to provide an information processing-based account of how specific alterations in self-self and self-environment interactions result in the experience of positive symptoms. This is key to improving how we understand the experience of psychosis. Moreover, it points us toward more comprehensive avenues for therapeutic research by providing a putative mechanism that could allow for the generation of new treatments from first principles. In order to demonstrate this, our conceptual paper will discuss the application of the insights from previous computational models to an important and complex set of evidence-based clinical interventions with strong social elements, such as coordinated specialty care clinics (CSC) in early psychosis and assertive community treatment (ACT). These interventions may include but also go beyond psychopharmacology, providing, we argue, structure and predictability for patients experiencing psychosis. We develop the argument that this structure and predictability directly counteract the relatively low precision afforded to sensory information in psychosis, while also providing the patient more access to external cognitive resources in the form of providers and the structure of the programs themselves. We discuss how computational models explain the resulting reduction in symptoms, as well as the predictions these models make about potential responses of patients to modifications or to different variations of these interventions. We also link, via the framework of computational models, the patient's experiences and response to interventions to putative neurobiology.
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Affiliation(s)
- David Benrimoh
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Andrew Sheldon
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Ely Sibarium
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Albert R Powers
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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Strang JF, Knauss M, van der Miesen A, McGuire JK, Kenworthy L, Caplan R, Freeman A, Sadikova E, Zaks Z, Pervez N, Balleur A, Rowlands DW, Sibarium E, Willing L, McCool MA, Ehrbar RD, Wyss SE, Wimms H, Tobing J, Thomas J, Austen J, Pine E, Griffin AD, Janssen A, Gomez-Lobo V, Brandt A, Morgan C, Meagher H, Gohari D, Kirby L, Russell L, Powers MD, Anthony LG. A Clinical Program for Transgender and Gender-Diverse Neurodiverse/Autistic Adolescents Developed through Community-Based Participatory Design. Journal of Clinical Child & Adolescent Psychology 2020; 50:730-745. [DOI: 10.1080/15374416.2020.1731817] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- John F. Strang
- Gender and Autism Program, Division of Neuropsychology, Children’s National Health System
- George Washington University School of Medicine, George Washington University
| | - Megan Knauss
- Gender and Autism Program, Division of Neuropsychology, Children’s National Health System
- Alliance of Community Health Plans
| | - Anna van der Miesen
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, VU University Medical Center
| | - Jenifer K. McGuire
- Department of Family Social Science, University of Minnesota
- National Center for Gender Spectrum Health, University of Minnesota
| | - Lauren Kenworthy
- George Washington University School of Medicine, George Washington University
- Center for Autism Spectrum Disorders, Children’s National Health System
| | | | | | - Eleonora Sadikova
- Gender and Autism Program, Division of Neuropsychology, Children’s National Health System
| | - Zosia Zaks
- Hussman Center for Adults with Autism, Towson University
| | | | | | | | | | - Laura Willing
- Gender and Autism Program, Division of Neuropsychology, Children’s National Health System
- George Washington University School of Medicine, George Washington University
| | - Marissa A. McCool
- Queer Indigenous and People of Color (QIPOC), Augsburg University
- V-Day, University of Pennsylvania
| | | | - Shannon E. Wyss
- Gender and Sexuality Education and Advocacy Program, Children’s National Medical Center
- Transgender Leadership Initiative, AIDS United
| | - Harriette Wimms
- Youth Gender Care Services, The Village Family Support Center of Baltimore
| | | | - John Thomas
- Transgender and Autism Services, Falls Church Counseling
| | | | - Elyse Pine
- LGBT Health Resource Center, Chase Brexton Health Care
| | | | - Aron Janssen
- Gender and Sexuality Service, Child Study Center, New York University Medical School
| | - Veronica Gomez-Lobo
- Gender and Autism Program, Division of Neuropsychology, Children’s National Health System
- Division of Pediatric Gynecology, Children’s National Health System
| | - Abigail Brandt
- Gender and Autism Program, Division of Neuropsychology, Children’s National Health System
- Division of Hearing and Speech, Children’s National Health System
| | - Colleen Morgan
- Gender and Autism Program, Division of Neuropsychology, Children’s National Health System
- Division of Hearing and Speech, Children’s National Health System
| | - Haley Meagher
- Gender and Autism Program, Division of Neuropsychology, Children’s National Health System
| | - Dena Gohari
- Gender and Autism Program, Division of Neuropsychology, Children’s National Health System
| | - Laura Kirby
- Gender and Autism Program, Division of Neuropsychology, Children’s National Health System
| | - Laura Russell
- Gender and Autism Program, Division of Neuropsychology, Children’s National Health System
| | - Meredith D. Powers
- Gender and Autism Program, Division of Neuropsychology, Children’s National Health System
| | - Laura G. Anthony
- Department of Psychiatry, Pediatric Mental Health Institute, Children’s Hospital of Colorado, University of Colorado School of Medicine
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