Voices and Thoughts in Psychosis: An Introduction

This is the final version. Available from Springer Verlag via the DOI in this record.In this introduction we present the orthodox account of auditory verbal hallucinations (AVHs), a number of worries for this account, and some potential responses open to its proponents. With some problems still remaining, we then introduce the problems presented by the phenomenon of thought insertion, in particular the question of how different it is supposed to be from AVHs. We then mention two ways in which theorists have adopted different approaches to voices and thoughts in psychosis, and then present the motivation and composition of this special issue.The two authors of this introduction were supported by a Wellcome Trust Strategic Award (WT098455MA)

Verbal problem-solving, executive functioning and language development in autism spectrum disorders

Autism spectrum disorders (ASDs) are primarily defined by problems with social interaction and communication, but they are also associated with a complex cognitive profile. One area of difficulty for children and adults with ASD is problem-solving, or the process of identifying a solution to a puzzle or question where the answer is hidden. This can be seen on the Twenty Questions Task (TQT), a commonly-used measure of verbal problem-solving and executive functioning. Children with autism are consistently less efficient than typically-developing children in their questioning on the task: for instance, rather than ask a general, category-based question (e.g. “Is it a living thing?”) they may ask about single items (“Is it the dog?”) or very restricted groupings (“Is it something you wear on your feet?”). This has previously been interpreted as an example of a concept formation deficit in autism, deriving from underlying difficulties with complex and integrative information processing. However, success in problemsolving relies on a number of cognitive and linguistic processes that may be impaired in ASD. This thesis attempts to identify which of these may better explain autistic problem-solving performance, using the TQT as a specific example. The first experiment presented here examines the role of executive functioning difficulties in this profile. The performance of 22 children with ASD and 21 age- and IQ-matched typically-developing (TD) children was compared on a version of the TQT adapted to assess planning skills prior to problem-solving and selective attention during the task. Compared to controls, ASD participants were less efficient in their planning of questions, although not all ASD participants had difficulty constructing a plan. No specific effects of selective attention were evident. The second and third experiments explore the importance of atypical language development to this profile, using the example of deafness. Experiment 2 compares the performance of deaf (n = 9) and hearing (n = 27) adults on the TQT, replicating prior evidence of less efficient problem-solving in deaf graduate students. Experiment 3 contrasts TQT performance in 13 deaf schoolchildren with the ASD and TD data acquired in experiment 1. Like ASD children, deaf children were less efficient in their questioning than TD participants, even when controlling for cognitive ability differences. Both autism and deafness are associated with delays in early language development, whereas Asperger Syndrome (AS) is not. To test whether language delay explains autistic problem-solving difficulties, experiment 4 compares TQT performance in 15 children with autism, 15 AS children and 15 age- and IQ- matched typically-developing controls. Participants with autism asked less efficient questions than both AS and TD participants, between whom no differences were observed. This suggests that the problem-solving profile in autism may be better explained as a consequence of atypical language development, rather than other aspects of information processing or executive dysfunction

Hearing voices in the resting brain: A review of intrinsic functional connectivity research on auditory verbal hallucinations

Resting state networks (RSNs) are thought to reflect the intrinsic functional connectivity of brain regions. Alterations to RSNs have been proposed to underpin various kinds of psychopathology, including the occurrence of auditory verbal hallucinations (AVH). This review outlines the main hypotheses linking AVH and the resting state, and assesses the evidence for alterations to intrinsic connectivity provided by studies of resting fMRI in AVH. The influence of hallucinations during data acquisition, medication confounds, and movement are also considered. Despite a large variety of analytic methods and designs being deployed, it is possible to conclude that resting connectivity in the left temporal lobe in general and left superior temporal gyrus in particular are disrupted in AVH. There is also preliminary evidence of atypical connectivity in the default mode network and its interaction with other RSNs. Recommendations for future research include the adoption of a common analysis protocol to allow for more overlapping datasets and replication of intrinsic functional connectivity alterations

Measurement practices in hallucinations research

Introduction In several sub-fields of psychology, there has been a renewed focus on measurement practices. As far as we are aware, this has been absent in hallucinations research. Thus, we investigated (a) cross-study variation in how hallucinatory experiences are measured and (b) the reliability of measurements obtained using two tasks that are widely employed in hallucinations research. Method In Study 1, we investigated to what extent there was variation in how the Launay-Slade Hallucination Scale (LSHS) has been used across 100 studies. In Study 2, we investigated the reliability of the measurements obtained through source monitoring and signal detection tasks, using data from four recent publications. Materials/data are available at doi: 10.17605/osf.io/d3gnk/. Results In Study 1, we found substantial variation in how hallucinatory experiences were assessed using the LSHS and that descriptions of the LSHS were often incomplete in important ways. In Study 2, we reported a range of reliability estimates for the measurements obtained using source monitoring and signal discrimination tasks. Some measurements obtained using source monitoring tasks had unacceptably low levels of reliability. Conclusions Our findings suggest that suboptimal measurement practices are common in hallucinations research and we suggest steps researchers could take to improve measurement practices

Imaginary companions in childhood: Relations to imagination skills and autobiographical memory in adults

The presence of a childhood imaginary companion (IC) has been proposed to reflect heightened imaginative abilities. This study hypothesized that adults who reported having a childhood IC would score higher on a task requiring the imaginative construction of visual scenes. Additionally, it was proposed that individuals who produced more vivid and detailed scenes would also report richer autobiographical memories, due to a shared reliance on imaginative abilities in construction and recollection. Sixty participants (20 with an IC), completed an adapted scene construction procedure and an autobiographical memory questionnaire. Participants reporting a childhood IC scored significantly higher on scene construction and rated themselves as more imaginative. Scene construction scores were also moderately related to the richness of autobiographical memories, although this was almost entirely due to scores on the thought/emotion/action component of scene construction. Autobiographical memory was unrelated to the presence of an IC. Implications for overlapping and dissociable aspects of imagination and memory are discussed

Exploring the Ecological Validity of Thinking on Demand: Neural Correlates of Elicited vs. Spontaneously Occurring Inner Speech

Psychology and cognitive neuroscience often use standardized tasks to elicit particular experiences. We explore whether elicited experiences are similar to spontaneous experiences. In an MRI scanner, five participants performed tasks designed to elicit inner speech (covertly repeating experimenter-supplied words), inner seeing, inner hearing, feeling, and sensing. Then, in their natural environments, participants were trained in four days of random-beep-triggered Descriptive Experience Sampling (DES). They subsequently returned to the scanner for nine 25-min resting-state sessions; during each they received four DES beeps and described those moments (9 × 4 = 36 moments per participant) of spontaneously occurring experience. Enough of those moments included spontaneous inner speech to allow us to compare brain activation during spontaneous inner speech with what we had found in task-elicited inner speech. ROI analysis was used to compare activation in two relevant areas (Heschl’s gyrus and left inferior frontal gyrus). Task-elicited inner speech was associated with decreased activation in Heschl’s gyrus and increased activation in left inferior frontal gyrus. However, spontaneous inner speech had the opposite effect in Heschl’s gyrus and no significant effect in left inferior frontal gyrus. This study demonstrates how spontaneous phenomena can be investigated in MRI and calls into question the assumption that task-created phenomena are often neurophysiologically and psychologically similar to spontaneously occurring phenomena

Experiences of hearing voices: analysis of a novel phenomenological survey

Background: Auditory hallucinations—or voices—are a common feature of many psychiatric disorders and are also experienced by individuals with no psychiatric history. Understanding of the variation in subjective experiences of hallucination is central to psychiatry, yet systematic empirical research on the phenomenology of auditory hallucinations remains scarce. We aimed to record a detailed and diverse collection of experiences, in the words of the people who hear voices themselves. Methods: We made a 13 item questionnaire available online for 3 months. To elicit phenomenologically rich data, we designed a combination of open-ended and closed-ended questions, which drew on service-user perspectives and approaches from phenomenological psychiatry, psychology, and medical humanities. We invited people aged 16–84 years with experience of voice-hearing to take part via an advertisement circulated through clinical networks, hearing voices groups, and other mental health forums. We combined qualitative and quantitative methods, and used inductive thematic analysis to code the data and χ2 tests to test additional associations of selected codes. Findings: Between Sept 9 and Nov 29, 2013, 153 participants completed the study. Most participants described hearing multiple voices (124 [81%] of 153 individuals) with characterful qualities (106 [69%] individuals). Less than half of the participants reported hearing literally auditory voices—70 (46%) individuals reported either thought-like or mixed experiences. 101 (66%) participants reported bodily sensations while they heard voices, and these sensations were significantly associated with experiences of abusive or violent voices (p=0·024). Although fear, anxiety, depression, and stress were often associated with voices, 48 (31%) participants reported positive emotions and 49 (32%) reported neutral emotions. Our statistical analysis showed that mixed voices were more likely to have changed over time (p=0·030), be internally located (p=0·010), and be conversational in nature (p=0·010). Interpretation: This study is, to our knowledge, the largest mixed-methods investigation of auditory hallucination phenomenology so far. Our survey was completed by a diverse sample of people who hear voices with various diagnoses and clinical histories. Our findings both overlap with past large-sample investigations of auditory hallucination and suggest potentially important new findings about the association between acoustic perception and thought, somatic and multisensorial features of auditory hallucinations, and the link between auditory hallucinations and characterological entities

Measurement practices in hallucinations research

In several sub-fields of psychology, there has been a renewed focus on measurement practices. As far as we are aware, this has been absent in hallucinations research. Thus, we investigated (a) cross-study variation in how hallucinatory experiences are measured and (b) the reliability of measurements obtained using two tasks that are widely employed in hallucinations research

The varieties of inner speech questionnaire – Revised (VISQ-R): Replicating and refining links between inner speech and psychopathology

Inner speech is a common experience for many but hard to measure empirically. The Varieties of Inner Speech Questionnaire (VISQ) has been used to link everyday phenomenology of inner speech – such as inner dialogue – to various psychopathological traits. However, positive and supportive aspects of inner speech have not always been captured. This study presents a revised version of the scale – the VISQ-R – based on factor analyses in two large samples: respondents to a survey on inner speech and reading (N = 1412) and a sample of university students (N = 377). Exploratory factor analysis indicated a five-factor structure including three previous subscales (dialogic, condensed, and other people in inner speech), an evaluative/critical factor, and a new positive/regulatory factor. Confirmatory factor analysis then replicated this structure in sample 2. Hierarchical regression analyses also replicated a number of relations between inner speech, hallucination-proneness, anxiety, depression, self-esteem, and dissociation