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)

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

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

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

The brain’s conversation with itself: neural substrates of dialogic inner speech

Inner speech has been implicated in important aspects of normal and atypical cognition, including the development of auditory hallucinations. Studies to date have focused on covert speech elicited by simple word or sentence repetition, while ignoring richer and arguably more psychologically significant varieties of inner speech. This study compared neural activation for inner speech involving conversations (‘dialogic inner speech’) with single-speaker scenarios (‘monologic inner speech’). Inner speech-related activation differences were then compared with activations relating to Theory-of-Mind (ToM) reasoning and visual perspective-taking in a conjunction design. Generation of dialogic (compared with monologic) scenarios was associated with a widespread bilateral network including left and right superior temporal gyri, precuneus, posterior cingulate and left inferior and medial frontal gyri. Activation associated with dialogic scenarios and ToM reasoning overlapped in areas of right posterior temporal cortex previously linked to mental state representation. Implications for understanding verbal cognition in typical and atypical populations are discussed

A linguistic approach to the psychosis continuum: (dis)similarities and (dis)continuities in how clinical and non-clinical voice-hearers talk about their voices

Introduction: “Continuum” approaches to psychosis have generated reports of similarities and differences in voice-hearing in clinical and non-clinical populations at the cohort level, but not typically examined overlap or degrees of difference between groups. / Methods: We used a computer-aided linguistic approach to explore reports of voice-hearing by a clinical group (Early Intervention in Psychosis service-users; N = 40) and a non-clinical group (spiritualists; N = 27). We identify semantic categories of terms statistically overused by one group compared with the other, and by each group compared to a control sample of non-voice-hearing interview data (log likelihood (LL) value 6.63+=p < .01; effect size measure: log ratio 1.0+). We consider whether individual values support a continuum model. / Results: Notwithstanding significant cohort-level differences, there was considerable continuity in language use. Reports of negative affect were prominent in both groups (p < .01, log ratio: 1.12+). Challenges of cognitive control were also evident in both cohorts, with references to “disengagement” accentuated in service-users (p < .01, log ratio: 1.14+). / Conclusion: A corpus linguistic approach to voice-hearing provides new evidence of differences between clinical and non-clinical groups. Variability at the individual level provides substantial evidence of continuity with implications for cognitive mechanisms underlying voice-hearing

Psychological and physiological effects of compassionate mind training: A pilot randomised controlled study

The development of the compassionate self, associated with practices such as slow and deeper breathing, compassionate voice tones and facial expressions and compassionate focusing is central to Compassion Focused Therapy. This study explores the impact of a two-week Compassionate Mind Training (CMT) program on emotional, self-evaluative and psychopathology measures and on heart rate variability (HRV). Participants (general population and college students) were randomly assigned to one of two conditions: CMT (n=56) and Wait-List Control (n=37). Participants in the CMTcondition were instructed to practice CMT exercises during two weeks. Self-report measures of compassion, positive affect, fears of compassion, self-criticism, shame, depression, anxiety and stress, and HRV were collected at pre and post intervention in both conditions. Compared to the control group, the experimental group showed significant increases in positive emotions, associated with feeling relaxed and also safe and content, but not activated; and in self-compassion, compassion for others and compassion from others. There were significant reductions in shame, self-criticism, fears of compassion, and stress. Only the experimental group reported significant improvement in HRV. Developing awareness of the evolved nature and inherent difficulties of our minds allied with practicing CMT exercises has beneficial effects on participants' psychological and physiological well-being.N/

Narrative and Cognitive Modeling: Insights From Beckett Exploring Mind's Complexity

Complex systems exacerbate a common problem for scientific enquiry: the difficulty of creating models able to discriminate fundamental elements or patterns from random behaviours or corollary components in the event or process at issue. This chapter argues that a similar tension between order and randomness has been a chief modelling problem of Samuel Beckett’s narratives, tied to his interest in a specific kind of complex system (the mind) and its emergent properties (consciousness and the narrative sense of self). Bulding on narratology, complex system frameworks, cognitive theories of emergence and of scientific modelling, this chapter introduces the idea of “fictional cognitive modelling”. Through this concept, the chapter analyses Beckett’s treatment of narrative devices as formal tools for the creation of “exploratory models” able to atomise the emerging unity of conscious experience and of a narrative sense of self into its core components (defined as the “narrative dynamic core”). It concludes by suggesting that Beckett’s narrative method shows how literature can occupy a proper position in the investigation and exploration of complex systems