Hearing Voices

Understanding AVATAR therapy: who, or what, is changing?

Background: Elements of voice content and characteristics of a hallucinatory voice are considered to be associated with compliance and resistance to auditory command hallucinations. However, a need for further exploration of such features remains.Aims: To explore the associations across different types of commands (benign, self-harm, harm-other) with a range of symptom measures and a trait measure of expressed compliance with compliance to the most recent command and command hallucinations over the previous 28 days.Methods: Participants meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for schizophrenia or schizoaffective disorder, with auditory hallucinations in the previous 28 days were screened. Where commands were reported a full-assessment of positive symptoms, social-rank, beliefs about voices and trait compliance was completed.Results: Compliance with the last self-harm command was associated with elevated voice malevolence, heightened symptom presentation and perceived consequences for non-compliance. Compliance with the last harm-other command was associated with elevated symptom severity, higher perceived consequences for non-compliance and higher levels of voice social rank. However, these associations were not maintained for compliance during the previous 28 days.Conclusions: Findings indicate the importance of identifying the content of commands, overall symptom severity and core variables associated with compliance to specific command categories. The temporal stability of established mediating variables needs further examination.

Introduction. Both clinical and non-clinical auditory hallucinations (AH) have been associated with source memory deficits, supporting a continuum of underlying cognitive mechanisms, though few studies have employed the same task in patient and nonpatient samples. Recent commentators have called for more debate on the continuum model of psychosis. Consequently, the current study investigated the continuity model of AH with reference to memory binding. Methods. We used an identical voice and word recognition memory task to assess binding in two separate studies of: (1) healthy hallucination-prone individuals and controls (30 high and 30 low scorers on the Launay-Slade Hallucination Scale–Revised) and (2) schizophrenia patient samples (32 with AH, 32 without AH) and 32 healthy controls. Results. There was no evidence of impaired binding in high hallucination-prone, compared to low hallucination-prone individuals. In contrast, individuals with schizophrenia (both with and without AH) had difficulties binding (remembering “who said what”), alongside difficulties remembering individual words and voices. Binding ability and memory for voices were also negatively linked to the loudness of hallucinated voices reported by patients with AH. Conclusions. These findings suggest that different mechanisms may exist in clinical and non-clinical hallucinators, adding to the growing debate on the continuum model of psychotic symptoms.

Auditory hallucinations that are viewed by patients as positive and useful may be barriers to treatment-seeking. The aim was to assess prevalence, impact, and course of, and attributions to, these voices in psychotic and non-psychotic patients. One hundred thirty-one patients of a Voices Clinic and 65 members of the Dutch Resonance Foundation were assessed with the Positive and Useful Voices Inquiry. Data were analyzed using Pearson's chi-square, one-way anova, and Crohnbach's alpha statistics. First voices are most often reported as negative. Positive voices occur more among non-psychotic subjects, but the specific characteristics and diagnosis are not significantly associated. Lifetime prevalence of positive and useful voices ranged between 40% and 60%, with varied prevalence rates over time. Positive voices are experienced by subjects as direct addresses in the third person. Perceived control of voices is significantly associated with the wish to preserve them. Attribution of protective power to positive voices has the strongest association with positive experience. Many patients express a desire to preserve these voices. Voice characteristics do not allow for validly discriminating psychotic from non-psychotic disorders.

Effects on Voice Quality of Thyroidectomy: A Qualitative and Quantitative Study Using Voice Maps

Performing (in) the Grave

BackgroundDespite Auditory Verbal Hallucinations (AVHs) having been long associated with mental illness, they represent a common experience also in the non-clinical population, yet do not exhibit distress or need for care. Shame and guilt are emotions related to one's perception of oneself and one's responsibility. As such, they direct our attention to aspects of AVHs that are under-researched and elusive, particularly about the status of voices as others, their social implications and the constitution and conceptualisation of the self.ObjectivesThis paper aims to provide a systematic review of studies that investigated the relationship between auditory hallucinations, shame, and guilt in people without relevant signs of psychiatric issues.MethodsWe searched studies reporting information about voices characteristics, the relationship between voices and hearers, hearer's reactions, and beliefs, paying peculiar attention to shame and guilt issues. Included papers were evaluated for risk of bias.ResultsEleven studies that explored the relationship between AVHs, shame and guilt, were extracted. Phenomenological, pragmatic, as well as neuropsychological features of hearing voices in non-clinical populations, allowed us to note a dynamic relationship and the constellation of subjective experiences that can occur. The role of guilt was characterized by few studies and mixed results, while shame was mainly common.ConclusionsDue to the high heterogeneity detected and the scarce sources available, further studies should focus on both the aetiology and the bidirectional relationship between hearing voices, shame, and guilt in non-clinical people. This can be helpful in therapies for non-clinical populations who are distressed by their voices (e.g., psychotherapy), and for whom shame, and guilt may contribute to negative consequences such as isolation, anxiety or future depression. Moreover, it might favour the development and implication of different treatments considering emotion regulation, distress tolerance and interpersonal sensitivity on the clinical populations.

Interpretations of voices in patients with hallucinations and non-patient controls: a comparison and predictors of distress in patients

BackgroundSensory brain areas typically reduce their activity when we speak, allowing us to differentiate our own from someone else’s speech. Similarly, the amplitude of the N100 component of the EEG event-related potential in response to own speech is smaller than for passive listening to own or someone else’s speech. This amplitude suppression effect seems to be altered in voice hearers, which in turn could result in source misattribution (e.g., self-produced voice attributed to an external source). Emotion in speech can have a comparable effect, altering not only self-voice processing but also differentiation of the quality of auditory hallucinations in clinical and non-clinical voice hearers. For example, unlike in non-clinical voice hearers, auditory hallucinations in clinical voice hearers are usually derogatory in content and negatively affect daily functioning. Recent research strongly suggests that clinical and non-clinical voice hearers lie on a continuum ranging from low to high hallucinatory proneness. Based on this notion, the present study used EEG to investigate the effects of manipulations of self-voice quality in self-generated and passively listened-to self-voice as a function of hallucinatory proneness (HP) in healthy young adults. This is the first EEG study that examined the interplay of sensory suppression, emotion, and HP in a non-clinical population.MethodsParticipants varying in HP (according to the Launay Slade Hallucination Scale) participated in a standardized button-press task to elicit their own voice (compared to passively listening to it) in which the self-voice changed stepwise from fully neutral to fully emotional. The experimental task comprised three conditions: motor-to-auditory (MA), where the button-press generated the voice, auditory only (AO), where the voice was presented without the button press, and motor only (MO-a control condition to remove the motor related artifacts from the MA condition), where the button press did not generate the voice. Neutral and angry self-voice (single syllable ‘ah’ and ‘oh’ vocalizations of 500 ms duration) were recorded for each participant before the EEG acquisition. These voices were morphed to generate a neutral to angry continuum consisting of five stimuli ranging from fully neutral to fully angry: 100% neutral, 60-40% neutral-angry, 50-50% neutral-angry and 40–60% neutral-angry and 100% angry.ResultsPreliminary results with 17 participants show a significant effect of emotional self-voice quality on N1 suppression effect, with a larger suppression effect for the 100% angry as compared to 100% neutral self-voice. On the other hand, 60-40% neutral-angry, 50-50% neutral-angry and 40–60% neutral-angry self-voice show an enhancement effect. Furthermore, the results show a significant interaction of HP and voice quality on N1 suppression effect such that high HP showed no N1 suppression effect for the 100% neutral self-voice and an enhanced N1 effect when emotional quality of the self-voice increased.DiscussionThese data suggest that participants perceive the manipulations in the self-voice quality such that they recognize their own fully neutral and angry voice depicted by N100 suppression effect. Similarly, an N100 enhancement effect for 50-50% neutral-angry voice suggest that it is perceived as the most uncertain or peculiar of all the stimuli. Further, low and high HP show difference in N100 suppression effect for different voices, suggesting that HP may alter self-voice processing and these alterations are enhanced for emotional self-voice. This further supports the fact that abnormal perceptual experiences in voice hearers are higher when auditory hallucinations are emotional in nature.

Hearing a voice in the absence of any speaker can be a significant feature of psychiatric illness, but is also increasingly acknowledged as an important aspect of everyday, non-pathological experience. This recognition has led to a growth of interest in voice-hearing in individuals without any psychiatric diagnosis, coupled with greater attention to the subjective experience of voice-hearing across diagnostic groups. Research has also focused on the overlap between some aspects of voice-hearing phenomenology and everyday experiences such as ‘hearing’ the voices of fictional characters and spiritual experience. In this Review, we synthesize research on the range of cognitive, neural, personal and sociocultural processes that contribute to voice-hearing as it occurs in clinical, non-clinical and everyday experience, with particular emphasis on linking mechanism to phenomenology. Heterogeneous forms of voice-hearing can be understood in terms of differing patterns of association among underlying mechanisms. We suggest an approach to hallucinatory experience that sees it as partly continuous with everyday inner experience, but which is critical regarding whether continuity of phenomenology across the clinical–non-clinical divide should be taken to entail continuity of mechanism. Hearing voices has long been associated with severe mental illness but also occurs in the general population. In this Review, Toh et al. describe the cognitive, neural, personal and sociocultural processes that contribute to voice-hearing in clinical, non-clinical and everyday experience, with emphasis on linking mechanism to phenomenology.

to understand narratives of children who hear voices, through their nature, characteristics and stories. a narrative and qualitative study. Benjamin's concepts of narrative and memory were used to analyze the contribution of four children who self-declared as voice hearers. from narratives, three categories emerged: 1) Children's multisensory experience: nature of experiences (all had voices, not all had visions or other sensations); 2) Hearing voices: an unusual beginning (narratives covered the month of beginning, time of day and activities carried out at the time); and 3) Voice characteristics: who are they? (the gender, age range, tone of voice, frequency and content of voices/visions were described). it was observed, from narratives, that children experience voices, visions and sensations in a unique, personal and non-transferable manner, and the construction of dialogue in the group promoted acceptance and even a positive coexistence with the phenomenon.

SUMMARY While auditory hallucinations are considered a core psychotic symptom, central to the diagnosis of schizophrenia, it has long been recognized that persons who are not psychotic may also hear voices. There is an entrenched clinical belief that distinctions can be made between these groups, typically, on the basis of the perceived location or the ‘third-person’ perspective of the voices. While it is generally believed that such characteristics of voices have significant clinical implications, and are important in the differential diagnosis between dissociative and psychotic disorders, there is no research evidence in support of this. Voices heard by persons diagnosed schizophrenic appear to be indistinguishable, on the basis of their experienced characteristics, from voices heard by persons with dissociative disorders or by persons with no mental disorder at all. On this and other bases outlined in this article, we argue that hearing voices should be considered a dissociative experience, which under...

Twenty-six psychotic patients selected for persistent auditory hallucinations were tested on the HDHQ Questionnaire. Their total hostility scores were found to be significantly higher than those of the mixed schizophrenic normative sample, suggesting a link between aggressive tendencies and auditory hallucinations. The total sample was further subdivided on the basis of duration, location and quality of voices, and subgroup comparisons undertaken. These suggested that location and quality of voices were independent of each other and differentially linked with other measures. Several hypothesis for further investigation were generated.

The use of mobile phones while driving has become a major source of distraction to drivers, leading to a large number of car accidents. In this paper, we study the problem of automatically detecting driver phone calls by monitoring smartphone activities and utilizing the vehicle on-board unit. The challenges to overcome include: i) passenger phone calls should be allowed while the calls of the driver should be blocked; ii) the detection mechanism should be phone position-independent and phone owner-independent as the driver may put the smartphone at any position in the front row and make calls via an earphone, or the driver may borrow a passenger's phone to make a call; iii) the in-vehicle environment is noisy resulted from the operating engine, the music the driver and passenger may listen to, and the conversation between passengers and/or the driver; and iv) the computational cost at the smartphone should be light as realtime phone call detection is expected to effectively block an ongoing call to and from the driver. To overcome these challenges and achieve our objective of detecting driver phone calls, we take advantage of the uniqueness of individual's voice features. Through a short period of learning stage, our proposed system can recognize the driver's voice from the collected audio data. Combined with the smartphone's call state, our scheme can determine whether the driver is participating in the current phone call or not. Our strategy takes into account the complicated in-vehicle environment, and the proposed algorithm does not rely on the location of the phone within the vehicle nor the ownership of the smartphone, as the most existing driver phone call detection mechanisms do. We develop a client-server based system with the smartphones being the clients and the vehicle on-board unit being the server. To validate our mechanism, we perform extensive real-world experiments under different scenarios. The results demonstrate a high probability of detecting driver phone calls with a small false alarm rate.

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.