Linguistic analysis of the valence, arousal and dominance of auditory hallucinations and internal thoughts in schizophrenia: Implications for psychoeducation and CBT

Gordon D Turkington,Watson Stuart,Taylor Lawrence

doi:10.1080/23311908.2019.1703463

Abstract

70% of patients with schizophrenia suffer from auditory verbal hallucinations (AVH) which are frequently described as distressing and disabling. The content of AVH, in relation to internal thought, has never been linguistically tested in a self-monitoring study. The aim of this preliminary study was to establish if there was a significant difference between AVH and inner thoughts on the key linguistic parameters of valence (pleasantness), dominance (control) and arousal (intensity of emotion produced). Six volunteers with a diagnosis of schizophrenia from voice hearing support groups produced real-time, detailed diaries of AVH and inner thoughts using randomised/fixed timers. Analysis of content was completed using an established linguistic database. AVH were significantly more unpleasant and controlling but not more emotionally arousing than inner thoughts. Psychoeducation around the experience of hallucination in schizophrenia should include information that the voices will be significantly more unpleasant and controlling than their own thoughts but not more emotionally arousing. CBT might therefore include the use of compassion focussed techniques to help with the unpleasantness of AVH and schema level techniques to improve coping with the dominance of AVH.

Highlights

Source monitoring bias has been viewed as a key mechanism of the production of auditory verbal hallucinations (AVH)
Statistical analysis was performed on the difference between linguistic scores on valence, dominance and arousal in the AVH and inner speech samples using appropriate non-parametric statistical tests (Wilcoxon Signed-Ranks Test)
The mean number of words per diary was 500 words (SD = 317; 8 diaries were completed by the 6 participants with 2 volunteers completing 2 diaries each) with 308 words (SD = 220) of auditory hallucination per diary (SD = 220) and 204 words (SD = 135) of inner thought per diary

Summary

Introduction

Source monitoring bias has been viewed as a key mechanism of the production of auditory verbal hallucinations (AVH). Brookwell, Bentall, and Varese (2013) in a meta-analytic review of the literature reported that externalizing biases were important cognitive underpinnings of hallucinatory experiences and that clinical interventions targeting these biases should be explored as possible treatments. They noted the lack of confirmatory information from self-monitoring studies due to a lack of published evidence. Tovar et al (2019) were able to report a syntactical linguistic analysis of AVH which showed that there was a distinctive linguistic profile to voice speech They noted that sentence-level content was largely personal rather than impersonal, and in impersonal utterances, it was generally vague. This is an important finding which this paper explores further by comparing AVH to internal thoughts on the three key linguistic parameters of valence, dominance and arousal

Methods

Results

Conclusion