Une approche psychologique des hallucinations : mécanismes psychologiques (partie I)

Abstract

Anglo-Saxon psychology has produced a significant number of studies showing the involvement of psychological mechanisms in the development and maintenance of auditory hallucinations (voice-hearing). Likewise, numerous studies have shown that hallucinations are also described in other psychiatric (e.g. post-traumatic stress disorder) and neurodegenerative (e.g. Parkinson's disease) clinical populations as well as in a minority of the general population. However, despite these advances, hallucinations are still considered as a specific characteristic of schizophrenia, which in most cases, is understood from a biological point of view. For this reason, in this review, we are specifically interested in the psychological models of auditory hallucinations from a transdiagnostic point of view. More specifically, we will describe (1) the role of beliefs about voices and self-schemas, (2) the experience of voice understood as a fundamentally relational phenomenon between the voice hearer and the voices, (3) the role of emotions and emotional regulation strategies, and, finally, (4) the role of past traumatic experiences and dissociation. Regarding the role of beliefs about voices and self-schemas, numerous studies are showing that more important than the experience of hearing voices it is how the individual appraisal their experience that will ultimately impact on how they will cope with the experiences and how they will feel about it (distressed or not). Voices appraised as malevolent and powerful are more often associated with avoidant, escape, confrontation, and compliance coping strategies. Moreover, they are also associated with higher levels of depression and anxiety regardless of the frequency of hallucinations and duration of the disorder. Besides the beliefs about the voices, how the individual perceives him/herself is also essential. It has been shown, for example, that the more individuals feel depressed and inferior in comparison to others in interpersonal relationships, the more inferior they feel about their voices. The relational approach proposed that the experience of voice understood as a fundamentally relational phenomenon between the voice hearer and the voices. Indeed, phenomenological studies have been able to show that voice-hearers describe voices as possessing human characteristics. As a result, voice-hearers often develop a relationship of virtual intimacy with their voices, which often seems to be complex and characterised by a certain ambivalence similar to the interpersonal relationships encountered in everyday life. Thus, current research suggests that it is essential to take into account these relational aspects when working with voice-hearers. Alongside cognitive and relational variables, emotional states and processes play a significant role in the development and maintenance of auditory hallucinations. Indeed, it has been shown that stress, anxiety and depression are predictors of hallucinations. Also, increased use of non-adaptive emotion regulation strategies may play a major role in the phenomenon of voice agreement. Studies have demonstrated that emotional regulation strategies such as experiential avoidance and abstract rumination seem to contribute to the increased frequency of hallucinations and associated distress. Finally, there is now strong evidence showing the involvement of past adverse experiences in the onset and content of hallucinations. In this framework, dissociation is seen as a protective mechanism that allows individuals to psychologically detach themselves from events that they cannot cope with. Consequently, the experience is attributed to external sources, ultimately leading to the phenomenon of voice-hearing. In summary, in this brief review, we have tried to present the best validated psychological models for understanding the experience of voice agreement. The goal is to provide information on how these psychological processes can help us to the adoption of a person-centred approach in mental health care that allows the person to describe their experiences in their own words and thus formulate an understanding of their suffering.