Cognitive Models Of Auditory Hallucinations Research Articles

Explications cognitives des hallucinations acoustico-verbales dans la schizophrénie : un article de synthèse de la littérature scientifique

AimsOur article consists in both analysis and synthesis of contemporary cognitive models of auditory verbal hallucinations (AVHs) in schizophrenia. Our work is based on the analysis of the scientific literature including original articles, literature reviews as well as meta-analysis. MethodologyIn order to identify the most pertinent studies in the electronic search, the three following databases were systematically searched: PubMed, PsycINFO and MEDLINE. For both the analysis and synthesis we selected original articles, literature reviews as well as meta-analysis referring to any cognitive explanation of the auditory hallucinatory experience in schizophrenia. A cognitive model of auditory hallucinations refers to any incorporation of cognitive frameworks and explanations in one's conceptualization of the hallucinatory phenomenon in schizophrenia. We also focused our work on past conceptualization of auditory hallucinations in order to explain the development and the contribution of current cognitive models in the understanding of the onset and the maintaining of AVHs. After a brief review of clinical characteristics and historical conceptualization of auditory verbal hallucinations, contemporary explanations were presented in the area of schizophrenia. These explanations referred to researches into cognitive psychopathology including metacognitive as well as neuroimaging studies. ResultsThe examination of scientific literature highlighted the complexity of AVHs through multifactorial explanations here mostly explained by cognitive and metacognitive deficits. We synthesized former conceptualizations of AVHs, which were sustained on mechanistic or sensory explanations. Esquirol, Baillarger and Briere de Boismont were the first as conceiving AVHs as a perception disorder and introduced the idea that auditory hallucinations resulted from a failure to control one's memories/fantasies. Later, Broca and Wernicke discovered auditory areas in the human brain implicated in language comprehension and production. AVHs began to be conceptualized by the scientific world as being mechanistically brain-related. Sigmund Freud was among the first to study the meaning of AVHs, a domain still being investigated by todays cognitive sciences. More recently, neuroimaging studies allowed the validation of these sensory explanations in considering the onset of AVHs through the deficit of cortical and subcortical areas implicated in the process of languages (e.g. Broca and Wernicke areas) and emotions (e.g. limbic system, amygdala, hippocampus). At a more mechanistic level, contemporary cognitive models of AVHs explained AVHs as an intrusive verbal representation into the awareness which is non-inhibited (i.e. deficit in intentional inhibition) and also non-recognized as one's own experience (i.e. deficit in source monitoring, planning and metacognition), or even attributed to an external source (attribution bias). In terms of inhibitory control, inhibition is a basic cognitive mechanism defined as a collection of processes that allows the suppression of previously activated cognitive contents and the clearing of irrelevant actions or attention from consciousness. Intentional inhibition is effortful and occurs when an individual deliberately suppresses the activation of an item after deciding it is irrelevant. Theoretical support for the suggestion that an inhibitory failure is involved in AVHs in schizophrenia arises from studies that have shown that a failure in inhibition results in intrusive thoughts from long-term memory. Recent findings also found that individuals with AVHs in schizophrenia demonstrated an impaired source monitoring. In episodic memory research, a distinction was made between content (an event) and context (e.g. source or temporal characteristics of an event) information. The context of memories provides cues that allow an individual to differentiate one memory from other memories. AVHs are conceptualized as a failure to access the contextual cues that would allow voice-hearer to form an intact representation of events in memories. Regarding planning, AVHs refer to the intrusion of unwanted memories into the inner speech that are not recognized from one's own representation. Previous cognitive theories highlighted the important role played by metacognitive skills and belief (i.e. thinking about one's thinking) in the explanation of AVHs. Finally, the external attribution bias was extensively studied over the last three decades and refers to the tendency to attribute negative events (situational or cognitive) to an external source. In this framework, AVHs refer to intrusive thoughts externally attributed to a voice. ConclusionFor more than one century, scientific discoveries in (bio)medical science have allowed the validation of former sensory and mechanistic explanations of AVHs. Nevertheless, many explanatory models account for the way AVHs are maintained (source monitoring, deficit in planning, externalizing bias), while they scarcely expose how they are triggered (intrusive thoughts, deficit in inhibition). The relation between AVHs and intrusive thoughts still remain unclear, and further studies are needed for the understanding of a potential causal relationship.

Psychometric properties of the hindi version of beliefs about voices questionnaire-revised

Background: The cognitive model of auditory hallucinations posits that the beliefs or appraisal of the voices plays an important role in the determination of consequent reactions. These beliefs are explored effectively through “Beliefs About Voices Questionnaire-Revised (BAVQ-R).” However, Hindi adaptation and psychometric evaluation of this tool are yet to be done. Hence, the present study aimed at translating the BAVQ-R in Hindi language and assessing the psychometric properties of the same. Methodology: The original version was translated in Hindi language using translation–back-translation method. This translated version of BAVQ-R was then administered to 51 schizophrenia patients with a history of active auditory hallucinations. All the participants were selected from Central India Institute of Mental Health and Neuro Sciences, Rajnandgaon (Chhattisgarh), using purposive sampling technique. Initially, the informed consent was taken from the patients, followed by the administration of the Hindi version of BAVQ-R and Psychotic Symptom Rating Scale (PSYRATS). Finally, the psychometric properties, e.g., internal consistency reliability, divergent validity, and convergent validity were calculated. Results: The internal consistency reliability was within the range of 0.6–0.94, as indicated by Cronbach's alpha. The divergent validity was high as malevolent voices and engagement feelings and behavior towards the voices were negatively correlated (r = −0.56, P

A commentary on: Affective coding: the emotional dimension of agency.

A commentary on: Affective coding: the emotional dimension of agency.

Psychological flexibility and nonjudgemental acceptance in voice hearers: relationships with omnipotence and distress.

The psychological flexibility model has been hypothesized as a transdiagnostic, process-oriented approach to understanding various clinical disorders and problems, including chronic pain, anxiety, and substance misuse. In this study we investigated the model's applicability to the experience of hearing distressing voices. Fifty people experiencing persisting auditory hallucinations were administered the Kentucky Inventory of Mindfulness Skills, Acceptance and Action Questionnaire, Beliefs about Voices Questionnaire-Revised, Thought Control Questionnaire, and the Beck Anxiety and Depression Inventories. We predicted that psychological flexibility, mindful action, and nonjudgemental acceptance would be negatively associated with distress, disability, and behavioural responses to voice hearing and would have additional explanatory power when included with appraisals of voices and thought-control strategies (as predicted by cognitive models of auditory hallucinations). The results showed differential contributions between measures of psychological flexibility and nonjudgemental acceptance. Psychological flexibility accounted for a significant proportion of the variance in regression-based models of depression and anxiety, while nonjudgemental acceptance contributed to the prediction of emotional and behavioural resistance to voices, in addition to appraisals of voices and use of thought-control strategies. However, this was not found for distress associated with voice hearing, life disruption, and engagement with voices, which were explained solely by cognitive variables. The study results suggest that psychological flexibility and nonjudgemental acceptance are related to general emotional well being and resistance response styles to voices, but not to specific dimensions of voice hearing.

CBT for Psychosis: A Symptom-Based Approachby HagenRoger, TurkingtonDouglas, BergeTorkil, and GraweRolf W.. New York, Routledge, 2010, 296 pp., $31.95.

CBT for Psychosis: A Symptom-Based Approachby HagenRoger, TurkingtonDouglas, BergeTorkil, and GraweRolf W.. New York, Routledge, 2010, 296 pp., $31.95.

Auditory Hallucinations: A Comparison of Beliefs about Voices in Individuals with Schizophrenia and Borderline Personality Disorder

Individuals with borderline personality disorder (BPD) may experience distressing auditory hallucinations, phenomenologically similar to those seen in psychosis. However, access to effective intervention is limited. The cognitive model of auditory hallucinations highlights the role of appraisals in maintaining distress. Cognitive behavioural therapy (CBT) that targets such beliefs has shown efficacy in psychosis. This study examined appraisals about voices in individuals with psychosis and those with BPD to establish whether CBT for voices might have clinical utility for those with BPD. Participants included 45 patients with distressing auditory hallucinations, recruited from the National Health Service. All participants received a structured clinical diagnostic interview and the Beliefs about Voices Questionnaire. Ten participants met criteria for BPD (22%), 23 met criteria for a diagnosis of schizophrenia (51%) and 12 met criteria for both disorders (27%). Multivariate analyses confirmed that there were no group differences in beliefs about the malevolence or omnipotence of voices, or in behavioural resistance or engagement. Those with BPD and those with both diagnoses reported significantly greater emotional resistance than those with schizophrenia. Those with schizophrenia reported significantly greater emotional engagement with their voices. Auditory hallucinations in psychosis and BPD do not differ in their phenomenology or cognitive responses (beliefs about the power and malevolence of their dominant voice). The main differential appears to be the affective response. CBT that focuses on appraisals and the relationship with voices may be helpful for distressing auditory hallucinations in individuals with BPD as well as psychosis.

CBT for Psychosis: A Symptom-Based Approach Edited by Roger Hagen, Douglas Turkington, Torkil Berge & Rolf W. Gråwe, Routledge, 2010, £19.99, pb, 296 pp. ISBN: 9780415549479

Edited by Roger Hagen, Douglas Turkington, Torkil Berge, Rolf W. Grawe Routledge, 2010, £19.99, pb, 296 pp. ISBN: 9780415549479 The book is divided into four parts, starting off with a section on cognitive models of auditory hallucinations and delusions and on the assessment of psychosis. The

On keeping (intrusive) thoughts to one's self: Testing a cognitive model of auditory hallucinations

Background. Previous studies have linked intrusive cognitions (hallucinations and obsessions) with inhibitory dysregulation. Combined deficits in intentional inhibition and context memory have been proposed to explain the intrusive nature and perceived nonself origin of auditory hallucinations (Waters et al., 2006). This study tested the prediction, from this model, that individuals with obsessive-compulsive disorder (OCD), who do not mistake the origin of their intrusive thoughts, will show a deficit of intentional inhibition but intact contextual memory. Method. The performance of 14 individuals with OCD and 24 healthy controls was compared on two measures of intentional cognitive inhibition and on a context memory task. Results. Participants with OCD were significantly impaired on both measures of inhibition but were not significantly different from controls in any condition of the context memory task. Conclusions. The predictions were confirmed. Individuals with OCD, like schizophrenia patients with auditory hallucinations, showed impaired intentional inhibition. This impairment might be responsible for the intrusive thoughts reported in both disorders, and might also partially account for the high rates of comorbidity of OCD and schizophrenia. Finally, intact context memory abilities in OCD may contribute to an efficient memory system, and may differentiate this group from those with hallucinations.

Auditory hallucinations in schizophrenia: Intrusive thoughts and forgotten memories

Introduction. This paper presents a new cognitive model of auditory hallucinations in schizophrenia. We suggest that auditory hallucinations are auditory representations derived from the unintentional activation of memories and other irrelevant current mental associations. Our model proposes that a combination of deficits in intentional inhibition and contextual memory is critical to the experience of auditory hallucinations. The failure in intentional inhibition produces unwanted and uncontrollable mental events which are not recognised because they have lost the contextual cues that would normally facilitate recognition. Methods. This article amalgamates recently published data and presents a reanalysis of the findings on 43 patients with a diagnosis of schizophrenia (Badcock, Waters, Maybery, & Michie, 2005; Waters, Badcock, Maybery, & Michie, 2003a; Waters, Maybery, Badcock, & Michie, 2004a). Relative risk was also estimated to determine whether the combination of deficits increases the risk of having auditory hallucinations. Results. Almost 90% of patients currently experiencing auditory hallucinations showed the predicted combination of deficits on both inhibition and context memory, compared to only a third of patients without hallucinations. In addition, the results showed that those patients with the specified cognitive deficits were at an especially increased risk of having auditory hallucinations relative to patients without the deficits. Conclusions. The results of our investigations strongly support the role of intentional inhibition and context memory in auditory hallucinations. Critical consideration of the findings also suggests that additional cognitive processes might be important for the expression of this symptom.

Compelling imagery, unanticipated speech and deceptive memory: Neurocognitive models of auditory verbal hallucinations in schizophrenia

Introduction. The application of neurocognitive models to study schizophrenia has been influential in understanding the nature of this complex and heterogeneous disorder. However, a comprehensive and empirically validated account of auditory hallucinations remains elusive. The aim of this review was to critically assess the current evidence for specific neurocognitive deficits associated with auditory verbal hallucinations (AVHs) in schizophrenia.Methods. A systematic literature search was conducted of research involving three influential cognitive models of auditory hallucinations: those implicating dysfunction in auditory imagery, verbal self-monitoring, and episodic memory.Results. The findings of the review suggested that AVHs have been associated with impaired verbal self-monitoring, impaired memory for self-generated speech, heightened influence of top-down processing on perception, and an externalising response bias.Conclusions. On the basis of the findings of the review a multidimensional model of AVHs is proposed incorporating the identified cognitive deficits and biases.

Intrusive Thoughts and Auditory Hallucinations: A Cognitive Approach

In this paper, an account of auditory hallucinations is outlined, incorporating the phenomena of intrusive thoughts; this is done with reference to the prevailing cognitive models of auditory hallucinations. The account proposes that metacognitive beliefs inconsistent with intrusive thoughts lead to their external attribution as auditory hallucinations, and that such a misattribution is maintained by reducing cognitive dissonance. It is also suggested that the appraisal of the resulting hallucinatory experience elicits behavioural, emotional and physiological responses that may be involved in the maintenance process. The possibility of extending such an account to certain other positive symptoms is discussed, and the theoretical and clinical implications of such an account are considered, and illustrated with a case example. Finally, a number of testable predictions are made.