Healthy Voice-hearers Research Articles

When Spirit Calls: A Phenomenological Approach to Healthy Voice-Hearers.

We present a mixed-methods study, from an anthropological perspective, of 22 healthy voice-hearers ie, people who report hearing voices but have no need for clinical care. They were interviewed using the Varieties Of Individual Voice-Experiences Scale (VOICES), a new scale assessing phenomenology, beliefs and relationships with voices, and their emotional and behavioral impact. Despite in many cases hearing voices daily, they report remarkably little distress, with almost all mentioning a positive impact on their life. Most interpreted their voices as spirits, and spoke of learning to understand, to manage, and even to train their experience of communicating with spirits productively. There was, however, considerable diversity in their voice experiences. Some described experiences they seemed to have discovered after starting a practice. Others described reaching for a practice to make sense of unusual experiences. This raises the possibility that cultural ideas about spirit communication may have two effects. On the one hand, they may help those who begin to hear voices involuntarily to interpret and manage their experience in a non-threatening way, through a meaning framework imposed on experiences. On the other hand, it also suggests that cultural ideas about spirit communication may lead some people to identify some thoughts as voices, and to come to feel that those thoughts are generated outside of themselves, through a meaning-framework shaping experiences. This should remind us that the culture-mind relationship is complex. There may be different kinds of phenomena described by individuals as "voices," with practice and interpretation changing how these phenomena are experienced.

Need for care, adversity exposure and perceived stress in clinical and healthy voice-hearers - Corrigendum.

Need for care, adversity exposure and perceived stress in clinical and healthy voice-hearers - Corrigendum.

Need for care, adversity exposure and perceived stress in clinical and healthy voice-hearers.

Psychosis, and in particular auditory verbal hallucinations (AVHs), are associated with adversity exposure. However, AVHs also occur in populations with no need for care or distress. This study investigated whether adversity exposure would differentiate clinical and healthy voice-hearers within the context of a 'three-hit' model of vulnerability and stress exposure. Samples of 57 clinical and 45 healthy voice-hearers were compared on the three 'hits': familial risk; adversity exposure in childhood and in adolescence/adulthood. Clinical voice-hearers showed greater familial risk than healthy voice-hearers, with more family members with a history of psychosis, but not with other mental disorders. The two groups did not differ in their exposure to adversity in childhood [sexual and non-sexual, victimisation; discrimination and socio-economic status (SES)]. Contrary to expectations, clinical voice-hearers did not differ from healthy voice-hearers in their exposure to victimisation (sexual/non-sexual) and discrimination in adolescence/adulthood, but reported more cannabis and substance misuse, and lower SES. The current study found no evidence that clinical and healthy voice-hearers differ in lifetime victimisation exposure, suggesting victimisation may be linked to the emergence of AVHs generally, rather than need-for-care. Familial risk, substance misuse and lower SES may be additional risk factors involved in the emergence of need-for-care and distress.

M52. VOICES IN THE HEAD: AUDITORY VERBAL HALLUCINATIONS (AVH) IN HEALTHY INDIVIDUALS

BackgroundAuditory verbal hallucinations (AVH) are conscious sensory experiences occurring in the absence of external stimulation. AVH are experienced by 75% of individuals diagnosed with schizophrenia and can manifest in other neuropsychiatric disorders. However, AVH are also reported amongst healthy individuals. This implies that hearing voices is not necessarily linked to psychopathology. Amongst voice hearers, the likelihood of AVH seems to reflect individual differences in hallucination proneness (HP). The HP construct allows placing individuals on a psychosis continuum ranging from non-clinical to clinical experiences. Clinical voice hearers tend to misattribute internal events to external sources (externalization bias). Specifically, they seem to experience altered sensory feedback in response to self-initiated stimuli: Although more predictable, clinical voice hearers show similar, neurophysiological responses in reaction to self-initiated vs. externally presented stimuli. EEG studies suggest that this aberrance of prediction is associated with diminished N1-suppression effects that are observed in healthy individuals in response to self-initiated stimuli. Accordingly, clinical voice hearers may have problems differentiating between self-initiated and externally generated speech, potentially leading to externalization of their own speech. In line with this proposal, the current study focusses on non-clinical aspects of the psychosis continuum in healthy voice hearers and controls. This approach avoids confounding factors (medication, disease onset/duration etc.) that typically impede comparisons of clinical and non-clinical voice hearers. By utilizing insights on prediction from the forward model concept within the auditory-sensory domain, we want to investigate how N1-amplitudes in reaction to one’s own or someone else’s voice are modulated as a function of HP. Next to ascertaining the mechanism behind AVH, this research could give direction to identifying risk factors that potentiate the emergence of first-incidence psychosis.MethodsHP was assessed by means of the Launay-Slade Hallucination Scale. Each participant’s voice was recorded prior to EEG data acquisition (monosyllabic utterances, “ah” & “oh”, duration = 500 ms). Voice stimuli were morphed with an anchor voice, so that voice identity could be alternated from self- to other-voice (0%, 40%, 50%, 60%, 100%). To contrast neurophysiological responses between self- vs. externally generated voice stimuli, a well-established motor-to-auditory paradigm was used: In a motor-to-auditory condition (MAC) participants were prompted to press a button, thereby eliciting a voice stimulus (self-initiation). In an auditory-only condition (AOC), participants were prompted to passively listen to the voice stimulus (external generation). The motor-only condition (MOC), in which participants executed the button press only, served as a control condition to correct for motor activity in MAC.ResultsData from 38 participants replicate the classical N1-suppression effects for self-initiated vs. externally generated self-voice stimuli. This pattern of suppression is also visible for other-voice stimuli. Furthermore, current findings seem to replicate reversed N1-suppression for self-voice in individuals with high HP.DiscussionPreliminary findings suggest that HP modulates voice identity processing. More specifically, HP determines how voice stimuli are processed within the internal and external domain. Particularly, individuals with high HP show a reversal of N1-suppression for self-voice stimuli, which corroborates the external biasing hypothesis.

Neuroimaging auditory verbal hallucinations in schizophrenia patient and healthy populations.

Auditory verbal hallucinations (AVH) are a cardinal feature of schizophrenia, but they can also appear in otherwise healthy individuals. Imaging studies implicate language networks in the generation of AVH; however, it remains unclear if alterations reflect biologic substrates of AVH, irrespective of diagnostic status, age, or illness-related factors. We applied multimodal imaging to identify AVH-specific pathology, evidenced by overlapping gray or white matter deficits between schizophrenia patients and healthy voice-hearers. Diffusion-weighted and T1-weighted magnetic resonance images were acquired in 35 schizophrenia patients with AVH (SCZ-AVH), 32 healthy voice-hearers (H-AVH), and 40 age- and sex-matched controls without AVH. White matter fractional anisotropy (FA) and gray matter thickness (GMT) were computed for each region comprising ICBM-DTI and Desikan-Killiany atlases, respectively. Regions were tested for significant alterations affecting both SCZ-AVH and H-AVH groups, relative to controls. Compared with controls, the SCZ-AVH showed widespread FA and GMT reductions; but no significant differences emerged between H-AVH and control groups. While no overlapping pathology appeared in the overall study groups, younger (<40 years) H-AVH and SCZ-AVH subjects displayed overlapping FA deficits across four regions (p < 0.05): the genu and splenium of the corpus callosum, as well as the anterior limbs of the internal capsule. Analyzing these regions with free-water imaging ascribed overlapping FA abnormalities to tissue-specific anisotropy changes. We identified white matter pathology associated with the presence of AVH, independent of diagnostic status. However, commonalities were constrained to younger and more homogenous groups, after reducing pathologic variance associated with advancing age and chronicity effects.

F123. BELIEFS ABOUT THEIR VOICES AND DEGREE OF RESILIENCE IN PERSONS WITH AUDITORY VERBAL HALLUCINATIONS WITH AND WITHOUT NEED FOR CARE

BackgroundAuditory Verbal Hallucinations (AVH) are prevalent in many psychopathologies but are also experienced by a minority of the healthy general population. There is cumulative evidence that the beliefs people hold about their voices (e.g., power) are strongly related to the impact of the voices (e.g., depression, anxiety) and to the coping strategies that they adopt (e.g., resistance, engagement). To date, research on resilience has identified many factors that promote wellbeing and that protect people from developing psychopathologies despite exposure to health or psychological adversities. However, no previous studies have examined resilience in people who experience AVH with and without need for care, and neither have the relations between resilience and beliefs about the voices been examined.MethodsFifty persons who report hearing voices frequently were recruited online. Based on the presence of a psychiatric diagnosis, the use of antipsychotic medication, and on the consultation of a psychiatrist, they were then classified as being Healthy Voice-Hearers (HVH) or Patients (P). One hundred and nineteen healthy participants who have never experienced hearing voices were also recruited as a control group (CTRL). All participants completed the Resilience Scale for Adults. In addition, the HVH and P groups completed questionnaires that assess the beliefs they hold about their voices (the revised Beliefs About Voices Questionnaire) and voice characteristics (frequency and emotional content).ResultsThe data collection is currently underway, and thus the following results are preliminary. Kruskal-Wallis ANOVAs revealed significant differences between the three groups (HVH, P, CTRL) on several resilience factors. In particular, post-hoc analyses demonstrated that the CTRL and HVH groups were more resilient than the P group for the perception of self and of future. In addition, the HVH group was found to be more resilient than the P group in terms of social competence. Finally, for social factors (social resources and family cohesion), results showed that the CTRL group was more resilient than the P group. However, the HVH group was not significantly different from the P and the CTRL groups. Concerning voice characteristics, Mann-Whitney tests revealed that, compared to the P, the HVH perceived their voices as being less omnipotent and malevolent, less negative and more positive, and showed less resistance against the voices. Finally, correlational analyses (Spearman) demonstrated that better resilience (and in particular the individual factors such as the perception of self and of the future, and social competence) was related to fewer negative beliefs about the voices, less resistance, lower voice frequency, and less negative and more positive emotional content.DiscussionThe present study showed that people who experience AVH without need for care have a different pattern of resilience compared to patients with AVH, and to healthy controls without AVH. In particular, the HVHs did not differ from the CTRL on the personal factors of resilience and did not differ from the patients in terms of social factors. In addition, better resilience (and especially the personal factors) was found to be related to fewer negative beliefs about the voices, better coping strategies, lower voice frequency, and less negative and more positive emotional content. Taken together, these results show that resilience – and in particular, the personal factors – may be an important variable influencing the need for care in people experiencing AVH. The present study has important theoretical and clinical implications, in particular, suggesting that the personal factors of resilience may be a treatment target in order to diminish the impact of voices.

Overgeneral autobiographical memory bias in clinical and non-clinical voice hearers.

Hearing voices can be a distressing and disabling experience for some, whilst it is a valued experience for others, so-called 'healthy voice-hearers'. Cognitive models of psychosis highlight the role of memory, appraisal and cognitive biases in determining emotional and behavioural responses to voices. A memory bias potentially associated with distressing voices is the overgeneral memory bias (OGM), namely the tendency to recall a summary of events rather than specific occasions. It may limit access to autobiographical information that could be helpful in re-appraising distressing experiences, including voices. We investigated the possible links between OGM and distressing voices in psychosis by comparing three groups: (1) clinical voice-hearers (N = 39), (2) non-clinical voice-hearers (N = 35) and (3) controls without voices (N = 77) on a standard version of the autobiographical memory test (AMT). Clinical and non-clinical voice-hearers also completed a newly adapted version of the task, designed to assess voices-related memories (vAMT). As hypothesised, the clinical group displayed an OGM bias by retrieving fewer specific autobiographical memories on the AMT compared with both the non-clinical and control groups, who did not differ from each other. The clinical group also showed an OGM bias in recall of voice-related memories on the vAMT, compared with the non-clinical group. Clinical voice-hearers display an OGM bias when compared with non-clinical voice-hearers on both general and voices-specific recall tasks. These findings have implications for the refinement and targeting of psychological interventions for psychosis.

Varieties of Voice-Hearing: Psychics and the Psychosis Continuum.

Hearing voices that are not present is a prominent symptom of serious mental illness. However, these experiences may be common in the non-help-seeking population, leading some to propose the existence of a continuum of psychosis from health to disease. Thus far, research on this continuum has focused on what is impaired in help-seeking groups. Here we focus on protective factors in non-help-seeking voice-hearers. We introduce a new study population: clairaudient psychics who receive daily auditory messages. We conducted phenomenological interviews with these subjects, as well as with patients diagnosed with a psychotic disorder who hear voices, people with a diagnosis of a psychotic disorder who do not hear voices, and matched control subjects (without voices or a diagnosis). We found the hallucinatory experiences of psychic voice-hearers to be very similar to those of patients who were diagnosed. We employed techniques from forensic psychiatry to conclude that the psychics were not malingering. Critically, we found that this sample of non-help-seeking voice hearers were able to control the onset and offset of their voices, that they were less distressed by their voice-hearing experiences and that, the first time they admitted to voice-hearing, the reception by others was much more likely to be positive. Patients had much more negative voice-hearing experiences, were more likely to receive a negative reaction when sharing their voices with others for the first time, and this was subsequently more disruptive to their social relationships. We predict that this sub-population of healthy voice-hearers may have much to teach us about the neurobiology, cognitive psychology and ultimately the treatment of voices that are distressing.

Cognitive biases and auditory verbal hallucinations in healthy and clinical individuals

Several cognitive biases are related to psychotic symptoms, including auditory verbal hallucinations (AVH). It remains unclear whether these biases differ in voice-hearers with and without a 'need-for-care'. A total of 72 healthy controls, 72 healthy voice-hearers and 72 clinical voice-hearers were compared on the Cognitive Biases Questionnaire for psychosis (CBQp), which assesses 'intentionalizing', 'jumping to conclusions', 'catastrophizing', 'dichotomous thinking' and 'emotional reasoning' in vignettes characterized by two themes, 'threatening events' and 'anomalous perceptions'. Healthy voice-hearers scored intermediately on total CBQp between the control and clinical groups, differing significantly from both. However, on four out of five biases the scores of the healthy voice-hearers were comparable with those of the healthy controls. The only exception was 'emotional reasoning', on which their scores were comparable with the clinical group. Healthy voice-hearers demonstrated fewer biases than the psychotic patients on the 'threatening events', but not the 'anomalous perceptions', vignettes. CBQp scores were related to both cognitive and emotional, but not physical, characteristics of voices. Most cognitive biases prevalent in clinical voice-hearers, particularly with threatening events themes, are absent in healthy voice-hearers, apart from emotional reasoning which may be specifically related to the vulnerability to develop AVH. The association between biases and both beliefs about voices and distress/emotional valence is consistent with the close links between emotions and psychotic phenomena identified by cognitive models of psychosis. The absence of reasoning biases might prevent the formation of threatening appraisals about anomalous experiences, thereby reducing the likelihood of distress and 'need for care'.

Neuroimaging of Voice Hearing in Non-Psychotic Individuals: A Mini Review

Auditory verbal hallucinations (AVH) or “voices” are a characteristic symptom of schizophrenia, but can also be observed in healthy individuals in the general population. As these non-psychotic individuals experience AVH in the absence of other psychiatric symptoms and medication-use they provide an excellent model to study AVH in isolation. Indeed a number of studies used this approach and investigated brain structure and function in non-psychotic individuals with AVH. These studies showed that increased sensitivity of auditory areas to auditory stimulation and aberrant connectivity of language production and perception areas is associated with AVH. This is in concordance with investigations that observed prominent activation of these areas during the state of AVH. Moreover, while effortful attention appears not to be related to AVH, individuals prone to hallucinate seem to have an enhanced attention bias to auditory stimuli which may stem from aberrant activation of the anterior cingulated regions. Furthermore, it was observed that decreased cerebral dominance for language and dopamine dysfunction, which are consistently found in schizophrenia, are most likely not specifically related to AVH as these abnormalities were absent in healthy voice hearers. Finally, specific aspects of AVH such as voluntary control may be related to the timing of the supplementary motor area and language areas in the experience of AVH.