Negative Voice Research Articles

Negative auditory hallucinations are associated with increased activation of the defensive motivational system in schizophrenia

Auditory hallucinations (AH) are the most common symptom of psychosis. The voices people hear make comments that are benign or even encouraging, but most often voices are threatening and derogatory. Negative AH are often highly distressing and contribute to suicide risk and violent behavior. Biological mechanisms underlying the valence of voices (i.e., positive, negative, neutral) are not well delineated. In the current study, we examined whether AH voice valence was associated with increased activation of the Defensive Motivational System, as indexed by central and autonomic system response to unpleasant stimuli. Data were evaluated from two studies that used a common symptom rating instrument, the Psychotic Symptom Rating Scale (PSY-RATS), to measure AH valence. Participants included outpatients diagnosed with SZ. Tasks included: Study 1: Trier Social Stress Task while heart rate was recorded via electrocardiography (N = 27); Study 2: Passive Viewing Task while participants were exposed to pleasant, unpleasant, and neutral images from the International Affective Picture System (IAPS) library while eye movements, pupil dilation, and electroencephalography were recorded (N = 25). Results indicated that negative voice content was significantly associated with: 1) increased heart rate during an acute social stressor, 2) increased pupil dilation to unpleasant images, 3) higher neural reactivity to unpleasant images, and 4) a greater likelihood of having bottom-up attention drawn to unpleasant stimuli. Findings suggest that negative AH are associated with greater Defensive Motivational System activation in terms of central and autonomic nervous system response.

“Distress is probably the wrong word”: exploring uncertainty and ambivalence in non-clinical voice-hearing and the psychosis continuum

ABSTRACT Background Non-clinical voice-hearers (NCVHs) have been the subject of a growing body of psychological research, a primary aim of which is the development of new therapeutic techniques to support those who struggle with voice-hearing. However, relatively little research has examined non-clinical voice-hearing experiences beyond their relationship with clinical voice-hearing. Methods The present study consists of a qualitative re-analysis of 17 semi-structured interviews conducted as part of an NCVH neuroimaging study which included items from the Psychotic Symptoms Rating Scale (PSYRATS) and Positive and Negative Syndrome Scale (PANSS). Results were generated using thematic analysis. Results Analysis of interview responses showed that participants often experience negative voice content and negative emotion, but have frameworks which normalize a range of voice-hearing experiences. Participants also reported experiences which are not captured by standard clinical scales, as well as reporting comfort with uncertainty and ambiguity surrounding voices. Discussion These results indicate that much of the experience of NCVHs may be missed by clinical measures and concepts, suggesting a need to approach them in ways that go beyond typical understandings of the psychosis continuum.

Effectiveness of Imagery Rescripting for Trauma-Affected Voice Hearers: An Open Trial.

People who hear voices (auditory verbal hallucinations) often have post-traumatic stress disorder (PTSD) symptoms. Cognitive behavioural therapies (CBT) have yielded inconsistent findings when treating voices and PTSD symptoms in voice hearers. Preliminary evidence suggests imagery rescripting (ImRs) is associated with large reductions in voice hearing and PTSD symptoms. This study replicated past studies using a larger sample to examine the effectiveness of ImRs in reducing such symptoms. Participants (N = 49; 65.3% female; Mage = 35.86) were clients at an Australian transdiagnostic clinic for voice hearers. A one-arm open trial design was used with three pre-treatment baselines and a mid-treatment, post-treatment and 3-month follow up assessments of PTSD symptoms (Posttraumatic Diagnostic Scale for DSM-5), voices (Hamilton Program for Schizophrenia Voices Questionnaire) and emotional symptoms (Depression Anxiety and Stress Scales-21). Five single-item measures were administered weekly to explore the trajectories of change in trauma intrusions, voice-related distress, voice frequency and positive and negative voice valance. ImRs was associated with very large reductions in PTSD symptoms and voices (both emotional and physical characteristics of voices) and emotional symptoms at post-treatment and follow-up (η2 p = 0.24-0.44). There were medium-large to large reductions in weekly symptoms of intrusions, voice-related distress, voice frequency and negative voices (η2 p = 0.12-0.16) and a non-significant increase in positive voices (η2 p = 0.05). This study provides further evidence that ImRs is an effective treatment for voices and PTSD symptoms in voice hearers with a range of diagnoses. Randomised controlled trials are needed to compare the efficacy of ImRs to CBT protocols.

An online survey on clinical and healthy individuals with auditory verbal hallucinations: Abuse did not lead to more negative voice content

Despite the clinical and theoretical importance of the negative content in auditory verbal hallucinations (AVHs), little research has been conducted on the topic. A handful of studies suggest that trauma or adverse life events contribute to negative content. The findings are somewhat inconsistent, however, possibly due to methodological limitations. Moreover, only trauma occurring in childhood has been investigated so far. In the present study, we studied the effect of abuse, experienced in either child- or adulthood, and clinical status on negative content of AVHs in four groups of participants that were assessed as part of a large, previously published online survey: Individuals with a psychotic disorder and AVHs (total n = 33), who had experienced abuse (n = 21) or not (n = 12) as well as a group of healthy individuals with AVHs (total n = 53), who had experienced abuse (n = 31) or not (n = 22). We hypothesized that having experienced abuse was associated with a higher degree of negative content. The clinical group collectively reported significantly higher degrees of negative AVHs content compared to the healthy group, but there was no effect of abuse on the degree of negative AVHs content. The presence of AVHs was more common amongst individuals who reported a history of abuse compared to individuals with no history of abuse, both in clinical and healthy participants with AVHs. This implies that at group level, being subjected to traumatic events increases an individual's vulnerability to experiencing AVHs. However, it does not necessarily account for negative content in AVHs.

Changes in positive and negative voice content in cognitive-behavioural therapy for distressing voices.

ObjectivePeople who experience distressing voices frequently report negative (e.g. abusive or threatening) voice content and this is a key driver of distress. There has also been recognition that positive (e.g. reassuring, or guiding) voice content contributes to better outcomes. Despite this, voice content has been neglected as a standalone outcome in evaluations of psychological therapies for distressing voices. We aimed to examine whether a modular cognitive‐behavioural therapy (CBT) intervention for voices led to changes in negative and positive voice content.Design/MethodsIn a naturalistic, uncontrolled pre‐ and post‐ service evaluation study, 32 clients at an outpatient psychology service for distressing voices received eight sessions of CBT for distressing voices and completed self‐report measures of negative and positive voice content at pre‐, mid‐ and post‐ therapy.ResultsThere was no significant change in positive voice content. There was no significant change in negative voice content from pre‐ to post‐therapy; however, there was a significant change in negative voice content between mid and post‐treatment in which the cognitive therapy component was delivered. The CBT treatment was also associated with significant changes in routinely reported outcomes of voice‐related distress and voice severity.ConclusionsThe cognitive component of CBT for distressing voices may be associated with changes in negative, but not positive, voice content. There may be benefit to enhancing these effects by developing treatments targeting specific processes involved in negative and positive voice content and further exploring efficacy in well‐powered, controlled trials with more comprehensive measures of voice content.

Voice rest after vocal fold polyp surgery: A Swedish register study of 588 patients.

ObjectiveTo evaluate the impact of voice rest on patient‐reported voice outcome 4 months after vocal fold polyp surgery.MethodsPreoperative information was collected about age, sex, and smoking habits and the voice handicap index‐10 (VHI‐10). Four months postoperatively, voice rest (total voice rest, spoke single words, and spoke normally), and pre and postoperative voice therapy were reported. This was correlated to voice satisfaction from a two‐category subjective evaluation “satisfied/ not satisfied” and to VHI‐10. Logistic regression models with relative risk for NOT being satisfied with voice after surgery were performed.ResultsData from 588 patients were available. The group “spoke normally” showed the highest degree of patient satisfaction (92%). Younger patients (<59 years) were more satisfied than older (90% vs. 81.5%). High age and low VHI‐10 scores before surgery were statistically significant for negative voice outcome. Gender or voice rest type did not significantly affect outcome. The largest improvement in VHI‐scores was in the group who spoke normally and least in the group who spoke single words.ConclusionWe found no significant difference in the two‐category subjective voice outcome depending on voice rest. VHI‐10 showed a statistically significant positive effect on self‐evaluated voice outcome, with the largest improvement in the group with no voice rest. However, the clinical relevance of the VHI changes is unclear. The present study does not show any advantage of total voice rest as compared to relative voice rest or speaking freely. High age and low preoperative VHI scores were significant risk factors for worse voice outcome. Level of evidence: 4

Аналіз передумов розвитку семантичного компоненту мовлення дітьми раннього немовлячого віку

The article contains a study of the origin of the first words in infants' speech, ways of their accumulation and awareness of meaning. Children's speech reactions were considered as elements of their adaptive behavior. Analysis of videos of infants from 0 to 12 months. allowed to highlight the main milestones in the early agreement period preceding the emergence of the first words. A specialized method of video-audio recording analysis has been developed: three types of voice reactions (negative voice reactions, neutral-positive reactions, complex voice reactions) and four types of related actions have been identified: indicative-research behavior, communicative activity, intentional-motivational manifestations and lack of behavioral manifestations), as well as some other manifestations. This made it possible to distinguish at least two subsystems in the structure of reactions - voice and cognitive-effective. The results of the research presented in the text show differences in the ways of development of voice and semantic subsystems in early ontogenesis. Theoretical ideas about the origin and development of the semantic (subjective) component in infants in the first months of their lives, the emergence of embryonic forms of consciousness, as well as the role of operant learning described by B. Skinner and E. Thorndike ("situation-reaction-reinforcement") in the formation of the first children's words. Emphasis is placed on the leading importance of enriching the mental and cognitive sphere of the baby, the influence of others, immediate life situations, games, research activities that shape the semantic experience of the child.

Recent Research in Singing

The following list of recent research in singing is a brief sampling of articles and dissertations published during the last few years. It is by no means comprehensive and reflects only a small fraction of the available documents.If you have published recent research in singing, voice pedagogy, voice science, vocal repertoire, pedagogic methodology, or other topics of interest to the membership of NATS, please send citations and abstracts to Donald Simonson at drs@iastate.edu for review and possible inclusion in future columns.Donahue, Erin, Wendy D. LeBorgne, Susan Baker Brehm, and Barbara D. Weinrich. Reported Habits of First-Year Undergraduate Musical Theater Majors in a Preprofessional Training Program: A 10-Year Retrospective Study. Journal of Voice 28, no. 3 (May 2014): 316-323.Over a period of 10 consecutive years, incoming freshman music theater students were asked to complete a survey on their perceptions of their voices and voice use. They were also screened by an experienced voice pathologist and were given a stroboscopic screening exam reviewed by a board-certified otolaryngologist. Of the 188 participants, the average age was 18.28 years; there were 90 female and 98 male subjects. The survey focused on self-reported training and practice habits, vocal health and hygiene practices, and current negative voice symptoms that might contribute to voice problems. The collected data revealed many potential risks to voice use in the study group. Over half of the group reported at least one current negative vocal symptom at the time of the study. The vast majority engaged in warm-ups, but very few performed cool-downs. Many reported behaviors that might put them at higher risk of developing acid reflux or experiencing symptoms similar to those caused by acid reflux. Additionally, the group reported generally poor hydration habits. The findings suggest that as a group, these students exhibited a lack of self-awareness, denial of problems, and a lack of knowledge that may impact future voice use. It is hoped that the collected data will provide impetus to further develop strategies to educate this group of singers, and thus to instill lifelong habits and awareness that will promote injury prevention, continuing education, and overall vocal longevity.Green, Kathryn, Warren Freeman, Matthew Edwards, and David Meyer. Trends in Musical Theatre Voice: An Analysis of Audition Requirements for Singers. Journal of Voice 28, no. 3 (May 2014): 324-327.Examining 1,238 professional music theater audition listings over a six-month period, the authors identified four main genres of expected performance capability. Legit, pop/rock, contemporary music theater, and traditional music theater were the main genres listed, with over 50% in the pop/rock and contemporary listings. Specifics regarding the characteristics for each type are included.Based on the study's results, it is clear that today's music theater performer needs a flexible approach to singing in various styles and genres; that over half of the listed jobs require techniques beyond those associated with legit or classical voice performance makes this very clear. Additionally, belt voice ability was requested in three of the four main genres identified, highlighting the need for its inclusion as a substantial part of music theater voice training.Guzman, Marco, Anne-Maria Laukkanen, Petr Krupa, Jaromir Horacek, Jan G. Svec, and Ahmed Geneid. Vocal Tract and Glottal Function During and After Exercising with Resonance Tube and Straw. Journal of Voice 27, no. 4 (July 2013): 523.e19-523.e34.This study was designed to evaluate vocal tract and glottal function during and after phonation into a tube and a stirring straw. A classically trained male singer was examined with computerized tomography (CT) while (1) phonating a sustained [a:], (2) phonating a sustained vowel-like sound into a resonance tube (27 cm long and 9mm inner diameter) for 15 minutes, and immediately after that (3) produce another sustained [a:] without the resonating tube. …

Prevalence of Complementary and Alternative Medicine Use in Professional Voice Users

Objectives To determine the prevalence and specific modalities of complementary and alternative medicine (CAM) by professional voice users (PVUs) for vocal ailments and to examine the PVU's health care utilization. Methods A Canadian national cross-sectional survey was conducted. Surveys were distributed electronically to members of the Alliance of Canadian Cinema, Television, and Radio Artists; the National Association of Teachers of Singing; the Canadian Actors Equity Association; and the Department of Vocal Performance at Western University. Participants were asked about the products/therapies they use to improve vocal health. Frequency of use, health care utilization, and general influencers in treatment choice were also collected. Results Two hundred eighty-eight participants completed the survey. 86% of participants claimed to have taken at least one form of CAM when experiencing voice loss or a negative voice change. Of the respondents, 18% claimed to use products/therapies for vocal health routinely in the absence of vocal ailments. The most common CAMs used were hot drinks with honey and/or lemon, lozenges, and inhaling steam. When vocally ill, PVUs were significantly more likely to use CAMs than any other treatment method. Voice teachers and medical doctors most commonly influenced the choice of the treatment. Conclusion This study illustrated the substantial prevalence of CAMs in the PVU community. Understanding the utilization of CAMs can help clinicians navigate treatment strategies for this patient population.

Exploring the Boundary Conditions and the Mechanisms Linking Coworker Negative Emotional Expressions to Employee Prohibitive Voice and Interpersonal Deviance

ABSTRACT The present study is designed to clarify when coworkers’ negative emotional expressions lead to prohibitive voice or interpersonal deviance, as well as the mechanisms that explain these associations. We collected data from 60 employees and their coworkers across 10 working days (resulting in 588 paired surveys). The results show that: (1) when employees are proactive, the indirect effect between coworker negative emotional expressions and employee prohibitive voice via daily prevention focus is positive while the indirect effect become negative when employees are less proactive; and (2) when employees are low in agreeableness, the indirect effect between coworker negative emotional expressions and employee interpersonal deviant behaviors via employee daily negative emotions is positive. However, this positive indirect effect is weakened when employees are more agreeable.

Can Gender Differences in Distress Due to Difficult Voices Be Explained by Differences in Relating?

BackgroundResearch on gender differences has found that women relate to negative voice hearing experiences with more negative emotions and report more distress due to voices, which may be rooted in differences in relating to voices. This study used a robust methodology and a large sample to explore gender differences in relating to voices and voice distress.MethodsMatched samples of male (n = 124) and female (n = 124) voice hearers were drawn from a survey for secondary analysis. Voice severity (e.g., frequency or loudness), voice distress, and different types of dysfunctional (i.e., passive or aggressive) and functional (assertive) relating were measured. Group comparisons, mediation models, and network analyses were calculated.ResultsFemale voice hearers reported more severe voices, more voice distress, more passive, and less assertive relating. Mediation and network analyses yielded evidence for pathways from gender to voice distress via relating and via differences in voice severity.ConclusionGender differences in the emotional impact of voices can be partially explained by relating behavior. Psychological interventions for voice hearing could be optimized by exploring the influence of gender in the emergence of distressing voices. Nevertheless, gender differences need to be treated as one of several different possible mechanisms when working with individual patients.

Negative emotions in the target speaker's voice enhance speech recognition under "cocktail-party" environments.

Under a "cocktail-party" environment with simultaneous multiple talkers, recognition of target speech is effectively improved by a number of perceptually unmasking cues. It remains unclear whether emotions embedded in the target-speaker's voice can either improve speech perception alone or interact with other cues facilitating speech perception against a masker background. This study used two target-speaker voices with different emotional valences to examine whether recognition of target speech is modulated by the emotional valence when the target speech and the maskers were perceptually co-located or separated. The results showed that both the speech recognition against the masker background and the separation-induced unmasking effect were higher for the target speaker with a negatively emotional voice than for the target speaker with a positively emotional voice. Moreover, when the negative voice was fear conditioned, the target-speech recognition was further improved against speech informational masking. These results suggested that the emotionally vocal unmasking cue interacts significantly with the perceived spatial-separation unmasking cue, facilitating the unmasking effect against a masking background. Thus, emotional features embedded in the target-speaker's vocal timbre are also useful for unmasking the target speech in "cocktail-party" environments.

Dealing with negative social media comments: The giant bullhorn that punctures holes in organizations’ walls, like an arrow to the chest

A negative comment on a corporate social media post can pierce like an arrow to the chest and puncture holes into an organization’s walls. A single negative voice in a sea of positive feedback can feel as though it is blaring from a giant bullhorn, striking fear into corporate community managers that an avalanche of negativity will overtake positivity like a contagious bandwagon. Why would a corporation consider telling its story in the online battlefield of social media and risk exposing its reputation to a cesspool of negativity? This paper will explore why negativity is an online barrier through research, industry advice and best practices – including from the researchers and experts who use the foregoing colourful idioms and metaphors to describe negative online comments. To answer the main question of why an organization would consider engaging on social media in the face of prolific negativity and hate speech, this paper will review the evolution of online emotions and the rise of negativity on social media. The paper will define negative online comments in the corporate context using research on trolls, cyberbullying and online personal attacks. Using the psychology of Pareto’s 80/20 rule and negativity bias, this paper will provide quantitative and qualitative perspectives on negativity to show why companies pay much more attention to negative comments than positive ones, and how analysis of negativity can help a company develop emotional intelligence. Examples will be presented from research and industry to understand and combat negativity and review research on user comments that classifies users to better understand their motivations. Using research on tone and voice in online conversation, this paper will share cautionary case studies that demonstrate how companies that are not self-aware can incite negative comments. Finally, this paper will review research on platform content moderation techniques to understand how social media platforms like Facebook manage negativity and will suggest similar solutions for corporations, including not only the online community’s ability but also our collective responsibility to moderate and overcome the online positivity deficit. Keywords: social media, community manager, online negativity, negativity bias, negative comments, online emotions, user categorization

Associations between responses to voices, distress and appraisals during daily life: an ecological validation of the cognitive behavioural model.

Cognitive models propose that behavioural responses to voices maintain distress by preventing disconfirmation of negative beliefs about voices. We used Experience Sampling Methodology (ESM) to examine the hypothesized maintenance role of behavioural responses during daily life. Thirty-one outpatients with frequent voices completed a smartphone-based ESM questionnaire 10 times a day over 9 days, assessing voice-related distress; resistance and compliance responses to voices; voice characteristics (intensity and negative content); appraisals of voice dominance, uncontrollability and intrusiveness. In line with predictions, behavioural responses were associated with voice appraisals (dominance and uncontrollability), but not voice characteristics. Greater resistance and compliance were reported in moments of increased voice distress, but these associations did not persist after controlling for concurrent voice appraisals and characteristics. Voice distress was predicted by appraisals, and, unexpectedly, also by voice characteristics. As predicted, compliance and resistance were related to increases in distress at subsequent timepoints, whilst antecedent voice appraisals and characteristics had no such effect. Compliance, but not resistance, additionally predicted subsequent increases in voice uncontrollability. In both cases, the reverse models showed no association, indicating directional effects of responses on subsequent distress, and of compliance on uncontrollability appraisals. These results provide support for the cognitive model by suggesting that momentary behavioural and emotional responses to voices are associated with concurrent negative voice appraisals. Findings suggest that behavioural responses may be driven by voice appraisals, rather than directly by distress, and may in turn maintain voice appraisals and associated distress during the course of daily life.

Beliefs about voices in voice-hearers: the role of schema functioning.

Evidence is emerging that beliefs about voices are influenced by broader schematic beliefs about the self and others. Similarly, studies indicate that the relationship an individual has with their voice may mirror wider patterns of relating observed in social relationships, which may be influenced by schematic beliefs. This study examined associations between beliefs about voices and self and other schemas. Furthermore, associations between schemas and the perceived relationship between the hearer and their predominant voice were explored. Forty-four voice-hearing participants were recruited across mental health services. Participants completed self-report measures of beliefs about voices, schema functioning, and relating between the hearer and their voice. Dimensions of voice experience, such as frequency and content, were assessed using a clinician-rated scale. Beliefs about voices correlated with negative voice content and schemas. After controlling for negative voice content, schemas were estimated to predict between 1 and 17% of the variance in the six measured beliefs about voices; three of the associations reached statistical significance. Negative-self schema were the strongest predictors of beliefs about voices, whilst positive-self also showed potential relationships. Schemas also correlated with dimensions of relating between the hearer and their voice. In line with previous research, this study provides evidence that schemas, particularly self-schema, may be important in the development of beliefs about voices. This study offers preliminary findings to suggest that schemas are also associated with the perceived relationship between the hearer and their voice.

Understanding the role of self in auditory verbal hallucinations using a self-discrepancy paradigm.

ObjectiveNegative auditory verbal hallucination (AVH) content is a major predictor of distress and typically occurs more frequently than positive or neutral content. Recent research has found that negative views of self are associated with the negative content of AVHs. However, research investigating the role of self in AVH content is in its infancy and warrants further study.DesignThe current study examined correspondence between negative voice content and internalized representations of self, using a self‐discrepancy paradigm incorporating multiple domains of self (ideal, ought, and feared). It also considered the impact of depression and anxiety.MethodAn adapted self‐discrepancy questionnaire was administered to a transdiagnostic clinical sample of 86 current voice‐hearers. Participants rated how similar they believed themselves to be (actual self), and how similar their voices would say they are (voice self), to their ideal, ought, and feared self‐concepts.ResultsVoice content was related to how the person viewed themselves in relation to their ideal, ought, and feared self‐concepts. Additionally, voices reflected negative feared self‐concepts, particularly in people with anxiety.ConclusionsThese findings provide further insight into the phenomenon of hearing voices and have the potential to change the way we approach formulation and treatment of AVHs. In particular, treatment approaches that reduce discrepancies between how one views themselves and their positive and negative self‐concepts, or alter the relationship one has with their self‐concepts and negative voices, have the potential to reduce the impact of distressing voices.Practitioner points Voice experiences can be meaningfully related to how the person views themselves in relation to concepts of their ideal, ought, and feared selvesNegative voice content might be understood as reflecting discrepancies from these self‐representations, which may have a self‐regulatory function in relation to goal‐directed behaviour.Identifying how voice content relates to self could be useful in not only challenging the extent of perceived self‐discrepancies, but also considering how to enact valued parts of self.

Characterizing positive and negative ‘voicers’ in elite sport teams: The role of the Five Factor Model and narcissism in players’ frequency and passing on of voice

ObjectiveThis study examined the role of the Five Factor Model and grandiose narcissism in players’ positive (i.e., constructive voice, supportive voice) and negative voice (i.e., defensive voice, destructive voice) in elite sport teams. MethodPlayers from six field hockey and seven korfball teams from the two highest national levels were assessed for four weeks. Using social network analyses, players’ personality was related to their self-reported voice frequency, their voice frequency as perceived by all teammates (other-ratings), and the extent to which they pass on voice. ResultsExtraversion was positively related to players’ frequency of positive and negative voice. Other traits such as conscientiousness and emotional stability were only related to, respectively, positive or negative types of voice. Not all personalities (e.g., extraversion) were consistent in how they assess their own voice versus how others perceive this. Interestingly, traits such as extraversion, emotional stability and the agentic facet of narcissism were found to predict the passing on of voice. ConclusionThis study explored the importance of personality for (a) players’ frequency of a differentiated set of positive and negative voice and (b) the extent to which they function as ‘gates’ that more covertly pass on voice. Further, the results provide perspective on how specific personalities view their voice behavior versus how their teammates perceive their voice behavior. In this way, this study is a first step in identifying players who have the potential to endanger or strengthen a team in a clear or subtle, yet influential way.

The comments of voices on the appearance of patients with psychosis: 'the voices tell me that I am ugly'.

There are high rates of obesity and low self-esteem in patients with psychosis. The occurrence of negative voice content directly about appearance is therefore plausible. Derogatory comments about appearance are likely to be distressing, increase depression and contribute to social withdrawal. To systematically assess the occurrence of voice content regarding appearance and identify correlates. Sixty patients experiencing verbal auditory hallucinations at least once a week in the context of non-affective psychosis completed a measure assessing positive and negative voice content about appearance. They also completed assessments about body image, self-esteem, psychiatric symptoms and well-being. Fifty-five (91.7%) participants reported hearing voices comment on their appearance. A total of 54 (90%) patients reported negative voice content about their appearance with 30 (50%) patients experienced negative appearance comments on a daily basis. The most common negative comment was 'the voices tell me that I am ugly' (n = 48, 80%). There were 39 (65%) patients who reported positive voice content on appearance. The most frequent positive comment was 'I look as nice as other people' (n = 26, 43.3%). Negative voice content about appearance was associated with body image concerns, paranoia, voice hearing severity, depression, worry, negative self-beliefs and safety-seeking behaviours. Positive appearance voice content was associated with greater body esteem and well-being and lower levels of depression and insomnia. Voice content about appearance is very common for patients seen in clinical services. Negative voice content may reflect - and subsequently reinforce - negative beliefs about one's appearance, low self-esteem, worry and paranoia. None.

The effects of voice content on stress reactivity: A simulation paradigm of auditory verbal hallucinations

ObjectivesPsychosis is associated with increased subjective and altered endocrine and autonomic nervous system stress-reactivity. Psychosis patients often experience auditory verbal hallucinations, with negative voice content being particularly associated with distress. The present study developed a voice-simulation paradigm and investigated the effect of simulated voices with neutral and negative content on psychophysiological stress-reactivity, and the effect of mindful voice-appraisals on stress-reactivity. MethodEighty-four healthy participants completed the Montreal Imaging Stress Task with simultaneous presentation of one of three randomly allocated auditory stimuli conditions: negative voices, neutral voices or non-voice ambient sounds. Subjective stress-levels and mindful voice-appraisals were assessed using questionnaire measures, and cortisol and α-amylase levels were measured using saliva samples. ResultsANOVA revealed a significant effect of condition on subjective stress-levels (p = .002), but not cortisol (p = .63) or α-amylase (p = .73). Post-hoc analyses showed that negative voices increased subjective stress-levels relative to neutral voices (p = .002) and ambient sounds (p = .01), which did not differ from each other (p = .41). Mindful voice-appraisals were associated with less distress across conditions (p = .003), although negative voices were also associated with less mindful appraisals (p < .001). ConclusionsNegative voice content, rather than voices or auditory stimuli per se, is linked to greater subjective but not physiological stress-reactivity. Mindful appraisals may partially moderate this effect. These findings highlight the importance of voice content for the impact of voice-hearing, and highlight the potential value of mindfulness training to treat voice distress in psychosis.

Preliminary Evidence for the Cognitive Model of Auditory Verbal Hallucinations in Youth With Borderline Personality Disorder.

Objectives: This is the first study to explore cognitive, emotional, and behavioral responses to voices in youth with borderline personality disorder (BPD) compared with those with schizophrenia spectrum disorder (SZ), and to examine if negative appraisals of voices predict depression and anxiety across the groups. Methods: The sample comprised 43 outpatients, aged 15–25 years, who reported auditory verbal hallucinations (AVH) and were diagnosed with either Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) BPD or SZ. Data were collected using the Psychotic Symptom Rating Scales, the revised Beliefs About Voices Questionnaire, the Voice Rank Scale, and the Depression Anxiety Stress Scale. Results: Youth with BPD did not differ from youth with SZ in beliefs about the benevolence or malevolence of voices. Youth with BPD appraised their voices as more omnipotent and of higher social rank in relation to themselves, compared with youth with SZ. In both diagnostic groups, beliefs about malevolence and omnipotence of voices were correlated with more resistance toward voices, and beliefs about benevolence with more engagement with voices. In addition, perceiving the voices as being of higher social rank than oneself and negative voice content were both independent predictors of depression, irrespective of diagnostic group. In contrast, negative appraisals of voices did not predict anxiety after adjusting for negative voice content. Conclusions: This study replicated the link between negative appraisals of voices and depression that has been found in adults with SZ in a mixed diagnostic youth sample. It, thus, provides preliminary evidence that the cognitive model of AVH can be applied to understanding and treating voices in youth with BPD.