The roles of thought suppression and metacognitive beliefs in proneness to auditory verbal hallucinations in a non-clinical sample

The Relationships Between Multidimensional Schizotypy and Metacognitive Beliefs

There has been a recent surge in schizotypy and metacognition research. Metacognition is an umbrella term for higher-order thought processes. Here, we focussed on maladaptive metacognitive beliefs, which are beliefs related to one's thought processes and often play an important role in the preponderance of psychological disorders. Despite the extensive literature, relatively less is known about metacognitive beliefs in the context of multidimensional schizotypy, which consists of positive, negative, and disorganised dimensions and represents the milder forms of schizophrenia symptoms and vulnerability to developing schizophrenia. This is the first study that examined the links not only with positive schizotypy, but also with negative and disorganised schizotypy. We also attempted to circumvent the limitations related to schizotypy assessment in the previous studies by using a newly developed measure, the Multidimensional Schizotypy Scale (MSS), which was based on the current operationalisations of the construct. We examined the links in a non-clinical sample, including first-year psychology students and members of the wider community of an Australian university (N = 68). Self-report data was collected by administering the Metacognitions Questionnaire-30, MSS, and Marlowe-Crowne Social Desirability Scale to control the self-report measures' social desirability biases. Results revealed positive correlations of maladaptive metacognitive beliefs not only with positive schizotypy, but also with negative and disorganised schizotypy. Our findings support the importance of examining schizotypy as a multidimensional construct. Further, our findings have implications for research and practice, including treatment modalities focusing on the modification of metacognitive beliefs for the prevention of schizophrenia and related conditions.

Mindfulness for voices: An experimental analogue study of the effect of manipulating response style to simulated voices in a non-clinical population

OBJECTIVES

We aimed to investigate the effects of directly manipulating response style to simulated voice hearing on emotional and cognitive outcomes in a non-clinical population.

DESIGN

A between-subjects design with one independent variable, response style (with two levels: mindful acceptance vs attentional avoidance). The dependent variables were subjective distress and anxiety (primary outcomes) and performance on a sustained attention task (secondary outcomes).

METHODS

Participants were randomly assigned to one of two response styles (mindful acceptance vs. attentional avoidance). They completed a computerised attention task (continuous performance task) whilst listening to a simulation of voice hearing. Participants rated their experience of anxiety and distress before and after completing the sustained attention task which was used to measure their accuracy and response times.

RESULTS

One hundred and one participants took part (mindful acceptance (n = 54); attentional avoidance (n = 47)). There were no statistically significant group differences on post-test distress and anxiety scores, correct response rate or response times on the computerised attention task. Participants reported a range of different response styles along the spectrum of avoidance to acceptance, but this had no association with their assigned experimental condition. Adherence to task instructions was therefore low.

CONCLUSIONS

We are unable to conclude from this study whether experimentally inducing people to respond to voices under cognitively demanding conditions in an avoidant or accepting way has an impact on their emotional or cognitive outcomes. Further research should focus on the development of more robust and reliable procedures for inducing differences in response style under experimental conditions.

Mediators of negative content and voice-related distress in a diverse sample of clinical and non-clinical voice-hearers

OBJECTIVES

Negative content in hearing voices (i.e., auditory verbal hallucinations) has been associated with adverse clinical outcomes including voice-related distress. Voice appraisals and responding mindfully to voices are theorized to reduce voice-related distress. This study aimed in examine mediators of the negative content voice-related distress relationship in clinical (those who recently received input from mental health services) and non-clinical voice-hearers.

METHODS

One hundred and twenty-one adults (71.9% female; 35.5% mixed or non-white ethnic background) who hear voices were recruited online and completed self-report measures of negative content of voices, voice-related distress, mindfulness of voices, interpretation of loss of control, thought suppression and intrusion.

RESULTS

Clinical voice-hearers had significantly higher levels of negative content, voice-related distress and interpretation of loss of control than non-clinical voice-hearers. A mindful approach to voices and interpretation of loss of control mediated the relationship between negative content and voice-related distress across the whole sample. Thought suppression and intrusion did not mediate the relationship.

CONCLUSIONS

The results support the use of mindfulness-based psychological intervention to reduce voice-related distress. Further development of valid and reliable measures specifically relating to constructs of voice content, voice-related distress and voice suppression will support further research in this area.

Unusual experiences and their association with metacognition: investigating ASMR and Tulpamancy

BACKGROUND

Unusual experiences in Tulpamancer and Autonomous Sensory Meridian Response (ASMR) communities are generally positive and sought after, unlike hallucinations and delusions in clinical populations. Metacognition, the ability to reflect on self-referential experiences, may aid sense-making around unusual experiences, reducing distress. This study investigated group differences in hallucination-proneness, delusion-proneness, and metacognition in these communities compared to controls, and whether metacognition predicted unusual experiences.

METHODS

243 participants reporting ASMR, Tulpamancy, or neither, with no history of psychosis, took part in an online observational study. Participants completed the Beck Cognitive Insight Scale, Metacognitions Questionnaire-30, and Brief Core Schema Scales to capture metacognition. A Tulpamancer+ (reporting ASMR) group was identified and included in analyses. ANCOVAs highlighted group differences in hallucination-proneness, with Tulpamancer+ scoring higher, and metacognitive beliefs, with Tulpamancers reporting lower metacognitive belief endorsement. There were no group differences in delusion-proneness, self-reflection, or self-schemas. Stepwise regression demonstrated metacognition does influence unusual experiences in the non-clinical population, and this influence varies across groups.

CONCLUSIONS

In non-clinical populations, unusual sensory experiences are not associated with increased metacognitive beliefs, but having multiple unusual experiences is associated with higher hallucination-proneness. Results suggest improving metacognition in clinical groups may help reduce distress related to unusual sensory experiences.

A time-series network approach to auditory verbal hallucinations: Examining dynamic interactions using experience sampling methodology

BACKGROUND

Identifying variables that influence daily-life fluctuations in auditory verbal hallucinations (AVHs) provides insight into potential mechanisms and targets for intervention. Network analysis, that uses time-series data collected by Experience Sampling Method (ESM), could be used to examine relations between multiple variables over time.

METHODS

95 daily voice-hearing individuals filled in a short questionnaire ten times a day for six consecutive days at pseudo-random moments. Using multilevel vector auto-regression, relations between voice-hearing and negative affect, positive affect, uncontrollable thoughts, dissociation, and paranoia were analysed in three types of networks: between-subjects (between persons, undirected), contemporaneous (within persons, undirected), and temporal (within persons, directed) networks. Strength centrality was measured to identify the most interconnected variables in the models.

RESULTS

Voice-hearing co-occurred with all variables, while on a 6-day period voice-hearing was only related to uncontrollable thoughts. Voice-hearing was not predicted by any of the factors, but it did predict uncontrollable thoughts and paranoia. All variables showed large autoregressions, i.e. mainly predicted themselves in this severe voice-hearing sample. Uncontrollable thoughts was the most interconnected factor, though relatively uninfluential.

DISCUSSION

Severe voice-hearing might be mainly related to mental state factors on the short-term. Once activated, voice-hearing appears to maintain itself. It is important to assess possible reactivity of AVH to triggers at the start of therapy; if reactive, therapy should focus on the triggering factor. If not reactive, Cognitive Behavioural interventions could be used first to reduce the negative effects of the voices. Limitations are discussed.

Affective and cognitive factors associated with hallucination proneness in the general population: the role of shame and trauma-related intrusions

Introduction: Feelings of shame may be an important factor implicated in the onset and maintenance of hallucination (or hearing voices). Shame has been shown to increase trauma-related intrusions and avoidance and may reinforce negative beliefs about the self, which in turn may contribute to hallucinations in clinical and non-clinical populations. To our knowledge, no study has so far explored the role of shame in hallucination-proneness. Therefore, the main goal of the present study is to explore the mediation role of shame, trauma-related intrusions and avoidance in the association between childhood trauma and hallucination-proneness.Methods: Self-report questionnaires were used to assess past traumatic experiences, trauma-related symptoms, shame, and hallucination proneness in 175 participants from the general population.Results: Mediation analyses (joint-significance test and Monte Carlo test) showed that both shame and intrusions mediated the association between childhood trauma and hallucination-proneness.Conclusions: Our results reinforce the importance of considering previous experiences of trauma and trauma-related symptoms, including feelings of shame in individuals experiencing hallucinations. Moreover, this study reinforces previous studies showing some preliminary evidence that compassion-focused therapy, whose primary goal is to reduce shame by increasing self-compassion, could have a significant effect on voices whose content is hostile.

Intentional inhibition but not source memory is related to hallucination-proneness and intrusive thoughts in a university sample

Proneness to unusual perceptual states - such as auditory or visual hallucinations - has been proposed to exist on a continuum in the general population, but whether there is a cognitive basis for such a continuum remains unclear. Intentional cognitive inhibition (the ability to wilfully control thoughts and memories) is one mechanism that has been linked to auditory hallucination susceptibility, but most evidence to date has been drawn from clinical samples only. Moreover, such a link has yet to be demonstrated over and above relations to other cognitive skills (source monitoring) and cognitive states (intrusive thoughts) that often correlate with both inhibition and hallucinations. The present study deployed two tests of intentional inhibition ability - the Inhibition of Currently Irrelevant Memories (ICIM) task and Directed Forgetting (DF) task - and one test of source monitoring (a source memory task) to examine how cognitive task performance relates to self-reported i) auditory hallucination-proneness and ii) susceptibility to intrusive thoughts in a non-clinical student sample (N = 76). Hierarchical regression analyses were used to assess the independent and combined contributions of task performance to proneness scores. ICIM performance but not DF or source memory scores were significantly related to both hallucination-proneness and intrusive thoughts. Further analysis suggested that intrusive thoughts may mediate the link between intentional inhibition skills and auditory hallucination-proneness, suggesting a potential pathway from inhibition to perception via intrusions in cognition. The implications for studying cognitive mechanisms of hallucination and their role in "continuum" views of psychosis-like experiences are discussed.

Musical hallucinations, musical imagery, and earworms: A new phenomenological survey

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We conducted a phenomenological survey comparing musical hallucinations to other inner music.

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MH were more likely to be reported as externally located than other experiences.

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MH were less controllable and less familiar than imagery or earworms.

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MH were less likely to include lyrical content than other forms of inner music.

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Individuals with higher levels of musical expertise were less likely to report MH.

Musical hallucinations (MH) account for a significant proportion of auditory hallucinations, but there is a relative lack of research into their phenomenology. In contrast, much research has focused on other forms of internally generated musical experience, such as earworms (involuntary and repetitive inner music), showing that they can vary in perceived control, repetitiveness, and in their effect on mood. We conducted a large online survey (N = 270), including 44 participants with MH, asking participants to rate imagery, earworms, or MH on several variables. MH were reported as occurring less frequently, with less controllability, less lyrical content, and lower familiarity, than other forms of inner music. MH were also less likely to be reported by participants with higher levels of musical expertise. The findings are outlined in relation to other forms of hallucinatory experience and inner music, and their implications for psychological models of hallucinations discussed.

Post-Traumatic Symptomatology and Compulsions as Potential Mediators of the Relation Between Child Sexual Abuse and Auditory Verbal Hallucinations

Background: Whilst evidence is mounting that childhood sexual abuse (CSA) can be a cause of auditory verbal hallucinations (AVH), it is unclear what factors mediate this relation. Recent evidence suggests that post-traumatic symptomatology may mediate the CSA–AVH relation in clinical populations, although this hypothesis has not yet been tested in the general population. There is also reason to believe that obsessive ideation could mediate the CSA–AVH relation. Aims: To test for evidence to falsify the hypotheses that post-traumatic symptomatology, obsessions, compulsions, anxiety and depression mediate the relation between CSA and AVH in a general population sample. Method: Indirect effects of CSA on AVH via potential mediators were tested for, using a regression-based approach employing data from the 2007 Adult Psychiatric Morbidity Survey (n = 5788). Results: After controlling for demographics, IQ and child physical abuse, it was found that CSA, IQ, post-traumatic symptomatology and compulsions predicted lifetime experience of AVH. Mediation analyses found significant indirect effects of CSA on AVH via post-traumatic symptomatology [odds ratio (OR): 1.11; 95% confidence interval (CI):1.00–1.29] and compulsions (OR: 1.10, 95% CI: 1.01–1.28). Conclusions: These findings offer further support for the hypothesis that post-traumatic symptomatology is a mediator of the CSA–AVH relation. Although no evidence was found for obsessional thoughts as a mediating variable, a potential mediating role for compulsions is theoretically intriguing. This study's findings reiterate the need to ask about experiences of childhood adversity and post-traumatic symptomology in people with AVH, as well as the likely therapeutic importance of trauma-informed and trauma-based interventions for this population.

Attentional avoidance increases voice hearing in an analogue task in people with psychosis: An experimental study

Cognitive models of psychosis suggest that unhelpful ways of responding to experiences can maintain such experiences and the associated distress. The response styles of attentional avoidance and attentional focusing were manipulated in an analogue voice-hearing task. Predictions were that both would increase detection of words in response to an ambiguous audio-recording but that attentional avoidance would lead to a greater increase than focusing. We also predicted that there would be a greater increase in anxiety and distress in the avoidance group. Predictions were tested in a sample of 44 participants with a diagnosis of schizophrenia. Participants were randomly assigned to either attentional avoidance or focusing while listening to an ambiguous auditory task. Number of words identified and anxiety and distress were recorded. As predicted, there was an increase in the number of words identified in both groups; however, this increase was greater in the avoidance group. The prediction that there would also be an increase in distress that would be greater in the avoidance group was not supported. It is possible that emotional reactions relate more closely to appraisals of the voice. The results suggest that avoidance of experiences is particularly counterproductive and can result in greater detection of experiences.

Is Shame Hallucinogenic?

Research into the causes of "hearing voices," formally termed auditory verbal hallucinations (AVH), has primarily focused on cognitive mechanisms. A potentially causative role for emotion has been relatively neglected. This paper uses historical and contemporary case studies of AVH to tentatively generate the hypothesis that shame can be a causal factor in the onset of AVH. Other sources of support for the generation of this hypothesis are then sought. First, evidence is examined for a role of shame in the etiology of post-traumatic stress disorder, a condition that is characterized by phenomena related to AVH (intrusions and dissociation) and in which a substantial minority of sufferers report AVH. Second, the effect on AVH of a psychological therapy specifically designed to counteract shame (Compassion Focused Therapy) is noted. The hypothesis generation process is then expanded to propose mechanisms that could mediate a relation between shame and AVH. It is proposed that employing absorbed or avoidant strategies to deal with shame may lead to AVH through mediating mechanisms such as rumination, suppression, and dissociation. Evolutionary reasons for a relation between shame and AVH are also proposed, including that AVH may be an evolved mechanism to encourage self-protective behaviors in the wake of trauma. It is concluded that existing research supports the generation of this paper's hypothesis, which is now worthy of dedicated empirical testing.

The role of metacognition and obsessive-compulsive symptoms in psychosis: an analogue study

BACKGROUND

Several studies have indicated that obsessive-compulsive disorder (OCD) is a common comorbidity in patients with psychotic disorders, but there is sparse knowledge about the relationship between symptoms of OCD and psychotic symptoms. Metacognitions which guides thinking and coping is theorized to be a transdiagnostic component central for development and maintenance of psychological disorders, OCD and psychosis included. The aim of the study was therefore to explore how symptoms of OCD and metacognitions relate to symptoms of psychosis. Our main hypotheses were that metacognitions would be significantly related to all symptoms of psychological distress, and that there is considerable overlap between symptoms of psychosis and OCD.

METHODS

Community controls (N = 194) completed an internet survey measuring levels of paranoid ideation, predisposition to hallucinations, symptoms of OCD, depression, anxiety, and metacognitions. Correlations and hierarchical multiple linear regression analyses were used to unveil the relationship between symptoms and beliefs.

RESULTS

Symptoms of OCD showed a strong positive correlation with symptoms of psychosis, and the relationships were still significant after controlling for symptoms of anxiety and depression. Metacognitions also showed strong positive correlations with all symptom measures. Metacognition and OCD-symptoms accounted for 53.8% of the variance in paranoid ideation and 43.8% of predisposition to hallucinations. There was a large overlap between symptoms of psychosis, OCD-symptoms, and metacognitions (30.2-37.3%).

CONCLUSIONS

In general, the results suggest considerable overlap between paranoid ideation, predisposition to hallucinations, and OCD and metacognitive beliefs in a non-clinical sample. Further experimental- and clinical studies are needed in order to explore metacognitive models of OCD and psychosis.

The Metacognitions Questionnaire-30: An Examination of a Bifactor Model and Measurement Invariance Among Men and Women in a Community Sample

The Metacognitions Questionnaire-30 (MCQ-30) is a self-report measure that assesses metacognitive beliefs (i.e., beliefs about thinking). Prior research has supported a correlated five-factor model, but no known published study has examined the tenability of second-order or bifactor models of the MCQ-30. Results supported a bifactor model of the MCQ-30 in a sample of community adults from the United States ( N = 785), as well as separately among men ( n = 372) and women ( n = 413). Multiple-groups confirmatory factor analysis supported the configural and metric/scalar invariance of the bifactor model among men and women. Results further supported the incremental validity of one of the MCQ-30 domain-specific factors in accounting for unique variance in an index of health anxiety beyond the general metacognition factor. Results provide support for a bifactor conceptualization of the MCQ-30 and the invariance of that model across men and women.

Dysfunctional coping with stress in psychosis. An investigation with the Maladaptive and Adaptive Coping Styles (MAX) questionnaire

OBJECTIVE

Psychotic episodes have long been conceptualized as inevitable incidents triggered by endogenous biological impairments. It is now well-accepted that the ability of an individual to deal with social and environmental challenges plays an important role in regard to whether or not a vulnerability to psychosis translates into symptoms. For the present study, we examined symptomatic correlates of dysfunctional coping in psychosis and aimed to elucidate a profile of coping strategies that distinguishes patients with schizophrenia from those with depression.

METHOD

The newly devised Maladaptive and Adaptive Coping Styles Scale (MAX) was administered to 75 individuals with psychosis, 100 individuals with depression and 1100 nonclinical controls.

RESULTS

Schizophrenia patients showed compromised coping abilities relative to nonclinical controls, particularly a lack of engaging in adaptive coping. Depression was more closely tied to dysfunctional coping than were positive symptoms as indicated by group comparisons and correlational analyses. Correlations between positive symptoms, particularly paranoid symptoms, and avoidance and suppression remained significant when depression was controlled for.

CONCLUSIONS

Although maladaptive and adaptive coping are unlikely to represent proximal mechanisms for the pathogenesis of positive symptoms, fostering coping skills may reduce positive symptoms via the improvement of depressive symptoms, which are increasingly regarded as risk factors for core psychotic symptoms. Furthermore, the reduction of avoidance and suppression may directly improve positive symptoms.

The intrasubjectivity of self, voices and delusions: A phenomenological analysis

To advance the area of phenomenology of voices and their interrelatedness to forms of delusions this study investigated the prevalence and interrelatedness of co-occurring auditory verbal hallucinations (AVHs) and delusions. Additionally we explored the characterization of distinct sub-categories/clusters of AVHs and delusions. Ninety-two participants experiencing psychosis were administered standardized clinical measures. We found a significant diagnostic difference with increased prevalence of co-occurring AVHs and delusions within the schizophrenia group compared to the bipolar with psychosis group. Regardless of diagnosis, there was a significant positive correlation between AVHs and delusions of reference, persecution, control, thought insertion, thought withdrawal and thought broadcasting. However, no significant relationship was found between AVHs and grandiose, somatic, religious, guilty or jealousy-themed delusions. Cluster analysis yielded two distinct cluster groups. Cluster One: Voices and Thought Delusions, and Cluster Two: Voices and Thematic Delusions. Cluster One participants showed elevated disorganized, cognitive and depressive symptoms, but not negative symptoms or excitement. This study underscores the need for expanded clinical and phenomenological research into the intersection of AVHs and delusions, including work that seeks to deconstruct conventional divisions between ostensible symptoms of perception' (hallucinations) and belief' (delusions).

Non-invasive Brain Stimulation and Auditory Verbal Hallucinations: New Techniques and Future Directions

Auditory verbal hallucinations (AVHs) are the experience of hearing a voice in the absence of any speaker. Results from recent attempts to treat AVHs with neurostimulation (rTMS or tDCS) to the left temporoparietal junction have not been conclusive, but suggest that it may be a promising treatment option for some individuals. Some evidence suggests that the therapeutic effect of neurostimulation on AVHs may result from modulation of cortical areas involved in the ability to monitor the source of self-generated information. Here, we provide a brief overview of cognitive models and neurostimulation paradigms associated with treatment of AVHs, and discuss techniques that could be explored in the future to improve the efficacy of treatment, including alternating current and random noise stimulation. Technical issues surrounding the use of neurostimulation as a treatment option are discussed (including methods to localize the targeted cortical area, and the state-dependent effects of brain stimulation), as are issues surrounding the acceptability of neurostimulation for adolescent populations and individuals who experience qualitatively different types of AVH.

Associations between intrusive thoughts, reality discrimination and hallucination-proneness in healthy young adults

INTRODUCTION

People who experience intrusive thoughts are at increased risk of developing hallucinatory experiences, as are people who have weak reality discrimination skills. No study has yet examined whether these two factors interact to make a person especially prone to hallucinatory experiences. The present study examined this question in a non-clinical sample.

METHODS

Participants were 160 students, who completed a reality discrimination task, as well as self-report measures of cannabis use, negative affect, intrusive thoughts and auditory hallucination-proneness. The possibility of an interaction between reality discrimination performance and level of intrusive thoughts was assessed using multiple regression.

RESULTS

The number of reality discrimination errors and level of intrusive thoughts were independent predictors of hallucination-proneness. The reality discrimination errors × intrusive thoughts interaction term was significant, with participants who made many reality discrimination errors and reported high levels of intrusive thoughts being especially prone to hallucinatory experiences.

CONCLUSIONS

Hallucinatory experiences are more likely to occur in people who report high levels of intrusive thoughts and have weak reality discrimination skills. If applicable to clinical samples, these findings suggest that improving patients' reality discrimination skills and reducing the number of intrusive thoughts they experience may reduce the frequency of hallucinatory experiences.

Cognitive-self consciousness and metacognitive beliefs: Stress sensitization in individuals at ultra-high risk of developing psychosis

OBJECTIVE

Metacognitive beliefs (MCB) may guide information and attention processes, increasing affective and symptomatic reactions to stressful events. Cognitive self-consciousness (CSC; i.e., a preoccupation with one's thoughts) may increase awareness of MCB, potentially triggering the onset of psychotic symptoms. This study tested the hypotheses that (1), MCB would moderate affective and symptomatic reactions to stress in individuals at ultra-high risk (UHR) of developing psychosis, and (2), greater CSC would precede worsening in psychotic symptoms in individuals with strong MCB.

METHOD

Twenty-seven individuals at UHR of developing psychosis completed a self-report diary when prompted by an electronic wristwatch several times each day for 6 days (experience sampling).

RESULTS

MCB moderated the association between affective, but not symptomatic, responses to social stress. CSC preceded the subsequent occurrence of hallucinations in individuals who reported strong beliefs about the need to control their thoughts.

CONCLUSIONS

The data suggest that MCB sensitize an individual to social stressors. CSC may represent times where an individual is aware that their thoughts are uncontrollable, and therefore contradicting their MCB, motivating them to make an external attribution. The findings have implications for improving the effectiveness of interventions for people experiencing hallucinations.

More than words? Hypomanic personality traits, visual imagery and verbal thought in young adults

The use of visual mental imagery has been proposed to be a risk factor for the development of bipolar disorder, due to its potential to amplify affective states. This study examined the relation between visual imagery (both trait usage and intrusive experiences of such imagery), intrusive verbal thought, and hypomania, as assessed by self-report questionnaires, in a sample of young adults (N=219). Regression analyses found (after controlling for anxiety, depression, and positive and negative affect) that levels of intrusive visual imagery predicted levels of hypomania, but that neither trait use of visual imagery nor intrusive verbal thought did. These results were consistent with the proposal that being a 'visualiser', as opposed to a 'verbaliser', is a risk factor for bipolar disorder, with the caveat that it is specifically intrusive experiences of imagery, rather than the tendency to utilize imagery per se, that acts as a risk factor.

From mind-pops to hallucinations? A study of involuntary semantic memories in schizophrenia

Involuntary semantic memories or mind-pops consist of isolated fragments of one's semantic knowledge (e.g., a word or a sentence, proper name, image or a melody) that come to mind unexpectedly, without any deliberate attempt to recall them. They can be experienced as alien and uncontrollable, and may share some phenomenological similarities with hallucinations. The aim of the present study was to investigate the nature and frequency of mind-pops in people with schizophrenia (N=37), as well as clinically depressed (N=31) and non-clinical controls (N=31). Results showed that schizophrenia patients reported experiencing mind-pops more frequently than both depressed and non-clinical controls. Schizophrenia patients also reported a wider range of different types of mind-pops than non-clinical controls. The depressed group did not differ from non-clinical controls in the frequency and range of mind-pops, indicating that mind-pops are not characteristic of clinical populations in general, but may be particularly prevalent in patients with schizophrenia. The possible implications of this finding to current models of auditory verbal hallucinations are discussed and the need for future research in this area is emphasized.

Cognitive mechanisms of auditory verbal hallucinations in psychotic and non-psychotic groups

The continuum model of psychosis has been extremely influential. It assumes that psychotic symptoms, such as auditory verbal hallucinations (AVH), are not limited to patients with psychosis but also occur in healthy, non-clinical individuals - suggesting similar mechanisms of origin. Recent debate surrounding this model has highlighted certain differences, as well as similarities, in the phenomenology of AVH in clinical and non-clinical populations. These findings imply that there may, in fact, be only partial overlap of the mechanism(s) involved in generating AVH in these groups. We review evidence of continuity or similarity, and dissimilarity, in cognitive, and related neural processes, underlying AVH in clinical and non-clinical samples. The results reveal some shared (intrusive cognitions, inhibitory deficits) and some distinct (aspects of source memory and cerebral lateralization) mechanisms in these groups. The evidence, therefore, supports both continuous and categorical models of positive psychotic symptoms. The review considers potential risks of uncritical acceptance of the continuum model and highlights some important methodological issues for future research.

Dissociative and metacognitive factors in hallucination-proneness when controlling for comorbid symptoms

INTRODUCTION

Recent studies have linked hallucination-proneness to dysfunctional metacognitive beliefs, dissociation, and disrupted capacity to discriminate between internal and external cognitive events (reality discrimination). This study addressed a number of methodological limitations of previous research by investigating the relationship between hallucination-proneness and the aforementioned variables while controlling for comorbid symptoms.

METHOD

A large sample of nonclinical participants was screened on measures of hallucination-proneness, cognitive intrusions, paranoid ideation, metacognitive beliefs, and dispositional mindfulness (including measures of dissociation-like experiences). In addition, a signal detection task was used to investigate reality discrimination in four subgroups of participants selected on the basis of their scores on hallucination-proneness and intrusions.

RESULTS

Regression analyses for the self-report data were conducted to investigate the predictors of hallucination-proneness and paranoia when controlling for comorbid symptoms. Also, between-group differences on the behavioural data were tested to determine whether perturbed reality discrimination is specifically associated with hallucination-proneness rather than cognitive intrusions. Results revealed that metacognitive beliefs are more strongly associated with intrusions and paranoia than hallucination-proneness, whereas hallucination-proneness is related to perturbed reality discrimination and dissociation.

CONCLUSIONS

These results clarify previous research on metacognitive dysfunction in hallucination-proneness, and highlight the importance of controlling for the covariation among symptoms when investigating the cognitive processes underlying psychotic experiences.

The metacognitive beliefs account of hallucinatory experiences: a literature review and meta-analysis

An influential model of hallucinations proposed by Morrison et al. (1995. Behavioural and Cognitive Psychotherapy, 23(3), 265-280) assumes that dysfunctional metacognitive beliefs lead to the misattribution of intrusive thoughts to external sources, therefore generating hallucinatory experiences. Following a comprehensive review of the literature, a series of meta-analyses was carried out to summarize the empirical findings on the association between hallucination-proneness and different metacognitive beliefs. The results of this research synthesis found little support for the existence of specific associations between hallucinations and dysfunctional metacognitive beliefs. While metacognitive beliefs are robustly associated with hallucination-proneness in non-clinical studies, they were only moderately associated with hallucinations in clinical samples. Additional analyses revealed that, after controlling for the effect of comorbid symptoms, hallucination-proneness was only weakly associated with metacognitive beliefs, suggesting that the large associations observed in previous research might stem from the failure to consider the covariation between different symptoms. These findings have important implications in relation to the role of metacognitive factors in psychopathological symptoms, as well as for the implementation of metacognitive-focused cognitive behavioural techniques for the treatment of psychosis.

Do we need multiple models of auditory verbal hallucinations? Examining the phenomenological fit of cognitive and neurological models

The causes of auditory verbal hallucinations (AVHs) are still unclear. The evidence for 2 prominent cognitive models of AVHs, one based on inner speech, the other on intrusions from memory, is briefly reviewed. The fit of these models, as well as neurological models, to the phenomenology of AVHs is then critically examined. It is argued that only a minority of AVHs, such as those with content clearly relating to verbalizations experienced surrounding previous trauma, are consistent with cognitive AVHs-as-memories models. Similarly, it is argued that current neurological models are only phenomenologically consistent with a limited subset of AVHs. In contrast, the phenomenology of the majority of AVHs, which involve voices attempting to regulate the ongoing actions of the voice hearer, are argued to be more consistent with inner speech-based models. It is concluded that subcategorizations of AVHs may be necessary, with each underpinned by different neurocognitive mechanisms. The need to study what is termed the dynamic developmental progression of AVHs is also highlighted. Future empirical research is suggested in this area.

Cognitive processes during acute psychosis: the role of heightened responsibility and catastrophic misinterpretations

BACKGROUND

This study investigated the role of cognitive mechanisms underlying obsessive compulsive and panic disorders in psychosis, and in particular, their possible contributions to acute psychosis.

METHOD

A total of 90 participants were recruited comprising three equal-size groups, including two clinical groups (acute and stable) and one non-clinical matched control group. Symptom severity and distress was assessed using the PSYRATS, and questionnaire measures of anxiety and obsessive beliefs were administered to all participants.

RESULTS

Individuals with a diagnosis of psychosis reported significantly higher levels of obsessional beliefs and anxiety sensitivity than the non-clinical group. Furthermore, acutely psychotic patients reported a significantly higher sense of responsibility and catastrophic misinterpretation than the stable psychiatric controls, and than samples of OCD and GAD patients.

CONCLUSIONS

Results suggest that these anxiety processes are particularly important during acute psychotic episodes, beyond the reported comorbidity. The theoretical and clinical implications of these findings, the limitations of the methodology employed, and suggestions for future research are discussed.

Social predictors of psychotic experiences: specificity and psychological mechanisms

It has become widely accepted that the psychotic disorders are endpoints of atypical developmental trajectories indexed by abnormal emotional and cognitive development early in life. However, the role of environmental factors in determining these trajectories has received relatively little attention. In this article, we argue that (1) the influence of environment on psychosis can best be understood if we focus on specific types of psychotic experiences such as hallucinations and delusions, (2) these symptoms are the products of specific cognitive biases and deficits, and (3) the development of these particular patterns of cognitive functioning is influenced by specific kinds of environmental adversity. This approach is at variance with more conventional approaches because it suggests that each type of experience, rather than being the manifestation of a common underlying illness process, is a product of a specific set of causal variables. Importantly, these variables include environmental determinants, although not to the exclusion of endogenous factors such as neurodevelopmental impairment or genetic vulnerability. We discuss the implications of this approach for neurobiological and genetic research into psychosis, as well as clinical practice.

Thought suppression and persecutory delusion-like beliefs in a nonclinical sample

INTRODUCTION

Thought suppression may play a role in the formation and/or maintenance of persecutory delusions, although this possibility has not yet been empirically studied. We investigated thought suppression levels in relation to the presence of persecutory delusion-like beliefs (PDLBs), and hypothesised that only when levels of anxiety or negative affect were high would thought suppression predict levels of PDLBs.

METHOD

Thought suppression, anxiety, negative affect, social desirability, and persecutory ideation were assessed in a nonclinical sample (N=183) using online questionnaires.

RESULTS

When gender, anxiety, and negative affect were controlled, the interaction between thought suppression and anxiety predicted levels of PDLBs. Further analysis of this interaction showed that thought suppression was positively associated with PDLBs only when anxiety was high. Neither thought suppression by itself, nor the two-way interaction between negative affect and thought suppression, nor the three-way interaction between negative affect, anxiety, and thought suppression, were predictors of PDLB levels.

CONCLUSION

The results are consistent with a proposed interaction between thought suppression and anxiety in the development of PDLBs. Possible causal mechanisms underlying this relation are considered further, future research in the area proposed, and potential clinical implications examined.