A Verbal Behavior Analysis of Auditory Hallucinations

Abstract

A review of recent research on the non-medical control of auditory hallucinations is presented. It is suggested that the decreases in hallucinatory behavior obtained in studies using aversive contingencies may be attributable to the disruption of the chains of behavior involved. The results of several additional studies are interpreted as indicating that methods of stimulus control and the use of incompatible behaviors may be effective in reducing the rate of auditory hallucinations. Research relating auditory hallucinations to subvocalizations is presented in support of the view that hallucinatory phenomena are sometimes related to the subject's own vocal productions. Skinner's views (1934, 1936, 1953, 1957, 1980) are then presented as possible explanations of some hallucinatory behavior. It is suggested that some auditory hallucinations consit of the mishearing of environmental and physiological stimuli as voices in a fashion similar to that which Skinner observed in his work with the verbal summator. The maintenance of long chains of such responses may be largely attributable to self-intraverbal influences (such as are present during automatic writing). With some auditory hallucinations, this progression involves first mishearing ambiguous stimuli as voices and then attributing the voices to some cause (e.g., insanity, the television, radio, or God). Later, the frequent and ongoing chains of such behavior may contaminate other verbal responses. Such verbal behavior may be parasitic on "normal verbal behavior" (and hence, not directly dependent on consquences for maintenance), may be cued by various stimuli (including respiration), and may interfere with other covert and overt behavior. Several studies to investigate this view are presented. It is hoped that such research will lead to a better understanding of the major issues involved in the etiology and treatment of auditory hallucinations in particular and perhaps of psychosis in general.

Factorial Structure of the Hallucinatory Experience

“…As a consequence of attributing many types of internally generated stimuli to external sources, it may be the case that hallucinators are more prone to experience life impairment and clinical dysfunction from their symptoms (Bentall, 1990;Frenkel, 1995;Johns and van Os, 2001). This interpretation is also consistent with previous studies finding that active hallucinators (e.g., Bentall et al, 1991;Keefe et al, 2002) and individuals at high risk for hallucinations (e.g., Aleman et al, 2000;Levine et al, 2004;Young et al, 1986) are more apt to make external attributions to internally generated stimuli, to have biased beliefs about unusual perceptual experiences (e.g., Morrison et al, 1995), and to misidentify subvocalized speech as externally generated (Burns et al, 1983).…”

Auditory hallucinations and delusional thinking: A review and critique of outcome studies

“…This approach is promising; however, as indicated by some of the studies presented in this review, generalization of effects has not been completely satisfactory. Burns et al (1983) present the view that auditory hallucinations consist of mishearing nonverbal external and internal stimuli as 'voices' and that these stimuli are heard as smaller or larger strings of verbal behavior. They also add, 'if one is continually interrupted with background voices [or noises], maintaining and regaining the threat of conversation may extinguish as a response class ' (p. 140).…”

“…The present paper has three aims. Although various aspects of the literature on hallucinatory and delusional behavior have been reviewed from physiological, psychological and biochemical points of view (for example Burns et al, 1983;Asaad and Shapiro, 1986), research involving behavioral interventions has not been summarized. This is the main contribution of the present review.…”

The modification of auditory hallucinations

“…There have only been a few attempts to analyze auditory hallucinations within a radical behavioral formulation (Burns, Heiby, & Tharp;Laying & Andronis, 1984) or within any behavioral formulation for that matter. One factor contributing to this may be in how the psychiatric and psychological communities define hallucinations.…”