Auditory Hallucinations in Schizophrenia and Nonschizophrenia Populations: A Review and Integrated Model of Cognitive Mechanisms

Abstract

While the majority of cognitive studies on auditory hallucinations (AHs) have been conducted in schizophrenia (SZ), an increasing number of researchers are turning their attention to different clinical and nonclinical populations, often using SZ findings as a model for research. Recent advances derived from SZ studies can therefore be utilized to make substantial progress on AH research in other groups. The objectives of this article were to (1) present an up-to-date review regarding the cognitive mechanisms of AHs in SZ, (2) review findings from cognitive research conducted in other clinical and nonclinical groups, and (3) integrate these recent findings into a cohesive framework. First, SZ studies show that the cognitive underpinnings of AHs include self-source-monitoring deficits and executive and inhibitory control dysfunctions as well as distortions in top-down mechanisms, perceptual and linguistic processes, and emotional factors. Second, consistent with SZ studies, findings in other population groups point to the role of top-down processing, abnormalities in executive inhibition, and negative emotions. Finally, we put forward an integrated model of AHs that incorporates the above findings. We suggest that AHs arise from an interaction between abnormal neural activation patterns that produce salient auditory signals and top-down mechanisms that include signal detection errors, executive and inhibition deficits, a tapestry of expectations and memories, and state characteristics that influence how these experiences are interpreted. Emotional factors play a particular prominent role at all levels of this hierarchy. Our model is distinctively powerful in explaining a range of phenomenological characteristics of AH across a spectrum of disorders.

Varieties of Voice-Hearing: Psychics and the Psychosis Continuum

“…Indeed, many of those interviewed report an increased perceived ability to control the occurrence of their voices and-crucially-report that they had not always possessed such an ability, instead developing it over time. Rather than reflecting enhanced executive function and cognitive control, as some have suggested, 8,43,44 this may instead be the result of intentional practice. This, in turn, may result from the lower distress exhibited by the psychics, leading to an increased willingness to engage with and ultimately control them.…”

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

“…Cognitive models propose that auditory hallucinations (AH) occur when an internal mental event is misattributed to an external source (e.g., Bentall, 1990;Waters et al, 2013). It has been suggested that intrusive thoughts may be the mental events that are misattributed to become AH (Morrison, Haddock, & Tarrier, 1995).…”

Use of an avatar in cognitive-behavioural therapy of a person who is chronically experiencing negative auditory hallucinations – case study

“…W trakcie jednego z dialogów (dialog A) nastąpiła zbieżność między treściami, jakie wypowiadał awatar (treść omamów), a treściami, jakie pacjent słyszał od ojca. W tym momencie nastąpiła zmiana w zakresie monitorowania źródła omamów słuchowych [24] i włączenie treści omamowych do własnych struktur poznawczych. Równocześnie do tego procesu pacjent przeformułował przekonania na temat siły, znaczenia, pochodzenia omamów słuchowych.…”

“…During one of the dialogues (dialogue A), the words spoke by the avatar (content of hallucinations) were similar to the words spoke to the patient by his father. At this point, there was a change in terms of the monitoring of the source of auditory hallucinations [24] and the inclusion of the content of hallucinations in own cognitive structures. Simultaneously with this process, the patient reformulated his beliefs about the power, meaning and source of auditory hallucinations.…”