Inner Speech and Clarity of Self-Concept in Thought Disorder and Auditory-Verbal Hallucinations

Abstract

Eighty patients and thirty controls were interviewed using one interview that promoted personal disclosure and another about everyday topics. Speech was scored using the Thought, Language and Communication scale (TLC). All participants completed the Self-Concept Clarity Scale (SCCS) and the Varieties of Inner Speech Questionnaire (VISQ). Patients scored lower than comparisons on the SCCS. Low scores were associated the disorganized dimension of TD. Patients also scored significantly higher on condensed and other people in inner speech, but not on dialogical or evaluative inner speech. The poverty of speech dimension of TD was associated with less dialogical inner speech, other people in inner speech, and less evaluative inner speech. Hallucinations were significantly associated with more other people in inner speech and evaluative inner speech. Clarity of self-concept and qualities of inner speech are differentially associated with dimensions of TD. The findings also support inner speech models of hallucinations.

The varieties of inner speech questionnaire – Revised (VISQ-R): Replicating and refining links between inner speech and psychopathology

“…the marginally significant reduction in dialogicality in the inner speech reported by Langdon, Jones, Connaughton, & Fernyhough, 2009 ). In contrast, a recent study with a clinical sample suggested that condensed and other people in inner speech were related to psychopathology ( de Sousa et al, 2016 ). As a potential explanation of these disparate findings, dialogic inner speech is typically the factor that correlates most with all of the other VISQ factors; this is also the case with the findings reported here.…”

“…In general, condensed inner speech scores also show few correlations with non-VISQ variables ( Ren et al, 2016 ). As noted above, there is evidence that patients with psychosis endorse this experience more than controls, and that it relates to increased levels of thought disorder ( de Sousa et al, 2016 ). As such, it would seem to be an important factor to retain and may be more informative when used in clinical samples.…”

“…A follow-up study in a similar sample also implicated relations with self-esteem and dissociation, with the latter partly mediating the link between inner speech and hallucination-proneness ( Alderson-Day et al, 2014 ). Since then the VISQ has been used to assess inner speech in people with psychosis ( de Sousa, Sellwood, Spray, Fernyhough, & Bentall, 2016 ) and explore relations with reading imagery ( Alderson-Day, Bernini, & Fernyhough, 2017 ), along with being adapted for use in Spanish ( Perona-Garcelán, Bellido-Zanin, Senín-Calderón, López-Jiménez, & Rodríguez-Testal, 2017 ), Colombian ( Tamayo-Agudelo, Vélez-Urrego, Gaviria-Castaño, & Perona-Garcelán, 2016 ), and Chinese populations ( Ren, Wang, & Jarrold, 2016 ). Self-reported dialogic inner speech on the VISQ has also been observed to correlate with neural activation of areas linked to producing inner dialogue during an fMRI task ( Alderson-Day et al, 2016 ).…”

Disorganisation, thought disorder and socio-cognitive functioning in schizophrenia spectrum disorders

“…For example, we have reported previously that difficulties in internal source monitoring (ability to correctly discriminate whether self-generated cognitions were verbalised or just thought) 93 coupled with negative affect are important to explain exacerbation of thought disorder during emotional challenge, 75 and that poverty of speech seems to be specifically associated with impoverished inner speech (especially dialogical inner speech). 35 Finally, how these mechanisms relate to important social predictors of thought disorder remains a matter of speculation. Some authors have suggested that difficulties recognising and reasoning about mental states in patients diagnosed with schizophrenia spectrum disorders could be a consequence of early experiences such as poor early attachments, childhood trauma or isolation, 94 factors that have been found to be associated with thought disorder.…”

“…Thought disorder assessment scales, such as the Scale for the Assessment of Thought, Language and Communication Disorders (TLC) 31 or the Thought Language Index, 32 distinguish between poverty of speech and disorganisation items, and such differentiation has been further supported by factor analytical studies 33 and studies on the psychological mechanisms of both positive and negative thought disorder. 34,35 Many studies have used measurements obtained by general psychopathology scales (e.g. Positive and Negative Syndrome Scale (PANSS) 36 or the Brief Psychiatric Rating Scale (BPRS) 37 ) to test hypotheses about the mechanisms involved in thought disorder.…”