Intrusive Thoughts and Auditory Hallucinations: A Cognitive Approach

Abstract

In this paper, an account of auditory hallucinations is outlined, incorporating the phenomena of intrusive thoughts; this is done with reference to the prevailing cognitive models of auditory hallucinations. The account proposes that metacognitive beliefs inconsistent with intrusive thoughts lead to their external attribution as auditory hallucinations, and that such a misattribution is maintained by reducing cognitive dissonance. It is also suggested that the appraisal of the resulting hallucinatory experience elicits behavioural, emotional and physiological responses that may be involved in the maintenance process. The possibility of extending such an account to certain other positive symptoms is discussed, and the theoretical and clinical implications of such an account are considered, and illustrated with a case example. Finally, a number of testable predictions are made. IntroductionThere has been a long tradition within clinical psychology of using theories of normal psychological processes to inform our understanding of clinical phenomena. This paper will attempt to outline a potentially useful, but speculative, account of certain positive symptoms of schizophrenia incorporating the phenomena of intrusive mental experiences. This will be done with reference to existing cognitive models of positive symptoms, and will initially focus on explaining auditory hallucinations, although other symptoms (thought insertion, visual hallucinations and delusions of control) will be considered briefly. The symptoms of schizophreniaSchizophrenia has received much attention from researchers over the last century, but the aetiology of this syndrome is still unknown. Recent Acknowledgements: The authors are grateful to Dr Adrian Wells for his helpful comments on an earlier version of this paper.Reprint requests to Tony Morrison,

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

“…These findings from analogue studies are consistent with data from studies that have employed clinical samples, where patients who experience AH report more frequent intrusive thoughts than do patients who do not experience AH (e.g., Lobban et al, 2002;Morrison & Baker, 2000). Together, these studies provide support for the idea that intrusive thoughts may be the raw material of AH, as suggested by Morrison et al (1995).…”

“…It has been suggested that intrusive thoughts may be the mental events that are misattributed to become AH (Morrison, Haddock, & Tarrier, 1995). In part, this is because both intrusive thoughts and AH have been described as being unwanted, uncontrollable, and distressing (Rachman, 1978(Rachman, , 1981Nayani & David, 1996).…”

The Phenomenological Diversity of Hallucinations: Some theoretical and clinical implications

“…A number of studies have provided evidence for an externalising bias in both clinical and non-clinical subjects (e.g., Baker & Morrison, 1998;Bentall, Baker, & Havers, 1991;Bentall & Slade, 1985a;Brébion et al, 2000;Ensum & Morrison, 2003;Johns & McGuire, 1999;Larøi, Van der Linden, & Marczewski, 2004a;Morrison & Haddock, 1997;Rankin & O'Carroll, 1995;Seal, Crowe, & Cheung, 1997). Furthermore, this stance is in accordance with the general supposition made by several cognitive theorists that hallucinations are inner events misattributed to an external source (e.g., Beck & Rector, 2003;Frith, 1992;Hoffman, 1986;Morrison, Haddock, & Tarrier, 1995). The principle differences between these theories lie in explaining how this externalisation arises.…”

The (perceived) meaning of spontaneous thoughts.

“…The tendency to interpret and assign meaning to thoughts that intrude on consciousness has been linked to psychological distress, autonomic arousal, auditory hallucinations among the mentally ill, and the propensity to self-harm among people with obsessive-compulsive tendencies (Magee & Teachman, 2007;Morrison, 1994;Morrison, Haddock, & Tarrier, 1995;Najmi et al, 2007).…”