Beliefs about hearing voices

People who experience auditory verbal hallucinations (AVHs) vary in whether they believe their AVHs are self-generated or caused by external agents. It remains unclear whether these differences are influenced by the “intensity” of the voices, such as their frequency or volume, or other aspects of their phenomenology. We examined 35 patients with schizophrenia or schizoaffective disorder who experienced AVHs. Patients completed a detailed structured interview about their AVHs, including beliefs about their cause. In response, 20 (57.1%) reported that their AVHs were self-generated, 9 (25.7%) were uncertain, and 6 (17.1%) reported that their AVHs were caused by external agents. Several analytical approaches revealed little or no evidence for associations between either AVH intensity or phenomenology and beliefs about the AVH’s cause; the evidence instead favoured the absence of these associations. Beliefs about the cause of AVHs are thus unlikely to be explained solely by the phenomenological qualities of the AVHs.     

Auditory Hallucinations as Social Self-Positions: A Theoretical Discussion from a Single-Case Study

This work uses social positioning analysis to investigate the phenomenon of the auditory verbal hallucination (AVH) in schizophrenia in order to describe its social and interactive nature. We focus in detail on a single-case study of a patient who verbalized her AVHs. We analyze 3 significant excerpts from an interview with a person with paranoid schizophrenia. This interview is part of a larger study conducted with 18 participants about life narrative construction in the sociocultural context of care homes. The interaction between the patient and her voices is examined closely to reveal the dynamic between interviewer, patient, and voices. The analysis differentiates the voice of the patient from that of the hallucination and reveals “social interaction” between this dyad and the interviewer. We discuss a possible social and interactive framework to understand the origin of AVHs and the self-construction process.     

Primary Care Physicians’ Awareness, Experience and Opinions of Direct-to-Consumer Genetic Testing

The purpose of this study was to assess primary care physicians’ awareness, experience, opinions and preparedness to answer patients’ questions regarding direct-to-consumer (DTC) genetic testing. An anonymous survey was mailed to 2,402 family and internal medicine providers in North Carolina. Of the 382 respondents, 38.7% (n = 148) were aware of and 15% (n = 59) felt prepared to answer questions about DTC genetic tests. Respondents aged 50 or older were more likely to be aware of DTC genetic testing than those less than 40 years old (OR = 2.42). Male providers were more likely to feel prepared to answer questions than female providers (OR = 2.65). Among respondents who reportedly were aware, family practitioners were more likely than internists (OR = 3.30) to think DTC testing was clinically useful, and 18.9% had patients ask questions or bring in test results. The small percent of physicians who were aware of DTC genetic testing or felt prepared to answer questions about it suggests that education of providers will be necessary if testing becomes more widespread.     

How does familiarity with a voice affect trait judgements?

From only a single spoken word, listeners can form a wealth of first impressions of a person’s character traits and personality based on their voice. However, due to the substantial within-person variability in voices, these trait judgements are likely to be highly stimulus-dependent for unfamiliar voices: The same person may sound very trustworthy in one recording but less trustworthy in another. How trait judgements differ when listeners are familiar with a voice is unclear: Are listeners who are familiar with the voices as susceptible to the effects of within-person variability? Does the semantic knowledge listeners have about a familiar person influence their judgements? In the current study, we tested the effect of familiarity on listeners’ trait judgements from variable voices across 3 experiments. Using a between-subjects design, we contrasted trait judgements by listeners who were familiar with a set of voices – either through laboratory-based training or through watching a TV show – with listeners who were unfamiliar with the voices. We predicted that familiarity with the voices would reduce variability in trait judgements for variable voice recordings from the same identity (cf. Mileva, Kramer & Burton, Perception, 48, 471 and 2019, for faces). However, across the 3 studies and two types of measures to assess variability, we found no compelling evidence to suggest that trait impressions were systematically affected by familiarity.     

The effect of familiarity on within-person age judgements from voices

Listeners can perceive a person’s age from their voice with above chance accuracy. Studies have usually established this by asking listeners to directly estimate the age of unfamiliar voices. The recordings used mostly include cross-sectional samples of voices, including people of different ages to cover the age range of interest. Such cross-sectional samples likely include not only cues to age in the sound of the voice but also socio-phonetic cues, encoded in how a person speaks. How age perpcetion accuracy is affected when minimizing socio-phonetic cues by sampling the same voice at different time points remains largely unknown. Similarly, with the voices in age perception studies being usually unfamiliar to listeners, it is unclear how familiarity with a voice affects age perception. We asked listeners who were either familiar or unfamiliar with a set of four voices to complete an age discrimination task: listeners heard two recordings of the same person’s voice, recorded 15 years apart, and were asked to indicate in which recording the person was younger. Accuracy for both familiar and unfamiliar listeners was above chance. While familiarity advantages were apparent, accuracy was not particularly high: familiar and unfamiliar listeners were correct for 68.2% and 62.7% of trials, respectively (chance = 50%). Familiarity furthermore interacted with the voices included. Overall, our findings indicate that age perception from voices is not a trivial task at all times – even when listeners are familiar with a voice. We discuss our findings in the light of how reliable voice may be as a signal for age.     

Why are familiar-only experiences more frequent for voices than for faces?

Hanley,Smith, and Hadfield (1998) showed that when participants were asked to recognize famous people from hearing their voice , there was a relatively large number of trials in which the celebrity's voice was felt to be familiar but biographical information about the person could not be retrieved. When a face was found familiar, however, the celebrity's occupation was significantly more likely to be recalled. This finding is consistent with the view that it is much more difficult to associate biographical information with voices than with faces. Nevertheless, recognition level was much lower for voices than for faces in Hanleyet al.'s study,and participants made significantly more false alarms in the voice condition. In the present study, recognition performance in the face condition was brought down to the same level as recognition in the voice condition by presenting the faces out of focus. Under these circumstances, it proved just as difficult to recall the occupations of faces found familiar as it was to recall the occupations of voices found familiar. In other words, there was an equally large number of familiar-only responses when faces were presented out of focus as in the voice condition. It is argued that these results provide no support for the view that it is relatively difficult to associate biographical information with a person's voice. It is suggested instead that associative connections between processing units at different levels in the voice-processing system are much weaker than is the case with the corresponding units in the face-processing system. This will reduce the recall of occupations from voices even when the voice has been found familiar. A simulation was performed using the latest version of the IAC model of person recognition (Burton, Bruce, & Hancock, 1999) which demonstrated that the model can readily accommodate the pattern of results obtained in this study.     

Educational Needs of Primary Care Physicians Regarding Direct-to-Consumer Genetic Testing

To assess the educational needs of North Carolina primary care physicians (PCPs) about direct-to-consumer (DTC) genetic testing, surveys were mailed to 2,402 family and internal medicine providers in North Carolina. Out of 382 respondents, 323 (85%) felt unprepared to answer patient questions and 282 (74%) reported wanting to learn about DTC genetic testing. A total of 148 (39%) were aware of DTC genetic testing. Among these, 63 (43%) thought DTC genetic testing was clinically useful. PCPs who felt either unprepared to answer patient questions (OR = 0.354, p = 0.01) or that DTC genetic testing was clinically useful (OR = 5.783, p = 0.00) were more likely to want to learn about DTC genetic testing. PCPs are interested in learning about DTC genetic testing, but are mostly unaware of DTC testing and feel unprepared to help patients with DTC testing results. Familiar and trusted channels that provide the information and tools PCPs need to help answer patient’s questions and manage their care should be used when creating educational programs.     

Metacognitive Interpersonal Therapy for Treating Auditory Verbal Hallucinations in First-onset Schizophrenia

Auditory verbal hallucinations (AVHs) are perceptive-like experiences happening without appropriate stimuli, occurring in two thirds of schizophrenia patients, where they often cause emotional suffering and dangerous behaviors, and interfere with social relationships. Patients with schizophrenia involving AVHs can also be drug-resistant or they may discontinue medications. The most well-known psychotherapeutic intervention for voice-hearing is cognitive behavioral therapy (CBT), which focuses on reducing distress by modifying hearers’ beliefs about their voices. We hypothesize that it is possible to reinforce the clinical approach to AVHs by taking into consideration (a) that patients generally hear voices in particular interpersonal contexts where they experience negative emotions; (b) the relationship between AVHs and metacognition, namely the ability to make sense of mental states. On this basis, AVHs can be seen not just as a cause of emotional distress as CBT postulates, but the outcome of difficulties in meta-cognitively making sense of interpersonal exchanges. In this paper, we describe the treatment of a young man at the onset of schizophrenia with pervasive negative AVHs. The patient was treated with metacognitive interpersonal therapy (MIT), aimed to promote the patient’s metacognition. With this aim, in the first part of the treatment, each time AVHs emerged, the patient’s level of arousal was high and his metacognitive ability very low, the therapist treated AVHs helping the patient to understand and cope with the emotional suffering connected with AVHs. At a more advanced stage of therapy, the therapist helped the patient reach the point of understanding the social triggers which, together with the patient’s self-schemas, ignited his auditory hallucinations; this created the conditions for a significant reduction of the pervasiveness of AVHs.     

Auditory Long term Memory: Repetition Priming of Voice Recognition

Two experiments examined repetition priming in the recognition of famous voices. In Experiment 1, reaction times for fame decisions to famous voice samples were shorter than in an unprimed condition, when voices were primed by a different voice sample of the same person having been presented in an earlier phase of the experiment. No effect of voice repetition was observed for non-famous voices. In Experiment 2, it was investigated whether this priming effect is voice-specific or whether it is related to post-perceptual processes in person recognition. Recognizing a famous voice was again primed by having earlier heard a different voice sample of that person. Although an earlier exposure to that person's name did not cause any priming, there was some indication of priming following an earlier exposure to that person's face. Finally, earlier exposure to the identical voice sample (as compared to a different voice sample from the same person) caused a considerable bias towards responding 'famous'-i.e. performance benefits for famous but costs for nonfamous voices. The findings suggestthat (1) repetition priming invoice recognition primarily involves the activation of perceptual representations of voices, and (2) it is important to determine the conditions in which priming causes bias effects that need to be disentangled from performance benefits.     

Perceptual scaling of voice identity: common dimensions for different vowels and speakers

The aims of our study were: (1) to determine if the acoustical parameters used by normal subjects to discriminate between different speakers vary when comparisons are made between pairs of two of the same or different vowels, and if they are different for male and female voices; (2) to ask whether individual voices can reasonably be represented as points in a low-dimensional perceptual space such that similarly sounding voices are located close to one another. Subjects were presented with pairs of voices from 16 male and 16 female speakers uttering the three French vowels “a”, “i” and “u” and asked to give speaker similarity judgments. Multidimensional analyses of the similarity matrices were performed separately for male and female voices and for three types of comparisons: same vowels, different vowels and overall average. The resulting dimensions were then interpreted a posteriori in terms of relevant acoustical measures. For both male and female voices, a two-dimensional perceptual space was found to be most appropriate, with axes largely corresponding to contributions of the larynx (pitch) and supra-laryngeal vocal tract (formants), mirroring the two largely independent components of source and filter in voice production. These perceptual spaces of male and female voices and their corresponding voice samples are available at: section Resources.     

Accounting for the phenomenology and varieties of auditory verbal hallucination within a predictive processing framework

Two challenges that face popular self-monitoring theories (SMTs) of auditory verbal hallucination (AVH) are that they cannot account for the auditory phenomenology of AVHs and that they cannot account for their variety. In this paper I show that both challenges can be met by adopting a predictive processing framework (PPF), and by viewing AVHs as arising from abnormalities in predictive processing. I show how, within the PPF, both the auditory phenomenology of AVHs, and three subtypes of AVH, can be accounted for.     

Integrating voice recognition into models of person perception

The results of one empirical study are presented to investigate whether voice recognition might profitably be integrated into a single IAC network for person perception. An identity priming paradigm was used to determine whether face perception and voice perception combined to influence one another. The results revealed within-modality priming of faces by prior presentations of faces, and of voices by prior presentation of voices. Critically, cross-modality priming was also revealed, confirming that the two modalities can be represented within a single system and can influence one another. These results are supported by the results of a simulation, and are discussed in terms of the theoretical development of IAC, and the benefits and future questions that arise from consideration of an integrated multimodal model of person perception.     

Perceiving vocal age and gender: An adaptation approach

Aftereffects of adaptation have revealed both independent and interactive coding of facial signals including identity and expression or gender and age. By contrast, interactive processing of non-linguistic features in voices has rarely been investigated. Here we studied bidirectional cross-categorical aftereffects of adaptation to vocal age and gender. Prolonged exposure to young (~ 20 yrs) or old (~ 70 yrs) male or female voices biased perception of subsequent test voices away from the adapting age (Exp. 1) and the adapting gender (Exp. 2). Relative to gender-congruent adaptor-test pairings, vocal age aftereffects (VAAEs) were reduced but remained significant when voice gender changed between adaptation and test. This suggests that the VAAE relies on both gender-specific and gender-independent age representations for male and female voices. By contrast, voice gender aftereffects (VGAEs) were not modulated by age-congruency of adaptor and test voices (Exp. 2). Instead, young voice adaptors generally induced larger VGAEs than old voice adaptors. This suggests that young voices are particularly efficient gender adaptors, likely reflecting more pronounced sexual dimorphism in these voices. In sum, our findings demonstrate how high-level processing of vocal age and gender is partially intertwined.     

Recalling episodic and semantic information about famous faces and voices

In this study, we used the distinction between remember and know (R/K) recognition responses to investigate the retrieval of episodic information during familiar face and voice recognition. The results showed that familiar faces presented in standard format were recognized with R responses on approximately 50% of the trials. The corresponding figure for voices was less than 20%. Even when overall levels of recognition were matched between faces and voices by blurring the faces, significantly more R responses were observed for faces than for voices. Voices were significantly more likely to be recognized with K responses than were blurred faces. These findings indicate that episodic information was recalled more often from familiar faces than from familiar voices. The results also showed that episodic information about a familiar person was never recalled unless some semantic information, such as the person's occupation, was also retrieved.     

How many voices did you hear? Natural variability disrupts identity perception from unfamiliar voices

Our voices sound different depending on the context (laughing vs. talking to a child vs. giving a speech), making within‐person variability an inherent feature of human voices. When perceiving speaker identities, listeners therefore need to not only ‘tell people apart’ (perceiving exemplars from two different speakers as separate identities) but also ‘tell people together’ (perceiving different exemplars from the same speaker as a single identity). In the current study, we investigated how such natural within‐person variability affects voice identity perception. Using voices from a popular TV show, listeners, who were either familiar or unfamiliar with this show, sorted naturally varying voice clips from two speakers into clusters to represent perceived identities. Across three independent participant samples, unfamiliar listeners perceived more identities than familiar listeners and frequently mistook exemplars from the same speaker to be different identities. These findings point towards a selective failure in ‘telling people together’. Our study highlights within‐person variability as a key feature of voices that has striking effects on (unfamiliar) voice identity perception. Our findings not only open up a new line of enquiry in the field of voice perception but also call for a re‐evaluation of theoretical models to account for natural variability during identity perception.     

Recalling semantic information about newly learned faces and voices

Several findings showed that semantic information is more likely to be retrieved from recognised faces than from recognised voices. Earlier experiments, which investigated the recall of biographical information following person recognition, used stimuli that were pre-experimentally familiar to the participants, such as famous people's voices and faces. We propose an alternative method to compare the participants’ ability to associate semantic information with faces and voices. The present experiments allowed a very strict control of frequency of exposure to pre-experimentally unfamiliar faces and voices and ensured the absence of identity clues in the spoken extracts. In Experiment 1 semantic information was retrieved from the presentation of a name. In Experiment 2 semantic and lexical information was retrieved from faces and/or voices. A memory advantage for faces over voices was again observed.     

Sex differences and individual consistency in voice identification

Results were combined from 5 experiments by Cook in 1998 with 728 participants who listened to one male voice and one female voice each saying a sentence, then attempted to recognise the voices from line-ups of six voices presented a week later. While 352 male listeners did not differ significantly in recognising female and male voices (38% correct vs 41%), 376 female listeners were significantly more likely to recognise female than male voices (51% vs 43% correct). There was no evidence for individual differences in voice recognition in that listeners who recognised the male voice were no more likely to recognise the female voice than those who failed to recognise the male voice.     

Auditory Verbal Hallucinations as Dialogical Experiences

The purpose of this study is to offer a model in which auditory verbal hallucinations (AVHs) can be conceptualized as dialogical experiences. This model is of interest in that it integrates several different perspectives (phenomenological, cognitive, social, and evolutionary) and the findings of empirical research on the subject. Hallucinations are understood as the product of a state of consciousness in which the self is dissociated into different positions or perspectives. After reviewing the most relevant results of psychological research, dialogical self theory is proposed as the theoretical framework for understanding hallucinatory experiences. It is argued that the voices possess a series of characteristics, pragmatic properties, relationships with the voices similar to their social surroundings, and more dissociative experiences in people who experience voices than in those who do not, with which they may be considered a dialogical experience. Finally, a model attempting to integrate psychological research on AVHs within the framework of dialogical self theory is presented.     

Neuropsychological impairments in the recognition of faces, voices, and personal names

In order to determine the dissociability of face, voice, and personal name recognition, we studied the performance of 36 brain-lesioned patients and 20 control subjects. Participants performed familiarity decisions for portraits, voice samples, and written names of celebrities and unfamiliar people. In those patients who displayed significant impairments in any of these tests, the specificity of these impairments was tested using corresponding object recognition tests (with pictures of objects, environmental sounds, or written common words as stimuli). The results showed that 58% of the patients were significantly impaired in at least one test of person recognition. Moreover, 28% of the patients showed impairments that appeared to be specific for people (i.e., performance was preserved in the corresponding object recognition test). Three patients showed a deficit that appeared to be confined to the recognition of familiar voices, a pattern that was not described previously. Results were generally consistent with the assumption that impairments in face, voice, and name recognition are dissociable from one another. In contrast, there was no clear evidence for a dissociability between deficits in face and voice naming. The results further suggest that (a) impairments in person recognition after brain lesions may be more common than was thought previously and (b) the patterns of impairment that were observed can be interpreted using current cognitive models of person recognition (Bruce & Young, 1986; Burton, Bruce, & Johnston, 1990).     

Acculturation and Familiarity With, Attitudes Towards and Beliefs about Genetic Testing for Cancer Risk Within Latinas in East Harlem, New York City

Recent research underscores the need for increasing use of genetic testing for cancer risk in Latinos. This study examined the influence of acculturation on attitudes, beliefs about and familiarity with genetic testing for cancer risk in a community-based sample of Latinas in East Harlem, New York City (N = 103). Multivariate linear regression models analyzed the relationship of acculturation to: (1) familiarity (2) perceived benefits (3) perceived barriers and (4) concerns about abuses of genetic testing for cancer risk. Controlling for sociodemographic factors, results revealed that with increasing acculturation Latinas were more familiar with genetic testing (β = 1.62, SE = 0.72, p = 0.03), more likely to cite perceived benefits (β = 1.67, SE = 0.79, p = 0.04), and less likely to report perceived barriers related to genetic testing (β = −2.76, SE = 1.64, p = 0.10). Study results may help inform the development of culturally-appropriate health education outreach materials and programs targeted to increase awareness, knowledge and understanding about genetic testing for cancer risk within Latinas.