Self-focused attention in schizophrenic patients with and without auditory hallucinations and normal subjects: A comparative study

Self-focused attention has been implicated in a number of psychiatric disorders, but little research has examined this in schizophrenic subjects. In this study, a sample of schizophrenic patients experiencing auditory hallucinations, schizophrenic patients not experiencing auditory hallucinations and normal controls were asked to complete the private self-consciousness subscale of the Self Consciousness Scale. It was found that patients experiencing auditory hallucinations exhibited significantly higher levels of self-focus than those not experiencing hallucinations, although they did not differ from normal subjects. It was also shown that level of self-focus predicted whether or not subjects experienced hallucinations. These results, and their implications, are discussed with reference to the literature.     

Delusions and hallucinations of cocaine abusers and paranoid schizophrenics: a comparative study

We compared delusions and hallucinations of 100 cocaine abusers and 100 paranoid schizophrenic subjects admitted to an East Texas state psychiatric hospital. Subjects in both groups feared that individuals or organized groups might harm them in some way, but delusions of the paranoid schizophrenic subjects were more often bizarre than those of the cocaine abuse subjects. "Cocaine bugs" (parasitosis) were more often found in the cocaine abuse subjects. Command hallucinations were found in both groups, but the commands of the schizophrenic group more often related to harming or killing others. Cocaine abusers had a greater frequency of visual hallucinations (47 to 7), distinguished by shadows, flashing lights ("snow lights"), objects moving and bugs crawling on the arm. Finally, the most distinguishing characteristics were identity delusions, possession delusions, grandiose delusions (other than identities and possessions), and delusions that their families were imposters (Capgras Syndrome) reported by paranoid schizophrenics. No such delusions were reported by the cocaine abusers.     

Brain-mind states: reciprocal variation in thoughts and hallucinations

The exclusion of thinking from recent studies of sleep mentation has hindered a full appreciation of how cognitive activity differs across the states of waking and sleep. To overcome this limitation, this study investigated thoughts and hallucinations using experience sampling, home-based sleep-wake monitoring, and formal analyses of the psychological data. The prevalence of thoughts decreased gradually from waking through sleep onset and non-REM sleep, to reach its nadir in REM sleep, whereas hallucinations increased sharply across these states. Furthermore, multiple occurrences of hallucinations but not of thoughts increased significantly from sleep onset through non-REM sleep, to a peak in REM sleep. This reciprocity in thoughts and hallucinations might reflect a progressive shift from high to low aminergic-to-cholinergic neuromodulatory ratios across wake-sleep states, accompanied by an array of changes in the regional activation patterns of the brain.     

The modification of auditory hallucinations

The ABAB withdrawal design was used to document the effectiveness of a behavioral treatment package in reducing the duration of auditory hallucinations of a chronically mentally ill inpatient. Results revealed clear functional control of the treatment package over the occurrence of the subject's auditory hallucinations during a 2-hr time period.     

Coping strategies for auditory hallucinations: A review

This article reviews the literature on the strategies which psychiatric patients spontaneously use in order to cope with their auditory hallucinations. The common strategies found between studies are described and these are grouped according to four categories: (i) social contact; (ii) sensory stimulation; (iii) physiological arousal; and (iv) cognitive strategies. An attempt is made to relate these strategies to the theoretical and experimental literature on auditory hallucinations and, finally, the role of the counselling psychologist in fostering the development of effective coping strategies is outlined.     

Functioning of the phonological loop in auditory hallucinations

Two experiments designed to assess the functioning of the phonological store and loop were carried out with schizophrenic patients experiencing auditory hallucinations, schizophrenic patients not experiencing hallucinations and normal subjects. In the first experiment, phonological encoding was assessed. Although both groups of psychiatric patients performed more poorly overall than the normal subjects, there were no significant differences between the performances of the hallucinating and nonhallucinating patients. In the second experiment, the unattended speech effect (a phenomenon thought to reflect the functioning of the phonological store in normal subjects) was assessed in hallucinating schizophrenic patients, non-hallucinating schizophrenic patients and normal controls. The psychiatric patients performed more poorly overall than the normal subjects, but there was no evidence of abnormal functioning of the phonological store or loop in either patient group. Overall, the findings indicate that phonological store and loop abnormalities are not implicated in the experience of auditory hallucinations.     

Hearing in passerine and psittacine birds: a comparative study of absolute and masked auditory thresholds

Operant conditioning and a psychophysical tracking procedure were used to measure auditory thresholds for pure tones in quiet and in noise for seven species of small birds--the budgerigar, canary, cockatiel, European starling, song sparrow, swamp sparrow, and the zebra finch. Audibility curves are roughly similar among the seven birds, with the maximum sensitivity between 2 and 5 kHz and poorer sensitivity outside this narrow region. Critical ratios (signal-to-noise ratio at masked threshold) were calculated from pure-tone thresholds in noise. Except for the budgerigar, the critical ratio functions of all birds increase at the rate of 3 dB/octave. This pattern is typical of that observed in most vertebrates. Critical ratios in the budgerigar, on the other hand, decrease gradually from 0.5 kHz to 2.8 kHz and increase dramatically above 2.8 kHz. The present research demonstrates that the critical ratio function for the budgerigar is not only different from other vertebrates but also different from other birds.     

The role of metacognitive beliefs in auditory hallucinations

The mechanisms contributing to the occurrence of auditory hallucinations have not been fully described, although many researchers agree that they may result from some type of misattributed cognitive event. A number of authors have shown that this misattribution may be influenced by ‘top down' processes such as beliefs and expectations. This type of cognitive bias has also been implicated in other psychological disorders. One area of focus, particularly within the anxiety disorders, has been on metacognitive beliefs and their role in the occurrence and maintenance of symptoms. Metacognitive beliefs have not been widely investigated in psychosis and tools to investigate them have not been developed. In this study, a metacognitions questionnaire [MCQ; Cartwright-Hatton, S., & Wells, A. (1997). Journal of Anxiety Disorders, 11(3),279–296.] (previously used with anxiety disorders) was modified and used to assess metacognitive beliefs with schizophrenic patients. Metacognitive beliefs were compared between schizophrenic patients who were currently experiencing auditory hallucinations and schizophrenic patients who had never had hallucinations. A group of patients with anxiety disorders and a group of non-patients were used as controls. Hallucinating and non-hallucinating schizophrenics scored significantly higher than both the non-patient group and the anxiety patient group on the amount to which they believed their thoughts should be consistent with each other. Hallucinators and anxiety controls had significantly lower confidence in their cognitive processes than non-hallucinating schizophrenics and normal controls. The significance of these findings are discussed in relation to the literature on cognitive processes in hallucinations.     

Alien voices and inner dialogue: towards a developmental account of auditory verbal hallucinations

The phenomenon of auditory verbal hallucinations (AVHs) is one of the most intriguing features of the psychiatric literature. Two alternative models of the development of AVHs in both normal and psychotic populations are proposed. In the disruption to internalisation (DI) model, AVHs result from a disruption to the normal processes of internalisation of inner speech. In the re-expansion (RE) model, AVHs result when normal inner speech is re-expanded into inner dialogue under conditions of stress and cognitive challenge. Both models draw on Vygotsky's (The Collected Works Of L.S. Vygotsky, New York, Plenum Press, 1987) ideas about the development of inner speech. On this view, normal inner speech is considerably abbreviated relative to external speech, and also undergoes some important semantic transformations. In both the DI and RE models, AVHs arise when the subject's inner speech involves inappropriately expanded inner dialogue, leading the subject to experience the voices in the dialogue as alien. The two models may prove useful in explaining some of the social-developmental evidence surrounding the phenomenon, and also make a number of testable predictions which are suggested as priorities for future research.     

Intrusive thoughts mediate the association between neuroticism and cognitive function

Although research has established a negative association between trait neuroticism and cognition, little is known about the mechanisms that underlie this relationship. We examined the tendency to experience intrusive thoughts and negative affect as potential mediators of the relationship between neuroticism and cognitive performance. We hypothesized that the tendency to experience intrusive thoughts reflects ineffective attentional control and would account for the relationship between neuroticism and cognitive performance over and above the mediating effect of negative affect. Three hundred seventeen adults (M_age = 49.43) completed a series of attention-demanding cognitive tasks as well as self-report measures of intrusive thoughts, negative affect, and neuroticism. Intrusive thoughts mediated the association between trait neuroticism and cognitive performance beyond negative affect. These findings are consistent with the hypothesis that the tendency to experience intrusive thoughts is a mechanism through which trait neuroticism influences cognitive performance.     

A verbal behavior analysis of auditory hallucinations

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.     

Intrusive thoughts and their relationship to actigraphic measurement of sleep: towards a cognitive model of insomnia

Although cognitive over-arousal has been hypothesised as a causal factor in sleep-onset insomnia, relatively little is known about the specific pre-sleep intrusions which delay sleep. To investigate this relationship adequately 'live', verifiable, unobtrusive and independent monitoring of thought process and sleep pattern is essential. This study was designed with these requirements in mind. Voice-activated audiotape recordings of spontaneous thoughts, and actigraphic data from which to estimate sleep parameters, were obtained over three consecutive nights from 21 participants (63 subject nights). Content analysis of transcribed audiotapes yielded eight categories of pre-sleep intrusion. Results from correlational and regression analyses indicate that thinking about sleep and the anticipated consequences of poor sleep, along with general problem-solving are the strongest predictors of objective sleep latency. Principal Components Analysis suggests that intrusions can be subsumed under one of three factors: 'active problem-solving', 'present state monitoring' and 'environmental reactivity'. Implications for cognitive models and treatments of insomnia are discussed.     

Intrusive thoughts and avoidance in breast cancer: Individual differences and association with psychological distress

Abstract Eighty-five women with newly diagnosed breast cancer were classified on the basis of high and low levels of cancer-related intrusive thoughts and avoidance at diagnosis, and their psychological adjustment was studied prospectively at 3 and 6 months post diagnosis. Patients who initially reported high levels of both intrusive thoughts and avoidance and those who reported high levels of intrusive thoughts but low avoidance experienced the highest levels of anxiety and depression symptoms, and continued intrusive thoughts and avoidance. Patients who were high in avoidance but low in intrusive thoughts also experienced adjustment problems, including increased intrusive thoughts, when compared with patients who were low in both types of symptoms. The findings highlight the value of considering subgroup differences in patterns of intrusion and avoidance as predictors of subsequent psychological adjustment to breast cancer.     

休谟与荀子正义思想比较研究

苏格兰启蒙运动研究和"中国正义论"研究的兴起为我们比较研究休谟和荀子的正义思想提供了可能与基础。休谟和荀子两人在"性恶"理论、正义产生的初始情境、正义产生的逻辑结构及以"分"为核心的正义规则特质方面有着相似的认识。不过,由于对"人为"的含义以及"分"的内容方面理解的差异,使得两者的正义思想最终呈现出对立的特质。荀子和休谟的正义思想的比较研究为我们沟通与理解中西方政治思想提供了一个生动的案例。     

Intrusive thoughts and avoidance in breast cancer: Individual differences and association with psychological distress

Abstract

Eighty-five women with newly diagnosed breast cancer were classified on the basis of high and low levels of cancer-related intrusive thoughts and avoidance at diagnosis, and their psychological adjustment was studied prospectively at 3 and 6 months post diagnosis. Patients who initially reported high levels of both intrusive thoughts and avoidance and those who reported high levels of intrusive thoughts but low avoidance experienced the highest levels of anxiety and depression symptoms, and continued intrusive thoughts and avoidance. Patients who were high in avoidance but low in intrusive thoughts also experienced adjustment problems, including increased intrusive thoughts, when compared with patients who were low in both types of symptoms. The findings highlight the value of considering subgroup differences in patterns of intrusion and avoidance as predictors of subsequent psychological adjustment to breast cancer.     

Connecting neurosis and psychosis: the direct influence of emotion on delusions and hallucinations

Diagnostic classification systems contain a core divide between neurosis and psychosis, leading to their separate study and treatment. The basis for the separation of the disorders is outlined and reassessed. It is argued that the empirical evidence does not support such a sharp distinction between neurosis and psychosis. The frequent occurrence of emotional disorder prior to and accompanying psychosis indicates that neurosis contributes to the development of the positive symptoms of psychosis. Psychological theories and experimental evidence concerning the influence of emotion on the content and form of delusions and hallucinations are therefore reviewed. It is argued that in many cases delusions are a direct representation of emotional concerns, and that emotion contributes to delusion formation and maintenance. The content of hallucinations less often directly expresses the emotional concerns of the individual, but emotion can trigger and contribute to the maintenance of hallucinatory phenomena, although how this occurs is not well understood. It is concluded that study needs to be made of the interaction between psychotic and neurotic processes in the development of delusions and hallucinations, and that neurotic and psychotic disorders may have common maintenance processes.     

Social anxiety and the shame of psychosis: a study in first episode psychosis

Social anxiety disorder (SaD) or social phobia is a co-morbid affective disorder in schizophrenia, present in up to one in three individuals. We employ 'social rank' theory to predict that one pathway to social anxiety in schizophrenia is triggered by the anticipation of a catastrophic loss of social status that the stigma of schizophrenia can entail. A group of 79 people with a first episode of psychosis were assessed for social anxiety: hypotheses were tested comparing 23 socially anxious and 56 non-anxious patients on measures of cognitive appraisals of shame/stigma of psychosis and perceived social status, controlling for depression, psychotic symptoms and general psychopathology. Participants with social anxiety experienced greater shame attached to their diagnosis and felt that the diagnosis placed them apart from others, i.e., socially marginalised them and incurred low social status. We propose a stigma model of social anxiety that makes testable predictions about how the shame beliefs may contaminate social interaction and thereby exacerbate and maintain social phobia.     

Dichotic listening in college students who report auditory hallucinations

College students were placed in 2 groups, hallucinators and nonhallucinators, on the basis of their responses to a verbal hallucinations questionnaire. Both groups were given a consonant-vowel version of a Dichotic Listening Test under 3 conditions: nonforced, forced-right, and forced-left. When hallucinators were instructed to attend to the left ear stimuli (forced-left condition), they had fewer correct responses to right ear syllables than did nonhallucinators. This resulted in a left ear advantage for hallucinators. When nonhallucinators were instructed to attend to the left ear, they maintained a right ear advantage. Results suggest that auditory hallucinations in college students are associated with differences in hemispheric functioning.     

Anxiety and depression and their links with delusions and hallucinations in people with a dual diagnosis of psychosis and substance misuse: a study using data from a randomised controlled trial

Rates of depression and anxiety have been linked to severity and distress associated with positive symptoms in psychosis. There is also tentative evidence to suggest that these concurrent symptoms might be related to delusional and hallucinatory content. Our aim was to assess the cross-sectional associations between anxiety and depression, and hallucination and delusion severity and distress in a sample of 327 people dually diagnosed with psychosis and substance misuse problems. In addition, the relationships between specific symptom content and levels of anxiety and depression were examined. Anxiety was associated with delusion distress and depression with hallucination distress, although neither was related to symptom severity. Auditory commands to harm or kill the self were associated with higher levels of depression. Delusions with themes pertaining to the paranormal, and those with references to celebrities were associated with lower levels of depression. No specific delusion or hallucination content was associated with level of anxiety, when other variables were controlled for. The results demonstrate that anxiety and depression are linked to distinct aspects of psychotic experience, highlighting the need to acknowledge the role of these concurrent symptoms in the context of psychosis. In addition, findings relating to specific types of delusions and hallucinations highlight avenues for further research.