Paranoid delusions and threatening hallucinations: a prospective study of sleep paralysis experiences

Previously we reported a three-factor structure for hallucinations accompanying sleep paralysis (SP). These earlier analyses were, however, based on retrospective accounts. In a prospective study, 383 individuals reported individual episodes online providing further evidence for the three-factor structure as well as clearer conceptually meaningful relations among factors than retrospective studies. In addition, reports of individual episodes permitted a more fine-grained analysis of the internal structure of factors to assess predictions based on the hypothesis that a sensed or felt presence (FP) is a core experience affecting other SP hallucinations. Results were generally consistent with this hypothesis. In particular, associations among, and temporal stability of, sensory hallucinations were largely explained by their common association with FP. The findings are consistent with REM initiation of a threat activated vigilance system with pervasive effects on the SP experience and suggest a potential model for the thematic organization of nightmares and dreams more generally.     

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.     

Infant psychopathology during the first year of life and its return during adolescence and adulthood

This is a presentation of different clinical cases having in common severe infantile traumatic events during the first year of life. From the disappearance of mother and father during Latin-American dictatorships, to another patient who hallucinates that bats fly out of his cheeks, this paper tries to bring light into the difficult times of these patients and how the analysts worked with infantile parts of the self which were inside the adult patients.     

An inter-subjective multi-factorial model of auditory verbal hallucinations in schizophrenia

Auditory verbal hallucinations (AVHs) are perceptive-like experiences happening without appropriate stimuli that in individuals with schizophrenia very often feature distressing contents. AVH frequently interfere with social relationships or result in dangerous behaviours. We hypothesize that in schizophrenia several vulnerability factors, especially when a subject is engaged in real or represented interpersonal transactions, lead to the appearance of AVHs, and favour their self-perpetuation over time. We analyse the different psychological factors that, according to empirical studies and clinical experience with persons with schizophrenia, seem involved in the genesis of AVHs. Several vulnerability factors appear to interact with situational ones to trigger AVHs: a) a facilitation of neural transmission from the premotor regions to the perceptual ones; b) a difficulty attuning with others, c) interpersonal schemas, provoking emotional suffering, intrusive thoughts and rumination; d) metacognitive dysfunctions. Once AVHs have appeared, further factors promote their perpetuation over time: a) cognitive factors like ruminative processing on AVHs, b) metacognitive beliefs about AVHs. An integrated theoretical model of AVHs is described and ideas for its empirical testing are suggested.     

Metacognitions in patients with hallucinations and obsessive-compulsive disorder: the superstition factor

On the basis of the analogy between intrusive thoughts and auditory hallucinations established by Morrison et al. [(1995). Intrusive thoughts and auditory hallucinations: a cognitive approach. Behavioural and Cognitive Psychotherapy, 23, 265-280], the present work compares the metacognitive beliefs and processes of five groups of patients (current hallucinators, never-hallucinated people with a diagnosis of schizophrenia, recovered hallucinators, obsessive-compulsive disorder (OCD) patients, and a clinical control group) and a non-clinical group. The results show that of the five metacognitive factors considered in this study, two were found to be different in the current hallucinators group in comparison to any other group in the design. Likewise, it is found that the metacognitive beliefs of the current hallucinators coincide with those of the OCD patients in various factors, particularly that relating to superstition, and this is interpreted as lending support to the model of Morrison et al. (1995). Furthermore, the results are discussed in the light of existing research on Thought-Action Fusion, stressing the role that may be played by superstitious beliefs and magical thinking in auditory hallucinations and OCD.     

Re-expanding the phenomenology of hallucinations: lessons from sixteenth-century Spain

The paradigm within which hallucinations are studied, and the explanatory frameworks employed, may bias the phenomenological analysis of these experiences. After introducing the new term, hallucination, this paper undertook an inter-disciplinary study of the phenomenology of hallucinations identified by the sixteenth-century theologians, St John of the Cross and St Teresa of Avila. It was examined whether the phenomenological properties they highlighted are identified and addressed by contemporary psychological research. Many of these properties were indeed found to be acknowledged and studied by contemporary research in psychiatric patients, as well as in healthy individuals during hypnagogia, near-death experiences and at times of stress. However, many experiences, such as “internal voices,” “soundless voices,” and “voices that save,” were found to be neglected by contemporary research, as was the potential for hallucinations to communicate novel/original information. Finally, it was examined how these phenomenological insights may be “front-loaded” into future experimental designs.     

Auditory Verbal Experience and Agency in Waking,Sleep Onset,REM, and Non‐REM Sleep

We present one of the first quantitative studies on auditory verbal experiences (“hearing voices”) and auditory verbal agency (inner speech, and specifically “talking to (imaginary) voices or characters”) in healthy participants across states of consciousness. Tools of quantitative linguistic analysis were used to measure participants’ implicit knowledge of auditory verbal experiences (VE) and auditory verbal agencies (VA), displayed in mentation reports from four different states. Analysis was conducted on a total of 569 mentation reports from rapid eye movement (REM) sleep, non‐REM sleep, sleep onset, and waking. Physiology was controlled with the nightcap sleep–wake mentation monitoring system. Sleep‐onset hallucinations, traditionally at the focus of scientific attention on auditory verbal hallucinations, showed the lowest degree of VE and VA, whereas REM sleep showed the highest degrees. Degrees of different linguistic‐pragmatic aspects of VE and VA likewise depend on the physiological states. The quantity and pragmatics of VE and VA are a function of the physiologically distinct state of consciousness in which they are conceived.     

Cognitive Therapy for Command Hallucinations: Not a Quasi-Neuroleptic

Command hallucinations (CH) are a distressing and high-risk group of symptoms that have long been recognised but little understood, with few effective treatments. In this paper we report and discuss the efficacy of cognitive therapy (CT) modified in accordance with ‘social rank theory,’ in a single blind randomised controlled trial. 38 patients with command hallucinations were randomly allocated to CT or treatment as usual and followed up for 6 then 12 months. Large reductions in compliance behaviour were obtained (effect size = 0.97) favouring the CT group. Other significant differences were found and maintained at 6 months follow up.     

Immediate source-monitoring, self-focused attention and the positive symptoms of schizophrenia

Previous research suggests that tendencies to misattribute one's own thoughts to an external source, as assessed by an immediate source-monitoring test, are associated with auditory verbal hallucinations (AVHs). However, recent research suggests that such tendencies are associated instead with symptoms of thought interference. The main aim of the present study was to examine whether such tendencies are differentially associated with different types of thought interference, with AVHs, or with both. It has also been suggested that external misattributions are especially likely to occur with emotionally salient material and if the individual's focus is on the self. These suggestions were also tested. The positive psychotic symptoms of 57 individuals with a diagnosis of schizophrenia were assessed and they then completed the Self-Focus Sentence Completion blank. Immediately after completing each sentence they were asked to indicate to what extent the sentence was their own. The number of sentences that were not rated as completely their own served as their externalisation score. Externalisation scores correlated significantly with the severity of three symptoms: voices commenting, delusions of being controlled, and thought insertion. In a logistic regression analysis, all three of these symptoms were significantly and independently related to externalisation. Externalisation was not associated with either a negative or a neutral self-focus. Thus tendencies to misattribute one's own thoughts to an external source are associated with AVHs and some, but not all, symptoms of thought interference. The importance for externalisation of self-focused attention and of the emotional salience of the elicited thoughts was not supported.     

The effects of focus of attention on attributional bias in patients experiencing auditory hallucinations

Cognitive models suggest that auditory hallucinations occur as the result of internal events attributed to an external source. The present study represents an attempt to evaluate the source monitoring performance of people who experience auditory hallucinations, specifically in terms of the suggested links between source monitoring, emotionality of stimuli and self-focused attention. The source monitoring performance of a group of 30 patients with a diagnosis of a schizophrenia spectrum disorder who experience auditory hallucinations was compared following successful experimental manipulation of their attention, designed to increase and decrease their levels of self-focused attention. The inclusion of words previously rated as emotionally salient by schizophrenic patients assessed the effect of emotionality on source monitoring performance. This study demonstrated that participants' ratings of both internality and control of their responses to the word association task were lower in the external focus condition than the internal focus condition. Furthermore, it was found that ratings of internality and control were lower for responses to both positive and negative stimuli compared to responses to neutral stimuli, and the magnitude of these differences was amplified in the internal focus condition relative to the external focus condition. Focus of attention has a significant effect on source monitoring performance in people experiencing auditory hallucinations. The theoretical and clinical implications of these findings are discussed.