Experiencing malevolent voices is associated with attentional dysfunction in psychotic patients

Kråkvik, Bodil; Stiles, Tore C.; Hugdahl, Kenneth

doi:10.1111/sjop.12024

Cited by 10 publications

(6 citation statements)

References 38 publications

(48 reference statements)

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“…Another clinical aspect of auditory hallucinations is capturing of attention, such that attention focus goes towards the inner voice rather than towards the outer surrounding environment. This has been the subject of psychological interventions (e.g., cognitive behaviour therapy), where the aim is to have the patient cognitively inhibit the inner voices and shift attention to the outer voices ( 4 ).…”

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confidence: 99%

Auditory Hallucinations as Translational Psychiatry: Evidence from Magnetic Resonance Imaging

Hugdahl

2017

Balkan Med J

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In this invited review article, I present a translational perspective and overview of our research on auditory hallucinations in schizophrenia at the University of Bergen, Norway, with a focus on the neuronal mechanisms underlying the phenomenology of experiencing “hearing voices”. An auditory verbal hallucination (i.e. hearing a voice) is defined as a sensory experience in the absence of a corresponding external sensory source that could explain the phenomenological experience. I suggest a general frame or scheme for the study of auditory verbal hallucinations, called Levels of Explanation. Using a Levels of Explanation approach, mental phenomena can be described and explained at different levels (cultural, clinical, cognitive, brain-imaging, cellular and molecular). Another way of saying this is that, to advance knowledge in a research field, it is not only necessary to replicate findings, but also to show how evidence obtained with one method, and at one level of explanation, converges with evidence obtained with another method at another level. To achieve breakthroughs in our understanding of auditory verbal hallucinations, we have to advance vertically through the various levels, rather than the more common approach of staying at our favourite level and advancing horizontally (e.g., more advanced techniques and data acquisition analyses). The horizontal expansion will, however, not advance a deeper understanding of how an auditory verbal hallucination spontaneously starts and stops. Finally, I present data from the clinical, cognitive, brain-imaging, and cellular levels, where data from one level validate and support data at another level, called converging of evidence. Using a translational approach, the current status of auditory verbal hallucinations is that they implicate speech perception areas in the left temporal lobe, impairing perception of and attention to external sounds. Preliminary results also show that amygdala is implicated in the emotional «colouring» of the voices and that excitatory neurotransmitters might be involved. What we do not know is why hallucinatory episodes occur spontaneously, why they fluctuate over time, and what makes them spontaneously stop. Moreover, is voice hearing a category or dimension in its own right, independent of diagnosis, and why is the auditory modality predominantly implicated in psychotic disorders, while the visual modality dominates in, for example, neurological diseases?

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Auditory Hallucinations as Translational Psychiatry: Evidence from Magnetic Resonance Imaging

Hugdahl

2017

Balkan Med J

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“… d Unpublished data from the Bergen ERC VOICE project, University of Bergen, Norway. e Data from Kråkvik et al (2013) 36 . f Data from Waters et al (2003) 37 .…”

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The Beliefs about Voices Questionnaire – Revised: A factor structure from 450 participants

Strauss

Hugdahl

Waters

et al. 2018

Psychiatry Research

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Hallucinated voices are common across psychiatric and non-clinical groups. The predominant cognitive theory about the impact of voices posits that beliefs about voice power (‘Omnipotence’) and voice intent (‘Malevolence’/‘Benevolence’) play a key role in determining emotional and behavioral reactions. The revised Beliefs about Voices Questionnaire (BAVQ-R) was designed to assess these constructs, together with two styles of responding (Engagement and Resistance). The BAVQ-R is widely used in clinical and research settings, yet it has not received validation of its constructs and factor structure. This study examined the factor structure of the BAVQ-R by combining datasets from five study centers, comprising 450 participants (belief constructs) and 269 participants (response styles), and using confirmatory and exploratory factor analysis. Findings failed to support a three factor belief model, instead showing a two-factor structure (‘Persecutory beliefs’ combining Omnipotence and Malevolence constructs, and a Benevolent construct). Emotional and behavioral items did not separate. Overall, results showed that (i) a two-factor model of beliefs (Persecutory and Benevolent beliefs) provides a better fit to the data than a three-factor model, and (ii) emotional and behavioral modes of responding items should not be separated. Theoretical implications of this finding are discussed in relation to the research and therapy.

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“…Reductions in conviction of beliefs about the power/ authority (omnipotence) of voices and compliance to voices have been observed in previous group CBTp trials (105)(106)(107) and are clinically important considering that our patients' hallucinations have failed to respond to effective antipsychotic drugs. Employing specialized interventions like CBTv to target beliefs about voice omnipotence, particularly with respect to commanding aspects of the voices, which have been linked to a range of dangerous behaviors (aggression, violence, self-harm, and suicide), is a therapeutically relevant goal as voice omnipotence predicts compliance to hallucinations, and reductions in these beliefs about voices are associated with reduced cognitive functioning given their negative relationship with exogenous attentional processes (26,(108)(109)(110).…”

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confidence: 99%

Change in the Neural Response to Auditory Deviance Following Cognitive Therapy for Hallucinations in Patients With Schizophrenia

et al. 2020

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Adjunctive psychotherapeutic approaches recommended for patients with schizophrenia (SZ) who are fully or partially resistant to pharmacotherapy have rarely utilized biomarkers to enhance the understanding of treatment-effective mechanisms. As SZ patients with persistent auditory verbal hallucinations (AVH) frequently evidence reduced neural responsiveness to external auditory stimulation, which may impact cognitive and functional outcomes, this study examined the effects of cognitive behavioral therapy for voices (CBTv) on clinical and AVH symptoms and the sensory processing of auditory deviants as measured with the electroencephalographically derived mismatch negativity (MMN) response. Twenty-four patients with SZ and AVH were randomly assigned to group CBTv treatment or a treatment as usual (TAU) condition. Patients in the group CBTv condition received treatment for 5 months while the matched control patients received TAU for the same period, followed by 5 months of group CBTv. Assessments were conducted at baseline and at the end of treatment. Although not showing consistent changes in the frequency of AVHs, CBTv (vs. TAU) improved patients' appraisal (p = 0.001) of and behavioral/emotional responses to AVHs, and increased both MMN generation (p = 0.001) and auditory cortex current density (p = 0.002) in response to tone pitch deviants. Improvements in AVH symptoms were correlated with change in pitch deviant MMN and current density in left primary auditory cortex. These findings of improved auditory information processing and symptom-response attributable to CBTv suggest potential clinical and functional benefits of psychotherapeutical approaches for patients with persistent AVHs.

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Experiencing malevolent voices is associated with attentional dysfunction in psychotic patients

Cited by 10 publications

References 38 publications

Auditory Hallucinations as Translational Psychiatry: Evidence from Magnetic Resonance Imaging

Auditory Hallucinations as Translational Psychiatry: Evidence from Magnetic Resonance Imaging

The Beliefs about Voices Questionnaire – Revised: A factor structure from 450 participants

Change in the Neural Response to Auditory Deviance Following Cognitive Therapy for Hallucinations in Patients With Schizophrenia

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