RESUMO
Auditory verbal hallucinations (AVH) are a characteristic symptom of psychosis. An influential cognitive model accounting for the mechanisms in the generation of AVHs describes a defective monitoring of inner speech, leading to the misidentification of internally generated thoughts as externally generated events. In this study, we utilized an inner speech paradigm during a simultaneous measurement with functional near-infrared spectroscopy (fNIRS) and functional magnetic resonance imaging (fMRI), in order to replicate the findings of neural correlates of inner speech and auditory verbal imagery (AVI) in healthy subjects, reported in earlier studies, and to provide the first validation of the paradigm for fNIRS measurements. To this end, 20 healthy subjects were required to generate and silently recite first and second person sentences in their own voice (inner speech) and imagine the same sentences in a different, alien voice (AVI). Furthermore, questionnaires were deployed to assess the predisposition to acoustic hallucinations and schizotypal traits to investigate their connection to activation patterns associated with inner speech and monitoring processes. The results showed that both methods, fNIRS and fMRI, exhibited congruent activations in key brain areas, claimed to be associated with monitoring processes, indicating that the paradigm seems to be applicable using fNIRS alone. Furthermore, the results showed similar brain areas activated during inner speech and monitoring processes to those from earlier studies. However, our results indicate that the activations were dependent more on the sentence form and less on the imaging condition, showing more active brain areas associated with second person sentences. Integration of the sentence construction into the model of inner speech and deficient monitoring processes as the basis for the formation of AVHs should be considered in further studies. Furthermore, negative correlations between questionnaires' scores and activations in precentral gyrus and premotor cortex indicate a relationship of schizotypal characteristics and a deficient activation pattern.
RESUMO
Inner speech has been shown to vary in form along several dimensions. Along condensation, condensed inner speech forms have been described, that are supposed to be deprived of acoustic, phonological and even syntactic qualities. Expanded forms, on the other extreme, display articulatory and auditory properties. Along dialogality, inner speech can be monologal, when we engage in internal soliloquy, or dialogal, when we recall past conversations or imagine future dialogs involving our own voice as well as that of others addressing us. Along intentionality, it can be intentional (when we deliberately rehearse material in short-term memory) or it can arise unintentionally (during mind wandering). We introduce the ConDialInt model, a neurocognitive predictive control model of inner speech that accounts for its varieties along these three dimensions. ConDialInt spells out the condensation dimension by including inhibitory control at the conceptualization, formulation or articulatory planning stage. It accounts for dialogality, by assuming internal model adaptations and by speculating on neural processes underlying perspective switching. It explains the differences between intentional and spontaneous varieties in terms of monitoring. We present an fMRI study in which we probed varieties of inner speech along dialogality and intentionality, to examine the validity of the neuroanatomical correlates posited in ConDialInt. Condensation was also informally tackled. Our data support the hypothesis that expanded inner speech recruits speech production processes down to articulatory planning, resulting in a predicted signal, the inner voice, with auditory qualities. Along dialogality, covertly using an avatar's voice resulted in the activation of right hemisphere homologs of the regions involved in internal own-voice soliloquy and in reduced cerebellar activation, consistent with internal model adaptation. Switching from first-person to third-person perspective resulted in activations in precuneus and parietal lobules. Along intentionality, compared with intentional inner speech, mind wandering with inner speech episodes was associated with greater bilateral inferior frontal activation and decreased activation in left temporal regions. This is consistent with the reported subjective evanescence and presumably reflects condensation processes. Our results provide neuroanatomical evidence compatible with predictive control and in favor of the assumptions made in the ConDialInt model.