Varieties of felt presence? Three surveys of presence phenomena and their relations to psychopathology.

BACKGROUND: Experiences of felt presence (FP) are well documented in neurology, neuropsychology and bereavement research, but systematic research in relation to psychopathology is limited. FP is a feature of sensorimotor disruption in psychosis, hypnagogic experiences, solo pursuits and spiritual encounters, but research comparing these phenomena remains rare. A comparative approach to the phenomenology of FP has the potential to identify shared and unique processes underlying the experience across these contexts, with implications for clinical understanding and intervention. METHODS: We present a mixed-methods analysis from three online surveys comparing FP across three diverse contexts: a population sample which included people with experience of psychosis and voice-hearing (study 1, N = 75), people with spiritual and spiritualist beliefs (study 2, N = 47) and practitioners of endurance/solo pursuits (study 3, N = 84). Participants were asked to provide descriptions of their FP experiences and completed questionnaires on FP frequency, hallucinatory experiences, dissociation, paranoia, social inner speech and sleep. Data and code for the study are available via OSF. RESULTS: Hierarchical linear regression analysis indicated that FP frequency was predicted by a general tendency to experience hallucinations in all three studies, although paranoia and gender (female > male) were also significant predictors in sample 1. Qualitative analysis highlighted shared and diverging phenomenology of FP experiences across the three studies, including a role for immersive states in FP. CONCLUSIONS: These data combine to provide the first picture of the potential shared mechanisms underlying different accounts of FP, supporting a unitary model of the experience.

Brain Mechanisms Underlying the Subjective Experience of Remembering.

The ability to remember events in vivid, multisensory detail is a significant part of human experience, allowing us to relive previous encounters and providing us with the store of memories that shape our identity. Recent research has sought to understand the subjective experience of remembering, that is, what it feels like to have a memory. Such remembering involves reactivating sensory-perceptual features of an event and the thoughts and feelings we had when the event occurred, integrating them into a conscious first-person experience. It allows us to reflect on the content of our memories and to understand and make judgments about them, such as distinguishing events that actually occurred from those we might have imagined or been told about. In this review, we consider recent evidence from functional neuroimaging in healthy participants and studies of neurological and psychiatric conditions, which is shedding new light on how we subjectively experience remembering.

Correlates of Hallucinatory Experiences in the General Population: An International Multisite Replication Study.

Hallucinatory experiences can occur in both clinical and nonclinical groups. However, in previous studies of the general population, investigations of the cognitive mechanisms underlying hallucinatory experiences have yielded inconsistent results. We ran a large-scale preregistered multisite study, in which general-population participants (N = 1,394 across 11 data-collection sites and online) completed assessments of hallucinatory experiences, a measure of adverse childhood experiences, and four tasks: source memory, dichotic listening, backward digit span, and auditory signal detection. We found that hallucinatory experiences were associated with a higher false-alarm rate on the signal detection task and a greater number of reported adverse childhood experiences but not with any of the other cognitive measures employed. These findings are an important step in improving reproducibility in hallucinations research and suggest that the replicability of some findings regarding cognition in clinical samples needs to be investigated.

Tailoring cognitive behavioural therapy to subtypes of voice-hearing using a novel tabletised manual: a feasibility study.

BACKGROUND: Cognitive behavioural therapy for psychosis (CBTp) is a recommended treatment for psychotic experiences, but its effectiveness has been questioned. One way of addressing this may be to tailor therapy materials to the phenomenology of specific psychotic experiences. AIM: In this study, we investigated the acceptability of a novel treatment manual for subtypes of 'voice-hearing' experiences (i.e. auditory verbal hallucinations). An uncontrolled, single-arm design was used to assess feasibility and acceptability of using the manual in routine care for people with frequent voice-hearing experiences. METHOD: The manual was delivered on a smart tablet and incorporated recent research evidence and theory into its psychoeducation materials. In total, 24 participants completed a baseline assessment; 19 started treatment, 15 completed treatment and 12 participants completed a follow-up assessment (after 10 sessions of using the manual). RESULTS: Satisfaction with therapy scores and acceptability ratings were high, while completion rates suggested that the manual may be more appropriate for help with participants from Early Intervention in Psychosis services rather than Community Mental Health Teams. CONCLUSION: Within-group changes in symptom scores suggested that overall symptom severity of hallucinations - but not other psychosis features, or beliefs about voices - are likely to be the most appropriate primary outcome for further evaluation in a full randomised controlled trial.

Mind-mindedness versus mentalistic interpretations of behavior: Is mind-mindedness a relational construct?

Mind-mindedness is a measure of the tendency to represent significant others in internal state terms and is central to supportive parent-infant relationships. The two studies reported here explored whether mind-mindedness generalizes to representations of unknown individuals, using a novel task that assessed individual differences in adults' tendency to interpret others' behavior with reference to their internal states: the Unknown Mother-Infant Interaction Task (UMIIT). We compared UMIIT performance with measures of mind-mindedness from (a) adults' descriptions of close friends and partners (Study 1, N = 96) and (b) mothers' appropriate versus nonattuned comments on their infants' internal states (Study 2, N = 56). In line with the proposal that mind-mindedness is a relational construct, UMIIT performance was unrelated to mind-mindedness in both studies.

La consciente mentalidad es una medida que tiende a representar a quienes nos son importantes en términos de un estado interno y es esencial para las relaciones de mucho apoyo entre progenitores e infantes. Los dos estudios que se reportan aquí exploraron si la mentalidad consciente generaliza al punto de representar a individuos desconocidos, usando una novedosa tarea que evalúa las diferencias individuales en la tendencia de los adultos a interpretar la conducta de otros en función de sus estados mentales: El Trabajo de la Interacción Madre Desconocida-Infante (UMIIT). Comparamos la actuación de UMIIT con las medidas de mentalidad consciente de (a) descripciones de adultos sobre amigos cercanos y parejas (Estudio 1, N = 96), y (b) los comentarios apropiados de las madres versus sus no armonizados comentarios con respecto a los estados internos de sus infantes (Estudio 2, N = 56). Alineado con la propuesta de que la mentalidad consciente es un concepto de la relación, la actuación de UMIIT no estuvo relacionada con la mentalidad consciente en ninguno de los estudios.

L'esprit-qualité mentale (en anglais mind-mindedness) est une mesure de la tendance à représenter les personnes qui nous sont chères en des termes d'état interne. Elle est centrale aux relations parent-enfant positives. Les deux études dont on fait état ici ont exploré si l'esprit-qualité mentale généralise les représentations d'individus inconnus, en utilisant une tâche nouvelle qui a évalué les différences individuelles dans la tendance des adultes à interpréter le comportement des autres en référence à leurs états internes: la Tâche de Mère Inconnue-Interaction du Nourrisson (UMIIT en anglais, soit Unknown Mother-Infant Interaction Task). Nous avons comparé la performance UMIIT aux mesures de l'esprit-qualité mentale de (a) descriptions d'adultes de leurs amis proches et de leurs partenaires (Etude 1, N = 96) et (b) de commentaires appropriés par rapport à pas trop appropriés des mères sur les états internes de leurs nourrissons (Etude 2, N = 56). Conformément à la proposition selon laquelle l'esprit-qualité mentale est une construction relationnelle, la performance de l'UMIIT n'était pas liée à l'esprit-qualité mentale dans les deux études.

Processing Speech and Thoughts during Silent Reading: Direct Reference Effects for Speech by Fictional Characters in Voice-Selective Auditory Cortex and a Theory-of-Mind Network.

Stories transport readers into vivid imaginative worlds, but understanding how readers create such worlds-populating them with characters, objects, and events-presents serious challenges across disciplines. Auditory imagery is thought to play a prominent role in this process, especially when representing characters' voices. Previous research has shown that direct reference to speech in stories (e.g., He said, "I'm over here") may prompt spontaneous activation of voice-selective auditory cortex more than indirect speech [Yao, B., Belin, P., & Scheepers, C. Silent reading of direct versus indirect speech activates voice-selective areas in the auditory cortex. Journal of Cognitive Neuroscience, 23, 3146-3152, 2011]. However, it is unclear whether this effect reflects differential processing of speech or differences in linguistic content, source memory, or grammar. One way to test this is to compare direct reference effects for characters speaking and thinking in a story. Here, we present a multidisciplinary fMRI study of 21 readers' responses to characters' speech and thoughts during silent reading of short fictional stories. Activations relating to direct and indirect references were compared for both speaking and thinking. Eye-tracking and independent localizer tasks (auditory cortex and theory of mind [ToM]) established ROIs in which responses to stories could be tracked for individuals. Evidence of elevated auditory cortex responses to direct speech over indirect speech was observed, replicating previously reported effects; no reference effect was observed for thoughts. Moreover, a direct reference effect specific to speech was also evident in regions previously associated with inferring intentions from communication. Implications are discussed for the spontaneous representation of fictional characters and the potential roles of inner speech and ToM in this process.

'I've learned I need to treat my characters like people': Varieties of agency and interaction in Writers' experiences of their Characters' Voices.

Writers often report vivid experiences of hearing characters talking to them, talking back to them, and exhibiting independence and autonomy. However, systematic empirical studies of this phenomenon are almost non-existent, and as a result little is known about its cause, extent, or phenomenology. Here we present the results of a survey of professional writers (n = 181) run in collaboration with the Edinburgh International Book Festival. Participants provided detailed descriptions of their experiences of their characters in response to a phenomenological questionnaire, and also reported on imaginary companions, inner speech and hallucination-proneness. Qualitative analysis indicated that the phenomenology of the experience of agentive characters varied in terms of the characters' separateness from the writer's self and the kinds of interaction this did or did not allow for. We argue that these variations can be understood in relation to accounts of mindreading and agency tracking which adopt intuitive as opposed to inferential models.

Modality-general and modality-specific processes in hallucinations.

There is a growing recognition in psychosis research of the importance of hallucinations in modalities other than the auditory. This has focused attention on cognitive and neural processes that might be shared by, and which might contribute distinctly to, hallucinations in different modalities. In this article, I address some issues around the modality-generality of cognitive and neural processes in hallucinations, including the role of perceptual and reality-monitoring systems, top-down and bottom-up processes in relation to the psychological and neural substrates of hallucinations, and the phenomenon of simultaneous multimodal hallucinations of the same entity. I suggest that a functional systems approach, inspired by some neglected aspects of the writings of A. R. Luria, can help us to understand patterns of hallucinatory experience across modalities and across clinical and non-clinical groups. Understanding the interplay between modality-general and modality-specific processes may bear fruit for improved diagnosis and therapeutic approaches to dealing with distressing hallucinations.

Mothers' Early Mind-Mindedness Predicts Educational Attainment in Socially and Economically Disadvantaged British Children.

Relations between mothers' mind-mindedness (appropriate and nonattuned mind-related comments) at 8 months (N = 206), and children's educational attainment at ages 7 (n = 158) and 11 (n = 156) were investigated in a British sample. Appropriate mind-related comments were positively correlated with reading and mathematics performance at both ages but only in the low-socioeconomic status (SES) group. Path analyses showed that in the low-SES group, appropriate mind-related comments directly predicted age-11 reading performance, with age-4 verbal ability mediating the relation between appropriate mind-related comments and age-7 reading. In contrast, maternal sensitivity and infant-mother attachment security did not predict children's educational attainment. These findings are discussed in terms of genetic and environmental contributions to reading and mathematics performance.

Origins of mother-child reminiscing style.

Maternal elaborative reminiscing supports preschool children's autobiographical memory, self-concept, and emotion understanding. What are the factors contributing to mothers' elaborative style of reminiscing? In a longitudinal community sample (n = 170 at the final data point), this study explored the role of maternal depression (8-44 months), maternal sensitivity and maternal mind-mindedness (8 months), as well as child factors of joint attention (15 months), attachment security (15 months), and language (26 months) for mother-child reminiscing about a positive (happy) and a negative (scared) event at 44 months. Mothers could be classed into two groups of low versus increasing depression from 8 to 44 months, yet maternal depression did not uniquely predict mother-child reminiscing after accounting for maternal sensitivity and other factors. Instead, maternal sensitivity, children's joint attention, and language uniquely predicted children's elaborations about the scared event at 44 months, and maternal sensitivity uniquely predicted mothers' elaborations about the scared event at 44 months. Mothers who are more sensitive in early interactions may later be better at engaging their children when reminiscing about negative emotions. These findings have implications for the design of interventions targeted at supporting mothers to engage in elaborative reminiscing with their preschool children.

Distinct processing of ambiguous speech in people with non-clinical auditory verbal hallucinations.

Auditory verbal hallucinations (hearing voices) are typically associated with psychosis, but a minority of the general population also experience them frequently and without distress. Such 'non-clinical' experiences offer a rare and unique opportunity to study hallucinations apart from confounding clinical factors, thus allowing for the identification of symptom-specific mechanisms. Recent theories propose that hallucinations result from an imbalance of prior expectation and sensory information, but whether such an imbalance also influences auditory-perceptual processes remains unknown. We examine for the first time the cortical processing of ambiguous speech in people without psychosis who regularly hear voices. Twelve non-clinical voice-hearers and 17 matched controls completed a functional magnetic resonance imaging scan while passively listening to degraded speech ('sine-wave' speech), that was either potentially intelligible or unintelligible. Voice-hearers reported recognizing the presence of speech in the stimuli before controls, and before being explicitly informed of its intelligibility. Across both groups, intelligible sine-wave speech engaged a typical left-lateralized speech processing network. Notably, however, voice-hearers showed stronger intelligibility responses than controls in the dorsal anterior cingulate cortex and in the superior frontal gyrus. This suggests an enhanced involvement of attention and sensorimotor processes, selectively when speech was potentially intelligible. Altogether, these behavioural and neural findings indicate that people with hallucinatory experiences show distinct responses to meaningful auditory stimuli. A greater weighting towards prior knowledge and expectation might cause non-veridical auditory sensations in these individuals, but it might also spontaneously facilitate perceptual processing where such knowledge is required. This has implications for the understanding of hallucinations in clinical and non-clinical populations, and is consistent with current 'predictive processing' theories of psychosis.

Musical hallucinations, musical imagery, and earworms: A new phenomenological survey.

Musical hallucinations (MH) account for a significant proportion of auditory hallucinations, but there is a relative lack of research into their phenomenology. In contrast, much research has focused on other forms of internally generated musical experience, such as earworms (involuntary and repetitive inner music), showing that they can vary in perceived control, repetitiveness, and in their effect on mood. We conducted a large online survey (N = 270), including 44 participants with MH, asking participants to rate imagery, earworms, or MH on several variables. MH were reported as occurring less frequently, with less controllability, less lyrical content, and lower familiarity, than other forms of inner music. MH were also less likely to be reported by participants with higher levels of musical expertise. The findings are outlined in relation to other forms of hallucinatory experience and inner music, and their implications for psychological models of hallucinations discussed.

The varieties of inner speech questionnaire - Revised (VISQ-R): Replicating and refining links between inner speech and psychopathology.

Inner speech is a common experience for many but hard to measure empirically. The Varieties of Inner Speech Questionnaire (VISQ) has been used to link everyday phenomenology of inner speech - such as inner dialogue - to various psychopathological traits. However, positive and supportive aspects of inner speech have not always been captured. This study presents a revised version of the scale - the VISQ-R - based on factor analyses in two large samples: respondents to a survey on inner speech and reading (N = 1412) and a sample of university students (N = 377). Exploratory factor analysis indicated a five-factor structure including three previous subscales (dialogic, condensed, and other people in inner speech), an evaluative/critical factor, and a new positive/regulatory factor. Confirmatory factor analysis then replicated this structure in sample 2. Hierarchical regression analyses also replicated a number of relations between inner speech, hallucination-proneness, anxiety, depression, self-esteem, and dissociation.

Mother-Child Attachment From Infancy to the Preschool Years: Predicting Security and Stability.

Relations between maternal mind-mindedness (appropriate and nonattuned mind-related comments), children's age-2 perspective-taking abilities, and attachment security at 44 (n = 165) and 51 (n = 128) months were investigated. Nonattuned comments predicted insecure preschool attachment, via insecure 15-month attachment security (44-month attachment) and poorer age-2 perspective-taking abilities (51-month attachment). With regard to attachment stability, higher perspective-taking abilities distinguished the stable secure groups from (a) the stable insecure groups and (b) children who changed from secure to insecure (at trend level). These effects were independent of child gender, stressful life events, and socioeconomic status (SES). The contribution of these findings to our understanding of stability and change in attachment security from infancy to the preschool years is discussed.

Uncharted features and dynamics of reading: Voices, characters, and crossing of experiences.

Readers often describe vivid experiences of voices and characters in a manner that has been likened to hallucination. Little is known, however, of how common such experiences are, nor the individual differences they may reflect. Here we present the results of a 2014 survey conducted in collaboration with a national UK newspaper and an international book festival. Participants (n=1566) completed measures of reading imagery, inner speech, and hallucination-proneness, including 413 participants who provided detailed free-text descriptions of their reading experiences. Hierarchical regression analysis indicated that reading imagery was related to phenomenological characteristics of inner speech and proneness to hallucination-like experiences. However, qualitative analysis of reader's accounts suggested that vivid reading experiences were marked not just by auditory phenomenology, but also their tendency to cross over into non-reading contexts. This supports social-cognitive accounts of reading while highlighting a role for involuntary and uncontrolled personality models in the experience of fictional characters.

How does restricted and repetitive behavior relate to language and cognition in typical development?

Relations between restricted and repetitive behavior at age 26 months and children's concurrent (N = 203) and later (n = 161) social cognition and language development were investigated. Restricted and repetitive behavior was assessed using two scales: sensory and motor repetitive behaviors and rigidity/routines/restricted interests. Language was assessed at ages 26 and 51 months; social cognition was assessed at ages 26 (symbolic play) and 51 and 61 months (theory of mind). Sensory and motor repetitive behavior was negatively related to children's (a) language performance at 26 and 51 months, (b) instructed symbolic play at 26 months, and (c) theory of mind performance at 51 and 61 months. Path analyses showed that children's sensory and motor repetitive behavior at age 26 months was related to lower receptive verbal ability and theory of mind at 51 months, which led to lower theory of mind at 61 months. Rigidity/routines/restricted interests at 26 months were unrelated to concurrent and later social cognition and language. These results are discussed in terms of the pathways via which sensory and motor repetitive behavior might impact negatively on development.

Proof of concept of a mind-mindedness intervention for mothers hospitalized for severe mental illness.

Studies 1 and 2 investigated how maternal severe mental illness (SMI) related to mothers' mind-mindedness (appropriate and nonattuned mind-related comments). Study 1 showed that mothers with SMI (n = 50) scored lower than psychologically well mothers for both appropriate and nonattuned comments, whereas mothers with SMI in Study 2 (n = 22) had elevated levels of nonattuned comments. Study 2 also tested the efficacy of a single-session video-feedback intervention to facilitate mind-mindedness in mothers with SMI. The intervention was associated with a decrease in nonattuned comments, such that on discharge, mothers did not differ from psychologically well controls. Study 3 assessed infant-mother attachment security in a small subset of intervention-group mothers from Study 2 (n = 9) and a separate group of standard care mothers (n = 30) at infant mean age 17.1 months (SD = 2.1). Infants whose mothers completed the intervention were more likely to be securely attached and less likely to be classified as insecure-disorganized than those of mothers who received standard care. We conclude that a single session of video-feedback to facilitate mind-mindedness in mothers with SMI may have benefits for mother-infant interaction into the second year of life.

Callous-unemotional traits and impulsivity: distinct longitudinal relations with mind-mindedness and understanding of others.

BACKGROUND: Problems in understanding other people's mental states may relate to distinct personality traits that are associated with early externalizing behavior. A distinction between theory of mind (ToM) and empathy has proven important in shedding light on the problems in understanding other minds encountered by children high on callous-unemotional (CU) traits and exhibiting impulsivity. The aim of this study was to investigate whether children's early ToM and emotion understanding abilities predicted CU traits and impulsivity at age 10. A further aim was to explore whether the quality of the parent-child relationship very early in the development indirectly or directly predicted the children's CU traits and impulsivity. METHOD: We examined whether ToM and empathy skills might differentially relate to personality traits associated with externalizing behaviors (i.e., impulsivity and CU traits). We examined these relations over time in a longitudinal cohort of 96 boys and girls using follow-back analyses, incorporating measures of maternal mind-mindedness (appropriate mind-related talk) to examine the possible role of parent-child interaction quality. RESULTS: Appropriate mind-related talk indirectly predicted CU traits (at age 10 years) via its effect on children's emotion understanding. ToM predicted impulsive/irresponsible traits, but ceased to be significant when controlling for externalizing behaviors. CONCLUSION: The present findings demonstrate that parents who remark appropriately on their infant's mental states may help the child to understand emotions and may mold an empathic understanding of others, thereby preventing CU traits.

The association between maternal-reported responses to infant crying at 4 weeks and 6 months and offspring depression at 18: a longitudinal study.

The purpose of the present study is to examine the association between maternal response to infant crying and the psychological health of the child in later life. Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort, consisting of 15,247 pregnancies, 10,278 with exposure variables and 3201 complete cases were identified as having exposure, covariate and outcome data. Using a postal questionnaire, mothers were asked regarding their infant at 4 weeks and 6 months, 'If they cry what do you do?': (a) pick them up immediately; (b) if they cry, leave them for a while, and if they do not stop, pick them up; or (c) never pick them up until you are ready. Outcome was an International Statistical Classification-10th revision criteria (ICD-10) diagnosis of depression at 18 years for the infant. Offspring of mothers who at 4 weeks reported that they never picked their infants up until they were ready were more likely to have depression at 18 years (OR = 2.06, CI 0.95-4.47, adjusted for sociodemographic confounding variables). There was no evidence for an association at 6 months. Including adjustment variables reduced the strength of our association; an observed objective measure of maternal response rather than a self-report may have more accurately determined the mother's actual responses. There is some evidence for an association between maternal reporting of responses to infant crying at 4 weeks and risk of developing depression at 18 years. If this association is found to be causal, interventions encouraging mothers to represent and respond to their infants' emotional states may help prevent offspring depression.