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.

Post-Traumatic Symptomatology and Compulsions as Potential Mediators of the Relation Between Child Sexual Abuse and Auditory Verbal Hallucinations.

BACKGROUND: Whilst evidence is mounting that childhood sexual abuse (CSA) can be a cause of auditory verbal hallucinations (AVH), it is unclear what factors mediate this relation. Recent evidence suggests that post-traumatic symptomatology may mediate the CSA-AVH relation in clinical populations, although this hypothesis has not yet been tested in the general population. There is also reason to believe that obsessive ideation could mediate the CSA-AVH relation. AIMS: To test for evidence to falsify the hypotheses that post-traumatic symptomatology, obsessions, compulsions, anxiety and depression mediate the relation between CSA and AVH in a general population sample. METHOD: Indirect effects of CSA on AVH via potential mediators were tested for, using a regression-based approach employing data from the 2007 Adult Psychiatric Morbidity Survey (n = 5788). RESULTS: After controlling for demographics, IQ and child physical abuse, it was found that CSA, IQ, post-traumatic symptomatology and compulsions predicted lifetime experience of AVH. Mediation analyses found significant indirect effects of CSA on AVH via post-traumatic symptomatology [odds ratio (OR): 1.11; 95% confidence interval (CI):1.00-1.29] and compulsions (OR: 1.10, 95% CI: 1.01-1.28). CONCLUSIONS: These findings offer further support for the hypothesis that post-traumatic symptomatology is a mediator of the CSA-AVH relation. Although no evidence was found for obsessional thoughts as a mediating variable, a potential mediating role for compulsions is theoretically intriguing. This study's findings reiterate the need to ask about experiences of childhood adversity and post-traumatic symptomology in people with AVH, as well as the likely therapeutic importance of trauma-informed and trauma-based interventions for this population.

Investigating the Lived Experience of Recovery in People Who Hear Voices.

Although there is evidence of both clinical and personal recovery from distressing voices, the process of recovery over time is unclear. Narrative inquiry was used to investigate 11 voice-hearers' lived experience of recovery. After a period of despair/exhaustion, two recovery typologies emerged: (a) turning toward/empowerment, which involved developing a normalized account of voices, building voice-specific skills, integration of voices into daily life, and a transformation of identity, and (b) turning away/protective hibernation, which involved harnessing all available resources to survive the experience, with the importance of medication in recovery being emphasized. Results indicated the importance of services being sensitive and responsive to a person's recovery style at any given time and their readiness for change. Coming to hold a normalized account of voice-hearing and the self and witnessing of preferred narratives by others were essential in the more robust turning toward recovery typology.

A preliminary investigation into the existence of a hypervigilance subtype of auditory hallucination in people with psychosis.

BACKGROUND: The phenomenological heterogeneity of auditory hallucinations (AHs) means individual models struggle to account for all aspects of the experience. One alternative is that distinct subtypes of AHs exist, with each requiring their own unique explanatory model and tailored cognitive behavioural intervention strategies. AIMS: This exploratory study tested for the presence of one specific potential AH-subtype, hypervigilance hallucinations (HV-AHs). METHOD: Four specific aspects of the phenomenology of AHs (chosen on the basis of the predicted phenomenology of HV-AHs) were assessed using a semi-structured interview in 32 individual AHs taken from reports from 15 patients with psychosis. RESULTS: Cluster analysis (at the level of the individual AH-experience) offered support for the existence of a distinct HV-AH subtype, characterized by hearing threatening, externally-located voices when attention was externally-focused. Other clusters identified all shared the contrasting properties of occurring in quiet contexts when patients' attention was internally focused. CONCLUSIONS: The results offered tentative support for the existence of an HV-AH subcategorization and justifies future research in larger samples. Potential implications for models of AHs are also considered.

Shot through with voices: dissociation mediates the relationship between varieties of inner speech and auditory hallucination proneness.

Inner speech is a commonly experienced but poorly understood phenomenon. The Varieties of Inner Speech Questionnaire (VISQ; McCarthy-Jones & Fernyhough, 2011) assesses four characteristics of inner speech: dialogicality, evaluative/motivational content, condensation, and the presence of other people. Prior findings have linked anxiety and proneness to auditory hallucinations (AH) to these types of inner speech. This study extends that work by examining how inner speech relates to self-esteem and dissociation, and their combined impact upon AH-proneness. 156 students completed the VISQ and measures of self-esteem, dissociation and AH-proneness. Correlational analyses indicated that evaluative inner speech and other people in inner speech were associated with lower self-esteem and greater frequency of dissociative experiences. Dissociation and VISQ scores, but not self-esteem, predicted AH-proneness. Structural equation modelling supported a mediating role for dissociation between specific components of inner speech (evaluative and other people) and AH-proneness. Implications for the development of "hearing voices" are discussed.

Hear today, not gone tomorrow? An exploratory longitudinal study of auditory verbal hallucinations (hearing voices).

BACKGROUND: Despite an increasing volume of cross-sectional work on auditory verbal hallucinations (hearing voices), there remains a paucity of work on how the experience may change over time. AIMS: The first aim of this study was to attempt replication of a previous finding that beliefs about voices are enduring and stable, irrespective of changes in the severity of voices, and do not change without a specific intervention. The second aim was to examine whether voice-hearers' interrelations with their voices change over time, without a specific intervention. METHOD: A 12-month longitudinal examination of these aspects of voices was undertaken with hearers in routine clinical treatment (N = 18). RESULTS: We found beliefs about voices' omnipotence and malevolence were stable over a 12-month period, as were styles of interrelating between voice and hearer, despite trends towards reductions in voice-related distress and disruption. However, there was a trend for beliefs about the benevolence of voices to decrease over time. CONCLUSIONS: Styles of interrelating between voice and hearer appear relatively stable and enduring, as are beliefs about the voices' malevolent intent and power. Although there was some evidence that beliefs about benevolence may reduce over time, the reasons for this were not clear. Our exploratory study was limited by only being powered to detect large effect sizes. Implications for clinical practice and future research are discussed.

Attributional style and theory of mind in people with Alzheimer disease and persecutory delusions.

OBJECTIVE: Between 7% and 40% of people with Alzheimer disease (AD) experience persecutory delusions (PDs) during the course of their dementia. Although attributional style and theory of mind processes have been linked with PDs in people with psychosis, they have not yet been examined in those with AD and PDs. The objective of this study was, hence, to explore the role of these cognitive processes in groups of participants with AD with and without PDs, as well as a nonclinical comparison group. METHOD: Measures of attributional style and theory of mind were administered to three groups: people with AD and PDs (n = 22), people with AD without PDs (n = 22), and a nonclinical group (n = 23). RESULTS: Although no clear differences in attributional style between the three groups were found, the group with AD and PDs were found to perform worse on the first-order (but not second-order) theory of mind task than the other two groups. CONCLUSIONS: Interventions designed to enhance theory of mind skills might be beneficial for individuals with AD and PDs.

More than words? Hypomanic personality traits, visual imagery and verbal thought in young adults.

The use of visual mental imagery has been proposed to be a risk factor for the development of bipolar disorder, due to its potential to amplify affective states. This study examined the relation between visual imagery (both trait usage and intrusive experiences of such imagery), intrusive verbal thought, and hypomania, as assessed by self-report questionnaires, in a sample of young adults (N=219). Regression analyses found (after controlling for anxiety, depression, and positive and negative affect) that levels of intrusive visual imagery predicted levels of hypomania, but that neither trait use of visual imagery nor intrusive verbal thought did. These results were consistent with the proposal that being a 'visualiser', as opposed to a 'verbaliser', is a risk factor for bipolar disorder, with the caveat that it is specifically intrusive experiences of imagery, rather than the tendency to utilize imagery per se, that acts as a risk factor.

Assessing negative cognitive style: Development and validation of a Short-Form version of the Cognitive Style Questionnaire.

The Cognitive Style Questionnaire (CSQ) is a frequently employed measure of negative cognitive style, associated with vulnerability to anxiety and depression. However, the CSQ's length can limit its utility in research. We describe the development of a Short-Form version of the CSQ. After evaluation and modification of two pilot versions, the 8-item CSQ Short Form (CSQ-SF) was administered to a convenience sample of adults (N = 278). The CSQ-SF was found to have satisfactory internal reliability and test-retest reliability. It also exhibited construct validity by demonstrating predicted correlations with measures of depression and anxiety. Results suggest that the CSQ-SF is suitable for administration via the Internet.

The varieties of inner speech: links between quality of inner speech and psychopathological variables in a sample of young adults.

A resurgence of interest in inner speech as a core feature of human experience has not yet coincided with methodological progress in the empirical study of the phenomenon. The present article reports the development and psychometric validation of a novel instrument, the Varieties of Inner Speech Questionnaire (VISQ), designed to assess the phenomenological properties of inner speech along dimensions of dialogicality, condensed/expanded quality, evaluative/motivational nature, and the extent to which inner speech incorporates other people's voices. In response to findings that some forms of psychopathology may relate to inner speech, anxiety, depression, and proneness to auditory and visual hallucinations were also assessed. Anxiety, but not depression, was found to be uniquely positively related to both evaluative/motivational inner speech and the presence of other voices in inner speech. Only dialogic inner speech predicted auditory hallucination-proneness, with no inner speech variables predicting levels of visual hallucinations/disturbances. Directions for future research are discussed.

The journey through cannabis use: a qualitative study of the experiences of young adults with psychosis.

The present study explored the personal experiences of cannabis and psychosis among young adults, including the reasons and meanings of cannabis use and the perceived relationship between cannabis and mental health. Interviews with seven young adults with psychosis who described regular current or past cannabis use were conducted and analyzed using Interpretative Phenomenological Analysis. Four master themes emerged: The Journey Through Cannabis Use, The Social and Cultural World, The Struggle to Make Sense, and The Depths and Beyond. Respondent validation supported these themes, particularly the idea of cannabis use as a journey that changed in time. Social and cultural factors clearly influenced the initiation of and decision whether to continue using cannabis. Individuals could simultaneously hold positive and negative views on using cannabis. Implications for clinical interventions are explored, and the relevance of motivational interviewing and the stages of change models of behavior change are noted.

Corrigendum: The Autonomous Mind: The Right to Freedom of Thought in the Twenty-First Century.

[This corrects the article DOI: 10.3389/frai.2019.00019.].

A Review of Multimodal Hallucinations: Categorization, Assessment, Theoretical Perspectives, and Clinical Recommendations.

Hallucinations can occur in different sensory modalities, both simultaneously and serially in time. They have typically been studied in clinical populations as phenomena occurring in a single sensory modality. Hallucinatory experiences occurring in multiple sensory systems-multimodal hallucinations (MMHs)-are more prevalent than previously thought and may have greater adverse impact than unimodal ones, but they remain relatively underresearched. Here, we review and discuss: (1) the definition and categorization of both serial and simultaneous MMHs, (2) available assessment tools and how they can be improved, and (3) the explanatory power that current hallucination theories have for MMHs. Overall, we suggest that current models need to be updated or developed to account for MMHs and to inform research into the underlying processes of such hallucinatory phenomena. We make recommendations for future research and for clinical practice, including the need for service user involvement and for better assessment tools that can reliably measure MMHs and distinguish them from other related phenomena.

The role of inner speech on the association between childhood adversity and 'hearing voices'.

Adverse childhood experiences are associated with later development of psychosis, particularly auditory verbal hallucinations and delusions. Although auditory hallucinations have been proposed to be misattributed inner speech, the relation between childhood adversity and inner speech has not been previously investigated. The first aim was to test whether childhood adversity is associated with inner speech in persons with psychosis. The second aim was to test for the influence of inner speech on the association between childhood adversity and auditory hallucinations. Our final aim was to test for evidence that would falsify the null hypothesis that inner speech does not impact the relationship between childhood adversity and delusions. In persons with psychosis, we found a positive association between childhood adversity and dialogic inner speech. There was a significant total effect of childhood adversity on auditory hallucinations, including an indirect effect of childhood adversity on auditory hallucinations via dialogic inner speech. There was also a significant total effect of childhood adversity on delusions, but no evidence of any indirect effect via inner speech. These findings suggest that childhood adversities are associated with inner speech and psychosis. The relation between childhood adversity and auditory hallucination severity could be partially influenced by dialogic inner speech.

The Autonomous Mind: The Right to Freedom of Thought in the Twenty-First Century.

To lose freedom of thought (FoT) is to lose our dignity, our democracy and our very selves. Accordingly, the right to FoT receives absolute protection under international human rights law. However, this foundational right has been neither significantly developed nor often utilized. The contours of this right urgently need to be defined due to twenty-first century threats to FoT posed by new technologies. As such, this paper draws on law and psychology to consider what the right to FoT should be in the twenty-first century. After discussing contemporary threats to FoT, and recent developments in our understanding of thought that can inform the development of the right, this paper considers three elements of the right; the rights not to reveal one's thoughts, not to be penalized for one's thoughts, and not to have one's thoughts manipulated. The paper then considers, for each element, why it should exist, how the law currently treats it, and challenges that will shape it going forward. The paper concludes that the law should develop the right to FoT with the clear understanding that what this aims to secure is mental autonomy. This process should hence begin by establishing the core mental processes that enable mental autonomy, such as attentional and cognitive agency. The paper argues that the domain of the right to FoT should be extended to include external actions that are arguably constitutive of thought, including internet searches and diaries, hence shielding them with absolute protection. It is stressed that law must protect us from threats to FoT from both states and corporations, with governments needing to act under the positive aspect of the right to ensure societies are structured to facilitate mental autonomy. It is suggested that in order to support mental autonomy, information should be provided in autonomy-supportive contexts and friction introduced into decision making processes to facilitate second-order thought. The need for public debate about how society wishes to balance risk and mental autonomy is highlighted, and the question is raised as to whether the importance attached to thought has changed in our culture. The urgency of defending FoT is re-iterated.

Compassion Focused Approaches to Working With Distressing Voices.

This paper presents an outline of voice-hearing phenomenology in the context of evolutionary mechanisms for self- and social- monitoring. Special attention is given to evolved systems for monitoring dominant-subordinate social roles and relationships. These provide information relating to the interpersonal motivation of others, such as neutral, friendly or hostile, and thus the interpersonal threat, versus safe, social location. Individuals who perceive themselves as subordinate and dominants as hostile are highly vigilant to down-rank threat and use submissive displays and social spacing as basic defenses. We suggest these defense mechanisms are especially attuned in some individuals with voices, in which this fearful-subordinate - hostile-dominant relationship is played out. Given the evolved motivational system in which voice-hearers can be trapped, one therapeutic solution is to help them switch into different motivational systems, particularly those linked to social caring and support, rather than hostile competition. Compassion focused therapy (CFT) seeks to produce such motivational shifts. Compassion focused therapy aims to help voice-hearers, (i) notice their threat-based (dominant-subordinate) motivational systems when they arise, (ii) understand their function in the context of their lives, and (iii) shift into different motivational patterns that are orientated around safeness and compassion. Voice-hearers are supported to engage with biopsychosocial components of compassionate mind training, which are briefly summarized, and to cultivate an embodied sense of a compassionate self-identity. They are invited to consider, and practice, how they might wish to relate to themselves, their voices, and other people, from the position of their compassionate self. This paper proposes, in line with the broader science of compassion and CFT, that repeated practice of creating internal patterns of safeness and compassion can provide an optimum biopsychosocial environment for affect-regulation, emotional conflict-resolution, and therapeutic change. Examples of specific therapeutic techniques, such as chair-work and talking with voices, are described to illustrate how these might be incorporated in one-to-one sessions of CFT.

Associations Between Forced and "Persuaded" First Intercourse and Later Health Outcomes in Women.

The effects of nonconsensual first experiences of sexual intercourse in women are understudied. This was investigated in 3,875 adult women of whom 6.7% reported "persuaded" first-sex and 0.8% reported forced first-sex. Compared with willing first-sex, both forced and "persuaded" first-sex occurred earlier, involved a greater age difference between partners, and were associated with more lifetime sexual partners and some measures of worse psychological well-being. In addition, "persuaded" first-sex was associated with worse general physical health. "Persuaded" first-sex and its relation to health need to be better understood, along with how culture influences women's experiences of first-sex.

Have we overlooked the significance of multinodal hallucinations in schizophrenia?

Scant research attention has been devoted to the phenomenon of multimodal hallucinations, with majority of studies focusing on auditory hallucinations (AH) in psychosis. The current study aimed to explore the frequency and characteristics of these multisensory hallucinations in a primary AH cohort. It was concluded more than half of our sample reported comorbid hallucinations in one or more sensory modes. This conveys significant research and clinical implications, in terms of steps taken for adequate assessment and intervention.

Paracingulate Sulcus Morphology and Hallucinations in Clinical and Nonclinical Groups.

Hallucinations are a characteristic symptom of psychotic mental health conditions that are also experienced by many individuals without a clinical diagnosis. Hallucinations in schizophrenia have been linked to differences in the length of the paracingulate sulcus (PCS), a structure in the medial prefrontal cortex which has previously been associated with the ability to differentiate perceived and imagined information. We investigated whether this putative morphological basis for hallucinations extends to individuals without a clinical diagnosis, by examining whether nonclinical individuals with hallucinations have shorter PCS than nonclinical individuals without hallucinations. Structural MRI scans were examined from 3 demographically matched groups of individuals: 50 patients with psychotic diagnoses who experienced auditory verbal hallucinations (AVHs), 50 nonclinical individuals with AVHs, and 50 healthy control subjects with no life-time history of hallucinations. Results were verified using automated data-driven gyrification analyses. Patients with hallucinations had shorter PCS than both healthy controls and nonclinical individuals with hallucinations, with no difference between nonclinical individuals with hallucinations and healthy controls. These findings suggest that the association of shorter PCS length with hallucinations is specific to patients with a psychotic disorder. This presents challenges for full-continuum models of psychosis and suggests possible differences in the mechanisms underlying hallucinations in clinical and nonclinical groups.

Traumagenics: At the intersect of childhood trauma, immunity and psychosis.

Early childhood trauma, including physical, sexual or emotional abuse, neglect, harm or threat of harm, is associated with adulthood dysregulation of the immune system. Trauma can induce chronic immune system activation. Associations between a chronic pro-inflammatory state and schizophrenia are an enduring finding of psychiatry, with elevated cytokine concentrations correlated with psychotic symptom severity. Most importantly, persons with schizophrenia and a history of childhood trauma demonstrate increased cytokine levels. Specific types of childhood trauma can also differentially impact the expression of unique immune markers. This study tested the hypotheses that levels of adverse childhood experiences (ACEs) would be associated with levels of peripheral immune activity assessed by IL6, IFNG, CXCL10, IRF1, STAT1 and TLR4 mRNA expression, and that there would be an association between ACEs and psychosis along a continuum from non-clinical controls (NCC) to psychotic disorders such as schizophrenia. These hypotheses were tested in 20 schizophrenia, 20 NCC. We found correlations between ACEs scores and immune markers, specifically IL6. We also found a positive association between ACEs and positive symptoms. Childhood trauma, through its effects on IL6, may be a risk factor for schizophrenia.