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Ruminative thought is a style of thinking which involves repetitively focusing upon one's own negative mood, its causes and its consequences. The negative effects of rumination are well-documented, but comparatively little is known about how rumination is experienced. The evaluative nature of rumination suggests that it could involve more inner speech than non-ruminative states. The present study (N = 31) combined facial electromyography and self-report questionnaires to determine the type of inner experience that occurs in rumination. The results showed that induced rumination involved similar levels of muscle activity related to inner speech as periods of induced distraction. However, experience sampling and questionnaire responses showed that rumination involved more verbal thought, and also involved more evaluative and dialogic inner speech than distraction. These findings contribute to the understanding of inner speech as a flexible phenomenon and confirms the importance of employing multiple methods to investigate inner speech. Future research should clarify the link between inner speech in rumination and its negative effects on wellbeing.

People rapidly make first impressions of others, often based on very little information-minimal exposure to faces or voices is sufficient for humans to make up their mind about personality of others. While there has been considerable research on voice personality perception, much less is known about its relevance to hallucination-proneness, despite auditory hallucinations being frequently perceived as personified social agents. The present paper reports two studies investigating the relation between voice personality perception and hallucination-proneness in non-clinical samples. A voice personality perception task was created, in which participants rated short voice recordings on four personality characteristics, relating to dimensions of the voice's perceived Valence and Dominance. Hierarchical regression was used to assess contributions of Valence and Dominance voice personality ratings to hallucination-proneness scores, controlling for paranoia-proneness and vividness of mental imagery. Results from Study 1 suggested that high ratings of voices as dominant might be related to high hallucination-proneness; however, this relation seemed to be dependent on reported levels of paranoid thinking. In Study 2, we show that hallucination-proneness was associated with high ratings of voice dominance, and this was independent of paranoia and imagery abilities scores, both of which were found to be significant predictors of hallucination-proneness. Results from Study 2 suggest an interaction between gender of participants and the gender of the voice actor, where only ratings of own gender voices on Dominance characteristics are related to hallucination-proneness scores. These results are important for understanding the perception of characterful features of voices and its significance for psychopathology.

Felt presence (FP) – sensing another person without clear sensory evidence – has been described in psychosis for over a century but rarely studied due to challenges in recognition and assessment. Recently FP has been identified as a transdiagnostic phenomenon and highlighted by people with lived experience of psychosis as a clinical priority. Here we describe FP presentation in a first-episode psychosis sample and report preliminary associations with affect, gender, and psychopathology.

While voice-hearing in psychosis has received much attention, perceptual experiences in other sensory modalities and psychiatric conditions have remained relatively overlooked. The present review aimed to address this gap by providing an overview of voices/altered perceptual experiences (APE) across psychotic, mood and anxiety disorders in terms of phenomenological characteristics, biopsychosocial mechanisms, etiological models and therapeutic interventions. Where possible, lived experience perspectives and transcultural considerations were embedded. A narrative literature review was conducted. Knowledge pertaining to voices in psychosis formed the foundation, broadened to include other sensory modalities and diagnostic conditions. Quality assessment demonstrated an excellent rating of 12/12. Notable findings related to: (i) phenomenological heterogeneity in voices/APE within individuals and across diagnostic conditions, with multisensory/multimodal experiences relatively widespread; (ii) existing mechanistic studies mainly focusing on the role of trauma and neurocognition in voices; (iii) prevailing explanatory models mostly focusing on voices; (iv) a need for emerging interventions to extrapolate to encompass broader therapeutic applications; and (v) wide-ranging specificity issues and transcultural considerations to be addressed. Future research should invest in appropriate assessment tools as well as ensuring methodological consistency in mechanistic studies. Incorporating lived experience perspectives and meaningfully embedding transcultural considerations in theoretical and empirical ways are also essential.

The existence of a network of brain regions which are activated when one undertakes a difficult visual search task is well established. Two primary nodes on this network are right posterior parietal cortex (rPPC) and right frontal eye fields. Both have been shown to be involved in the orientation of attention, but the contingency that the activity of one of these areas has on the other is less clear. We sought to investigate this question by using transcranial direct current stimulation (tDCS) to selectively decrease activity in rPPC and then asking participants to perform a visual search task whilst undergoing functional magnetic resonance imaging. Comparison with a condition in which sham tDCS was applied revealed that cathodal tDCS over rPPC causes a selective bilateral decrease in frontal activity when performing a visual search task. This result demonstrates for the first time that premotor regions within the frontal lobe and rPPC are not only necessary to carry out a visual search task, but that they work together to bring about normal function.

Abstract Recent therapeutic approaches to auditory verbal hallucinations (AVH) exploit the person-like qualities of voices. Little is known, however, about how, why, and when AVH become personified. We aimed to investigate personification in individuals’ early voice-hearing experiences. We invited Early Intervention in Psychosis (EIP) service users aged 16–65 to participate in a semistructured interview on AVH phenomenology. Forty voice-hearers (M = 114.13 days in EIP) were recruited through 2 National Health Service trusts in northern England. We used content and thematic analysis to code the interviews and then statistically examined key associations with personification. Some participants had heard voices intermittently for multiple years prior to clinical involvement (M = 74.38 months), although distressing voice onset was typically more recent (median = 12 months). Participants reported a range of negative emotions (predominantly fear, 60%, 24/40, and anxiety, 62.5%, 26/40), visual hallucinations (75%, 30/40), bodily states (65%, 25/40), and “felt presences” (52.5%, 21/40) in relation to voices. Complex personification, reported by a sizeable minority (16/40, 40%), was associated with experiencing voices as conversational (odds ratio [OR] = 2.56) and companionable (OR = 3.19) but not as commanding or trauma-related. Neither age of AVH onset nor time since onset related to personification. Our findings highlight significant personification of AVH even at first clinical presentation. Personified voices appear to be distinguished less by their intrinsic properties, commanding qualities, or connection with trauma than by their affordances for conversation and companionship.

Hearing a voice in the absence of any speaker can be a significant feature of psychiatric illness, but is also increasingly acknowledged as an important aspect of everyday, non-pathological experience. This recognition has led to a growth of interest in voice-hearing in individuals without any psychiatric diagnosis, coupled with greater attention to the subjective experience of voice-hearing across diagnostic groups. Research has also focused on the overlap between some aspects of voice-hearing phenomenology and everyday experiences such as ‘hearing’ the voices of fictional characters and spiritual experience. In this Review, we synthesize research on the range of cognitive, neural, personal and sociocultural processes that contribute to voice-hearing as it occurs in clinical, non-clinical and everyday experience, with particular emphasis on linking mechanism to phenomenology. Heterogeneous forms of voice-hearing can be understood in terms of differing patterns of association among underlying mechanisms. We suggest an approach to hallucinatory experience that sees it as partly continuous with everyday inner experience, but which is critical regarding whether continuity of phenomenology across the clinical–non-clinical divide should be taken to entail continuity of mechanism.Hearing voices has long been associated with severe mental illness but also occurs in the general population. In this Review, Toh et al. describe the cognitive, neural, personal and sociocultural processes that contribute to voice-hearing in clinical, non-clinical and everyday experience, with emphasis on linking mechanism to phenomenology.

Abstract Background and Hypothesis Voice-hearing in clinical and nonclinical groups has previously been compared using standardized assessments of psychotic experiences. Findings from several studies suggest that nonclinical voice-hearing is distinguished by reduced distress and increased control. However, symptom-rating scales developed for clinical populations may be limited in their ability to elucidate subtle aspects of nonclinical voices. Moreover, such experiences often occur within specific contexts and belief systems, such as spiritualism. We investigated similarities and differences in the phenomenology of clinical voice-hearing and nonclinical voice-hearer (NCVH). Study Design We conducted a comparative interdisciplinary study which administered a semi-structured interview to NCVH individuals (N = 26) and psychosis patients (N = 40). The nonclinical group was recruited from spiritualist communities. We used content analysis and inductive thematic analysis to create a coding frame which was used across both spiritual and patient groups to compare phenomenological features of voice-hearing. Study Results The findings were consistent with previous results regarding distress and control. Additionally, in the NCVH group, multiple modalities were often integrated into 1 entity, and there were high levels of associated visual imagery, and subtle differences in the location of voices relating to perceptual boundaries. Most NCVHs reported voices before encountering spiritualism, suggesting that their onset was not solely due to deliberate practice. Conclusions Nonclinical spiritual voice-hearing has important similarities and differences to voices in psychosis. Future research should aim to understand how spiritual voice-hearers cultivate and control voice-hearing after its onset, which may inform interventions for people with psychosis with distressing voices.

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. 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, = 75), people with spiritual and spiritualist beliefs (study 2, = 47) and practitioners of endurance/solo pursuits (study 3, = 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. 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. 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.

Abstract Background Sleep dysfunction shares a bidirectional relationship with hallucinatory experiences, with the strongest path from sleep dysfunction to the occurrence of hallucinatory experiences. This review aimed to identify potential mechanisms through which sleep dysfunction leads to hallucinations. Study Design A narrative review was conducted across 4 levels of explanation: phenomenology (via lived-experience accounts), psychology, neural networks, and neurophysiology. Study Results Relatively few studies have directly tested underlying mechanisms linking sleep dysfunction to hallucinations, particularly at the levels of neural networks and neurophysiology. There is good support for stress as a mediator between sleep dysfunction and hallucinations. Stress was a plausible mechanism across levels of explanation and was supported by sleep manipulation studies in non-clinical populations. Inflammation of the nervous system is affected by sleep loss, which in turn impacts the brain connectivity underpinning hallucinatory experiences. Lived-experience accounts identified 3 novel mechanisms, all of which are meaningful to people with lived experience of hallucinations: source monitoring, mental resilience, and reasoning skills. Quantitative studies show these mechanisms are impacted by sleep loss, but the full causal path from sleep dysfunction to hallucinations via these mechanisms requires testing. Conclusions Key priorities for future research are to (1) test stress as a mediator in clinical populations experiencing hallucinations, with stress assessed across the levels of explanation simultaneously; (2) carry out experimental tests of novel potential mediators identified in this review (eg, source monitoring, inflammation, prefrontal cortical networks); and (3) identify potential moderators that might explain individual differences in the lived-experience accounts of the effect of sleep dysfunction on hallucinations.