Hallucinatory Activity in Schizophrenia: The Relationship with Childhood Memories, Submissive Behavior, Social Comparison, and Depression

Authors: C. Barreto Carvalho, C. da Motta, J. Pinto-Gouveia, E. B. Peixoto

Abstract:

Auditory hallucinations among the most invalidating and distressing experiences reported by patients diagnosed with schizophrenia, leading to feelings of powerlessness and helplessness towards their illness. In more severe cases, these auditory hallucinations can take the form of commanding voices, which are often related to high suicidality rates in these patients. Several authors propose that the meanings attributed to the hallucinatory experience, rather than characteristics like form and content, can be determinant in patients’ reactions to hallucinatory activity, particularly in the case of voice-hearing experiences. In this study, 48 patients diagnosed with paranoid schizophrenia presenting auditory hallucinations were studied. Multiple regression analyses were computed to study the influence of several developmental aspects, such as family and social dynamics, bullying, depression, and sociocognitive variables on the auditory hallucinations, on patients’ attributions and relationships with their voices, and on the resulting invalidation of hallucinatory experience. Overall, results showed how relationships with voices can mirror several aspects of interpersonal relationship with others, and how self-schemas, depression and actual social relationships help shaping the voice-hearing experience. Early experiences of victimization and submission help predict the attributions of omnipotence of the voices, and increased hostility from parents seems to increase the malevolence of the voices, suggesting that socio-cognitive factors can significantly contribute to the etiology and maintenance of auditory hallucinations. The understanding of the characteristics of auditory hallucinations and the relationships patients established with their voices can allow the development of more promising therapeutic interventions that can be more effective in decreasing invalidation caused by this devastating mental illness.

Keywords: Auditory hallucinations, beliefs, life events, schizophrenia.

Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1106995

References:

[1] B. Alford and A. T. Beck, “Schizophrenia and other psychotic disorders,” in The integrative power of cognitive therapy, B. A. Alford and A. T. Beck, Eds. New York, NY: Guilford Press, 1997, pp. 137– 164.
[2] P. Chadwick, S. Sambrooke, S. Rasch, and E. Davies, “Challenging the omnipotence of voices: group cognitive behavior therapy for voices.,” Behav. Res. Ther., vol. 38, no. 10, pp. 993–1003, Oct. 2000.
[3] A. Beck-Sander, M. Birchwood, and P. Chadwick, “Acting on command hallucinations: a cognitive approach.,” Br. J. Clin. Psychol., vol. 36 ( Pt 1), pp. 139–48, Feb. 1997.
[4] L. Tait, M. Birchwood, and P. Trower, “Adapting to the challenge of psychosis: personal resilience and the use of sealing-over (avoidant) coping strategies.,” Br. J. Psychiatry, vol. 185, pp. 410–5, Nov. 2004.
[5] P. Chadwick, M. Birchwood, and P. Trower, Cognitive Therapy for Delusions, Voices and Paranoia. London: Wiley, 1996.
[6] P. Chadwick, S. Lees, and M. Birchwood, “The revised beliefs about voices questionnaire (BAVQ-R),” Br. J. Psychiatry, pp. 229–232, 2000.
[7] M. Birchwood and P. D. J. Chadwick, “The omnipotence of voices: testing the validity of a cognitive model,” Psychol. Med., vol. 27, no. 6, pp. 1345–1353, Nov. 1997.
[8] H. Close and P. Garety, “Cognitive assessment of voices: further developments in understanding the emotional impact of voices.,” Br. J. Clin. Psychol., vol. 37 ( Pt 2), pp. 173–188, 1998.
[9] I. Leuder and P. Thomas, Voices of reason, voices of insanity: Studies of verbal hallucinations. Philadelphia: Routledge, 2000.
[10] M. Hayward, “Interpersonal relating and voice hearing : To what extent does relating to the ...,” 2003.
[11] P. Chadwick and M. Birchwood, “The omnipotence of voices. A cognitive approach to auditory hallucinations,” Br. J. Psychiatry, vol. 164, pp. 190–201, 1994.
[12] P. Gilbert, “Evolutionary psychopathology: why isn’t the mind designed better than it is?,” Br. J. Med. Psychol., vol. 71 ( Pt 4), no. 4, pp. 353– 373, Dec. 1998.
[13] M. Birchwood, P. Gilbert, J. Gilbert, P. Trower, A. Meaden, J. Hay, E. Murray, J. N. V Miles, S. Mental, H. Trust, and D. Mental, “Interpersonal and role-related schema influence the relationship with the dominant ‘voice’ in schizophrenia: a comparison of three models.,” Psychol. Med., vol. 34, no. 8, pp. 1571–1580, Nov. 2004.
[14] M. Birchwood, A. Meaden, P. Trower, P. Gilbert, and J. Plaistow, “The power and omnipotence of voices: subordination and entrapment by voices and significant others.,” Psychol. Med., vol. 30, pp. 337–344, 2000.
[15] T. H. Nayani and A. S. David, “The auditory hallucination: a phenomenological survey,” Psychol. Med., vol. 26, no. 01, p. 177, Jul. 2009.
[16] P. Gilbert, M. Birchwood, J. Gilbert, P. Trower, J. Hay, B. Murray, A. Meaden, K. Olsen, and J. N. Miles, “An exploration of evolved mental mechanisms for dominant and subordinate behaviour in relation to auditory hallucinations in schizophrenia and critical thoughts in depression.,” Psychol. Med., vol. 31, no. 6, pp. 1117–27, Aug. 2001.
[17] S. Vaughan and D. Fowler, “The distress experienced by voice hearers is associated with the perceived relationship between the voice hearer and the voice.,” Br. J. Clin. Psychol., 2004.
[18] a Gracie, D. Freeman, S. Green, P. a Garety, E. Kuipers, a Hardy, K. Ray, G. Dunn, P. Bebbington, and D. Fowler, “The association between traumatic experience, paranoia and hallucinations: a test of the predictions of psychological models.,” Acta Psychiatr. Scand., vol. 116, no. 4, pp. 280–9, Oct. 2007.
[19] P. E. Bebbington, D. Bhugra, T. Brugha, N. Singleton, M. Farrell, R. Jenkins, G. Lewis, and H. Meltzer, “Psychosis, victimisation and childhood disadvantage: evidence from the second British National Survey of Psychiatric Morbidity.,” Br. J. Psychiatry, vol. 185, pp. 220– 6, Sep. 2004.
[20] P. Davies, P. Thomas, and I. Leudar, Dialogical engagement with voices: a single case study., vol. 72 ( Pt 2). 1999, pp. 179–187.
[21] I. Kelleher, M. Harley, F. Lynch, L. Arseneault, C. Fitzpatrick, and M. Cannon, “Associations between childhood trauma, bullying and psychotic symptoms among a school-based adolescent sample.,” Br. J. Psychiatry, vol. 193, no. 5, pp. 378–82, Nov. 2008.
[22] M. L. C. Campbell and A. P. Morrison, “The relationship between bullying, psychotic-like experiences and appraisals in 14-16-year olds,” Behav. Res. Ther., vol. 45, no. 7, pp. 1579–1591, 2007.
[23] C. Barreto Carvalho, C. da Motta, J. Pinto-Gouveia, and E. Bernardo Peixoto, “Emotional, cognitive and behavioral reactions to paranoid symptoms in clinical and nonclinical populations.,” Clin. Schizophr. Relat. Psychoses, pp. 1–25, Jun. 2014.
[24] A. Hardy, D. Fowler, D. Freeman, B. Smith, C. Steel, J. Evans, P. Garety, E. Kuipers, P. Bebbington, and G. Dunn, “Trauma and hallucinatory experience in psychosis.,” J. Nerv. Ment. Dis., vol. 193, no. 8, pp. 501–507, 2005.
[25] S. Allan and P. Gilbert, “A social comparison scale: Psychometric properties and relationship to psychopathology,” Personality and Individual Differences, vol. 19. pp. 293–299, 1995.
[26] S. Allan and P. Gilbert, “A social comparison scale: Psychometric properties and relationship to psychopathology,” Pers. Individ. Dif., 1995.
[27] C. Barreto Carvalho and J. Pinto-Gouveia, “Social Comparison Scale - Voices.” 2007.
[28] G. Haddock, J. McCarron, N. Tarrier, and E. B. Faragher, “Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS).,” Psychol. Med., vol. 29, pp. 879– 889, 1999.
[29] C. Barreto Carvalho and J. Pinto–Gouveia, “Psychotic Symptom Rating Scale – voices (Portuguese version),” 2007.
[30] A. T. Beck, “Beck Depression Inventory,” Depression, vol. 2006, pp. 2– 4, 1961.
[31] A. Vaz-Serra and J. L. P. Abreu, “Aferição dos quadros clínicos depressivos I. - Ensaio de aplicação do ‘Inventário Depressivo de Beck’ a uma amostra portuguesa de doentes deprimidos.,” Coimbra Med., vol. 20, no. 6, pp. 623–644, 1973.
[32] P. Gilbert, M. S.-P. Cheung, T. Grandfield, F. Campey, and C. Irons, “Recall of threat and submissiveness in childhood: development of a new scale and its relationship with depression, social comparison and shame,” Clin. Psychol. Psychother., vol. 10, no. 2, pp. 108–115, Mar. 2003.
[33] A. Bifulco, O. Bernazzani, P. M. Moran, and C. Jacobs, “The childhood experience of care and abuse questionnaire (CECA.Q): validation in a community series.,” Br. J. Clin. Psychol., vol. 44, no. Pt 4, pp. 563–581, 2005.
[34] A. Bifulco, O. Bernazzani, P. M. Moran, and C. Jacobs, “The childhood experience of care and abuse questionnaire (CECA.Q): validation in a community series.,” Br. J. Clin. Psychol., vol. 44, no. Pt 4, pp. 563–81, Dec. 2005.
[35] T. Tobin and L. K. Irvin, “The Olweus Bully/Victim Questionnaire: Evidence and Consequences Regarding Use in the United States.,” Reclaiming Child. Youth J. Emot. Behav. Probl., vol. 5, no. 1, pp. 29–33, Nov. 1995.
[36] B. Lopes, “Paranoia e Ansiedade Social na população não-clínica: Dois fenómenos diferentes?,” Universidade de Coimbra, 2010.
[37] K. Goss, P. Gilbert, and S. Allan, “An exploration of shame measures— I: The other as Shamer scale,” Pers. Individ. Dif., vol. 17, no. 5, pp. 713–717, 1994.
[38] S. Man, P. Gilbert, S. Allan, and P. Gilbert, “Submissive behaviour and psychopathology,” Br. J. Clin. Psychol., vol. 36 ( Pt 4), pp. 467–88, Nov. 1997.
[39] A. & Gilbert, “The Submissive Behavior Scale.” 1997.
[40] J. Zubin and B. Spring, “Vulnerability: a new view of schizophrenia.,” J. Abnorm. Psychol., 1977.
[41] B. Tiernan, R. Tracey, and C. Shannon, “Paranoia and self-concepts in psychosis: A systematic review of the literature.,” Psychiatry Res., vol. 216, no. 3, pp. 303–313, May 2014.
[42] M. Birchwood and N. Tarrier, Innovations in the Psychological Management of Schizophrenia: Assessment, Treatment and Services. London: wiley, 1995.
[43] J. van Os, M. Hanssen, R. V Bijl, and a Ravelli, “Strauss (1969) revisited: a psychosis continuum in the general population?,” Schizophr. Res., vol. 45, no. 1–2, pp. 11–20, Sep. 2000.
[44] S. S. L. Mayhew and P. Gilbert, “Report Training with People Who Hear Malevolent Voices : A Case Series Report,” Clin. Psychol. Psychother., vol. 138, pp. 113–138, 2008.
[45] C. Connor and M. Birchwood, “Power and perceived expressed emotion of voices: Their impact on depression and suicidal thinking in those who hear voices,” Clin. Psychol. Psychother., vol. 20, no. 3, pp. 199–205, 2013.