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Moment-to-moment dynamics between auditory verbal hallucinations and negative affect and the role of beliefs about voices

Published online by Cambridge University Press:  07 January 2020

Suzanne Ho-wai So*
Department of Psychology, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
Lawrence Kin-hei Chung
Department of Psychology, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
Chun-Yu Tse
Department of Psychology, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
Sandra Sau-man Chan
Department of Psychiatry, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
George Heung-chuen Chong
Clinical Psychology Service, Kwai Chung Hospital, Kowloon, Hong Kong SAR, China
Karen Shee-yueng Hung
Department of Psychiatry, Castle Peak Hospital, New Territories, Hong Kong SAR, China and
Iris E. C. Sommer
Department of Neuroscience and Department of Psychiatry, University Medical Center Groningen, The University of Groningen, Groningen, The Netherlands
Author for correspondence: Suzanne Ho-wai So, E-mail:



Negative affect (NA) has been suggested to be both an antecedent and a consequence of auditory verbal hallucinations (AVH). Furthermore, negative appraisals of voices have been theorized to contribute to the maintenance of AVH. Using the experience sampling method (ESM), this study examined the bi-directional relationship between NA and AVH, and the moderating effect of negative beliefs about voices.


Forty-seven patients diagnosed with schizophrenia spectrum disorders with frequent AVH completed a clinical interview, followed by ESM for 10 times a day over 6 days on an electronic device. Time-lagged analyses were conducted using multilevel regression modeling. Beliefs about voices were assessed at baseline.


A total of 1654 data points were obtained. NA predicted an increase in AVH in the subsequent moment, and AVH predicted an increase in NA in the subsequent moment. Baseline beliefs about voices as malevolent and omnipotent significantly strengthened the association between NA and AVH within the same moment. In addition, the belief of omnipotence was associated with more hallucinatory experiences in the moment following NA. However, beliefs about voices were not associated directly with momentary levels of NA or AVH.


Experiences of NA and AVH drove each other, forming a feedback loop that maintained the voices. The associations between NA and AVH, either within the same moment or across moments, were exacerbated by negative beliefs about voices. Our results suggest that affect-improving interventions may stop the feedback loop and reduce AVH frequency.

Original Article
Copyright © Cambridge University Press 2020

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