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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*
Affiliation:
Department of Psychology, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
Lawrence Kin-hei Chung
Affiliation:
Department of Psychology, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
Chun-Yu Tse
Affiliation:
Department of Psychology, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
Sandra Sau-man Chan
Affiliation:
Department of Psychiatry, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
George Heung-chuen Chong
Affiliation:
Clinical Psychology Service, Kwai Chung Hospital, Kowloon, Hong Kong SAR, China
Karen Shee-yueng Hung
Affiliation:
Department of Psychiatry, Castle Peak Hospital, New Territories, Hong Kong SAR, China and
Iris E. C. Sommer
Affiliation:
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: shwso@psy.cuhk.edu.hk

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2020

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References

Addington, D., Addington, J., Maticka-Tyndale, E., & Joyce, J. (1992). Reliability and validity of a depression rating scale for schizophrenics. Schizophrenia Research, 6, 201208.CrossRefGoogle ScholarPubMed
Allen, T. E., & Agus, B. (1968). Hyperventilation leading to hallucinations. American Journal of Psychiatry, 125, 632637.10.1176/ajp.125.5.632CrossRefGoogle ScholarPubMed
Andreasen, N. C. (1984). The Scale for the Assessment of Positive Symptoms (SAPS). Iowa City, Iowa: The University of Iowa.Google Scholar
Andrew, E., Gray, N. S., & Snowden, R. J. (2008). The relationship between trauma and beliefs about hearing voices: A study of psychiatric and non-psychiatric voice hearers. Psychological Medicine, 38, 14091417.CrossRefGoogle ScholarPubMed
Badcock, J. C., Paulik, G., & Maybery, M. T. (2011). The role of emotion regulation in auditory hallucinations. Psychiatry Research, 185, 303308.CrossRefGoogle ScholarPubMed
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893897.CrossRefGoogle ScholarPubMed
Bell, I. H., Fielding-Smith, S. F., Hayward, M., Rossell, S. L., Lim, M. H., Farhall, J., & Thomas, N. (2018a). Smartphone-based ecological momentary assessment and intervention in a blended coping-focused therapy for distressing voices: Development and case illustration. Internet Interventions, 14, 1825.CrossRefGoogle Scholar
Bell, I. H., Fielding-Smith, S. F., Hayward, M., Rossell, S. L., Lim, M. H., Farhall, J., & Thomas, N. (2018b). Smartphone-based ecological momentary assessment and intervention in a coping-focused intervention for hearing voices (SAVVy): Study protocol for a pilot randomised controlled trial. Trials, 19, 262.CrossRefGoogle Scholar
Bell, I. H., Lim, M. H., Rossell, S. L., & Thomas, N. (2017). Ecological momentary assessment and intervention in the treatment of psychotic disorders: A systematic review. Psychiatric Services, 68, 11721181.CrossRefGoogle ScholarPubMed
Benjamin, L. S. (1989). Is chronicity a function of the relationship between the person and the auditory hallucination? Schizophrenia Bulletin, 15, 291310.CrossRefGoogle ScholarPubMed
Birchwood, M., & Chadwick, P. (1997). The omnipotence of voices: Testing the validity of a cognitive model. Psychological Medicine, 27, 13451353.10.1017/S0033291797005552CrossRefGoogle ScholarPubMed
Birchwood, M., Macmillan, F., & Smith, J. (1992). Early intervention. In Birchwood, M. & Tarrier, N. (Eds.), Innovations in the psychological management of schizophrenia (pp. 115145). Chichester: Wiley.Google Scholar
Broome, M. R., Woolley, J. B., Tabraham, P., Johns, L. C., Bramon, E., Murray, G. K., … Murray, R. M. (2005). What causes the onset of psychosis? Schizophrenia Research, 79, 2334.CrossRefGoogle Scholar
Carter, D. M., Mackinnon, A., & Copolov, D. L. (1996). Patients’ strategies for coping with auditory hallucinations. The Journal of Nervous and Mental Disease, 184, 159164.CrossRefGoogle ScholarPubMed
Chadwick, P., & Birchwood, M. (1994). The omnipotence of voices: A cognitive approach to auditory hallucinations. The British Journal of Psychiatry, 164, 190201.CrossRefGoogle ScholarPubMed
Chadwick, P., & Birchwood, M. (1995). The omnipotence of voices II: The beliefs about voices questionnaire (BAVQ). The British Journal of Psychiatry, 166, 773776.CrossRefGoogle Scholar
Chadwick, P., Lees, S., & Birchwood, M. (2000). The revised beliefs about voices questionnaire (BAVQ–R). The British Journal of Psychiatry, 177, 229232.CrossRefGoogle Scholar
Chan, Y., So, S. H. W., Mak, A. D. P., Siah, K. T. H., Chan, W., & Wu, J. C. Y. (2019). The temporal relationship of daily life stress, emotions, and bowel symptoms in irritable bowel syndrome – diarrhea subtype: A smartphone-based experience sampling study. Neurogastroenterology & Motility, 31, e13514.CrossRefGoogle ScholarPubMed
Cheng, S. K. W., Wong, C. W., Wong, K. C., Chong, G. S. C., Wong, M. T. P., Chang, S. S. Y., … Wu, K. O. (2002). A study of psychometric properties, normative scores, and factor structure of the Beck Anxiety Inventory – the Chinese version. Chinese Journal of Clinical Psychology, 10, 46.Google Scholar
Copolov, D. L., Mackinnon, A., & Trauer, T. (2004). Correlates of the affective impact of auditory hallucinations in psychotic disorders. Schizophrenia Bulletin, 30, 163171.CrossRefGoogle ScholarPubMed
Cosoff, S. J., & Hafner, R. J. (1998). The prevalence of comorbid anxiety in schizophrenia, schizoaffective disorder and bipolar disorder. Australian and New Zealand Journal of Psychiatry, 32, 6772.CrossRefGoogle ScholarPubMed
Csipke, E., & Kinderman, P. (2006). A longitudinal investigation of beliefs about voices. Behavioural and Cognitive Psychotherapy, 34, 365369.CrossRefGoogle Scholar
Curran, P. J., & Bauer, D. J. (2011). The disaggregation of within-person and between-person effects in longitudinal models of change. Annual Review of Psychology, 62, 583619.CrossRefGoogle ScholarPubMed
Delespaul, P., Devries, M., & van Os, J. (2002). Determinants of occurrence and recovery from hallucinations in daily life. Social Psychiatry and Psychiatric Epidemiology, 37, 97104.CrossRefGoogle ScholarPubMed
Fahrenberg, J., Myrtek, M., Pawlik, K., & Perrez, M. (2007). Ambulatory assessment – monitoring behavior in daily life settings: A behavioral-scientific challenge for psychology. European Journal of Psychological Assessment, 23, 206213.CrossRefGoogle Scholar
Goldstein, H. (1987). Multilevel models in educational and social research. London, England: Oxford University Press.Google Scholar
Hacker, D., Birchwood, M., Tudway, J., Meaden, A., & Amphlett, C. (2008). Acting on voices: Omnipotence, sources of threat, and safety-seeking behaviours. British Journal of Clinical Psychology, 47, 201213.CrossRefGoogle ScholarPubMed
Haddock, G., McCarron, J., Tarrier, N., & Faragher, E. (1999). Scales to measure dimensions of hallucinations and delusions: The psychotic symptom rating scales (PSYRATS). Psychological Medicine, 29, 879889.CrossRefGoogle Scholar
Hartley, S., Barrowclough, C., & Haddock, G. (2013). Anxiety and depression in psychosis: A systematic review of associations with positive psychotic symptoms. Acta Psychiatrica Scandinavica, 128, 327346.CrossRefGoogle ScholarPubMed
Kane, J., Honigfeld, G., Singer, J., & Meltzer, H. (1988). Clozapine for the treatment-resistant schizophrenic: A double-blind comparison with chlorpromazine. Archives of General Psychiatry, 45, 789796.CrossRefGoogle ScholarPubMed
Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261276.CrossRefGoogle Scholar
Kimhy, D., Delespaul, P., Corcoran, C., Ahn, H., Yale, S., & Malaspina, D. (2006). Computerized experience sampling method (ESMc): Assessing feasibility and validity among individuals with schizophrenia. Journal of Psychiatric Research, 40, 221230.CrossRefGoogle ScholarPubMed
Kimhy, D., Wall, M. M., Hansen, M. C., Vakhrusheva, J., Choi, C. J., Delespaul, P., … Malaspina, D. (2017). Autonomic regulation and auditory hallucinations in individuals with schizophrenia: An experience sampling study. Schizophrenia Bulletin, 43, 754763.CrossRefGoogle ScholarPubMed
Larøi, F., Thomas, N., Aleman, A., Fernyhough, C., Wilkinson, S., Deamer, F., & McCarthy-Jones, S. (2019). The ice in voices: Understanding negative content in auditory-verbal hallucinations. Clinical Psychology Review, 67, 110.CrossRefGoogle ScholarPubMed
Leff, J., Tress, K., & Edwards, B. (1988). The clinical course of depressive symptoms in schizophrenia. Schizophrenia Research, 1, 2530.CrossRefGoogle Scholar
Leung, M. H. T., So, S. H. W., Kwok, N. T. K., Ng, I. H. C., Chan, P. S., Lo, C. C. W., … Lee, S. (2019). Moment-to-moment interaction between affectivity and coping behaviours in bipolar disorder and the role of cognitive appraisals. BJPsych Open, 5, e44.CrossRefGoogle ScholarPubMed
Lysaker, P. H., & Salyers, M. P. (2007). Anxiety symptoms in schizophrenia spectrum disorders: Associations with social function, positive and negative symptoms, hope and trauma history. Acta Psychiatrica Scandinavica, 116, 290298.CrossRefGoogle ScholarPubMed
Mawson, A., Cohen, K., & Berry, K. (2010). Reviewing evidence for the cognitive model of auditory hallucinations: The relationship between cognitive voice appraisals and distress during psychosis. Clinical Psychology Review, 30, 248258.CrossRefGoogle ScholarPubMed
Meltzer, H. Y. (1992). Treatment of the neuroleptic-nonresponsive schizophrenic patient. Schizophrenia Bulletin, 18, 515542.CrossRefGoogle ScholarPubMed
Morrison, A. P., & Renton, J. C. (2001). Cognitive therapy for auditory hallucinations: A theory-based approach. Cognitive and Behavioral Practice, 8, 147160.CrossRefGoogle Scholar
Myin-Germeys, I., Birchwood, M., & Kwapil, T. (2011). From environment to therapy in psychosis: A real-world momentary assessment approach. Schizophrenia Bulletin, 37, 244247.CrossRefGoogle ScholarPubMed
Myin-Germeys, I., Delespaul, P., & van Os, J. (2005). Behavioural sensitization to daily life stress in psychosis. Psychological Medicine, 35, 733741.CrossRefGoogle ScholarPubMed
Myin-Germeys, I., Kasanova, Z., Vaessen, T., Vachon, H., Kirtley, O., Viechtbauer, W., & Reininghaus, U. (2018). Experience sampling methodology in mental health research: New insights and technical developments. World Psychiatry, 17, 123132.CrossRefGoogle ScholarPubMed
Myin-Germeys, I., Nicolson, N., & Delespaul, P. A. (2001). The context of delusional experiences in the daily life of patients with schizophrenia. Psychological Medicine, 31, 489498.CrossRefGoogle ScholarPubMed
Myin-Germeys, I., Oorschot, M., Collip, D., Lataster, J., Delespaul, P., & van Os, J. (2009). Experience sampling research in psychopathology: Opening the black box of daily life. Psychological Medicine, 39, 15331547.CrossRefGoogle Scholar
Nayani, T. H., & David, A. S. (1996). The auditory hallucination: A phenomenological survey. Psychological Medicine, 26, 177189.CrossRefGoogle ScholarPubMed
Oorschot, M., Lataster, T., Thewissen, V., Bentall, R., Delespaul, P., & Myin-Germeys, I. (2012). Temporal dynamics of visual and auditory hallucinations in psychosis. Schizophrenia Research, 140, 7782.CrossRefGoogle ScholarPubMed
Peters, E., Lataster, T., Greenwood, K., Kuipers, E., Scott, J., Williams, S., … Myin-Germeys, I. (2012a). Appraisals, psychotic symptoms and affect in daily life. Psychological Medicine, 42, 10131023.CrossRefGoogle Scholar
Peters, E. R., Williams, S. L., Cooke, M. A., & Kuipers, E. (2012b). It's not what you hear, it's the way you think about it: Appraisals as determinants of affect and behaviour in voice hearers. Psychological Medicine, 42, 15071514.CrossRefGoogle Scholar
Scollon, C. N., Prieto, C. K., & Diener, E. (2009) Experience sampling: Promises and pitfalls, strength and weaknesses. In Diener, E. (Ed.), Assessing well-being (pp. 157180). Dordrecht: Springer.CrossRefGoogle Scholar
Shiffman, S., Stone, A. A., & Hufford, M. R. (2008). Ecological momentary assessment. Annual Review of Clinical Psychology, 4, 132.CrossRefGoogle ScholarPubMed
Simons, C. J. P., Drukker, M., Evers, S., van Mastrigt, G. A. P. G., Höhn, P., Kramer, I., … Wichers, M. (2017). Economic evaluation of an experience sampling method intervention in depression compared with treatment as usual using data from a randomized controlled trial. BMC Psychiatry, 17, 415.CrossRefGoogle ScholarPubMed
Slade, P. (1976). An investigation of psychological factors involved in the predisposition to auditory hallucinations. Psychological Medicine, 6, 123132.CrossRefGoogle ScholarPubMed
Smith, B., Fowler, D. G., Freeman, D., Bebbington, P., Bashforth, H., Garety, P., … Kuipers, E. (2006). Emotion and psychosis: Links between depression, self-esteem, negative schematic beliefs and delusions and hallucinations. Schizophrenia Research, 86, 181188.CrossRefGoogle ScholarPubMed
So, E., Kam, I., Leung, C., Chung, D., Liu, Z., & Fong, S. (2003). The Chinese-bilingual SCID-I/P Project: Stage 1 – reliability for mood disorders and schizophrenia. Hong Kong Journal of Psychiatry, 13, 719.Google Scholar
So, S. H., & Wong, C. (2008). Experience and coping with auditory hallucinations in first-episode psychosis: Relationship with stress coping. East Asian Archives of Psychiatry, 18, 115121.Google Scholar
So, S. H. W., Peters, E. R., Swendsen, J., Garety, P. A., & Kapur, S. (2013). Detecting improvements in acute psychotic symptoms using experience sampling methodology. Psychiatry Research, 210, 8288.CrossRefGoogle ScholarPubMed
So, S. H. W., Peters, E. R., Swendsen, J., Garety, P. A., & Kapur, S. (2014). Changes in delusions in the early phase of antipsychotic treatment – an experience sampling study. Psychiatry Research, 215, 568573.CrossRefGoogle ScholarPubMed
Soppitt, R. W., & Birchwood, M. (1997). Depression, beliefs, voice content and topography: A cross-sectional study of schizophrenic patients with auditory verbal hallucinations. Journal of Mental Health, 6, 525532.Google Scholar
Tarrier, N., Beckett, R., Harwood, S., Baker, A., Yusupoff, L., & Ugarteburu, I. (1993). A trial of two cognitive-behavioural methods of treating drug-resistant residual psychotic symptoms in schizophrenic patients: I. Outcome. British Journal of Psychiatry, 162, 524532.CrossRefGoogle ScholarPubMed
Thomas, N., Hayward, M., Peters, E., van der Gaag, M., Bentall, R. P., Jenner, J., … McCarthy-Jones, S. (2014). Psychological therapies for auditory hallucinations (voices): Current status and key directions for future research. Schizophrenia Bulletin, 40, S202S212.CrossRefGoogle ScholarPubMed
Turnbull, G., & Bebbington, P. (2001). Anxiety and the schizophrenic process: Clinical and epidemiological evidence. Social Psychiatry and Psychiatric Epidemiology, 36, 235243.CrossRefGoogle ScholarPubMed
Udachina, A., Bentall, R. P., Varese, F., & Rowse, G. (2017). Stress sensitivity in paranoia: Poor-me paranoia protects against the unpleasant effects of social stress. Psychological Medicine, 47, 28342843.CrossRefGoogle ScholarPubMed
Vaessen, T., Kasanova, Z., Hernaus, D., Lataster, J., Collip, D., van Nierop, M., & Myin-Germeys, I. (2018). Overall cortisol, diurnal slope, and stress reactivity in psychosis: An experience sampling approach. Psychoneuroendocrinology, 96, 6168.CrossRefGoogle ScholarPubMed
van der Gaag, M., Hageman, M. C., & Birchwood, M. (2003). Evidence for a cognitive model of auditory hallucinations. The Journal of Nervous and Mental Disease, 191, 542545.CrossRefGoogle ScholarPubMed
van der Gaag, M., Valmaggia, L. R., & Smit, F. (2014). The effects of individually tailored formulation-based cognitive behavioural therapy in auditory hallucinations and delusions: A meta-analysis. Schizophrenia Research, 156, 3037.CrossRefGoogle ScholarPubMed
van Os, J., Verhagen, S., Marsman, A., Peeters, F., Bak, M., Marcelis, M., … Delespaul, P. (2017). The experience sampling method as an mHealth tool to support self-monitoring, self-insight, and personalized health care in clinical practice. Depression and Anxiety, 34, 481493.CrossRefGoogle ScholarPubMed
Varese, F., Udachina, A., Myin-Germeys, I., Oorschot, M., & Bentall, R. P. (2011). The relationship between dissociation and auditory verbal hallucinations in the flow of daily life of patients with psychosis. Psychosis, 3, 1428.CrossRefGoogle Scholar
Wang, L. P., & Maxwell, S. E. (2015). On disaggregating between-person and within-person effects with longitudinal data using multilevel models. Psychological Methods, 20, 6383.CrossRefGoogle ScholarPubMed
Waters, F., & Fernyhough, C. (2017). Hallucinations: A systematic review of points of similarity and difference across diagnostic classes. Schizophrenia Bulletin, 43, 3243.CrossRefGoogle ScholarPubMed
Westermann, S., Grezellschak, S., Oravecz, Z., Moritz, S., Lüdtke, T., & Jansen, A. (2017). Untangling the complex relationships between symptoms of schizophrenia and emotion dynamics in daily life: Findings from an experience sampling pilot study. Psychiatry Research, 257, 514518.CrossRefGoogle ScholarPubMed
Wong, A. W., & Chen, E. Y. (2015). Psychometric properties of translated outcome measures of cognitive behavioural therapy for psychosis in the Chinese context. Asian Journal of Psychiatry, 13, 6265.CrossRefGoogle ScholarPubMed
Yung, A. R., & McGorry, P. D. (1996). The prodromal phase of first-episode psychosis: Past and current conceptualizations. Schizophrenia Bulletin, 22, 353370.CrossRefGoogle ScholarPubMed