This month in voices: November 2013

Well, as I last posted on Christmas day, it seems appropriate to start up again on Easter Sunday. I’ll try and get through the backlog of research as soon as possible.


ICHR photoDurham, UK. Flavie Waters, Angela Woods and Charles Fernyhough report on what went on at the 2nd International Consortium on Hallucination Research, held in Durham.

Accessible summary: This is a clear and concise paper, plus free to read, so I won’t summarise it here. You can access it below.

Link to paper (free to read):


Melbourne3Melbourne, Australia. Bendall and colleagues examine how childhood sexual abuse may lead to voice-hearing.

Accessible summary. It has been proposed that childhood sexual abuse (CSA) results in intrusive experiences associated with posttraumatic stress disorder (e.g., thinking about the event when you didn’t
mean to), which in turn underpin voice-hearing experiences. This study found, within people with first episode psychosis who had experienced CSA, that there was a trend for greater levels of post-traumatic intrusions to be associated with more severe hallucinations. The authors conclude that hallucinations in psychosis may involve posttraumatic intrusions, and that clinicians should be alert to the importance of assessing for childhood trauma and the symptoms of PTSD in people diagnosed with psychosis.

Link to paper:


Groningen2Groningen, Netherlands. Curčić-Blake and colleagues examine the role of neural connectivity in voice-hearing.

Accessible summary: A number of theories of voice-hearing focus on how changes to the connections between different areas of the brain, particularly those involved in speech production and speech perception, may underpin voice-hearing. This study found evidence that a number of signalling pathways (white matter) in the brain had decreased structural integrity in people diagosed with schizophrenia who heard voices, compared to people diagnosed with schizophrenia who did not hear voices. For example, decreased integrity in the signalling pathway between the two hemispheres (the corpus callosum), as well as in pathways (such as the arcuate fasiculus) linking the frontal parts of the brain (e.g., those involved in speech production) to the temporal parts of the brain (e.g., those involved in speech perception) were found to be associated with hearing voices. The authors conclude that “hallucinations in schizophrenia patients are associated with a complex set of white matter abnormalities [i.e., changes in the signalling pathways of the brain] that involve at least three distinct systems: the language network, putatively in the ‘inner speech’ domain [thinking silently in words to yourself] ; and the central in attention and perception loop; and the limbic system, providing the emotional edge.” One could muse on how this study might link with the previous one discussed, e.g., could there be a role for childhood trauma in changing the signalling pathways in the brain?

Link to paper:


BandungBandung, Indonesia. Suryani and colleagues examine voice-hearing in Indonesian people diagnosed with schizophrenia.

Accessible summary. This was a qualitative study (very basically: sit down and have a chat with people, then later examine what was said to find common themes across participants) of 13 Indonesian people diagnosed with schizophrenia who heard voices. The first theme that emerged from this study was of people “feeling more like a robot than a human being”. In Indonesian culture reference to not being a human being is to suggest a point of difference in which the person no longer has the capacity to live a normal life with the freedom to make personal choices as part of daily living. In this case, this was due to people feeling powerless to resist what the voices told them to do, e.g., “2 years ago, the voices instructed me to climb a mountain. At the time, I just followed their instruction. I could not reject it”.

The second theme was “Voices of Contradiction—A Point of Confusion”. This reflected how voices would often give contradictory commands, and tell people to do things which conflicted with their social and religious norms. The third theme was “Tattered Relationships and Family Disarray”. In this participants described how ‘family
relationships and family life imploded as the mental illness and the hallucinations took grip of the person’s life leaving them with feelings of chaos’. One participant stated how “I feel inferior and ashamed. I seemed to talk alone like a crazy man. I felt ashamed…about being mentally ill and hearing voices, I am in the process of divorce with my wife”. The final theme was “Normalizing the Presence of Auditory Hallucinations as Part of Everyday Life”. This theme reflected for a number of the participants, normalizing the voice-hearing was the most effective way of being able to live with them. One participant stated that “Hearing voices? Nothing special, like a conversation, the voices sometimes appear, but sometimes don’t. I get used to hearing the voices. It’s like part of my life.”

Link to paper:


Wills Kate wombatSydney, Australia. Amanda Waegeli, John Watkins and I wrote a paper considering the relation between spirituality and voice-hearing.

Accessible summary: I hope the paper is fairly easy to read, and you can check it out on-line, as it is free to read (thanks to the kind people at the Wellcome Trust). We begin by examining the ways which spirituality may help people with hearing voices, including offering an alternative explanation for people not satisfied by medical explanations, aiding coping, enhancing social support, allowing the person to undertake a defined social role, and enabling forgiveness. We then consider the flip side, how spirituality may have a detrimental effect, such as through encouraging people to have frightening or coercive interpretations of their voices, and missing opportunities for potentially successful medication or psychotherapeutic interventions. We then have a think about the categories of ‘spiritual’ and ‘psychotic’ voice-hearing, and highlight people’s right to their own interpretations of their experiences.

Link to paper (free to read):


Other studies

More soon. SMJ

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This month in voices: October 2013

Adam West's tribute to Monroe seemed a good idea at the time.

The consensus was that the vent had been kinder to Marilyn Monroe.

As I mentioned in a previous post, Melbourne might currently be voice-hearing’s second city (after Utrecht), and sure enough, this month we’ll start with some research from this fine city.

As a quick aside, the city now known as Melbourne was originally called Batmania, self-named by one of the first white people to live there, the magnificently named John Batman, a syphilitic farmer from Sydney. Why would anyone want to change such a magnificent city name? Well, for a number of reasons, see a quick history of Batmania here. But, I have digressed, let’s get back to the research.


Melbourne, a town so cool even its Rhinos skateboard.

A Melbourne tram advert. The town is so cool even its Rhinos skateboard.

Melbourne, Australia. Neil Thomas and colleagues examine the relationship between what people think of themselves and other people, and what they believe about their voices.

Accessible summary: The meanings someone gives to their voices are influenced by what they think about themself and other people in their world (i.e., in psychology speak, the schemas they have). For example, research has already shown that people who feel powerless in relation to their voices tend to feel a lack of power in relationships with other people in their social world. This interesting study set out to examine the relationship between what people believed about their voices, and how they viewed themselves and other people in their social world.

After controlling for a range of variables, it was found that the more negatively voice-hearers viewed other people, the more malevolent they perceived their voices to be (i.e., the more they believed their voices wished to do evil to them). However, the more negatively voice-hearers viewed themselves, the more all-powerful they were likely to believe their voices to be.

However, the authors could not establish the direction of causation. So, for example, whilst it could be that having negative views of others makes you more likely to interpret your voices as malevolent, it is also possible that how malevolent you perceive your voices to be influences what you think about other people (or both!).

The authors note that “Beliefs in voice malevolence are not easy to directly modify into an alternative belief without either colluding with the idea that voices are sentient others, or challenging the person’s overall explanatory model”. Collusion seems a strong word here.

The authors conclude that techniques such as acceptance and mindfulness-based therapies that can defuse the impact of negative beliefs about oneself might be helpful for voice-hearers.

Link to paper:


Coventry, England. Marwaha and colleagues examine the role of mood instability in psychosis.

Accessible summary: Mood stability was assessed in this study using the question, “Do you have a lot of sudden mood changes?”. People answering ‘yes’ were defined as having mood instability.

The study found that the higher mood instability was in members of the general population, the higher people’s levels of auditory hallucinations were. The authors then examined if the data was consistent with the hypothesis that childhood sexual abuse led to increased mood instability which in turn led to auditory hallucinations (i.e., whether mood instability mediated the relation between child sexual abuse and voice-hearing). The data was consistent with this (although the nature of the study didn’t allow causation to be established).

People’s levels of mood instability were also found to predict their levels of auditory hallucinations 18 months later. However, when people’s levels of general negative mood were controlled for, this relationship was no longer significant (i.e., it was plausible the association was just due to chance).

The authors conclude by suggesting that “direct therapeutic targeting of MI [mood instability] may reduce the propensity to recrudescence of psychotic symptoms”. After looking up what ‘recrudescence’ means, I think the authors are saying that therapy to help make peoples moods more stable might stop their voices re-occurring (of course, this makes the assumption that the voices breaking out again isn’t of any help to the person, which might not be true if we take seriously the idea that some voices are meaningful messangers).

Link to paper: (free to access).


Durham: Photo taken c.1400 (nothing changes!)

Durham: Not originally known as Batham.

Durham, England. Pete Moseley and colleagues examine the potential for neurostimulation to help us understand voice-hearing.

Accessible summary: This paper examines the use of neurostimulation techniques, such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), to help people with their voices (see previous posts for how these techniques work). The paper examines the evidence for whether these techniques work, and how they might have their potential effects (e.g., improving people’s abilities to recognise their own internally-generated mental creations as their own). It would take too long to summarise this paper, and in any case it is very readable and free to access.

Link to paper: (free to access)


Show me the Monet!

Show me the Monet!

Sandviken, Norway. Johnsen and colleagues examine the effectiveness of antipsychotics for hallucinations.

Accessible summary: This study randomly assigned 226 adults, who had been admitted to an emergency ward for psychosis, to be treated with one of four antispsychotics (risperidone, olanzapine, quetiapine, or ziprasidone). The study was particularly interested in whether these drugs helped people with their hallucinations when they were re-assessed 6 weeks later and then 2 years later.

At the start of the study 68% of patients had hallucinations. After 6 weeks this figure had decreased to 33%. Rates of hallucinations decreased quicker (over the two year period) in the patients who took quetiapine or ziprasidone. The authors conclude that “Hallucinations are fairly responsive to antipsychotic drug treatment”.

Is this a reasonable conclusion to reach from the authors’ findings?


First, there was no unmedicated control group. Basically put, until you know what would have happened to people’s rates of hallucinations if they were admitted and supported in  a similar way, but not medicated, you have no good leg to stand on in order to argue that the antipsychotics caused the hallucinations to reduce.

Second, 52% (i.e., over half) of the patients didn’t make it to the 6 week follow up stage. It is quite possible that the people who dropped out were more likely to have hallucinations than those who didn’t drop out. This would have artificially reduced the percentage of people with of hallucination at the 6 week stage.

Third,  people were counted as having hallucinations even if they were only rated as having “One or two clearly formed but infrequent hallucinations, or else a number of vague abnormal perceptions which do not result in distortions of thinking or behavior” (equating to a score of 3 on a measure called the Positive and Negative Syndrome Scale). This is in contrast to many other studies which require a score of 4 or more on this scale (reflecting more severe hallucinatory experiences) in order for hallucinations to be defined as being present.

Antipsychotics may well reduce hallucinations, but unfortunately this study does not prove it (see Appendix A of my book for further discussion on antipsychotics and hallucinations).

Link to paper: (free to access)


Other papers:

How does tDCS have it’s effect in helping voice-hearing? Link here.

What is the significance of “psychotic symptoms” in children. Free access to paper here.

Altered auditory steady state response to stimuli in people with  auditory hallucinations. Link here.

Is hallucination-proneness related to use of cannabis or cocaine? Link here (paper free to access).

Psychosis in Alzheimer’s Disease. Link here.

Hallucinations in dementia. Link here.

More next month, in the meantime Happy Christmas!


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This month in voices: September 2013

This month’s research is brought to you courtesy of the appalling England Cricket Team, whose performances I’m so desperate to avoid that I’ve returned to blogging earlier than expected.


An archive footage from the ground of the Brooklyn Dodgers. Notably, even when wearing a huge hat and holding a bunch of flowers in one hand, this women in the crowd could catch better than the England Cricket Team.

An archive photo from the ground of the Brooklyn Dodgers. Notably, even when wearing a huge hat and holding a bunch of flowers in one hand, this woman in the crowd could still catch better than the England Cricket Team. Sign her up!

Brooklyn, New York, USA. Cohen and colleagues investigate what the voices heard by older people diagnosed with schizophrenia are like.

Accessible summary: This paper examined voice-hearing in people aged 55 years or older who had a diagnosis of schizophrenia (recieved before they were 45 years of age). Their voice-hearing appeared to be much like that of younger people (although there was no direct comparison data collected from younger people). The authors argue that hearing pleasant voices appears to be a bit more common in older people than in younger people, and the commands of voices seem more likely to be obeyed. Voice-hearing was more common in patients who were depressed and in those who had delusions. Men were found to have higher rates of voice-hearing than women in this population. Notably, lifetime trauma scores did not predict the presence of voices.

Link to paper:


An empty Melbourne Cricket Ground. Somehow England still lose three wickets.

An empty Melbourne Cricket Ground. Somehow England still lose three wickets.

Melbourne, Australia. McLachlan and colleagues investigate changes to auditory processing in people who hear voices and have been diagnosed with schizophrenia.

Accessible summary: This study compared people diagnosed with schizophrenia who did and did not hear voices, to see if there were differences with how their brains processed sounds. It was found that people who heard voices  performed worse than those who did not on tasks involving 1) detecting changes in pitch, and 2) auditory streaming (detecting changes to a melody). The authors conclude that some form of “auditory dysfunction” may be associated with voice-hearing.

Link to paper:


A cricket bat. Used to hit cricket balls. By some teams, at least.

A cricket bat. Used to hit cricket balls. By some teams, at least.

Melbourne, Australia (again: Melbourne is to Southern Hemisphere voice-hearing research, what Utrecht is to the Northern Hemisphere). Here, Tucker and colleagues examine if there are changes to auditory processing in first degree relatives of people who hear voices and have been diagnosed with schizophrenia.

Accessible summary: This study examined whether unaffected first degree relatives (of people diagnosed with schizophrenia who heard voices) showed differences in performance on some auditory processing tasks compared to control participants (i.e., non-psychiatric members of the general population). The study found that the relatives were slower than controls at identifying emotions (happy, sad, fearful, and neutral) from words they heard played to them over headphones, particularly for happy and neutral sentences.

To assess people’s pitch discrimination ability, they were first played a 500Hz tone and then a second tone which could be the same, or 2%, 5%, 10% ,25% or 50% different. (Here’s a 10% higher tone, i.e., 550HZ, for you to compare with the 500Hz one). They had to say whether the second tone was the same or different to the first. As with the previous study, the more prone people were to hearing voices the worse their pitch discrimination abilities were. The authors conclude that these results suggest “basic impairments in auditory processing are present in relatives of AVH [voice-hearing] patients… and predict AVH proneness.” When you think about it, and listen to the tones, it is quite striking that this very simple difference on a very simple task is associated with the quite different and more complex experience of hearing voices, highlighting the idea that a basic change to the auditory system could be associated with hearing voices.

Link to paper: (free to access)


Geneva, home to CERN. Things go round in circles and then fall apart. But that's enough about the England cricket team.

Geneva, home to CERN. Things go round in circles and then fall apart. But that’s enough about the England cricket team.

Geneva, Switzerland. Ottet and colleagues examine how changes to the connectivity of the brain may be involved in voice-hearing.

Accessible summary: Some people have what is called a 22q11.2 deletion syndrome, which results from the deletion of a small piece of chromosome 22. Such individuals are often studied in schizophrenia research because they have around a 30% risk of developing schizophrenia (making them the third highest risk group, after having monozygotic twin with schizophrenia -50% risk- or both parents being affected -46% risk, the authors note). The authors studied a number of people with this sydrome, and used some seriously jazzy math to figure out how connectivity between different areas of the brain was related to the level of hallucinations these people had.


Neural connectivity maps of the two groups of participants. No comparisons were made with the brains of the English Cricket Team as these could not be located.

They found that, after taking into account variations in the age and gender of people, that the efficiency (i.e., the ability to exchange information with other brain regions) of three key ‘hub regions’ were associated with hallucinations. Worse efficiency of the pars triangularis (Broca’s area – associated with speech production) and transverse temporal (Wernicke’s area – associated with speech comprehension) regions were associated with more severe hallucinations. Increased efficiency of the dorsolateral prefrontal region (involved in a range of skills such as short term memory and executive functions, i.e., the control of thinking) was associated with more severe hallucinations.

Thus, this study suggested that the ability of regions of the brain involved in speech production and comprehension, as well as in short-term memory and the control of thought, to communicate with the rest of the brain, may play a role in creating hallucinations.

This is a really interesting paper, and I can’t believe it has only been accessed 424 times at my time of writing.

Link to paper: (free to access)


Other papers

  • Assessment and meaning of hallucinations in young people: link here.
  • A paper for those of you interested in the mechanics of corollory discharge: link here.
  • A comparison of hallucinations between people with  non-affective (i.e., schizophrenia) and affective (i.e., bipolar) diagnoses: link here (paper free to access).
  • Report on people’s experiences of TMS for voice-hearing: link here (paper free to access)

More soon or, if England’s Cricket Team keep up their current level of shambolic performances, more tomorrow.


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This month in voices: August 2013

MiffyPlenty more research in August, including (inevitably yet thankfully) some from Utrecht. What is the official slogan of the Utrecht Tourist Board I hear you ask. Well, as you ask, it is “Utrecht: Too much fun for one day”. And to be fair, this does seem to be true.

Interested in Dutch Popes? You can visit a house made by Adrianus VI. Interested in Aboriginal Art, but don’t live in Australia? No problem, you can visit the only European museum devoted to contemporary Aboriginal art from Australia. Fan of Miffy the rabbit? Dick Bruna was born there!

Utrect5Feel that leaving train stations could be made more fun? Visit Utrecht’s Overvecht railway station which has a ‘transfer accelerator’ installed (i.e., a big kids slide).  Sick of mindless canoeing? (oddly, if you google “mindless canoeing” the first of the three hits you get contains the phrase “Democratic Convention to save schizophrenic Democrats from their mindless canoeing.” Oh dear). Anyway, Utrecht has “mindful canoeing” to save us from the social blight that is mindless canoeing. But I digress.


manchester4Manchester, England. Hartley and colleagues examine what kind of emotions immediately precede experiences of hearing voices.

Accessible summary: This study employed a technique called experience sampling. In this, people carry mobile phone-like devices with them, which beep randomly 10 times a day, for six days. Each time they beep, the person completes ratings of specific thoughts, emotions and voice-hearing experiences which they are currently having, and have had since the last beep. The study found that both worry and rumination predicted the onset of hearing voices. As such, the authors suggest that working on these issues may help.

Link to paper:


Newcastle3Newcastle, England. In this next study, also from the North of England, Lucy Garwood and colleagues test for the existence of a subtype of voice-hearing called a ‘hypervigilance hallucination’.

Accessible summary. This paper aimed to test Dodgson and Gordon’s theory of hypervigilance hallucinations (HV-AHs). HV-AHs are proposed to result from an exaggeration of the normally useful ability we have to detect threats. The theory suggests that typically some form of stressful life-event occurs (e.g., something happens that you feel ashamed about), and the person then becomes hypervigilant for related threat stimuli (e.g., other people saying things that indicate they know what happened). This is proposed to reduce people’s threshold for detecting threats in the environment and increasing the chance of auditory ‘false-positives’, i.e. hearing voices saying things. As a result of this theory, HV-AHs are proposed to be characterised by hearing either a voice or sounds (e.g., laughter) with threatening content, which is perceived as coming from the external environment. Given the role of hypervigilance, the theory makes the key prediction that HV-AHs will only occur in situations where the individual’s attention is externally-focussed.

This study used cluster analysis to examine whether the properties of voice-hearing which were proposed to characterise HV-AHs did indeed tend to co-occur together. It found, albeit in a small sample of people, that a subset of voices were characterised by the co-occurence of being threatening, externally-located and occurring when attention was externally focussed. A trial of a form of talking therapy (cognitive behavioural therapy), which will try and help with this specific type of voice-hearing, is now underway.

Link to paper:


BangaloreBangalore, India. Shivakumar and colleagues examine the use of tDCS for voice-hearing.

Accessible summary. tDCS (transcranial direct current stimulation) is a way to alter the activity of specific parts of the brain, through the application of a mild electrical current directly to the scalp. It appears to be painless and safe. This study offered a single case example, claiming tDCS to be useful for ameliorating voices. It concluded that this technique is worth “exploring through further rigorous studies” (although a larger trial had already been published to this end – see Brunelin et al., 2012)

Link to paper:


AalborgAalborg, Denmark. Pedersen and Nielsen give a new case study of a deaf voice-hearer.

Accessible summary: The paper is free to read, and hasn’t got too much jargon. What particularly stood out for me was when the person had a visual hallucination of her dead cousin and “experienced a two-way verbal communication, both by hearing his voice and by lip reading.” I’d never heard of hallucinated verbal communications via lip reading from a vision before.

Link to paper: (free to access)


The Annual Festival of Unrepetent Stealing of Other Countries National Symbols. This year: Ireland.

The Utrecht Annual Festival of Unrepetent Stealing of Other Countries National Symbols and Subsequent Brandishing of Them. This year: Ireland.

Utrecht, Netherlands. van Lutterveld and colleagues note an important problem with symptom-capture studies of voice-hearing.

Accessible summary: This is probably a paper mainly of interest to researchers, but I felt it important to mention. This interesting short paper examined the validity of studies which ask people to sit in an MRI scanner and indicate when they hear voices by pressing a button, in order to allow researchers to find out what areas of the brain light up when people hear voices (“symptom capture studies”). This study found evidence that the neural activation resulting from the attentional and motor processes involved in detecting a sound meant that it was likely that processes involved in signalling hallucinations explained a large part of the brain activation observed in symptom capture studies. Alternate designs are hence required to work out what areas of the brain are really activated during voice-hearing.

Link to paper:


WombleOther papers:

A Womble proposes a horse sedative as a treatment for PTSD (yes, I’m serious): link here.

Hallucinations as subconscious attempts to restore perceptual coherence: link here.

People with childhood problems with communication, reading and mathematics have an increased risk of developing voice-hearing: link here.

A method for helping psychiatric-mental health nurses help voice hearers: link here.

New case report of auditory hallucinations in a deaf patient. Link here (free to access).

More hallucinations in people born in Winter? Link here (free to access)

That’s all for this month. More stories from a Tourist Board, possibly in your town, next month.



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This month in voices: July 2013

JC2July, Julius Caesar’s month. Pre-J.C. it had the much more stylish name of Quintilis. Now, going off on what is probably only a degree shy of an tangent, J.C. was  possibly the worst kidnapee one could wish for. When pirates kidnapped him in 75BC, and demanded a ransom of 20 talents of silver (equivalent to £270,000), J.C. took offense at this, and insisted they increase this to 50 talents of silver (£675,000). Because he was worth it.

J.C., then demanded that the pirates not talk when he wanted to sleep, and spent most of his time writing and reciting poetry and speeches to the pirates. Now I’m not sure what J.C.’s poetry was like, and whether he would make the top 3 worst poets in the Universe (coming above or below the Vogon’s; god rest Douglas Adams’ soul) but he seems like he would have been pretty insufferable, even for pirates. Although it probably wasn’t a relief for the pirates when they were crucified (which is what J.C., had done to them once he was freed), it may have been close. Anyway, I have significantly digressed. Back to voices.


Geneva1Geneva, Switzerland. Dahoun and colleagues examine how differences in the neural basis of taking the perspective of another person may be related to hearing voices.

Accessible summary: The voices people hear may quite often speak to them in the third person (e.g., saying “he’s making a fool of himself” or “she’s being stupid”). Previous research has found that people who hear voices are less likely to be able to successfully recall whether a given action was something they did or something other person did. As a result, research is interested in whether, when voice-hearers take a third person perspective, whether their brains behave differently to non-voice hearers.

What this study did was ask “typically developing” adolescents, and hallucination-prone adolescents (who were either at high risk of developing hallucinations or already experiencing some hallucinations), to do a task where they had to imagine doing things from a 1st person and 3rd person perspective. For example, participant’s had to imagine themselves playing a violin (1st person perspective) and/or their best friend playing the violin (3rd person perspective). All this was done in an fMRI scanner so the researchers could see what people’s brains were up to during the task.

The study found that in the 3rd person condition, hallucination-prone individuals had lower levels of brain activation in the parieto-occipital region of the brain, compared to the “typically developing” group.

So, next question, what does the parieto-occipital region of the brain do? Well, loads of things, but among them is having a hand in episodic memory (i.e., recalling events from one’s past) and being involved in the ability to make distintions between the imagined actions performed by oneself and those performed by other people. The authors hence suggest that one factor related to hearing voices, in addition to effects based in autobiographical memory, may be “impairment in the capacity to shift perspective” which may causes problems in correctly identifying self-produced thoughts in the form of the 3rd person.

Link to paper: (free to access)


geneva2Geneva, Switzerland (again! Is Geneva the new Utrecht? Surely not?). Rachid and colleagues report on the success of theta burst stimulation for voice-hearing.

Accessible summary: This was a single person case study, so should be treated with caution, but is interesting nonetheless. Normal transcranial magnetic stimulation (TMS) involves placing a ping-pong bat like device over a specific part of the scalp. A rapidly changing magnetic field in the bat causes an electric field to be induced in the cortex (surface) of the brain directly below the bat, and alters the activity of this part of the brain, and its connections with other parts of the brain. The magnetic field is usually applied with a frequency of 1Hz. Such 1Hz TMS was done with this patient (over the temporoparietal junction part of the brain), but her voices didn’t improve. However, theta burst stimulation, which uses the same principle but a higher frequency of magnetic field (and has been found to decrease cortical activity) was then applied over the same part of the brain.

The authors report that “on the 8th day of treatment, she reported a total suppression of her AVH [voice-hearing] for at least 5 h and after she had received 18 sessions of cTBS, she was hearing almost no voices and had more than 80% reduction in AHRS [a measure of auditory hallucinations] score from baseline”. The authors suggest the need now for a formal controlled trial of this approach.

Link to paper:


chicagoChicago, USA. Nev Jones leads a paper reflecting on the principles of the Hearing Voices Movement (HVM).

Accessible summary: The paper is extremely accessible already and offers a useful discussion of the principles of the HVM, e.g., that using antipsychotics to suppress voices can often be ineffective/insufficient, and voices may actually carry important messages that need to be explored rather than silenced (contrast this to the previous paper above). The paper also makes some intriguing comments based on the authors’  on-going phenomenological work, such as “participants in an in-depth phenomenological study of psychosis we are currently conducting, for example, have reported consciously assigning inherently ambiguous unusual sensory experiences to a single modality (such as voice or sight), focusing on only certain experiences and thus, over time, strengthening those experiences while others drop away”. I would recommend a read of this paper, and I look forward to highlighting the authors’ novel and important detailed phenomenological work when it is published.

Link to paper:


jenaJena, Germany. Nenadic and colleagues examine the role of that most arrogant of temporal gyrus’, the superior, in voice-hearing.

Accessible summary: The superior temporal gyrus (or STG for short), the upper part of the temporal lobe, has been implicated as being involved in voice-hearing for decades. If you directly electrically stimulate it, you will likely hear voices, and neuroimaging studies have shown that it is activated when people experience auditory verbal hallucinations. This study examined the metabolic activity of cells in the STG in people diagnosed with schizophrenia who heard voices but were not on antipsychotic medication. It found that more severe voices were associated with greater changes at a cellular level in the STG. The authors do not go on to say why this relation should exist, and the problem here is that the STG does so many things, but likely to be of importance are the STG’s role in language perception and comprehension, and its role in source-monitoring (working out the source of an event, e.g., whether we thought something or perceived it).

Link to paper:


Other papers:

  • Language lateralisation found not to be associated with severity of voices. Link here.
  • Reduced supramarginal cortical thickness (part of the parietal lobe of the brain, involved in many things, including processing heard speech) is predictive of increasing hallucinations over time in Alzheimer’s Disease. Link here.
  • Association between hallcination-proneness (but not a specific measure of auditory hallucination-proneness) and a proxy measure of mistaking internally generated thoughts for externally generated ones. Link here.
  • A review which touches on the relation between attachment and hallucinations (nothing definitive found). Link here.
  • People’s relationships with their voices were found not to change over a 6 month period, when no targetted intervention was used. This suggest that there is the need for a tailored intervention to alter voice-hearers relations with their voices, to help reduce the distress associated with voice-hearing. Link here.

That’s all for this month. More voice-hearing research, and probably digressions (after all, August was named after another Caesar…), next month.


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This month in voices: June 2013

June. One of my favourite months, particularly if it finds me in Iceland, as on June the 24th, according to Icelandic folklore, not only do cows gain the powers of speech (what do they say? can they also sing? the latter question being one for you right Broca fans out there. You know who you are) but seals become human (why seals? why?). Furthermore, if you sit at a crossroads where all four roads lead to separate churches, elves will attempt to seduce you with food and gifts (wikipedia, I hope you’re not misleading me). Anyway, I appear to have digressed. Back to voices…


Durham UKDurham, England. Angela Woods explores the figure of the “voice-hearer”.

Accessible summary. This paper examines how, 25 years after the beginning of Hearing Voices Movement (which allows the author the wonderful line, “Before 1987, there were no voice-hearers”), the identity of “the voice-hearer” has become established as an one which people can “adopt, inhabit, and mobilise in order to lay claim to a view of voice-hearing as meaningful within the context of people’s lives”. It is an excellent read, and I recommend it.

Link to paper:


Bern Switzerland2Bern, Switzerland. Homan and colleagues examine brain activity in voice-hearing’s favourite gyrus, the superior temporal (the inferior frontal comes in a respectable second).

Accessible summary: This paper found that people who hear voices, when ‘at rest’ (i.e., sitting in an MRI scanner doing nothing in particular), have greater activity in their left superior temporal gyrus (lSTG), than non-voice hearers. Furthermore, even after they have been treated by transcranial magnetic stimulation (see previous posts for infomation on this treatment) directed at the lSTG, their levels of resting lSTG activation are still higher than non-voice hearers. The authors therefore conclude that higher resting levels of lSTG activation is a trait of voice-hearers (i.e., a stable characteristic) , rather than a state (i.e., it doesn’t only increase when people are hearing voices). The authors fit this into a model where (and take a deep breath now if you don’t like ‘deficit’ terminology) voices are a caused by a “permanent defective monitoring of inner speech (i.e., a trait which is always there) and a “temporary misattribution of internally generated speech” (i.e., a state which varies).

Link to paper: (paper is free to read)


St LouisSt Louis, USA. Sheffield and colleagues examine if childhood sexual abuse (CSA) is associated with hearing voices.

Accessible summary: After examining whether there was an association between voice-hearing and a range of forms of child abuse, the authors concluded that their findings supported the notion that “childhood sexual abuse is a specific risk factor for the experience of auditory hallucinations in psychotic disorder patients.”

For those of you with a statistical bent though, the results section may raise a few eyebrows regarding the question of the specificity of CSA to voices. This does not negate the authors’ important conclusion though that “Clinicians should obtain an abuse history from patients who experience auditory hallucinations, since the patient might not reveal such a history and miss appropriate treatment”

Link to paper:


Other papers:

  • A paper on the need for “Experience Focused Counselling”, which makes some interesting points, but, without wishing to editorialise, I have no absolutely idea how it got through peer-review.


Anyway, more next month. For those of you appalled that there are no papers from Utrecht this month, please make do with this picture and hope that next month brings a restoration of normality.


I’m off to ponder what cows would say if they could talk.


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This month in voices: May 2013

Loads more papers on voices published in May…


BirminghamBirmingham, UK. Connor and Birchwood look at self-critical thoughts and the self-
reassuring capacity in people who hear voices, and how this relates to what their voices are like.

Accessible summary: The study found that people who heard voices which had content involving themes of shame had a reduced capacity to self-reassure themselves after self-critical thoughts. Furthermore, voice-hearers with the greatest level of self-critical thoughts (involving self-hatred and inadequacy) were found to view their voices as powerful and to have voices which were critical and hostile (i.e.,  had high ‘expressed emotion’).  The authors note that, given these findings, Compassionate Mind Training, which aims to reduce levels of self-critical thoughts and increase feelings of self-reassurance and acceptance, may help people who hear voices.

Link to paper (free to read):


Newcastle2Newcastle, UK. Milligan and colleagues (including me) examine how voices change over time.

Accessible summary. This study looked at how voices changed over time in people who were in an Early Intervention for Psychosis service. We found that six themes emerged as part of people’s hearing voices journey. Voices typically emerged after negative life events and were at first rejected as being part of the self. Crisis events could then lead to either positive changes (e.g., the voice-hearer opening up to talking to their friends and services about their voices) or negative ones (e.g., voices becoming more critical/abusive). Voice-hearers could enter a phase involving discovering, adjusting and trying to cope with the voices, based on three key resources: themselves, others, and services. Finally, a “New Understanding” phase could be reached where participants changed from simply rejecting their voices to different understandings, such as that their voices were a part of them, and were potentially there for the long-term. The stages we found didn’t match with the three phases previously proposed by Romme and Escher, but this could have been due to the specific early stage that many of the voice-hearers in this study were at.

Link to paper (or email me for a copy):


Birmingham2Birmingham, UK. Connor and Birchwood publish another study, this time looking at the relation between the perceived power of voices (and their critical/hostile nature) and depression/suicidal thinking in voice-hearers.

Accessible summary: This study found that 78% of voice-hearers who had voices which they perceived to be powerful, and hostile/critical voiced, had significantly elevated levels of depression. People who rated their voices as emotionally supportive showed the lowest levels of depression and suicidal thinking. The authors conclude that many of the talking therapies that are routinely used to help depressed people with relationship difficulties should be helpful to people who hear voices. They also note that the supportive aspect of the voice hearer with their voices should not be undermined if the voice-hearer doesn’t have any other supportive social network.

Link to paper (free to read):


Warwick3Warwick, UK. Noorani examines service-user involvement, including the Hearing Voices Movement, in mental health services.

Accessible summary: This interesting paper looks at how the radical survivor movement has transformed into the service user movement.  The new experiential authority of ‘experts-by-experience’ is examined, and it is considered how the resultant knowledge is able to contest the knowledge and authority
of medical psychiatry. (It is likely to be informative to compare this paper with the great blogs of Nev Jones, available via

Link to paper:


london5London, UK. Hepworth and colleagues examine whether people diagnosed with schizophrenia respond to their voices differently compared to people diagnosed with borderline personality disorder (BPD).

Accessible summary: The study looked at how people diagnosed with BPD differ in their psychological responses to hearing voices, as compared to people diagnosed with psychosis. They found that both groups of people held similar levels of beliefs about the omnipotence and malevolence of their most dominant voice. However, people diagnosed with BPD were found to report that their dominant voice had a more
negative impact. The authors note that this is consistent with previous research which found that, for those with BPD, voices are experienced as more distressing and
have greater levels negative content than for the voices heard by people diagnosed with schizophrenia (on average). They suggets that the higher level of child sexual abuse found in the group of people diagnosed with BPD , compared to the group of people diagnosed with schizophrenia, could explain the difference, i.e., the dominant voice in the BPD group may be more likely to be that of an abuser, and hence cause greater distress.

Link to paper:


London6London, UK: Howard and colleagues examine how people try to cope with their voices.

Accessible summary: This study looked to see how people naturally coped with their voices. The majority of voice-hearers were found to either cope with their voices through distraction or a form of non-engagement. Only 20% of voice-hearers used what could be termed “engagement strategies” such as focusing on the characteristics of the voice, and talking back to the voice on the mobile telephone. The authors conclude that “coping strategies naturally utilised by voice hearers tend to be of limited benefit and may perpetuate the voice hearing experience”.

Link to paper:


Other studies

Plenty on transcranial magnetic stimulation (TMS). Hoffman and colleagues find further evidence that  may help some voice-hearers. Link to paper here. Kindler and colleagues find that a variant of TMS, specifically theta burst stimulation, can help some voice-hearers. Link here. Plus, more on TMS from Hubl and Dierks colleagues. Link here.

Hugdahl and colleagues find hearing voices interferes with the ability to attend to the outer world. They note it should be possible to “cognitively train AVH patients to learn to re-focus attention away from the “voices” and to cognitively inhibit such experiences (contrast with Howard et al study about). Link here.

Jardri and colleagues publish an interesting paper about the relation between temporal instabilities of the default mode network and hallucinations in general. Link here.

Kim and colleagues find a variation (rs4773092) in the IRS1 gene (insulin receptor substrate 2) to be associated with auditory hallucinations. Link here.

Koeda and colleagues examines the neural activation associated with perceptions of greetings, in people who hear voices. Link here.

Orr and colleagues find that giving nursing students simulated sounds and voices to listen to (recorded by consumers on mp3 players) during a task helped them develop an understanding of voice-hearing, increased their awareness of its impact on functioning, and helped them consider the communication skills necessary to engage with consumers who hear voices. Link to paper here.

Stephane highlights the importance of the phenomenology of hearing voices. Link to paper (free to access) here.

I think that’s enough for one month. Well, maybe one more quick paper – here’s an article by myself and Eleanor Longden, free to read.

More soon!



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