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Cited by 113Hallucinations in medical conditionsSchizophrenia research and treatmentTranscranial Magnetic Stimulation Studies

Auditory verbal hallucinations as atypical inner speech monitoring, and the potential of neurostimulation as a treatment option

Open access
Moseley, Peter, Fernyhough, Charles, Ellison, Amanda·2013·Neuroscience & Biobehavioral Reviews
DOI 10.1016/j.neubiorev.2013.10.001PMC PMC3870271
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Abstract

Auditory verbal hallucinations (AVHs) are the experience of hearing voices in the absence of any speaker, often associated with a schizophrenia diagnosis. Prominent cognitive models of AVHs suggest they may be the result of inner speech being misattributed to an external or non-self source, due to atypical self- or reality monitoring. These arguments are supported by studies showing that people experiencing AVHs often show an externalising bias during monitoring tasks, and neuroimaging evidence which implicates superior temporal brain regions, both during AVHs and during tasks that measure verbal self-monitoring performance. Recently, efficacy of noninvasive neurostimulation techniques as a treatment option for AVHs has been tested. Meta-analyses show a moderate effect size in reduction of AVH frequency, but there has been little attempt to explain the therapeutic effect of neurostimulation in relation to existing cognitive models. This article reviews inner speech models of AVHs, and argues that a possible explanation for reduction in frequency following treatment may be modulation of activity in the brain regions involving the monitoring of inner speech.

AI snapshot

Written from the paper’s full text.

TL;DR

This review argues that auditory verbal hallucinations (AVHs) can be understood as inner speech misattributed to an external/non-self source due to atypical self- or reality monitoring, and that neurostimulation may reduce AVHs by modulating the involved temporal and monitoring networks. It concludes that rTMS/tDCS evidence is promising but equivocal, with sham control, power, and AVH heterogeneity limiting firm conclusions.

Key findings

  • AVHs are experienced by around 60–80% of people diagnosed with schizophrenia and by between 1.5% and 3% of the general population; they may be refractory to current treatment in around 25% of cases.
  • Inner speech/self-monitoring models are supported by subvocalization, neuroimaging, and monitoring-task evidence implicating left temporal regions, including STG, and connected frontal/cingulate areas; atypical monitoring may lead inner speech to be experienced as alien or external.
  • rTMS findings are mixed: Hoffman et al. (2005; N=50) reported an effect size of .94 for reduced AVH frequency; Hoffman et al. (2013; N=83) reported .65, rising to .74 when motor threshold was consistently detectable; Slotema et al. (2011; N=62) found no significant advantage over sham; a meta-analysis still reported a moderate effect size of .38.
  • In the only reported tDCS trial at the time, Brunelin et al. (2012; N=30) found a 31% reduction in hallucination severity with active stimulation versus 8% with sham, still present at 3 months, with 6 of 15 active-condition participants showing >50% reduction in hallucination frequency.

Methods

  • Design: narrative review integrating cognitive models of AVHs as misattributed inner speech with evidence on noninvasive neurostimulation treatment.
  • Data/sample: no primary sample; the paper synthesizes prior clinical, neuroimaging, electrophysiological, and neurostimulation studies, including samples of hallucinating patients, schizophrenia patients, and healthy controls.
  • Main analysis: conceptual synthesis of self-monitoring, reality monitoring, forward-model, and inner speech accounts with rTMS/tDCS efficacy findings and post-stimulation neuroimaging correlates.

Limitations

  • The paper states that efficacy evidence for neurostimulation in AVHs remains equivocal, that rTMS sham conditions are often inadequate, that publication bias is possible, and that many studies lack adequate statistical power.
  • It states that most rTMS studies recruited medication- or therapy-resistant patients with schizophrenia, that AVHs are likely heterogeneous, and that no studies had examined rTMS efficacy across different AVH types; tDCS evidence came from only one small study, and long-term effects past one month were minimally evidenced.
  • Evident from the text: this is a narrative review without a systematic search or formal meta-analysis, so its conclusions depend on the selected literature and on the authors’ interpretive integration rather than on new primary data.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.neubiorev.2013.10.001

Cites

134 of 134 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 109 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    An fMRI study of 24 hallucinating patients concluded that the right homologue of Broca's area (IFG) and the right superior temporal gyrus, as well as bilateral insula and anterior cingulate gyri, were most active during AVHs.

    “An fMRI study using a sample of 24 hallucinating patients, concluded that the right homologue of Broca's area (IFG) and the right superior temporal gyrus, as well as the bilateral insula and anterior cingulate gyri, were most active during AVHs (Sommer et al., 2008).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Sommer et al., 2008 source

      Not checked in the free run.

  • Premisecitation

    Some AVHs have been shown to be less frequent when patients explicitly vocalized competing utterances, for example humming.

    “some AVHs have been shown to be less frequent when patients explicitly vocalized competing utterances, for example humming (Green and Kinsbourne, 1990).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Green and Kinsbourne, 1990

      Not checked in the free run.

  • Premisecitation

    In one case, subvocalizations were amplified into intelligible speech which corresponded well to the contents of the AVH.

    “In one case, the subvocalizations were amplified into intelligible speech which corresponded well to the contents of the AVH (Green and Preston, 1981)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Green and Preston, 1981

      Not checked in the free run.

  • Interpretationreasoning

    The validity of common inner speech tasks in relation to the kinds of inner speech experienced in real life, or related to AVHs, may be tenuous.

    “their validity in relation to the kinds of inner speech that we experience in real life, or that may be related to the experience of AVHs, may be tenuous.”
    Quote in the paperNot a substantial claim
  • Premisecitation

    Similar cortical areas are active during inner speech as during AVHs.

    “Further evidence from neuroimaging studies suggests that similar cortical areas are active during inner speech as during AVHs.”
    Quote in the paperSubstantial claim
  • May combine two claims. 28
  • Classified as probably not a substantial claim. 36

  • May combine two claims.

    Interpretationreasoning

    The unbidden thoughts model is not incompatible with the typical view of inner speech as the raw material of AVHs, additionally emphasizing the importance of subcortical structures such as the putamen in conscious experience.

    “Although different in its details, this model is not incompatible with the typical view of inner speech as the raw material of AVHs, additionally emphasizing the importance of subcortical structures such as the putamen in conscious experience.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Many models have assumed that the raw material of AVHs is a kind of inner speech.

    “Many models have assumed that the raw material of AVHs is a kind of inner speech (Bentall, 2003; Fernyhough, 2004)”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Bentall, 2003

      Not checked in the free run.

    • cites Fernyhough, 2004 source

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  • May combine two claims.

    Premisecitation

    Single pulse TMS can induce 'covert speech arrest' by stimulating either motor or non-motor language areas in the inferior frontal gyrus in the left hemisphere, but not right hemispheric non-motor language areas.

    “Aziz-Zadeh et al. (2005) were able to induce ‘covert speech arrest’ by stimulating either motor or non-motor language areas in the inferior frontal gyrus (IFG) in the left hemisphere, but not right hemispheric non-motor language areas.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Aziz-Zadeh et al., 2005 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    These findings may be interpreted as discordant with the inner speech theory of AVHs, especially in light of Aziz-Zadeh et al.'s findings.

    “These findings may be interpreted as discordant with the inner speech theory of AVHs, especially in light of Aziz-Zadeh et al.’s findings”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    A better model to explain AVHs involves the surfacing of 'unbidden thoughts' into consciousness, through a hyperconnected corticostriatal loop involving Wernicke's area and its right homologue, the left inferior frontal gyrus, and the putamen bilaterally.

    “Hoffman et al. (2011) have argued that a better model to explain AVHs involves the surfacing of ‘unbidden thoughts’ into consciousness, through a hyperconnected corticostriatal loop involving Wernicke's area and its right homologue, the left inferior frontal gyrus, and the putamen bilaterally.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Hoffman et al., 2011 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    AVHs may be refractory to current treatment options in around 25% of cases.

    “they may be refractory to current treatment options in around 25% of cases (Shergill et al., 1998).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Shergill et al., 1998 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    One study reported no phenomenological difference between the inner speech of hallucinating patients diagnosed with schizophrenia and a control group who did not hear voices.

    “One study reported no phenomenological difference between the inner speech of hallucinating patients diagnosed with schizophrenia and a control group of participants who did not hear voices (Langdon et al., 2009)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Langdon et al., 2009 source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Right-sided language areas could be involved in the contextualisation of AVHs, influencing emotional valence and attentional salience.

    “Alternatively, right-sided language areas could be involved in the contextualisation of AVHs (influencing emotional valence and attentional salience, for example).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Inconsistent neuroimaging findings in relation to the lateralization of AVHs may reflect the varying phenomenology of the experience.

    “Inconsistent neuroimaging findings in relation to the lateralization of AVHs may reflect the varying phenomenology of the experience”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    AVHs are usually experienced as non-self generated and usually, but not always, located in external space.

    “AVHs are usually experienced as non-self generated and usually (but not always) located in external space.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Most hallucinations take the form of another person's voice, often giving commands or commenting on actions, and usually being experienced as 'alien' to the self.

    “most hallucinations take the form of another person's voice, often giving commands or commenting on actions of the person, and usually being experienced as ‘alien’ to the self (Nayani and David, 1996).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Nayani and David, 1996 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Inner speech is the result of the internalization of external dialogues during psychological development.

    “Vygotsky's (1934/1987) argument that inner speech is the result of the internalization of external dialogues during psychological development.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Vygotsky, 1934/1987

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Inner speech is fundamentally dialogic in nature, or 'shot through' with other voices.

    “Fernyhough (1996, 2004) has argued that inner speech is fundamentally dialogic in nature, or ‘shot through’ with other voices.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Fernyhough, 1996 source

      Not checked in the free run.

    • cites Fernyhough, 2004 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Differential findings of inner speech and AVH neuroimaging studies may be due to the type of task used to elicit inner speech.

    “It may be that the differential findings of inner speech and AVH neuroimaging studies are in fact due to the type of task used to elicit inner speech.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    If inner speech is not recognized as self-initiated, it may be experienced as an AVH.

    “Frith (1992) suggests that, if inner speech is not recognized as self-initiated, it may be experienced as an AVH.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Frith, 1992

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The main difference between neural activation during AVHs and during imagining speech was that AVHs showed less activation in the supplementary motor area, otherwise similar areas were recruited.

    “Raij and Riekki (2012) showed that the main difference between neural activation during AVHs and during imagining speech was that AVHs showed less activation in the SMA, otherwise implying that similar areas were recruited for imagining speech and AVHs.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Raij and Riekki, 2012

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Theta and gamma band coherence between frontal and temporal areas is impaired in patients with schizophrenia, implying that synchronous neural activity may be the neural substrate of the efference copy.

    “Further EEG studies have shown that theta and gamma band coherence between frontal and temporal areas is impaired in patients with schizophrenia, implying that synchronous neural activity may be the neural substrate of the efference copy (Ford and Mathalon, 2005).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Ford and Mathalon, 2005

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    If AVHs are the result of inner speech being misattributed to an external/non-self source, it may follow that a mechanism that usually distinguishes between internally and externally produced stimuli is disrupted.

    “If AVHs are indeed the result of inner speech being misattributed to an external/non-self source, it may follow that a mechanism that usually distinguishes between internally and externally produced stimuli is disrupted.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationcitation

    Previous findings may not simply be due to a disrupted verbal self-monitoring system, but at least partly due to an externalizing bias possibly due to disrupted top-down processing of auditory stimuli.

    “The authors argued that previous findings may not simply be due to a disrupted verbal self-monitoring system, but at least partly due to an externalizing bias possibly due to disrupted top-down processing of auditory stimuli.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Allen et al., 2004 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    A deficit in self-monitoring as measured by some tasks is not enough in itself to explain the misattribution to external sources, and there must be a specific bias towards labelling events as external.

    “It has, however, been argued that a deficit in self-monitoring as measured by some of the aforementioned tasks is not enough in itself to explain the misattribution to external sources that has been proposed to explain AVHs, and that there must be a specific bias towards labelling events as external (Allen et al., 2004).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Allen et al., 2004 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S1 (asserted).

    Premisereasoning

    An internal forward model is disrupted in those that experience AVHs.

    “one prominent theory has suggested that an internal forward model is disrupted in those that experience AVHs.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Hallucinating patients show atypical functional connectivity of the anterior cingulate cortex with left temporoparietal junction, suggesting this connectivity may be related to a 'core control network' which exhibits conscious control over experiences.

    “Vercammen et al. (2010c) have demonstrated atypical functional connectivity of the ACC with left TPJ in hallucinating patients, suggesting that this connectivity may be related to a ‘core control network’ which exhibits conscious control over experiences.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Vercammen et al., 2010c

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Some models specify that the efference copy will dampen activity in the appropriate sensory area, to label the percept as self-generated.

    “Some models specify that the efference copy will dampen activity in the appropriate sensory area, to label the percept as self-generated (Ford and Mathalon, 2005; Whitford et al., 2012).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Ford and Mathalon, 2005

      Not checked in the free run.

    • cites Whitford et al., 2012 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Left temporal language areas are important in labelling a percept as externally located, and over-activation of this area may increase the likelihood that a percept will be incorrectly labelled as external.

    “This evidence, though, implicates left temporal language areas as important in labelling a percept as externally located, and it follows that over-activation of this area may therefore increase the likelihood that a percept will be incorrectly labelled as external.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    The essentially subjective measures of severity of hallucinations arguably leave the studies even more susceptible to being confounded by the placebo effect.

    “Further, the essentially subjective measures of severity of hallucinations arguably leave the studies even more susceptible to being confounded by the placebo effect.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    AVHs cannot be treated as one homogeneous group, and may differ both phenomenologically and in their cognitive and neural substrates.

    “there is a growing realization that AVHs cannot be treated as one homogeneous group, and may in fact differ both phenomenologically and in their cognitive and neural substrates”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Jones, 2010 source

      Not checked in the free run.

    • cites Nayani and David, 1996 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    The sham condition used in studies using tDCS is more effective, and therefore may be less susceptible to placebo effects.

    “As already mentioned, the sham condition used in studies using tDCS is more effective, and therefore may be less susceptible to placebo effects.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The IPL is immediately adjacent to the posterior STG, and may be part of an alternative pathway that runs laterally to the arcuate fasciculus between Wernicke's and Broca's area.

    “The IPL is immediately adjacent to the posterior STG (including the planum temporale and Wernicke's area), and may be part of an alternative pathway that runs laterally to the arcuate fasciculus between Wernicke's and Broca's area”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Catani et al., 2005 source

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    • cites Frey et al., 2008 source

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  • May combine two claims.

    Interpretationcitation

    This supports both the efficacy of rTMS as a treatment option for AVHs, and the link between AVHs and reality monitoring.

    “This can therefore be seen to support both the efficacy of rTMS as a treatment option for AVHs, and the link between AVHs and reality monitoring.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationown data

    The data was gained from only a single participant, and so further research is needed to support this finding.

    “The data, though, was gained from only a single participant (a child diagnosed with childhood-onset schizophrenia), and so further research is needed to support this finding.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Hoffman et al. (2013) replicated their initial findings with a sample size of 83, with reduced effect size of .65 for reduction in frequency of AVHs, increased to .74 when only patients with consistently detectable motor threshold were included.

    “Recently, Hoffman et al. (2013) replicated their initial findings with a sample size of 83, albeit it with reduced effect size of .65 for reduction in frequency of AVHs. This effect size was increased to .74 when only patients with whom they could consistently detect a motor threshold were included.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Hoffman et al., 2013 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Many studies have not achieved adequate statistical power.

    “Another major criticism, also made by Slotema et al., is that many studies have not achieved adequate statistical power”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    No studies to date have looked at the efficacy of rTMS in the treatment of different types of AVH.

    “No studies to date have looked at the efficacy of rTMS in the treatment of different types of AVH”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    There is a subtype of AVH known as 'hypervigilance hallucinations', characterized by their occurrence when attention is externally focused.

    “Recent studies, for example, have suggested a subtype of AVH known as ‘hypervigilance hallucinations’, characterized by their occurrence when attention is externally focused”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Garwood et al., 2013

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Previous attempts to treat AVHs with noninvasive brain stimulation have not been carried out based on a clear prediction from our understanding of the cognitive mechanisms underlying AVHs.

    “Previous attempts to treat AVHs with noninvasive brain stimulation have not been carried out based on a clear prediction from our understanding of the cognitive mechanisms underlying AVHs.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    This is difficult to reconcile with imaging studies of monitoring tasks and symptom-capture studies of AVHs, in which superior temporal regions, particularly on the left, are often shown to be important.

    “This is difficult to reconcile with imaging studies of monitoring tasks and symptom-capture studies of AVHs, in which superior temporal regions, particularly on the left, are often shown to be important.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Low-frequency stimulation of the right TPJ could improve performance on both types of task, but not decrease frequency of AVHs; left TPJ stimulation achieved both.

    “Jardri et al. (2009) showed that low-frequency stimulation of the right TPJ could improve performance on both types of task, but not decrease frequency of AVHs; meanwhile, left TPJ stimulation achieved both.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Jardri et al., 2009 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Previous studies have suggested bilateral involvement of the IPL in feelings of agency, with a right sided dominance.

    “Previous studies have suggested bilateral involvement of the IPL in feelings of agency, with a right sided dominance”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Farrer et al., 2003 source

      Not checked in the free run.

    • cites Jardri et al., 2007 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Initial studies indicated that rTMS may be effective as a treatment to reduce AVHs, with a large effect size of .94 in a 50 patient sample reducing frequency of AVHs.

    “These initial studies indicated that rTMS may be effective as a treatment to reduce AVHs, as measured by the Auditory Hallucinations Rating Scale, a 7-item scale which assesses hallucination frequency, number of voices, volume, vividness, salience, length and distress caused. A large effect size of .94 was found in the 50 patient sample, reducing the frequency of AVHs.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Hoffman et al., 2005 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    Temporal lobe regions are implicated in both self-monitoring failures in tests of forward model theories and reality monitoring biases towards the external.

    “Temporal lobe regions, then, as well as being important in inner speech and often active during AVHs, have been implicated in both self-monitoring failures in tests of forward model theories and reality monitoring biases towards the external.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The evidence regarding efficacy of noninvasive brain stimulation techniques as a treatment for AVHs is still equivocal.

    “To summarize, the evidence regarding efficacy of noninvasive brain stimulation techniques as a treatment for AVHs is still equivocal.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Patients that received active rTMS were less likely to misattribute an imagined word as one they had said after stimulation, whereas those in the sham condition did not show this pattern.

    “Patients that received active rTMS were less likely to misattribute an imagined word as one they had said after stimulation, whereas those that were allocated to the sham condition did not show this pattern.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Brunelin et al., 2006 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationcitation

    The fact that many patients were able to tell which condition they were in may have affected the results.

    “the fact that many patients were able to tell which condition they were in may have affected the results.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The effects of stimulation are relatively specific to a reduction in AVHs, because there was no improvement in other scores relating to positive or negative symptoms of schizophrenia.

    “There was no improvement in other scores relating to positive or negative symptoms of schizophrenia, implying that the effects of stimulation are relatively specific to a reduction in AVHs.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    This effect was still present 3 months later, with 6 of 15 participants in the experimental condition showing a reduction in hallucination frequency of more than 50%.

    “This effect was still present 3 months later, with 6 of 15 participants in the experimental condition showing a reduction in hallucination frequency of more than 50%.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Brunelin et al., 2012 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Slotema et al. (2012) conclude that there is little evidence of a publication bias.

    “Nevertheless, Slotema et al. (2012) conclude that there is little evidence of a publication bias”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Slotema et al., 2012

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Currently, most studies of inner speech rely on asking participants to repeat sentences to themselves or to count syllables.

    “Currently, most studies rely on asking participants to repeat sentences to themselves (e.g. McGuire et al., 1995) or requiring participants to count syllables (e.g. Aziz-Zadeh et al., 2005).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites McGuire et al., 1995 source

      Not checked in the free run.

    • cites Aziz-Zadeh et al., 2005 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Controversy exists as to whether the putative therapeutic effects of rTMS can be attributed to an ineffective sham condition.

    “Although controversy still exists as to whether the putative therapeutic effects of rTMS can simply be attributed to an ineffective sham condition, future studies, especially those using tDCS, could settle this debate.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisenone given

    Currently, minimal evidence exists on the long-term effects of neurostimulation on AVHs past one month.

    “Further study is also needed into the long-term effects on AVHs of this treatment – currently, minimal evidence exists into the effects past one month.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Neurostimulation treatment protocols reviewed above suggest that in some cases stimulation of the right TPJ may be successful in reduction of AVH frequency, which may imply a causal role for right temporal regions in the experience of AVHs, rather than simply contextualisation.

    “Nevertheless, neurostimulation treatment protocols reviewed above suggest that in some cases stimulation of the right TPJ may be successful in reduction of AVH frequency, which may imply a causal role for right temporal regions in the experience of AVHs, rather than simply contextualisation.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationcitation

    Asking participants to imagine a conversation, evaluate behaviour, or plan a speech for a future event should be more accurate approximations of inner speech than current methods.

    “More valid forms of inner speech could be evoked by, for example, asking participants to imagine a conversation, evaluate behaviour, or plan a speech for a future event – these have all been suggested as important functions of inner speech (McCarthy-Jones and Fernyhough, 2011), and so should be more accurate approximations.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites McCarthy-Jones and Fernyhough, 2011 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning

    Current inner speech theories might predict that right hemispheric language areas are not integral to the creation of AVHs, but are instead important in their contextualisation.

    “current inner speech theories might predict that they are not integral to the creation of AVHs, but are instead important in their contextualisation”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    Neurostimulation of the TPJ may affect mechanisms that are involved with the monitoring of inner speech.

    “As outlined, it may be that neurostimulation of the TPJ affects mechanisms that are involved with the monitoring of inner speech.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    While it seems likely that, at a cognitive level, the effect of treatment may be due to an improvement in self- and/or reality monitoring, it is hard to discount the possibility that a decrease in AVH frequency may lead to improvements in monitoring capability.

    “While it seems likely that, at a cognitive level, the effect of treatment may be due to an improvement in self- and/or reality monitoring, it is hard to discount the possibility that a decrease in AVH frequency may lead to improvements in monitoring capability”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Some AVHs can best be described as misattributed inner speech, whereas others might best be described as intrusive memories, and others still as 'hypervigilance' towards detecting stimuli in the environment.

    “it is possible that some AVHs can best be described as misattributed inner speech, whereas others might best be described as intrusive memories (Waters et al., 2006), and others still as ‘hypervigilance’ towards detecting stimuli in the environment”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Waters et al., 2006 source

      Not checked in the free run.

    • cites Dodgson and Gordon, 2009

      Not checked in the free run.

    • cites Garwood et al., 2013

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Currently, evidence suggests no negative effects of neurostimulation on short-term verbal memory or hearing function (pure-tone audiometry).

    “Currently, evidence suggests that there are no negative effects on neuropsychological measures such a short-term verbal memory (Hoffman et al., 2005) or measures of hearing function such as pure-tone audiometry (Schonfeldt-Lecuona et al., 2012)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Hoffman et al., 2005 source

      Not checked in the free run.

    • cites Schonfeldt-Lecuona et al., 2012 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Hoffman et al. (2007) found no reduction in AVHs after stimulating Broca's area, but did show that responders to the rTMS treatment tended to show reduced functional connectivity between left TPJ and the right homologue of Broca's area.

    “It is interesting that Hoffman et al. (2007) found no reduction in AVHs after stimulating Broca's area, but did show that responders to the rTMS treatment tended to show reduced functional connectivity between left TPJ and the right homologue of Broca's area”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Hoffman et al., 2007 source

      Not checked in the free run.

57 of 57

  • The paper relies on this without support.

    There has so far been little attempt to explain the therapeutic effects of neurostimulation, if not a placebo effect, in relation to pre-existing cognitive or neuroscientific models of AVHs.

    “There has so far been little attempt to explain the therapeutic effects of neurostimulation (if not a placebo effect) in relation to pre-existing cognitive or neuroscientific models of AVHs.”

  • The paper relies on this without support.

    Ideas surrounding the dialogic nature of inner speech have not yet been tested within a cognitive-neuroscientific framework.

    “ideas surrounding the dialogic nature of inner speech are yet to be tested within a cognitive-neuroscientific framework”

  • The paper relies on this without support.

    Typical neurostimulation protocols direct stimulation to affect left superior temporal regions and connected areas.

    “Typical neurostimulation protocols, meanwhile, direct the stimulation to affect these areas.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Several authors have related auditory hallucinations to an over-saliency of inner speech, considered a covert motor action, which is misattributed to an alien source.

    “Several authors have also related auditory hallucinations to an over-saliency of the inner speech (considered a covert motor action), which is misattributed to an alien source (McGuire et al., 1995; Allen et al., 2007; Moseley et al., 2013).”

    From What visual illusions teach us about schizophrenia (2014) · cites this paper as Moseley et al., 2013

  • People prone to hallucinations experience a perceptual bias which increases the influence of prior (top-down) information over bottom-up sensory input ('over-weighted priors').

    “There is evidence that people prone to hallucinations experience a perceptual bias which increases the influence of prior (top-down) information over bottom-up sensory input (“over-weighted priors”). 26 , 31 , 32”

    From Towards an Integrative Account of Potential Mechanisms Mediating the Path From Sleep Dysfunction to Hallucinations (2025) · cites this paper as [32]

Cites

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Related

Authors
Moseley, P., Fernyhough, C., & Ellison, A.
Affiliations
Durham University (GB)
Corresponding author
Moseley, Peter
ORCID
Venue
Neuroscience & Biobehavioral Reviews
Publisher
Elsevier BV
Published
2013-12
Volume
37
Issue
10
Pages
2794-2805
ISSN
0149-7634 (ISSN-L)
DOI
10.1016/j.neubiorev.2013.10.001
PMC
PMC3870271
OpenAlex
W2106286929
Cited by
113
References
134
Citations by year
2026: 14 · 2025: 10 · 2024: 9 · 2023: 8 · 2022: 7 · 2021: 11 · 2020: 6 · 2019: 8 · 2018: 8 · 2017: 5 · 2016: 10 · 2015: 11 · 2014: 6
FWCI
0.76
Type
journal article
Language
en
Open access
Licence
Locations
  • Neuroscience & Biobehavioral Reviews (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Durham Research Online (Durham University) (publishedVersion, other-oa)
  • Durham Research Online (Durham University) (acceptedVersion, other-oa)
  • Durham Research Online (Durham University) (submittedVersion, cc-by)
  • CLOK (University of Central Lancashire) (submittedVersion)
Funders
  • Seedcorn Research Fund
  • Faculty of Science at Durham University
  • Wellcome Trust Strategic Award (WT098455MA)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Hallucinations in medical conditions
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
Keywords
auditory verbal hallucinations, inner speech, self-monitoring, reality monitoring, schizophrenia, non-invasive brain stimulation, superior temporal cortex
MeSH terms
Acoustic Stimulation, Electric Stimulation Therapy, Hallucinations, Humans, Speech, Speech Perception

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

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