Auditory Hallucinations in Schizophrenia and Nonschizophrenia Populations: A Review and Integrated Model of Cognitive Mechanisms
Open accessAbstract
While the majority of cognitive studies on auditory hallucinations (AHs) have been conducted in schizophrenia (SZ), an increasing number of researchers are turning their attention to different clinical and nonclinical populations, often using SZ findings as a model for research. Recent advances derived from SZ studies can therefore be utilized to make substantial progress on AH research in other groups. The objectives of this article were to (1) present an up-to-date review regarding the cognitive mechanisms of AHs in SZ, (2) review findings from cognitive research conducted in other clinical and nonclinical groups, and (3) integrate these recent findings into a cohesive framework. First, SZ studies show that the cognitive underpinnings of AHs include self-source-monitoring deficits and executive and inhibitory control dysfunctions as well as distortions in top-down mechanisms, perceptual and linguistic processes, and emotional factors. Second, consistent with SZ studies, findings in other population groups point to the role of top-down processing, abnormalities in executive inhibition, and negative emotions. Finally, we put forward an integrated model of AHs that incorporates the above findings. We suggest that AHs arise from an interaction between abnormal neural activation patterns that produce salient auditory signals and top-down mechanisms that include signal detection errors, executive and inhibition deficits, a tapestry of expectations and memories, and state characteristics that influence how these experiences are interpreted. Emotional factors play a particular prominent role at all levels of this hierarchy. Our model is distinctively powerful in explaining a range of phenomenological characteristics of AH across a spectrum of disorders.
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Not all cognitive mechanisms under the rubric of inhibition are meaningfully related to hallucinations.
“For example, not all the cognitive mechanisms falling under the rubric of inhibition may be meaningfully related to hallucinations.3”
From Are hallucinations due to an imbalance between excitatory and inhibitory influences on the brain? (2016) · cites this paper as [3]
Research into the causes of auditory verbal hallucinations (AVH) has primarily focused on cognitive mechanisms, and a potentially causative role for emotion has been relatively neglected.
“Research into the causes of “hearing voices,” formally termed auditory verbal hallucinations (AVH), has primarily focused on cognitive mechanisms. A potentially causative role for emotion has been relatively neglected.”
From Is Shame Hallucinogenic? (2017) · cites this paper as Waters et al., 2012
Intrusions from memory have been linked to AVH.
“Given that intrusive thoughts (Morrison and Baker, 2000; Jones and Fernyhough, 2006), intrusions from memory (Brébion et al., 2010; Waters et al., 2012), and dissociation (Longden et al., 2012; Varese et al., 2012; Pilton et al., 2015) have all been linked to AVH”
From Is Shame Hallucinogenic? (2017) · cites this paper as Waters et al., 2012
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- Authors
- Waters, F., Allen, P., Aleman, A., Fernyhough, C., Woodward, T. S., Badcock, J. C., Barkus, E., Johns, L., Varese, F., Menon, M., Vercammen, A., & Laroi, F.
- Affiliations
- The University of Western Australia (AU)
- King's College London (GB)
- University Medical Center Groningen (NL)
- Durham University (GB)
- University of British Columbia (CA)
- University of Wollongong (AU)
- Bangor University (GB)
- Centre for Addiction and Mental Health (CA)
- Corresponding author
- Waters, F.
- ORCID
- Venue
- Schizophrenia Bulletin
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-03-23
- Volume
- 38
- Issue
- 4
- Pages
- 683-693
- ISSN
- 0586-7614 (ISSN-L)
- 1745-1701
- PMC
- PMC3406530
- OpenAlex
- W2107193705
- Cited by
- 423
- References
- 56
- Citations by year
- 2026: 22 · 2025: 33 · 2024: 34 · 2023: 28 · 2022: 28 · 2021: 26 · 2020: 33 · 2019: 32 · 2018: 27 · 2017: 31 · 2016: 36 · 2015: 26 · 2014: 38 · 2013: 21 · 2012: 8
- FWCI
- 2.35
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Schizophrenia Bulletin (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Durham Research Online (Durham University) (acceptedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Research Bank (Australian Catholic University) (submittedVersion)
- Research Online (University of Wollongong) (submittedVersion)
- Lancaster EPrints (Lancaster University) (submittedVersion)
- Durham Research Online (Durham University) (submittedVersion, cc-by)
- Research Portal (King's College London) (submittedVersion)
- ORBi (University of Liège) (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Funders
- Medical Research Council
- National Health and Medical Research Council
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Hallucinations in medical conditions
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- auditory hallucinations, schizophrenia
- MeSH terms
- Attention, Cognition Disorders, Hallucinations, Humans, Inhibition, Psychological, Memory, Short-Term, Models, Psychological, Schizophrenia, Self Concept, Executive Function
About these checks
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.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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