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Reality monitoring and psychotic hallucinations
Abstract
Hallucinating psychiatric patients, patients with delusions but without a history of hallucinations and normal controls were compared on a reality-monitoring task in which they were first required to generate answers to easy or difficult clues and to listen to low-probability or high-probability paired associates. After an interval of one week, the subjects were presented with a list in which their answers to the clues were mixed with the associates and with words not previously presented, and they were required to identify the source of each item (self-generated, presented by the experimenter or new). The psychiatric patients were generally less accurate in identifying the source of the items in comparison with the normal controls. However, hallucinators more often misattributed high cognitive effort self-generated items (answers to difficult clues) to the experimenter than either the psychiatric or the normal controls. The results are interpreted as consistent with the hypothesis that hallucinations are self-generated events misattributed to an external source.
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“Findings typically indicate that hallucinating patients or hallucination-prone participants are more likely to misattribute recalled items to the experimenter (Bentall et al., 1991; Laroi et al., 2004)”
From Auditory verbal hallucinations as atypical inner speech monitoring, and the potential of neurostimulation as a treatment option (2013) · cites this paper as Bentall et al., 1991
In the citing paper
“There is evidence supporting the theory that voice-hearing results from inner speech being misattributed to an external source, that is, a problem of source monitoring. 23-25”
From Towards an Integrative Account of Potential Mechanisms Mediating the Path From Sleep Dysfunction to Hallucinations (2025) · cites this paper as [23]
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Brébion, G., Stephan‐Otto, C., Ochoa, S., Roca, M., Nieto, L. L., & Usall, J. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.01381 · Cited by 31
“…reported that schizophrenia patients with auditory/verbal hallucinations tend to misattribute their own verbal production to an external source (Bentall et al., 1991; Johns et al., 2001, 2006; Woodward et al., 2007; Costafreda et al., 2008), a bias also observed in patients with delusions…”
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Source monitoring improvement in patients with schizophrenia receiving antipsychotic medications
Keefe, R. S. E., Poe, M. P., McEvoy, J. P., et al. (2003) · Psychopharmacology · doi:10.1007/s00213-003-1476-0 · Cited by 29
“Psychotic patients with hallucinations tended to be more likely than psychotic non-hallucinators to misattribute to the experimenter items they had generated themselves (Bentall et al. 1991).”
BackgroundDistinguishing familiarity-based from source-based memory performance in patients with schizophrenia
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Suggestibility and signal detection performance in hallucination-prone students
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Self-citationNeural correlates of reality monitoring during adolescence
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“Several theorists already argue for an association between reality monitoring deficits and the expression of psychosis (Bentall et al., 1991; Frith, 1992), and numerous reports observe reality monitoring deficits in schizophrenic patients (Keefe et al., 2002; Vinogradov et al., 1997), healthy…”
InfluentialInterpersonal attributional biases in hallucinatory-prone individuals
Levine, E. (2003) · Schizophrenia Research · doi:10.1016/s0920-9964(02)00493-0 · Cited by 27
“number of studies have found systematic biases in source-monitoring judgments of hallucinating patients, with such patients consistently over-reporting the percentage of internally generated items having been presented externally (Heilbrun, 1980; Heilbrun et al., 1983; Bentall et al., 1991; Rankin and O’Carroll, 1995;…”
BackgroundAttentional modulation of external speech attribution in patients with hallucinations and delusions
Kambeitz‐Ilankovic, L., Allen, P., Engel, R. R., Kambeitz, J. P., Riedel, M. J., Müller, N., & Hennig‐Fast, K. (2011) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2011.01.016 · Cited by 29
Verbal Memory Errors and Symptoms in Schizophrenia
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“Previous studies (Brébion et al., 1999, 2000; Heilbrun, 1980; Heilbrun et al., 1983; Bentall et al., 1991) showed this association, utilizing specific tasks to evaluate reality monitoring.”
BackgroundHallucinations, neuroplasticity, and prediction errors in schizophrenia
McCleery, A., Wynn, J. K., & Green, M. F. (2018) · Scandinavian Journal of Psychology · doi:10.1111/sjop.12413 · Cited by 25
Hallucinatory Experiences in Non-clinical Populations
Hill, K., & Linden, D. E. J. (2012) · Springer eBooks · doi:10.1007/978-1-4614-4121-2_2 · Cited by 26
“Depending on the accompanying psychopathology, the capacity to distinguish between hallucinations and physically present stimuli varies and can be completely missing as in many cases of psychosis (Bentall et al. 1991 ) .”
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Vianin, P. (2007) · Annales Médico-psychologiques revue psychiatrique · doi:10.1016/j.amp.2007.01.008 · Cited by 34
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“A tendency to report false alarms has been reported in patients with psychosis who report hallucinations (Bentall et al., 1991; Bentall and Slade, 1985).”
BackgroundThe role of set-shifting in auditory verbal hallucinations
Siddi, S., Петретто, Д. Р., Burrai, C., Scanu, R., Baita, A., Trincas, P., Trogu, E., Campus, L., Contu, A., & Preti, A. (2017) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2017.01.011 · Cited by 23
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“…deal of research has focussed on reality monitoring because it has been proposed that it may play a role in the pathogenesis of some of the positive symptoms of schizophrenia, such as hallucinations and delusions (Bentall et al., 1991; Frith, 1992; Frith and Done, 1988; Rankin and O'Carroll, 1995).”
BackgroundDoré, M.-C., Caza, N., Gingras, N., & Rouleau, N. (2007) · Cognitive Neuropsychiatry · doi:10.1080/13546800701614098 · Cited by 22
“At first glance, this result seems quite surprising considering studies revealing an externalisation bias in adult patients with hallucinations (Bentall et al., 1991; Brébion et al., 2000; Woodward, Menon, & Hu, 2005).”
ResultHallucinations and Delusions in Children and Adolescents
Larøi, F., der Linden, M. V., & Goëb, J.-L. (2006) · Current Psychiatry Reviews · doi:10.2174/157340006778699756 · Cited by 23
Source monitoring and olfactory hallucinations in schizophrenia.
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Investigating the roles of medial prefrontal and superior temporal cortex in source monitoring
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UnReal? Investigating the Sense of Reality and Psychotic Symptoms with Virtual Reality
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“, [5,9,10]), the ability to discriminate between real and false perceptions in real time (i.”
BackgroundMonitoring of self‐generated speech in adolescents with 22q11.2 deletion syndrome
Debbané, M., der Linden, M. V., Glaser, B., & D, S. E. M. (2009) · British Journal of Clinical Psychology · doi:10.1348/014466509x468223 · Cited by 22
“Interestingly, source-monitoring performances in schizophrenic patients appear to be penalized in high cognitive effort conditions (Bentall et al., 1991).”
BackgroundResultCommand Hallucinations: Who Obeys and Who Resists When?
Erkwoh, R., Willmes, K., Eming-Erdmann, A., & Kunert, H. J. (2002) · Psychopathology · doi:10.1159/000067065 · Cited by 21
Schizophrenia as disturbance of the self-construct
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Context binding in schizophrenia: Effects of clinical symptomatology and item content
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“Specifically, numerous studies have reported that source monitoring deficits involve misattribution of self-generated items to external sources, such that patients exhibit a bias towards attributing their own words or thoughts to the experimenter (Bentall et al., 1991; Brébion et al., 1997, 2000, 2002; Vinogradov et a…”
BackgroundNeurocognitive Basis of Schizophrenia: Information Processing Abnormalities and Clues for Treatment
Aleman, A. (2014) · Advances in Neuroscience · doi:10.1155/2014/104920 · Cited by 21
Bendall, S., Jackson, H. J., & Hulbert, C. A. (2011) · Schizophrenia Research · doi:10.1016/j.schres.2011.03.028 · Cited by 20
“This finding is inconsistent with the results from studies showing an externalising bias in people with chronic psychotic disorders and hallucinations (Bentall et al., 1991; Brebion et al., 2002).”
BackgroundResultInfluentialReality-monitoring deficits and visual hallucinations in schizophrenia
Mondino, M., Dondé, C., Lavallé, L., Haesebaert, F., & Brunelin, J. (2019) · European Psychiatry · doi:10.1016/j.eurpsy.2019.08.010 · Cited by 23
“Even if early reality-monitoring models of hallucinations [7] did not propose that the deficits would concern some specific sensory modalities of hallucinations rather than others, most of the studies focused on AH.”
BackgroundInflexibility of beliefs and jumping to conclusions in active schizophrenia
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BackgroundNeural Mechanisms of Positive Mood Induced Modulation of Reality Monitoring
Subramaniam, K., Gill, J. S., Slattery, P., Shastri, A., Mathalon, D. H., Nagarajan, S. S., & Vinogradov, S. (2016) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2016.00581 · Cited by 18
“Reality monitoring is defined as the ability to distinguish the contextual source of internal experiences (self-generated information) from outside reality (external information; Bentall et al., 1991; Johnson et al., 1993; Morrison and Haddock, 1997; Vinogradov et al., 1997, 2008; Keefe et al., 1999; Subramaniam et al…”
BackgroundSens du corps dans la schizophrénie
Farrer, C., & Franck, N. (2008) · L Encéphale · doi:10.1016/j.encep.2007.08.011 · Cited by 19
Buchy, L., Hawco, C., Bodnar, M., Izadi, S., Dell'Elce, J., Messina, K., & Lepage, M. (2014) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.12177 · Cited by 17
Mémoire de source – présentation générale et revue des études dans la schizophrénie
Ferchiou, A., Schürhoff, F., Bulzacka, E., Mahbouli, M., Leboyer, M., & Szöke, A. (2010) · L Encéphale · doi:10.1016/j.encep.2009.12.010 · Cited by 16
“L'intervalle entre les deux parties du test peut également varier d'un test à un autre : rappel immédiat [9] [32] [36] ou différé [4] [21] [26].”
BackgroundDestination memory in schizophrenia: “Did I told Elvis Presley about the thief?”
Haj, M. E., Altman, R. A. E., Bortolon, C., Capdevielle, D., & Raffard, S. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.12.023 · Cited by 16
Misattribution Models (II): Source Monitoring in Hallucinating Schizophrenia Subjects
Woodward, T. S., & Menon, M. (2012) · Springer eBooks · doi:10.1007/978-1-4614-4121-2_10 · Cited by 21
“However, even accepting the assumption that the experimental conditions do reflect pure inner and outer sources, most studies include only one internal and one external source (Baker & Morrison, 1998; Bentall et al., 1991; Bentall & Slade, 1985; Ensum & Morrison, 2003; Johns & McGuire, 1999; Larøi et al., 2004; Morris…”
BackgroundComputational motor control as a window to understanding schizophrenia
Izawa, J., Asai, T., & Imamizu, H. (2015) · Neuroscience Research · doi:10.1016/j.neures.2015.11.004 · Cited by 17
A Psychological Model for Verbal Auditory Hallucinations
Garcelán, S. P. (2004) · Dialnet (Universidad de la Rioja) · Cited by 18
Are basic auditory processes involved in source-monitoring deficits in patients with schizophrenia?
Dondé, C., Mondino, M., Leitman, D. I., Javitt, D. C., Suaud‐Chagny, M., d’Amato, T., Brunelin, J., & Haesebaert, F. (2019) · Schizophrenia Research · doi:10.1016/j.schres.2019.05.034 · Cited by 15
Being the agent: Memory for action events
Daprati, E., Nico, D., Franck, N., & Sirigu, A. (2003) · Consciousness and Cognition · doi:10.1016/s1053-8100(03)00074-6 · Cited by 17
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Neural mechanisms of mood-induced modulation of reality monitoring in schizophrenia
Subramaniam, K., Ranasinghe, K. G., Mathalon, D. H., Nagarajan, S. S., & Vinogradov, S. (2017) · Cortex · doi:10.1016/j.cortex.2017.01.005 · Cited by 16
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The Relationship of Mental Disorder to Suggestibility and Confabulation among Forensic Inpatients
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Episodic Memory Precision and Reality Monitoring Following Stimulation of Angular Gyrus
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“It is possible that in schizophrenia, for example, patients’ memories lack precision, obscuring the self-referential characteristics that distinguish them as personal memories (Bentall et al., 1991; Seal et al., 1997; Waters et al., 2006; Woodward et al., 2007).”
BackgroundResultThe potential link between sense of agency and output monitoring over speech
Sugimori, E., Asai, T., & Tanno, Y. (2012) · Consciousness and Cognition · doi:10.1016/j.concog.2012.07.010 · Cited by 14
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“This result contrasts with findings of significant binding difficulties in clinical hallucinators (e.g., Bentall et al., 1991; Brebion et al., 2002), and suggests that the ability to integrate information about voices and words is intact in healthy individuals predisposed to hallucinations.”
BackgroundResultASSESSMENT OF ESSENTIAL COMPONENTS OF SCHIZOTYPY USING NEUROCOGNITIVE MEASURES
Rodrigo, A. M. L., González, J. L. B., Paíno, M., Giráldez, S. L., & Inda, M. (2000) · Psychology in Spain · Cited by 14
Pacientes, síntomas, trastornos, organicidad y psicopatología
Ezama, E., Alonso, Y., & Gómez, Y. F. (2010) · Dialnet (Universidad de la Rioja) · Cited by 13
Ambiguity between self and other: Individual differences in action attribution
de Bézenac, C. E., Sluming, V., O’Sullivan, N., & Corcoran, R. (2015) · Consciousness and Cognition · doi:10.1016/j.concog.2015.04.010 · Cited by 11
Robin, F. (2010) · Phenomenology and the Cognitive Sciences · doi:10.1007/s11097-010-9159-x · Cited by 13
“monitoring as confirmed by Bentall et al. ( Bentall et al. 1991; Johnson 2006; Mitchell and Johnson 2009).”
MethodExternalization Errors of Olfactory Source Monitoring in Healthy Controls—An fMRI Study
Leclerc, M., Kellermann, T., Freiherr, J., Clemens, B., Habel, U., & Regenbogen, C. (2019) · Chemical Senses · doi:10.1093/chemse/bjz055 · Cited by 16
Valoración de los componentes esenciales de la esquizotipia a través de medidas neurocognitivas
Giráldez, S. L., Inda, M., Rodrigo, A. M. L., et al. (1999) · Psicothema · Cited by 13
Functioning of the phonological loop in auditory hallucinations
Haddock, G., Slade, P. D., Prasaad, R., & Bentall, R. P. (1996) · Personality and Individual Differences · doi:10.1016/0191-8869(96)00006-2 · Cited by 13
Self-citationExamining the relationships between cognition and auditory hallucinations: A systematic review
Bell, A. P., Toh, W. L., Allen, P., Cella, M., Jardri, R., Larøi, F., Moseley, P., & Rossell, S. L. (2024) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674241235849 · Cited by 20
Boubert, L., & Barnes, J. (2015) · SAGE Open · doi:10.1177/2158244015585827 · Cited by 12
Visual Memory Errors in Parkinson's Disease Patient With Visual Hallucinations
Barnes, J., & Boubert, L. (2010) · International Journal of Neuroscience · doi:10.3109/00207454.2010.539308 · Cited by 13
Neurocognitive Impairments in Schizophrenia: Their Character and Role in Symptom Formation
Goldberg, T. E., David, A. S., & Gold, J. M. (2010) · Wiley eBooks · doi:10.1002/9781444327298.ch8 · Cited by 12
Developments in Cognitive-Behaviour Therapy for Persistent Psychotic Symptoms
Haddock, G., Sellwood, W., Tarrier, N., & Yusupoff, L. (1994) · Behaviour Change · doi:10.1017/s0813483900004472 · Cited by 12
Targeted effects of ketamine on perceptual expectation during mediated learning in rats
Fleming, L. M., Jaynes, F.-J. B., Thompson, S. L., Corlett, P. R., & Taylor, J. R. (2022) · Psychopharmacology · doi:10.1007/s00213-022-06128-2 · Cited by 11
“2011), which underlies propensity towards hallucinations (Bentall et al. 1991; Corlett et al., 2019; Powers et al. 2017).”
Action simulation in hallucination-prone adolescents
Dahoun, T., Eliez, S., Chen, F., Badoud, D., Schneider, M., Larøi, F., & Debbané, M. (2013) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2013.00329 · Cited by 11
“…sources in hallucination-prone adults (Bentall and Slade, 1985; Rankin and O’Carroll, 1995; Larøi et al., 2004, 2005), in adults with schizophrenia (Bentall et al., 1991; Rankin and O’Carroll, 1995; Blakemore et al., 2000; Brebion et al., 2000; Frontiers in Human Neuroscience www.frontiersin.org…”
BackgroundGodoy-Cervera, V., & Higueras, L. (2005) · Redalyc (Universidad Autónoma del Estado de México) · Cited by 11
Brunelin, J., Poulet, E., Marsella, S., et al. (2007) · European Review of Applied Psychology · doi:10.1016/j.erap.2006.05.004 · Cited by 11
Is Cognitive Psychopathology Plausible? Illustrations from Memory Research
Danion, J., Weingartner, H., & Singer, L. (1996) · The Canadian Journal of Psychiatry · doi:10.1177/070674379604100702 · Cited by 11
“Schizophrenia has also been shown to be associated with a reality-monitoring impairment, that is, an inability to discriminate between previously read and previously selfgenerated items (52,53).”
BackgroundĆurĉić‐Blake, B., de Vries, A., Renken, R. J., Marsman, J.-B., Garrison, J. R., Hugdahl, K., & Aleman, A. (2023) · Schizophrenia Bulletin · doi:10.1093/schbul/sbac072 · Cited by 11
“3,4 With regard to their neural basis, a distributed network has been implied of cortical and subcortical regions.”
BackgroundThe Role of the Medial Prefontal Cortex in Self-Agency in Schizophrenia
Subramaniam, K. (2021) · Journal of Psychiatry and Brain Science · doi:10.20900/jpbs.20210017 · Cited by 12
“With this goal in mind, given that SZ manifest auditory hallucinations, which are thought to result from impaired self-prediction mechanisms of speech monitoring that result in the misattribution of their inner speech as an external voice [3,11,17,18], we integrate prior findings using distinct reality monitoring and…”
Result
Metadata
- Authors
- Bentall, R. P., Baker, G. A., & Havers, S.
- Affiliations
- University of Liverpool (GB)
- Corresponding author
- Bentall, Richard P.
- ORCID
- Bentall, Richard P.
- Venue
- British Journal of Clinical Psychology
- Publisher
- Wiley
- Published
- 1991-09
- Volume
- 30
- Issue
- 3
- Pages
- 213-222
- ISSN
- 0144-6657 (ISSN-L)
- 2044-8260
- OpenAlex
- W2068781732
- Cited by
- 312
- References
- 0
- Citations by year
- 2026: 2 · 2025: 8 · 2024: 5 · 2023: 5 · 2022: 4 · 2021: 6 · 2020: 6 · 2019: 15 · 2018: 8 · 2017: 9 · 2016: 7 · 2015: 11 · 2014: 12 · 2013: 14 · 2012: 18
- FWCI
- 2.86
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- British Journal of Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Life Sciences › Neuroscience › Cognitive Neuroscience › Hallucinations in medical conditions
- Life Sciences › Neuroscience › Cognitive Neuroscience › Memory Processes and Influences
- Keywords
- reality monitoring, delusions, source monitoring, self-generated information, misattribution, paired associates, cognitive effort
- MeSH terms
- Adult, Attention, Delusions, Female, Hallucinations, Humans, Internal-External Control, Male, Paired-Associate Learning, Reality Testing, Schizophrenia, Schizophrenic Psychology, Speech Perception
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