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Synch Before You Speak: Auditory Hallucinations in Schizophrenia
Abstract
OBJECTIVE: Synchronization of neural activity preceding self-generated actions may reflect the operation of the forward model, which acts to dampen sensations resulting from those actions. If this is true, pre-action synchrony should be related to subsequent sensory suppression. Deficits in this mechanism may be characteristic of schizophrenia and related to positive symptoms, such as auditory hallucinations. If so, schizophrenia patients should have reduced neural synchrony preceding movements, especially patients with severe hallucinations. METHOD: In 24 patients with schizophrenia or schizoaffective disorder and 25 healthy comparison subjects, the authors related prespeech neural synchrony to subsequent auditory cortical responsiveness to the spoken sound, compared prespeech neural synchrony in schizophrenia patients and healthy comparison subjects, and related prespeech neural synchrony to auditory hallucination severity in patients. To assess neural synchrony, phase coherence of single-trial EEG preceding talking was calculated at a single site across repeated trials. To assess auditory cortical suppression, the N1 event-related brain potentials to speech sound onset during talking and listening were compared. RESULTS: In healthy comparison subjects, prespeech neural synchrony was related to subsequent suppression of responsiveness to the spoken sound, as reflected in reduction of N1 during talking relative to listening. There was greater prespeech synchrony in comparison subjects than in patients, especially those with severe auditory hallucinations. CONCLUSIONS: These data suggest that EEG synchrony preceding speech reflects the action of a forward model system, which dampens auditory responsiveness to self-generated speech and is deficient in patients who hallucinate.
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“in line with the “comparator model” theory, positing that AHs are related to inner-speech self-monitoring impairments.[37][38][39]”
From Are hallucinations due to an imbalance between excitatory and inhibitory influences on the brain? (2016) · cites this paper as [38]
In the citing paper
“This hypothesis is supported by studies showing non-suppression of the N100 event-related potential and impaired pre-speech inter-trial electroencephalographic (EEG) coherence in patients with AVHs (6,7).”
From Elevated functional connectivity along a corticostriatal loop and the mechanism of auditory/verbal hallucinations in patients with schizophrenia (2011) · cites this paper as [7]
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“A different study investigated a different measure of neural synchrony—namely, temporal coherence preceding self-generated speech—and explored how it was associated with subsequent auditory cortical attenuation.(96) Reduced neural synchrony preceding talking (vs.”
BackgroundResultInsights into hallucinations in schizophrenia: Novel treatment approaches
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“Contrary to previous reports the N1 (as well as the P2) was not significantly shorter during passive listening compared to active vocalization (Curio et al., 2000; Ford, Mathalon, Kalba, et al., 2001; Ford et al., 2007).”
ResultLanguage-Related Neurophysiological Deficits in Schizophrenia
Hirano, S., Spencer, K., Onitsuka, T., & Hirano, Y. (2019) · Clinical EEG and Neuroscience · doi:10.1177/1550059419886686 · Cited by 27
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“This set of results (1) is congruent with a number of existing accounts of inner-outer confusion in schizophrenia (Ford et al., 2007; Northoff and Qin, 2011), (2) can account for the observation of externalization errors (Seal et al., 2004; Ditman and Kuperberg, 2005; Woodward et al., 2006; Larøi…”
Neuropsychological Functioning in Schizophrenia Patients with First-Rank (Passivity) Symptoms
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“However, no other deficits were found on tasks of cognitive inhibition, attention, working memory and verbal fluency (word generation), contrary to a proposal based on broad executive dysfunction in FRS. The present study did not include direct tests of the self-monitoring framework, given our focus on using only stan…”
ResultFord, J. M., Roach, B. J., Loewy, R. L., Stuart, B. K., Ford, J. M., & Mathalon, D. H. (2020) · Schizophrenia Bulletin · doi:10.1093/schbul/sbaa110 · Cited by 23
Self-citationThe comparator account on thought insertion, alien voices and inner speech: some open questions
Vicente, A. (2013) · Phenomenology and the Cognitive Sciences · doi:10.1007/s11097-013-9303-5 · Cited by 21
“For instance, Ford et al. (2007) approvingly cite Jackson’s (1958) claim that “thinking is our most complex motor act” (p. 459).”
BackgroundThe Etiology of Auditory Hallucinations in Schizophrenia: From Multidimensional Levels
Shao, X., Liao, Y., Gu, L., Chen, W., & Tang, J. (2021) · Frontiers in Neuroscience · doi:10.3389/fnins.2021.755870 · Cited by 21
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If waking and dreaming consciousness became de-differentiated, would schizophrenia result?
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“Moreover, during waking, the mind-brain makes a distinction between these worlds, without this distinction, internally generated precepts may be experienced as having external sources (Ford et al., 2007).”
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“Although multiple existing conceptual models of AVHs, such as top-down and bottomup (Hugdahl, 2009), corollary discharge (Ford et al., 2007), nondominant language intrusion (Sommer et al., 2008; van Lutterveld et al., 2014), and interhemispheric miscommunication (Curcic-Blake et al., 2013;…”
BackgroundResultReconciling competing mechanisms posited to underlie auditory verbal hallucinations
Thakkar, K. N., Mathalon, D. H., & Ford, J. M. (2020) · Philosophical Transactions of the Royal Society B Biological Sciences · doi:10.1098/rstb.2019.0702 · Cited by 21
“‘Expectations’ in the corollary discharge account comprise the predicted low-level sensory experience on the basis of a set of planned movement dynamics and are established in the milliseconds preceding an action and are dynamically updated as one moves, speaks and, possibly, thinks [29].”
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“(13), for example, demonstrated that a deficit in neuronal synchrony is directly related to auditory hallucinations in schizophrenia.”
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Communication breakdown: delta-9 tetrahydrocannabinol effects on pre-speech neural coherence
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“Note the time window used is of longer duration than that used in the Ford et al 2007 study (64 ms) allowing resolution of theta and alpha frequencies.”
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“Figure 7 summarizes results that were obtained either prestimulus or during a resting state (16, 29, 36, 37, 47), including measures from both individual frequency bands and other dynamic measures.”
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A possible key role of vision in the development of schizophrenia
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“Furthermore, the association between N1/P2 components and clinical improvement under medication is also weak [34,37,38].”
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“However, this approach does have some precedent in schizophrenia research (see Ford et al., 2007), and it may be possible to modify the paradigm used in the present study to address this question.”
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Impaired motor-to-sensory transformation mediates auditory hallucinations
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“For example, patients with auditory hallucinations, the core symptoms of schizophrenia, often “hear” voices in the absence of sound [11].”
BackgroundResultHallucination Proneness Alters Sensory Feedback Processing in Self-voice Production
Duggirala, S. X., Schwartze, M., Goller, L. K., Linden, D. E. J., Pinheiro, A. P., & Kotz, S. A. (2024) · Schizophrenia Bulletin · doi:10.1093/schbul/sbae095 · Cited by 9
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BackgroundThe Aberrant Connectivity Hypothesis in Schizophrenia
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Predictive processing accounts of psychosis: bottom-up or top-down disruptions
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“Similar deficits are observed in eye-tracking paradigms, where predictive saccadic suppression is diminished 126 , and in electroencephalography (EEG) studies showing reduced suppression of auditory N1-responses to self-generated speech 127 .”
The Visual Word Form Area compensates for auditory working memory dysfunction in schizophrenia
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Neurophysiology of a possible fundamental deficit in schizophrenia
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“We have collected data from several samples of patients and controls with this paradigm and showed that auditory cortical responsiveness to sounds is dampened during talking in healthy controls but less so in patients with schizophrenia (5-9).”
BackgroundSelf-citationThe feeling of thinking: Sense of agency in delusions of thought insertion.
Gerrans, P. (2015) · Psychology of Consciousness Theory Research and Practice · doi:10.1037/cns0000060 · Cited by 9
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“Ford and colleagues [7,8,37,38] obtained similar results in the auditory modality.”
BackgroundResultFrick, J., Rieg, T., & Buettner, R. (2021) · Hawaii International Conference on System Sciences (HICSS) · doi:10.24251/hicss.2021.460 · Cited by 7
“In healthy individuals, a significantly inhibited N100 amplitude occurs when a sound is generated by pressing a button, indicating less necessary neuronal activity [30, 31].”
BackgroundWhitford, T. J., Chung, L. K.-H., Griffiths, O., Jack, B. N., Pelley, M. E. L., Spencer, K., Barreiros, A. R., Harrison, A. W., Han, N. T., Libesman, S., et al. (2025) · Schizophrenia Bulletin · doi:10.1093/schbul/sbaf167 · Cited by 8
Self-citationSelf-initiation enhances perceptual processing of auditory stimuli in an online study
Kiepe, F., Kraus, N., & Hesselmann, G. (2023) · Attention Perception & Psychophysics · doi:10.3758/s13414-023-02827-w · Cited by 8
“…SA have revealed a reduction in amplitude of auditory event-related potentials (ERPs; N1 and P2), compared to externally generated auditory stimuli (Ford et al., 2007; Mifsud & Whitford, 2017), studies observed enhancement of self-initiated stimuli in the visual modality and attenuation in the…”
Gadd45 in Neuronal Development, Function, and Injury
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Vocalizing and singing reveal complex patterns of corollary discharge function in schizophrenia
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Self-citationConnectivity Issues of the ‘Hallucinating’ Brain
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Auditory Cortex Thickness Is Associated With N100 Amplitude in Schizophrenia Spectrum Disorders
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“As one of the most prominent symptoms in schizophrenia, auditory verbal hallucination (AVH) is de fi ned as the experience of perceiving voices in the absence of external auditory stimuli [1, 2].”
For distinguished contributions to psychophysiology: Judith M. Ford
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“This may arise from an impaired connectivity between areas generating the predictions and those assessing the input (Ford et al. 2007), speaking to a generalized notion of PEs that is less directly related to phasic dopaminergic prediction errors (Rao and Ballard 1999) but rather to the…”
BackgroundTan, S., Jia, Y., Mathew, M., Jariwala, N., Pongos, A. L. A., Brent, K., Ford, J. M., Mathalon, D. H., Houde, J. F., Nagarajan, S. S., et al. (2025) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2025.10.011 · Cited by 3
Self-citationEvent Related Potential Studies and Findings: Schizophrenia as a Disorder of Cognition
Tang, Y., & Niznikiewicz, M. A. (2020) · Springer eBooks · doi:10.1007/978-3-030-35206-6_14 · Cited by 3
Unreal? A Behavioral, Physiological, and Computational Model of the Sense of RealityPreprint
Drori, G., Bar-Tal, P., Hirsh, O., berlinger, A., Goldberg, N., Zvilichovsky, Y., Hertz, U., Zaidel, A., & Salomon, R. (2025) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2025.04.07.647542 · Cited by 3
Neurophysiological Research: EEG and MEG
van Lutterveld, R., & Ford, J. M. (2011) · Springer eBooks · doi:10.1007/978-1-4614-0959-5_21 · Cited by 2
Self-citationVoces que No lo Son: Los Problemas del Concepto Pseudoalucinación
López-Silva, P., & Cavieres-Fernández, A. (2020) · Revista chilena de neuro-psiquiatría · doi:10.4067/s0717-92272020000100029 · Cited by 2
Meyer, L., Lakatos, P., & He, Y. (2020) · doi:10.31234/osf.io/9akxz · Cited by 2
Perception of self- and externally-generated visual stimuli: Evidence from EEG and behaviourPreprint
Ody, E., Straube, B., He, Y., & Kircher, T. T. J. (2022) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2022.05.30.492531 · Cited by 2
Tan, S., Jia, Y., Mathew, M., et al. (2024) · medRxiv · doi:10.1101/2024.09.30.24314623 · Cited by 2
“Auditory Vocal Hallucination Rating Scale (AVHRS).”
MethodInfluentialSelf-citationOdy, E., Kircher, T. T. J., Straube, B., & He, Y. (2024) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2024.12.03.626576 · Cited by 3
Roger, R. D., & Whittington, M. A. (2010) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780195342796.003.0011 · Cited by 1
Sincronía neuronal y esquizofrenia: luces y sombras
Niklitschek, S., Paula Pino, P., & Aboitiz, F. (2011) · Revista chilena de neuro-psiquiatría · doi:10.4067/s0717-92272011000400009 · Cited by 1
Roger, R. D., & Whittington, M. A. (2010) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780195342796.003.0012 · Cited by 1
Santiago, Ó. M. (2016) · UVaDOC UVaDOC University of Valladolid Documentary Repository (University of Valladolid) · doi:10.35376/10324/18776 · Cited by 1
Okimura, T., Maeda, T., Mimura, M., & Yamashita, Y. (2022) · doi:10.31234/osf.io/8dgs5 · Cited by 1
Awareness is necessary for predictive learning and prediction-based motor attenuationPreprint
Liang, L., Tam, C. K. W., Livesey, E. J., & Tran, D. M. D. (2025) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.64898/2025.12.01.691731 · Cited by 1
Samantaray, S., Goyal, N., Kesavan, M., Venkatasubramanian, G., Shreekantiah, U., Bose, A., Sreeraj, V., Das, M., Raj, J., & Kumar, S. (2025) · Schizophrenia Research · doi:10.1016/j.schres.2025.07.003 · Cited by 1
Ody, E., Kircher, T. T. J., He, Y., & Straube, B. (2025) · European Journal of Neuroscience · doi:10.1111/ejn.70236 · Cited by 2
“Several previous studies have found significant correlations be-tween measures of premovement activity and sensory ERPs in contingent paradigm experiments (e.g., Ford et al. 2007, 2014).”
Chung, L. K.-H., Whitford, T. J., Griffiths, O., Jack, B. N., Pelley, M. E. L., Spencer, K., Barreiros, A. R., Harrison, A. W., Han, N. T., Libesman, S., et al. (2025) · Schizophrenia Bulletin · doi:10.1093/schbul/sbaf219 · Cited by 1
Self-citationPredictive processes linking sense of agency and fatigue: a novel allostatic framework
Pizzolla, E., Marotta, A., Longo, M. R., & Fiorio, M. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1792850 · Cited by 1
“…has been consistently demonstrated across different modalities: in audition, self-produced sounds elicit weaker neural responses than external ones (Ford et al., 2007; Kiepe et al., 2021; Mifsud and Whitford, 2017), while in the tactile domain, self-produced touches are perceived as less intense…”
Predicting the Self: Lessons from Schizophrenia
Hardcastle, V. G. (2017) · Review of Philosophy and Psychology · doi:10.1007/s13164-017-0335-6 · Cited by 1
“…actions, implicitly tagging them as being their own (cf., Crapse and Sommer 2008; Curio et al. 2000; Houde et al. 2002; Martikainen et al. 2005; Ford et al. 2007a, b; see also Shergill et al. 2003).10 Among other things, this allows us to predict our own behaviors precisely, which reinforces…”
BackgroundQu, H., Zhao, S., Li, Z., Wu, J., Murai, T., Li, Q., Wu, Y., & Zhang, Z. (2024) · Cerebral Cortex · doi:10.1093/cercor/bhae274 · Cited by 1
Slapø, N. B., Jørgensen, K. N., Nerland, S., Mørch-Johnsen, L. E., Pettersen, J. H., Roelfs, D., Parker, N., Valstad, M., Pentz, A. B., Timpe, C. M. F., et al. (2026) · Schizophrenia · doi:10.1038/s41537-025-00715-w · Cited by 1
Expectations about dynamic visual objects facilitates early sensory processing of congruent sounds
Marin, A., Störmer, V. S., & Carver, L. J. (2021) · Cortex · doi:10.1016/j.cortex.2021.08.006 · Cited by 2
“Many studies have reported that the auditory response is attenuated when hearing temporally predictable sounds (Clementz et al., 2002; D’Andrea-Penna et al., 2020; Ford et al., 2007; Ford & Hillyard, 1981; Kononowicz & van Rijn, 2014; Lange, 2009; Menceloglu et al., 2020; Schafer et al., 1981).”
BackgroundVercammen, A. (2009) · University of Groningen research database (University of Groningen / Centre for Information Technology) · Cited by 1
Using neurophysiological techniques to study auditory hallucinations in schizophrenia
Ford, J. M., & Mathalon, D. H. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511642197.019 · Cited by 1
Self-citation
Metadata
- Authors
- Ford, J. M., Roach, B. J., Faustman, W. O., & Mathalon, D. H.
- Affiliations
- VA Connecticut Healthcare System (US)
- Venue
- American Journal of Psychiatry
- Published
- 2007-03
- Volume
- 164
- Issue
- 3
- Pages
- 458-466
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2014504186
- Semantic Scholar
- d5578f7ae1c175a0e407e33e7036a0549403a43c
- Cited by
- 245
- References
- 40
- Citations by year
- 2026: 8 · 2025: 12 · 2024: 11 · 2023: 7 · 2022: 11 · 2021: 10 · 2020: 10 · 2019: 7 · 2018: 7 · 2017: 12 · 2016: 13 · 2015: 12 · 2014: 14 · 2013: 13 · 2012: 24
- FWCI
- 11.86
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01mh058262-17)
- National Institute of Mental Health (MH067967, K02MH067967, MH-58262, R01MH-058262)
- 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 › Neural dynamics and brain function
- Keywords
- auditory hallucinations, schizophrenia, forward model, sensory suppression, N1 event-related potential, phase coherence, schizoaffective disorder, positive symptoms
- MeSH terms
- Adult, Auditory Cortex, Auditory Perception, Cortical Synchronization, Electroencephalography, Evoked Potentials, Auditory, Female, Hallucinations, Humans, Male, Models, Neurological, Schizophrenia, Schizophrenic Psychology, Speech, Speech Perception
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