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Neural Correlates of Inner Speech and Auditory Verbal Hallucinations: a Critical Review and Theoretical Integration 260 Durham E-Theses Cognitive mechanisms associated with clinical and non-clinical psychotic experiences Jones, Simon R. How to cite: Jones, Simon R. (2009) Cognitive mechanisms associated with clinical and non-clinical psychotic experiences, Durham theses, Durham University. Available at Durham E-Theses Online: http://etheses.dur.ac.uk/2053/ Use policy The full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-prot purposes provided that: • a full bibliographic reference is made to the original source • a link is made to the metadata record in Durham E-Theses • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders. Please consult the full Durham E-Theses policy for further details. Academic Support Oce, Durham University, University Oce, Old Elvet, Durham DH1 3HP e-mail: [email protected] Tel: +44 0191 334 6107 http://etheses.dur.ac.uk 2 Gognitive meehanisms assdciated with cJinical and npn-c experiences Simon R. Jones BSe., PGDip., MA. The.cppyright of tWs thesU reste w^^^ the author or the uniyersity to which it was submitted. No quotation from, it, or iiifonnatioii derived' from it may be: published without the prior written consent of the author or university, and any inforihatioii derived from it should be aclaaowledged. Thesis isubmitted for the degree of Doctor of Philosophy Durham University, 2009 Declaration The research contained in this thesis was carried out by the author between 2005 and 2008 while a postgraduate student in the Department of Psychology at Durham University. None of the work contained in this thesis has been submitted in candidature for any other degree. The Rasch analyses reported in Chapter 3 were performed by David Meads of the Galen Institute. The author was assisted by Lee de-Wit in some of the data collection reported in Chapter 6. Statement of Copyright The copyright of this thesis rests with the author. No quotation from it should be published in any form, including electronic and the internet, without the author's prior written consent. All ihfonnation derived from this thesis must be acknowledged appropriately. ACKNOWLEDGEMENTS Firstly, I would like to thank Dr Charles Femyhough for his generosity with his time, humouring my work cycle, and going beyond what I could ever have expected from a supervisor. Thanks are also due to my second supervisors, Prof Findlay and Dr John. Many other staff at Durham University have provided fantastic support for me over the past three years. Elaine Stanton, Richard Stock, Bob Metcalf, and Dr Mike Burt have given me invaluable computing support, and Drs Steve Muncer and Bob Williams have given me valuable statistical guidance. I am also very grateful to Dr Vincent Reid for the significant effort, time and patience he put into teaching me electrophysiology. I was fortunate to receive an Economic and Social Research Council and Medical Research Council Studentship which allowed my work to take place. Thanks also go to Dr Robyn Langdon and Prof Max Coltheart for inviting me to, and hosting me at, Macquarie University, Sydney, Australia, where I spent an extremely enjoyable research visit. Over the past three years I have been privileged to meet many people through the Hearing Voices Network, including Peter Bullimore, Rufus May, and Jacqui Dillon, among many others. Talking with them has radically changed my views of how we should approach hallucinations. Before I met them I was interested in hallucinations. Now 1 am interested in the person behind the hallucination. They humbled and inspired me. I must also thank my Mum, Rosemary, for teaching me to read, and my Dad, David, for teaching me to drive. I literally wouldn't have got to Durham otherwise. Last but not least I must thank, my now fiancee, Roseline. I couldn't have got through my PhD without her patience, support, love and understanding. HI TABLE OF CONTENTS Acknowledgements • • •.• • iii List of Tables xii List of Figures — xiii Publications included in this thesis •••• xiv Abstract xvii GENERAL INTRODUCTION. 1 Introduction 1 Complaint-based approaches to psychopathology 1 Persecutory delusions — 3 The continuity hypothesis of persecutory delusions 3 Auditory verbal hallucinations..... 5 A brief history of hearing voices — 6 Not a necessary signifier of rnental illness 7 The continuum hypothesis of hallucinations 9 Ethical considerations • • ••• 11 References.... 14 PERSECUTORY IDEATION 20 CHAPTER 1. Thought suppression and persecutory delusion-like beliefs in a non-clinical sample • •. • 21 Abstract 21 iv Introduction... 22 Method 28 Participants... 28 Measures 28 Results. 30 Discussion • 34 References •• 37 CHAPTER 2. Anxiety, anomalous experiences, jumping to conclusions and persecutory delusion-like beliefs 45 Abstract 45 Introduction ••• 46 Method 48 Participants — 48 Measures — • 49 Results 51 Initial analyses 51 Distribution of draws to decisions 54 Multiple linear regression analyses 55 Discussion 59 References 64 HALLUCINATIONS AND INTRUSIONS 67 Foreword to Chapters 3 and 4 — 68 V CHAPTER 3. In a dark time: Development, validation, and correlates of the Durham Hypnagogic and Hypnopompic Hallucinations Questionnaire 69 Abstract • 69 Introduction 70 Method • 72 Participants 72 Measures.... • 73 Results 75 Durham Hypnagogic Hallucinations Questionnaire 75 Development of the DHQ 75 Pattern of responses to the DHQ 81 Reliability and validity of the DHQ 81 Intrusion-proneness and H&H experiences 82 Discussion 83 References • 87 CHAPTER 4. Rumination, reflection, intrusive thoughts, and hallucination-proneness: towards a new model 90 Abstract 90 Introduction 91 Method 97 Participants 97 Measures 97 vi Results 99 Discussion. 103 References 109 HALLUCINATIONS AND AGENCY 115 Foreword to Chapters 5 and 6 116 CHAPTER 5. Thought as Action: Inner speech, self-monitoring, and auditory verbal hallucinations 117 Abstriact 117 Introduction 118 Explaining Agency: Is It Me? 118 The Application of the Forward Model to AVHs 122 Inner Speech as a Kind of Action 127 References 133 CHAPTER 6. A new spin on the Wheel of Fortune: Gender effects in priming of action-authorship judgments 138 Abstract 138 Introduction ••• 139 Priming and the artificial enhancement of conscious will 140 Applying the Wheel of Fortune task to questions of psychopathology 142 Method 145 Participants and design 145 vii Measures 146 Experimental task and procedure 147 Events in a trial 148 Effect-priming 148 Measurement of potential control 149 Debriefing 150 Results 150 Authorship ratings and effect-priming 150 Potential control 152 Discussion 154 Effect-priming and gender effects 155 Passivity experiences, AVH-proneness, and effect-priming 158 Conclusions and future directions 159 References 160 HALLUCINATIONS AND INNER SPEECH 164 Foreword to Chapters 7 and 8 165 CHAPTER 7. The Nl event-related potential in response to sound during inner speech: Disentangling attentional demands from evidence of corollary discharge mechanisms 166 Abstract 166 Introduction 167 Method 171 viii Participants 171 Procedure 172 Experimental stimuli 172 Experimental conditions 172 ERP Procedure 174 Results 175 Discussion • 184 References. 188 CHAPTER 8. Do we need multiple models of auditory verbal hallucinations? Examining the phenomenological fit of cognitive and neurological models 191 Abstract • 191 Introduction 192 A VHs and inner speech 192 AVHs as a sin of memory • • • 193 AVHs as memories: a phenomenological fit to the experience? 196 AVHs consistent with memory-based models 196 AVHs not consistent with memory-based models 197 AVHs as inner-speech based: a phenomenological fit to the experience? 200 Neurological models and the phenomenology of AVHs. 206 Separate phenomenologies, separate causes? 208 Dynamic developmental progression 211 Conclusions 213 References 216 ix • GENERAL DISCUSSION 224 Summary of findings,. 224 Persecutory ideation 224 Hallucinations and intrusions.... 225 Hallucinations and agency 226 Hallucinations and inner speech. 228 Directions for future research , 230 Persecutory ideation 230 Hypnagogic and hypnopompic hallucinations 233 Trauma and hallucinations 235 Agency and hallucinations — 236 Subcategorisation of AVHs and dynamic developmental progression 237 Shared mechanisms in hallucinations and delusions 238 Interventions for those with hallucinations 239 Hope 240 APPENDICES 247 Appendix A: A Message in the Medium? Assessing the Reliability of Psychopathology E-questioimaires. 248 Appendix B: Neural correlates of inner speech and auditory verbal hallucinations: A critical review and theoretical integration 260 Appendix C: Scale for assessment of passivity experiences in the general population (SAPE-GP) ....276 X AppendixO: Participant Information Sheet. ..,......;.. 277 Appendix E: Visual stimuli 'Utilised: im mental rotation task 280 XI LIST OF TABLES Table 1.1: Descriptive statistics for variables under investigation 30 Table 1.2: Bivariate correlations between variables under investigation 31 Table 1.3: Results of hierarchical multiple linear regression of PIQ scores 32 Table 2.1: Descriptive statistics 52 Table 2.2: Non-parametric bivariate correlational analysis between continuous variables 53 Table 2.3: Non-parametric bivariate correlational analysis between interval level measures for JTC- (JTC+) group 53 Table 2.4: Results of multiple linear regressions 58 Table 3.1: Endorsement rates for
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