Changing the way psychosis patients respond to and deal with auditory hallucinations may help to improve their functioning, claim US researchers, who found that psychics who hear voices are better able to control this experience.
In an innovative study comparing psychics with patients who have psychosis (either with and without auditory hallucinations), the team found that the "low-level" experience was similar. However, psychics were better able to control the occurrence of voices and were more likely to regard the voices as positive and even protective.
Albert Russell Powers III, MD, PhD, a psychiatry fellow at the Yale School of Medicine, New Haven, Connecticut, noted that the differences in the "higher-level" experiences of hearing voices between "clairaudient" psychics and psychosis patients are "going to be pretty important" in understanding how to reduce their impact.
He told Medscape Medical News that if an individual can regard the voices they hear as being not particularly distressing and can ignore them, "then you are likely to be functioning better than other people."
These findings, published online October 7 in Schizophrenia Bulletin, suggest that training psychosis patients to adopt a different perspective on auditory hallucinations may be beneficial.
Coauthor Philip R. Corlett, PhD, an assistant professor of psychiatry at Yale School of Medicine, agreed and noted the results "resonate with recent changes over the past few years."
Developing Coping Mechanisms
Pointing to psychosis patient Eleanor Longden's TED talk about learning to listen to her voices, Dr Corlett said, "There's been indications that one could use cognitive-behavioral therapy in particular to teach people hearing voices not to completely ignore them or push them down but to learn to live with them and to work around them.
"We think that perhaps the people in our psychic group might have learned to do that on their own, and may be more capable than patients with schizophrenia to do that on their own," said Dr Corlett.
"By comparing the psychics to the schizophrenia group, we think we may be able to learn more about how they do it. Ultimately, we'd like to try to teach patients how to do that or come up with new interventions that we can use to help patients come to that conclusion as well," he added.
Such interventions could include psychotherapies as well as transcranial magnetic stimulation. To examine the underlying neurobiology that differentiates clairaudient psychics and psychosis patients, the researchers scanned participants' brains while they performed a series of cognitive tasks.
"What we're trying to do is identify differences in the neural circuitry underlying these experiences and use those as signposts for treatment development and for different interventions, including transcranial magnetic stimulation, targeted at those specific circuits," Dr Corlett explained.
Dr Powers noted that approximately 80% of schizophrenia patients suffer from auditory hallucinations. Furthermore, 20% to 50% of patients do not respond completely to antipsychotic medications and continue to experience residual symptoms, including auditory hallucinations.
"Some of my patients are pretty traumatized by auditory hallucinations, and we are pretty limited in the options we can offer them for treatment if they fail that first line. One of the reasons for that is that we don't really understand how hallucinations arise in the brain," he said.
Similarities and Differences
It is difficult to disentangle the effects of psychotic illness and medications from the brain mechanisms that underlie auditory hallucinations.
"For that purpose, it would be really useful to have a population that doesn't have medications, that functions quite well and does not have the full spectrum of psychotic disorders but does, nonetheless, have auditory hallucinations."
The investigators recruited 16 voice-hearers with a diagnosable psychotic disorder (P+H+), 17 voice-hearers without a diagnosable psychotic disorder (clairaudient psychics), 16 non-voice-hearers with a diagnosable psychotic disorder (P+H-), and 18 non-voice-hearers without a diagnosable psychotic disorder (control participants).
Participants completed the Positive and Negative Syndrome Scale, the Structured Clinical Interview for DSM-4 Axis I Disorders and Axis II Disorders, the Launay-Slade Hallucinations Scale, the Auditory Hallucinations Rating Scale, the Beliefs About Voices Questionnaire (BAVQ), the Peters et al Delusions Inventory, and the Brief Multidimensional Measurement of Religiosity and Spirituality.
Dr Powers explained that the scales were used, in part, to "make sure we had a valid positive control population...so we employed a number of different scales meant to detect malingering that we borrowed from forensic psychiatry.
"You can imagine that, in the forensic setting, there are individuals who have an interest in faking hallucinations. These scales include items that don't, on their surface, sound unusual — voices that change gender mid-sentence, for example, or voices that are very loud most of the time — but turn out to be endorsed only very rarely in those who hear voices in the setting of psychosis. None of the self-identified clairaudient psychics endorsed any of these items," he said.
There were no significant differences in baseline characteristics between the four groups, although participants without a psychotic disorder were more likely to be employed than those with psychotic disorders, at 82.35% and 77.78% for clairaudient psychics and controls, respectively, vs 25.00% and 31.25% for P+H+ and P+H- individuals, respectively.
There were no differences between psychics and psychosis patients who hear voices in terms of the low-level characteristics of the voices, including the acoustic characteristics of the voices (including their clarity), the nature of voices they heard (whether they were robotic, changed gender, etc), and the content of the messages.
However, there were significant differences between psychics and psychosis patients in the way in which they interacted with the voices, the inferences they made about the origin of the voices, and their affective response to the voices.
Specifically, psychics were significantly more likely than psychosis patients to say that they could make the voices occur at will and prevent them from occurring (P = .049). Psychics were also significantly more likely to attribute the voices to a divine or spiritual source (P = .018) and to see the voices as protective of their safety (P = .040).
Psychics were also significantly less likely than psychosis patients to describe the voices as bothersome (P = .010). Psychosis patients correspondingly had higher malevolence scores on the BAVQ than psychics (P = .008) and higher scores for behavioral resistance (P < .0001) and emotional resistance (P = .0001).
Although both groups reported having daily hallucinatory experiences, there were differences in frequency of hearing voices, with psychics reporting that voices occurred 1 to 10 times daily, and psychosis patients saying they occurred an average of 3 to 6 times daily (P = .029). Interestingly, psychics reported hearing their first voice at a significantly younger age than psychosis patients (average age, 7.5 years vs 22.9 years; P = .0002).
Valuable Research Subjects
Addressing the skepticism that has already greeted their research concerning the validity of using self-identified psychics to examine auditory hallucinations, Dr Powers said the research team is not "interested in validating or debunking the psychics' claims about the origins of their purported perceptual experiences.
"Indeed, some might question how we might be so confident in asserting that these participants have these perceptual experiences in the first place — couldn't they just be making it up?"
He said that the "combination of evidence" they have assembled "leads us to believe that this small group of psychics we interviewed may well have veridical perceptual experiences. At the very least, if they were faking their experiences, they were doing so in a very informed way.
"That said, of course, we don't think everyone who claims to be a clairaudient psychic necessarily is hearing voices, and we acknowledge that this group was susceptible to quite a selection bias — you can imagine that the people who are faking their experiences might not wish to volunteer for a study that plans to study the brain mechanisms behind voice-hearing."
Nevertheless, the researchers believe that the psychics they recruited are "extremely valuable for the systematic study of hallucinations and their relationship to psychotic illness."
The Yale Department of Psychiatry and the Brain and Behavior Research Foundation provided primary funding for the research. The researchers have disclosed no relevant financial relationships.
Schizophr Bull. Published online October 7, 2016. Abstract
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Cite this: Psychics Shed Light on Auditory Hallucinations - Medscape - Oct 07, 2016.