The aim of this study was to explore the experience of hearing voices in the general New Zealand adult population. This included mapping the topography of voices and the impact of the experience on participants’ lives, exploring participants’ explanatory models, investigating coping strategies and support structures, and developing a model of the essence of hearing voices. Quantitative and qualitative analyses of questionnaire (n=154) and interview (n=50) data revealed a great diversity of experiences, both within and among participants. Of all topographical variables significantly related to emotional impact (content, form, duration, intrusiveness and control), voice content was the only significant predictor variable, accurately predicting the emotional response of 93.3% of participants. Overall, participants who valued their voice experiences tended to have spiritual beliefs, a more positive emotional reaction and less contact with mental health services. In contrast, participants who experienced mostly unwanted voices tended to have biological and/or psychological understandings of their voice experiences, a more negative emotional reaction to them, and increased contact with mental health services. Participants reported using a vast array of coping strategies, with varying degrees of success. Individualised techniques were reported to be the most effective, followed by setting aside a time to listen to the voices. In terms of help and support, participants called for a model of intervention that accepted their voice experiences as real, took an holistic approach incorporating contextual, cultural and spiritual factors, and worked with voice-hearers, their families and the public to provide information about voice phenomena and normalise the experience. Using a phenomenological approach, a model of the essential structure of hearing voices is proposed, comprising five components: the content of the voices is personally meaningful to the voice-hearer; the voices have a characterised identity; the person has a relationship with their voices; the experience has a significant impact on the voice-hearer’s life; and the experience has a compelling sense of reality. The implications of this research include validating voice-hearers’ perspectives of the experience, informing clinical work with voice-hearers, and informing the development of local and national-level services, such as a New Zealand Hearing Voices Network.

The aim of this study was to explore the experience of hearing voices in the general New Zealand adult population. This included mapping the topography of voices and the impact of the experience on participants’ lives, exploring participants’ explanatory models, investigating coping strategies and support structures, and developing a model of the essence of hearing voices. Quantitative and qualitative analyses of questionnaire (n=154) and interview (n=50) data revealed a great diversity of experiences, both within and among participants. Of all topographical variables significantly related to emotional impact (content, form, duration, intrusiveness and control), voice content was the only significant predictor variable, accurately predicting the emotional response of 93.3% of participants. Overall, participants who valued their voice experiences tended to have spiritual beliefs, a more positive emotional reaction and less contact with mental health services. In contrast, participants who experienced mostly unwanted voices tended to have biological and/or psychological understandings of their voice experiences, a more negative emotional reaction to them, and increased contact with mental health services. Participants reported using a vast array of coping strategies, with varying degrees of success. Individualised techniques were reported to be the most effective, followed by setting aside a time to listen to the voices. In terms of help and support, participants called for a model of intervention that accepted their voice experiences as real, took an holistic approach incorporating contextual, cultural and spiritual factors, and worked with voice-hearers, their families and the public to provide information about voice phenomena and normalise the experience. Using a phenomenological approach, a model of the essential structure of hearing voices is proposed, comprising five components: the content of the voices is personally meaningful to the voice-hearer; the voices have a characterised identity; the person has a relationship with their voices; the experience has a significant impact on the voice-hearer’s life; and the experience has a compelling sense of reality. The implications of this research include validating voice-hearers’ perspectives of the experience, informing clinical work with voice-hearers, and informing the development of local and national-level services, such as a New Zealand Hearing Voices Network.

The aim of this study was to explore the experience of hearing voices in the general New Zealand adult population. This included mapping the topography of voices and the impact of the experience on participants’ lives, exploring participants’ explanatory models, investigating coping strategies and support structures, and developing a model of the essence of hearing voices. Quantitative and qualitative analyses of questionnaire (n=154) and interview (n=50) data revealed a great diversity of experiences, both within and among participants. Of all topographical variables significantly related to emotional impact (content, form, duration, intrusiveness and control), voice content was the only significant predictor variable, accurately predicting the emotional response of 93.3% of participants. Overall, participants who valued their voice experiences tended to have spiritual beliefs, a more positive emotional reaction and less contact with mental health services. In contrast, participants who experienced mostly unwanted voices tended to have biological and/or psychological understandings of their voice experiences, a more negative emotional reaction to them, and increased contact with mental health services. Participants reported using a vast array of coping strategies, with varying degrees of success. Individualised techniques were reported to be the most effective, followed by setting aside a time to listen to the voices. In terms of help and support, participants called for a model of intervention that accepted their voice experiences as real, took an holistic approach incorporating contextual, cultural and spiritual factors, and worked with voice-hearers, their families and the public to provide information about voice phenomena and normalise the experience. Using a phenomenological approach, a model of the essential structure of hearing voices is proposed, comprising five components: the content of the voices is personally meaningful to the voice-hearer; the voices have a characterised identity; the person has a relationship with their voices; the experience has a significant impact on the voice-hearer’s life; and the experience has a compelling sense of reality. The implications of this research include validating voice-hearers’ perspectives of the experience, informing clinical work with voice-hearers, and informing the development of local and national-level services, such as a New Zealand Hearing Voices Network.

[Truncated abstract] Auditory hallucinations are some of the most distressing and disabling symptoms of schizophrenia. However very little is known about the exact processes responsible for auditory hallucinations. The aim of this thesis is to provide a new perspective on the nature of the cognitive deficits underlying auditory hallucinations in schizophrenia. As a preliminary study to the investigation of auditory hallucinations in schizophrenia, a factor analysis of a measure of hallucinatory predisposition, the Launay- Slade Hallucination Scale-Revised (Bentall & Slade, 1985), was carried out on data from a large sample of undergraduate students (N = 562). An overlap in characteristics between hallucinatory-like experiences in normal individuals and auditory hallucinations in schizophrenia should draw attention to factors that are important to the hallucinatory experience in general. One of the findings from this study was that intrusiveness is a commonly reported characteristic of hallucinatory-like experiences in normal individuals. Intrusiveness is also one of the defining features of auditory hallucinations in schizophrenia. Since the process of inhibition is essential for suppressing unwanted thoughts, the first set of two studies using patients with schizophrenia (N = 43) investigated the presence of an (intentional) inhibition failure in auditory hallucinations using the Hayling Sentence Completion Test (HSCT; Burgess & Shallice, 1996) and the Inhibition of Currently Irrelevant Memories Task (ICIM; Schnider & Ptak, 1999). It was found that auditory hallucinations were linked to a deficit in intentional inhibition as measured by these tasks. The process of inhibition was further investigated using the Affective Shifting task, but auditory hallucinations were not associated with a deficit on this task. Possible differences in the inhibitory demands of the HSCT, ICIM and Affective Shifting tasks are discussed.

The aim of this study was to explore the experience of hearing voices in the general New Zealand adult population. This included mapping the topography of voices and the impact of the experience on participants’ lives, exploring participants’ explanatory models, investigating coping strategies and support structures, and developing a model of the essence of hearing voices. Quantitative and qualitative analyses of questionnaire (n=154) and interview (n=50) data revealed a great diversity of experiences, both within and among participants. Of all topographical variables significantly related to emotional impact (content, form, duration, intrusiveness and control), voice content was the only significant predictor variable, accurately predicting the emotional response of 93.3% of participants. Overall, participants who valued their voice experiences tended to have spiritual beliefs, a more positive emotional reaction and less contact with mental health services. In contrast, participants who experienced mostly unwanted voices tended to have biological and/or psychological understandings of their voice experiences, a more negative emotional reaction to them, and increased contact with mental health services. Participants reported using a vast array of coping strategies, with varying degrees of success. Individualised techniques were reported to be the most effective, followed by setting aside a time to listen to the voices. In terms of help and support, participants called for a model of intervention that accepted their voice experiences as real, took an holistic approach incorporating contextual, cultural and spiritual factors, and worked with voice-hearers, their families and the public to provide information about voice phenomena and normalise the experience. Using a phenomenological approach, a model of the essential structure of hearing voices is proposed, comprising five components: the content of the voices is personally meaningful to the voice-hearer; the voices have a characterised identity; the person has a relationship with their voices; the experience has a significant impact on the voice-hearer’s life; and the experience has a compelling sense of reality. The implications of this research include validating voice-hearers’ perspectives of the experience, informing clinical work with voice-hearers, and informing the development of local and national-level services, such as a New Zealand Hearing Voices Network.

abstract: ABSTRACT Auditory hallucinations are a characteristic symptom of schizophrenia. Research has documented that the auditory cortex is metabolically activated when this process occurs, and that imbalances in the dopaminergic transmission in the striatum contribute to its physiopathology. Most animal models have focused the effort on pharmacological approaches like non-competitive N-methyl-D-aspartate (NMDA) receptor antagonists to produce activation of the auditory cortex, or dopamine antagonists to alleviate it. I hypothesize that these perceptual phenomena can be explained by an imbalance activation of spiny projecting neurons in the striatal pathways, whereby supersensitive postsynaptic D2-like receptor, signaling in the posterior caudatoputamen generates activation of the auditory cortex. Therefore, I characterized the neuroanatomical component involved in the activation of the auditory cortex. I evaluated the participation of dopamine D2-like receptor using selective dopamine antagonist manipulations and identified the circuits related to the auditory cortex by retrograde trans-synaptic tracing using pseudorabies virus (PRV-152). My results show that dopamine infused in the posterior caudatoputamen dose dependently increases the transcription of the immediate early gene, zif268 in the auditory cortex, predominantly in layers III and IV, but also in cortical columns, suggesting enhanced functional auditory activity. This indicates the participation of the posterior striatum in the modulation of the secondary auditory cortex. I was able to demonstrate also that a coinfusion of a selective dopamine D2-like receptor antagonist, eticlopride and dopamine, attenuate the activation of the auditory cortex. Furthermore, using PRV-152 I delineate the distinctive circuit by axial mapping of the infected neurons. Thus, I found secondary projections from the posterior caudatoputamen that synapse in the thalamus before reaching the auditory cortex. These striatal projections correspond to the same brain region affected by dopamine during auditory cortical activation. My results further characterized a mechanism to generate intrinsic perception of sound that may be responsible for auditory hallucinations. I propose this paradigm may elucidate insight on the biological basis of psychotic behavior. / Dissertation/Thesis / Figure 9C. 3D brain reconstruction after 48 hours of PRV-152 inoculations / Figure 9A. 3D brain reconstruction after 24 h postinoculation / Figure 9B. 3D brain reconstruction after 36 h postinoculation / Doctoral Dissertation Neuroscience 2014

Objectives. Mindfulness and acceptance-based therapies are becoming increasingly popular in practise and meta-analyses have been conducted to evaluate their effects on a range of mental health difficulties. The purpose of this review was to evaluate the evidence base for mindfulness and acceptance-based therapies in the treatment of distressing auditory hallucinations. Method. Five electronic databases were searched in addition to an internet search engine. Authors of included studies were contacted and reference lists were reviewed. Quality criteria were developed and studies were rated independently by three raters. Results. Nine studies met the inclusion criteria; four controlled studies and five case studies. There was substantial variation in study design and outcomes. Overall, the quality of the studies was poor. Reductions in hallucination-related distress, belief conviction, cognitive appraisals and hallucination proneness were noted. Participants’ ability to respond mindfully to hallucinations increased. Conclusion. Although the results of this review suggest that mindfulness and acceptance-based therapies may result in several beneficial effects, the quality of these studies was poor and the results are likely to have been subject to considerable bias. More research is needed before such therapies can be considered evidence-based treatments for distressing hallucinations. Suggestions for future research are made.

Dans sa conception contemporaine, l’hallucination est simplement définie comme une ‘perception sans objet à percevoir’. Elle reste cependant complexe à mettre en évidence et à appréhender en pratique clinique, notamment en population pédiatrique. L’anamnèse, au cours de laquelle le praticien devra éviter des écueils, tels que l’immaturité psychique et la potentielle existence d’un compagnon imaginaire, peut être complétée par des méthodes d’évaluation lui permettant une caractérisation plus spécificique du phénomène. Ce symptôme a fait l’objet d’un regain d’intérêt ces 30 dernières années dans le domaine scientifique. Il est maintenant admis que les hallucinations ne se retrouvent pas exclusivement dans un contexte étiologique schizophrénique, mais qu’elles peuvent également apparaître au cours du développement normal et être de résolution spontanée. Malgré cela, encore peu d’études à l’heure actuelle se sont spécifiquement intéressées à son caractère précoce, transdiagnostique et à sa thérapeutique chez l’enfant et l’adolescent. Néanmoins différentes pistes d’intervention sont à notre disposition pour nous aider à mieux appréhender ce symptôme, qu’il s’agisse de son évaluation ou de sa thérapeutique. Au cours de ce doctorat, nous nous sommes intéressés dans un premier temps aux aspects cognitifs de l’hallucination. Sur la base du modèle de défaut d’attribution de la source, postulant que les hallucinations seraient le résultat d’une tendance à attribuer plus souvent les évènements auto-générés à un sujet externe, nous avons normalisé une tâche évaluant cette capacité cognitive. Nous avons pu mettre en évidence d’une part, chez nos sujets sains recrutés pour l’étude de normalisation, un effet du vieillissement pathologique préférentiellement pour le reality monitoring (distinguant une source interne au sujet d’une source externe à lui) ; d’autre part, ces données confrontées à la pathologie, ont révélé des performances réellement déficitaires chez des patients souffrant de schizophrénie et présentant des hallucinations pharmaco-résistantes pluri-modales. Notre objectif est par la suite d’obtenir des données normatives pour une population pédiatrique. Dans un second temps, nous nous sommes intéressés à l’évaluation psychométrique des hallucinations précoces. Au vu du manque d’outils, nous avons associé l’aspect ludique des nouvelles technologies à une évaluation complète et rigoureuse du symptôme. Ainsi, nous avons développé une application pour tablette tactile combinant l’évaluation de la cognition, notamment de la théorie de l’esprit, et de la sévérité du symptôme. En effet, les capacités de théorie de l’esprit ont récemment été identifiées comme marqueurs pronostiques dans la résolution des hallucinations chez l’enfant. L’objectif premier de ce travail est donc de fournir un outil fiable d’évaluation de l’hallucination précoce, l’objectif sous-jacent de cet outil étant de permettre un suivi longitudinal de l’enfant et d’adapter au mieux sa thérapeutique. Enfin, nous nous sommes attelés à la mise en place d’une thérapeutique innovante chez l’enfant et l’adolescent, qui n’est autre que la stimulation magnétique transcrânienne répétée (rTMS). Cette technique de neuromodulation a pour avantage de cibler un symptôme et non une pathologie et peut donc s’appliquer à un certain nombre de sujets hallucinés. L’objectif de ce travail était d’étudier plus en avant l’hallucination précoce au moyen d’approches diverses et variées facilitant la mise en confiance de l’enfant et la caractérisation tant phénoménologique que cognitive du symptôme par le praticien. Les résultats réunis dans ce travail de doctorat mettent en évidence qu’il est possible d’appréhender le symptôme hallucinatoire précoce grâce à la cognition et aux nouvelles technologiques. Ces approches nous permettent d’améliorer notre prise en charge en nous donnant une meilleure compréhension du symptôme et des mécanismes associés. / In its contemporary conception, the hallucination is simply defined as a ‘perception without object to perceive’. It remains however complex to highlight it in clinical practice, in particular in pediatric population. The clinical interview, during which the clinician have to avoid stumbling blocks, such as psychic immaturity and potential existence of an imaginary companion, can be completed by methods allowing a more specific caracterisation of the phenomenon. This symptom has been a renewed interest in the last 30 years in scientific domain. It is now accepted that the hallucinations are not found exclusively in schizophrenic etiological context, but they can also occur during normal development and be spontaneous resolution. Despite this, few studies currently have a specific interest in its early and transdiagnostic character, and his treatment in children and adolescents.Nevertheless, differents strategies for actions are available to help us better understand this symptom, whether its evaluation or therapeutic. In this PhD work, we initially focused on cognitive aspects of hallucination. Based on the source monitoring framework, assuming that hallucinations are the result of a tendency to attribute more often self-generated events to an external subject, we standardized a task assessing this cognitive ability.We first highlight an age effect in our healthy subjects enrolled in the study of standardization, preferentially for the reality monitoring task (distinction between an external source and an internal source). We then compare these data with those obtained from patients suffering from schizophrenia, revealing loss performance for both tasks. Our goal is then to obtain normative data for a pediatric population.In a second step, we are interested in the psychometric assessment of early-onset hallucinations. Given the lack of tools, we have combined the playfulness of new technologies in a comprehensive and rigorous assessment of the symptom. We thus developed an application for touchpad associating the assessment of cognition, including the theory of mind, and symptom severity. Theory of mind developpement have recently been identified as prognostic marker in the resolution of hallucinations in children. The first objective of this work is to provide a reliable assessment or early-onset hallucinations, the underlying objective is to allow longitudinal assessment of this symptom in children and adolescents and to better adapt its therapeutic. Finally, we are interested in the development of an innovative therapy in children and adolescents, which is the repetitive trancranial magnetic stimulation (rTMS). This neuromodulation technique has the advantage to target a symptom, not a disease, and can therefore be applied to a number of hallucinated subjects.The objective of this work was to study early-onset hallucination through diverse approaches facilitating the trust of the child and both phenomenological and cognitive caracterisation of the symptom by the clinician.The results gathered in this PhD work demonstrate that it is possible to understand the early-onset hallucinatory symptoms through cognition and new technologies. These approaches allow us to adapt our daily practice, gives us a better understanding of the symptoms and associated cognitive mechanisms, thereby improving our therapeutic management .

Schizophrenia is accompanied by distortion of all mental functions, including thinking, speech, motivation, perception or general experiencing of the world and oneself. Theoretical part of the thesis describes the process of schizophrenia and its symptoms with focus on auditory hallucinations, which roughly 70% of people with schizophrenia have some experience with. Main contribution of the theoretical part is the summary of the self- disturbances concept, which incorporates for instance loss of control over parts of mental experience, disruption of boundaries between the person and its surroundings and other similar aspects that are for a person who never experienced them almost unimaginable, and are difficult to explain even for an individual who does experience these disturbances of oneself. The thesis puts theoretical outcomes of self-disturbances into perspective, as well as current approaches and knowledge. First part of the research validates that the newly developed method for measurement of self-disturbances acquires sufficient internal consistency. Results of the next part confirm that the self-disturbances measure varies among patients with schizophrenia and healthy volunteers in all of the individual domains. Last research part presents relationships between currently experienced...

This thesis looks at the percentage of hallucinations in two large language models (LLM), ChatGPT 3.5 and ChatGPT 4 output for a set of prompts. This work was motivated by two factors: the release of ChatGPT 4 and its parent company OpenAI, claiming it to be much more potent than its predecessor ChatGPT 3.5, which raised questions regarding the capabilities of the LLM. Furthermore, the other factor is that ChatGPT 3.5 showcased hallucinations (creating material that is factually wrong, deceptive, or untrue.) in response to different prompts, as shown by other studies. The intended audience was members of the computer science community, such as researchers, software developers, and policymakers. The aim was to highlight large language models' potential capabilities and provide insights into their dependability. This study used a quasi-experimental study design and a systematic literature review.Our hypothesis predicted that the percentage of hallucinations (creating factually wrong, deceptive, or untrue material) would be more prevalent in ChatGPT 3.5 compared to ChatGPT 4. We based our prediction on the fact that OpenAI trained ChatGPT 4 on more material than ChatGPT 3.5. We experimented on both LLMS, and our findings supported The hypothesis. Furthermore, we looked into the literature and found studies that also agree that ChatGPT 4 is better than ChatGPT 3.5. The research concluded with suggestions for future work, like using extensive datasets and comparing the performance of different models, not only ChatGPT 3.5 and ChatGPT 4.