![]() ![]() Perhaps most strikingly, some individuals in non-treatment-seeking groups report an ability to control the onset and offset of their voices 29, 35, 36, which may make the experience of living with these voices significantly less disruptive and distressing 37. Non-treatment-seeking voice-hearing populations also consistently endorse a higher degree of control over their experiences than their treatment-seeking counterparts 23, 27, 29, 30, 32, 33, 34. AVH in treatment-seeking and non-treatment-seeking individuals tend to be similar in terms of low-level acoustic qualities such as loudness, location, duration 27, 28, 29, but show key differences in higher level, attributional characteristics such as interpretation of the voices’ origins, their perceived malevolence, and their ability to be engaged meaningfully 23, 29, 30, 31. Some have suggested that all voice-hearing experiences lie on a continuum 23, while others argue that the experiences of treatment-seeking and non-treatment-seeking voice hearers are fundamentally different 24, and still others suggest the possibility of multiple, potentially discontinuous continua 25, perhaps defined by a separable factor coding for overall distress or dysfunction 26. Epidemiological studies suggest that 7–15% of the general population hears voices, at times regularly 20, 21, 22, and only 20% of those who experience psychotic experiences (including AVH) go on to develop a psychotic disorder 22. The advent of this work was made possible in part by the recognition that many of those who hear voices may never seek treatment 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19. Only recently have many researchers begun to recognize the possibility that phenomenologically rich, real-seeming auditory verbal hallucinations (AVH) can, in some cases, be voluntarily controlled. ” This was in keeping with an understanding of hallucinations as being distinct from voluntary imagery 7 or the pseudohallucinations of neurological illness, which, in addition to being amenable to initiation or interruption by will 3, were described as often exhibiting a oneness of identity with the hearer, lacking the perceptual detail characterized by true hallucinations and necessarily occurring in the context of full insight into their unreality 8. In their seminal book on the subject, Slade and Bentall 6 added a third requirement, namely that hallucinations not be “susceptible to being voluntarily directed or controlled by those who experience. Only in the late twentieth century did some in the field begin to define hallucinations as being necessarily outside of voluntary control. ![]() ![]() 4, who required that a hallucination: (1) have the appearance of a sensory event and (2) produce conviction in its reality 5. Others of the French school quickly adopted the definition 2, which was carried forward by the major psychiatric textbook writers of the twentieth century, including Jaspers 3 and Ey et al. A more detailed understanding of the discrete types of control, their development, and their neural underpinnings is essential for translating this knowledge into new therapeutic approaches.įaced with the seemingly unimodal nature of the pre-existing term vision, Esquirol 1 first introduced the term hallucination to the nascent field of psychiatry as follows: “A person is said to labor under a hallucination or to be a visionary who has a thorough conviction of the perception of a sensation, when no external object, suited to excite this sensation, has impressed the senses”. Established relationships between control, health status, and functioning suggest that the development of control over AVH could increase functioning and reduce distress. Finally, we reconcile the possibility of control with the field’s current understanding of the proposed cognitive, computational, and neural underpinnings of hallucinations and perception more broadly. We then link control to various cognitive constructs that appear to be important for voice hearing. We first examine the relationship between control over AVH and health status as well as the psychosocial factors that may influence control and functioning. This review provides an overview of the research examining control over AVH in both treatment-seeking and non-treatment-seeking populations. Evidence suggests that this ability may be a key factor in determining health status, but little systematic examination of control in AVH has been carried out. ![]() However, recent work with voice hearers makes clear that both treatment-seeking and non-treatment-seeking voice hearers may exert varying degrees of control over their voices. Auditory verbal hallucinations (AVH) have traditionally been thought to be outside the influence of conscious control. ![]()
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