Cognitive processes in auditory hallucinations: attributional biases and metacognition

BACKGROUND: Cognitive models suggest that auditory hallucinations are experienced when mental events are misattributed to an external source; therefore, this study was designed to examine attributional biases in patients experiencing auditory hallucinations. The study also examined the role of metacognitive beliefs in the experience of auditory hallucinations, as some theories have implicated metacognition in the development and maintenance of auditory hallucinations. METHODS: Fifteen participants with a diagnosis of schizophrenia experiencing auditory hallucinations were compared with 15 non-hallucinating schizophrenics and 15 non-psychiatric control subjects on several measures, including an immediate source monitoring task and a questionnaire assessing metacognitive beliefs. RESULTS: Results indicated that patients experiencing hallucinations exhibited the predicted bias towards misattributing internal events to an external source, as measured by ratings of internality of responses in a word association task. All groups had lower perceived levels of internality and control for emotionally salient words, which provides further evidence for the importance of emotional content in hallucinations. Patients experiencing hallucinations were found to score higher than the other two groups on metacognitive beliefs about uncontrollability and danger and positive beliefs about worry. In addition, a logistic regression analysis showed that beliefs about uncontrollability and danger were predictive of whether subjects experienced auditory hallucinations or not. CONCLUSIONS: These results offer considerable support to cognitive bias models of auditory hallucinations, particularly those that implicate metacognition.     

Effects of attributions for success on the alleviation of learned helplessness and depression.

Investigated the effects of attributions for success on the alleviation of mood and performance deficits of 104 19–60 yr old clinically depressed inpatients. Ss were assigned to either an acutely depressed group or an improved depressed group that was exposed to a learned helplessness induction procedure. Ss received 80% positive feedback on a task allegedly measuring social intelligence. Concurrently, Ss were exposed to experimental manipulations designed to induce attributions of this experience to 1 of 4 types of causes (internal–general, internal–specific, external–general, external–specific). Following this task, Ss' mood, expectancies, and anagram performance were assessed. Results indicate that helpless and depressed Ss who received the internal attribution manipulations reported less depressed mood than Ss in the external attribution conditions. Similarly, Ss in the general attribution conditions performed better and reported higher expectancies for success on the anagrams than Ss in the specific attribution conditions. Results are supportive of an attribution theory model of learned helplessness and depression. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-awareness, probability of improvement, and the self-serving bias.

Evidence for the self-serving bias (attributing success internally and failure externally) is inconsistent. Although internal success attributions are consistently found, researchers find both internal and external attributions for failure. The authors explain these disparate effects by considering the intersection of 2 systems, a system comparing self against standards and a causal attribution system. It was predicted that success and failure attributions are moderated by self-awareness and by the ability to improve. When self-focus is high (a) success is attributed internally, (b) failure is attributed internally when people can improve, (c) failure is attributed externally when people cannot improve, and (d) these attributions affect state self-esteem. Implications for the self-serving bias are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attribution processes in distressed and nondistressed couples: IV. Self–partner attribution differences.

The importance of the self–other distinction for understanding the relation between attributions and marital satisfaction is examined in two studies. In Study 1, causal attributions for naturally occurring behavior by the self and spouse were investigated. Study 2 examined both causal and responsibility attributions for hypothetical behaviors. In both studies, the attributions of spouses seeking therapy were investigated in relation to those of happily married persons in the community. The results showed that self–other attribution differences varied as a function of marital distress. Nondistressed spouses showed a positive attribution bias by making more benign attributions for partner behavior as opposed to self-behavior, whereas distressed spouses showed a negative attribution bias by making less benign attributions for partner behavior than for self-behavior. These findings suggest that self-attributions may, in part, determine the impact of attributions for spouse behavior on marital satisfaction. The clinical relevance of the results and their implications for research on actor–observer attribution differences are outlined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attributional responses of anxious individuals to different patterns of social feedback: Nothing succeeds like improvement.

The causal attributions of socially anxious and nonanxious subjects were studied following four patterns of social feedback: consistent success, improvement, deterioration, and consistent failure. Providing anxious subjects with improving feedback produced the strongest internal attribution for positive outcomes, albeit to the unstable factor of effort. Nonanxious subjects, on the other hand, accepted greatest personal responsibility for consistent success. Socially anxious individuals also ascribed greater importance to the external factors of luck and task difficulty than did nonanxious subjects. Possible implications for treatment of socially anxious clients are discussed. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of causal attributions on affective reactions to success and failure.

Assessed the impact of outcome (success vs failure) and attribution (internal vs external) on affect in an achievement setting. Following the theorizing of B. Weiner et al (1978, 1979), it was anticipated that the outcome manipulation would determine general positive and negative affective reactions, whereas the attribution manipulation would influence affects related to self-esteem. 53 female undergraduates received success or failure feedback on a social accuracy test and were induced to attribute their performance to either an internal (ability) or an external cause (characteristics of the task). A factor analysis revealed 3 dimensions: Negative Affect, Positive Affect, and Self-Esteem. ANOVA indicated that the nature of the attribution influenced all 3 forms of affective reactions. Success produced greater positive affect, less negative affect, and higher self-esteem than failure only when ability attributions were induced. Although additional analyses offered some support for the presence of affects influenced solely by outcome, the majority of analyses supported the notion that attributions are the primary determinants of affective reactions to success and failure. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sex and ethnic differences in the use of power.

Hypothesized that women and Chicanos would make less internal and more external attributions for their own successful performance than would Anglo males. 40 Chicano male, 40 Chicano female, 40 Anglo male, and 40 Anglo female undergraduates participated as managers in an industrial simulation study. Ss were randomly assigned to 1 of 4 experimental conditions: designated powers vs unspecified powers, and supervision of male or female workers. Following the managerial task, Ss completed a questionnaire assessing their own performance and that of their workers. All Anglos devalued their workers as a function of controlling power and attributed workers' performance to external factors. All Ss tended to use their power to persuade workers. Males attempted to influence workers to a greater degree than did females. The predicted sex differences in terms of attribution were evident only among Anglos. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expectations, aspirations, and evaluations as influenced by another's attributions for success and failure.

A study with 80 male and female students aged 16–18 yrs examined the effects of another's attributions for performance on one's own expectations, aspirations, and evaluations of performance. Ss witnessed an other (O) who had attributed his (or her) performance (successful or unsuccessful) on an anagram task to luck, task ease or difficulty, effort, or ability. When O had succeeded, Ss expected to perform best if O had attributed his success to the task (rather than to luck, effort, or ability); when O had failed, Ss expected to perform worst when O had attributed his failure to the task. In addition, Ss witnessing a successful O were more hopeful if O had made a task attribution, but Ss witnessing an unsuccessful O were more hopeful if O had made an effort attribution. Finally, Ss showed a tendency to attribute their own performance to the same cause to which O had attributed his own performance. Results are discussed in relation to the stability–instability and internal–external dimensions of causal attributions and to the need to perceive oneself as exercising effective control over the environment. (French summary) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hallucinations, Negative Symptoms, and Response Bias in a Verbal Recognition Task in Schizophrenia.

Several studies have reported an association between hallucinations and tendency to make false alarms in acoustic signal detection tasks. Previous work on patients with schizophrenia has suggested that false recognitions and other types of memory error were positively associated with hallucinations and inversely associated with certain negative symptoms of withdrawal. In this study, 40 patients with schizophrenia were administered a word recognition task. Mixed lists of high- and low-frequency words were presented, then the target words had to be recognized among distractors in immediate and delayed recognition conditions. Hallucination scores were correlated with an increased bias toward false recognitions of nonpresented words. Affective flattening tended to be correlated with a reduced bias toward false recognitions. Anhedonia was significantly correlated with a reduced response bias. Hallucinations and anhedonia therefore presented an opposite association with the response bias. The influence of word frequency and delay on this association is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Where the imaginal appears real: a positron emission tomography study of auditory hallucinations

An auditory hallucination shares with imaginal hearing the property of being self-generated and with real hearing the experience of the stimulus being an external one. To investigate where in the brain an auditory event is "tagged" as originating from the external world, we used positron emission tomography to identify neural sites activated by both real hearing and hallucinations but not by imaginal hearing. Regional cerebral blood flow was measured during hearing, imagining, and hallucinating in eight healthy, highly hypnotizable male subjects prescreened for their ability to hallucinate under hypnosis (hallucinators). Control subjects were six highly hypnotizable male volunteers who lacked the ability to hallucinate under hypnosis (nonhallucinators). A region in the right anterior cingulate (Brodmann area 32) was activated in the group of hallucinators when they heard an auditory stimulus and when they hallucinated hearing it but not when they merely imagined hearing it. The same experimental conditions did not yield this activation in the group of nonhallucinators. Inappropriate activation of the right anterior cingulate may lead self-generated thoughts to be experienced as external, producing spontaneous auditory hallucinations.     

Word recognition, discrimination accuracy, and decision bias in schizophrenia: association with positive symptomatology and depressive symptomatology

The purpose of this experiment was to replicate and extend to a memory task Bentall and Slade's (1985) finding that hallucinations in schizophrenic patients were linked to a liberal decision bias. A word recognition task was administered to 40 schizophrenic patients and 40 normal controls that yielded two indices of performance: an index of discrimination accuracy (Pr) and one of decision bias (Br). Patients obtained a lower Pr than controls, whereas Br was similar in both groups. In patients, Br was selectively correlated with positive symptomatology: the more the positive symptoms, the more liberal the bias. In particular, there was a specific correlation between decision bias and hallucinations. Conversely, Pr was inversely correlated with severity of depression, but not with either positive or negative symptoms. Thus, positive symptomatology may be linked more to difficulties in distinguishing between representations of internal versus external events than to deficits in encoding external events.     

Processing causally relevant information.

Two experiments tested an information-processing model of causal judgment proposed by D. L. Hamilton, P. D. Grubb, D. A. Acorn, T. K. Trolier, and S. Carpenter (1990). In Exp 1 the explanatory quality (plausibility, sufficiency, and likelihood) of context information pertaining to a behavioral event was varied independently of its implications for internal or external causality. In Exp 2 perceivers performed tasks requiring either item-specific elaboration or relational encoding of the information in addition to making external versus internal causal attributions. Results imply that (a) perceivers encode the causal potency of individual information items even when the judgment task requires only a general internal versus external attribution and (b) perceivers engage in multiple modes of encoding information, depending on the implicational structure of the information array and on the explanatory quality of the context items. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attributions of responsibility for group tasks: The egocentric bias and the actor–observer difference.

In each of 3 experiments it was demonstrated that under certain conditions individuals who work on a task in a dyad will tend to attribute greater responsibility for a positive outcome to their partners than to themselves. In Exp I 56 college students, who had qualifying scores on the Beck Depression Inventory, working in dyads on a crossword puzzle attributed more responsibility to their partners than to themselves for an outcome they were led to believe was quite good, thus contradicting the expected "egocentric bias" effect. This was true across depression categories. In Exp II, 100 college students working in dyads on the puzzle attributed more responsibility to their partners than to themselves for a positive outcome when asked immediately after the task to make the attribution. However, Ss attributed greater responsibility to themselves than to their partners when asked to make the attribution 3 days later, thus replicating the egocentric bias effect. Half of the 30 dyads in Exp III believed they were being videotaped while working on the puzzle, whereas the other half did not. "Videotaped" Ss attributed more responsibility for the positive outcome to themselves than to their partners, whereas the nonvideotaped Ss attributed more responsibility to their partners than to themselves when both groups were asked to give their attributions immediately after the task. The relationship between the egocentric bias effect and the actor–observer difference phenomenon is discussed. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Understanding failure in the job acquisition process: An attributional approach.

Examined differences in the attributions made by nondisabled persons of failure to obtain employment by disabled vs nondisabled job applicants. Four experimental groups, each consisting of 30 college students, read stimulus material in which an unsuccessful job applicant was described as alcoholic, mentally ill, deaf, or nondisabled. Ss were then asked to respond to a scale constructed to test for 4 sources of attribution of failure to secure the job: ability, effort, 12-item Likert-type task difficulty, and luck. Implications for the effects of different attributions on client motivation are discussed. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intrusions in Alzheimer's disease in immediate and delayed memory as a function of presentation modality

Young and elderly participants, and participants with Alzheimer's disease (AD) were compared via the suffix paradigm, where a not-to-be-recalled item is appended onto sequences to be immediately recalled. This task was followed by delayed tasks. In immediate recall, AD subjects showed both extralist and suffix intrusions. Recall of auditorily as compared with visually presented stimuli was superior, with the difference increasing in older subjects. The auditory but not the visual suffix produced an end-of-sequence decrement, which was greater in AD than in other groups. After delay, the elderly and young showed virtually perfect performance. The AD participants showed relatively high performance; however, extralist intrusions were frequent, resulting in a relatively low hit rate. As in immediate recall, intrusions showed specificity for AD, and in this paradigm appeared to be a marker differentiating AD and normal subjects. However, the sample size limits the power and generalizability of these findings.     

Attribution and the double bind in paradoxical interventions.

Tested the hypothesis that clear identification of an internal, nonvolitional agent of therapeutic change would enhance therapeutic change and the maintenance of change in response to paradoxical interventions (PIs) and explored the double-bind explanation of PIs. 29 depressed (as determined by the Beck Depression Inventory [BDI]) college students were assigned to 1 of 3 interview treatments containing PIs: A no-elaboration condition contained only PIs; a developmental-meaning condition contained an additional paragraph explicitly identifying a developmental agent of change; and a metacommunication condition contained an additional paragraph explicitly identifying the paradoxical nature and intent of the treatment. At follow-up, Ss completed a battery that included the BDI, a self-perception inventory, and the Barrett-Lennard Relationship Inventory. Results indicate that PIs that explicitly identified an internal, nonvolitional cause of change resulted in decreased external attribution of change but not greater therapeutic change. Explaining the double-bind aspects of PIs resulted in favorable client views of therapists but diminished the immediate therapeutic effects of the interventions. Results suggest that clients' perceptions of the qualities of their therapists and clients' attributions about the causes of their behaviors may not be causes of therapeutic change but simply additional dependent variables in the therapeutic process. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-confirmatory attribution, egocentrism, and the perpetuation of self-beliefs.

Examined the relations between prior self-conceptions (PSCs), the attributions people make for their own behavior, and their expectations for similar behavior from others (egocentric bias). In Study 1, with 106 undergraduates, an anticipated behavior was considerably more apt to be attributed to dispositional factors if it would confirm the S's PSCs and to situational factors if inconsistent with PSCs. This pattern held equally well whether in settings that were perceived generally to compel or inhibit the behavior. Thus, the normativeness of the behavior for the S was a more important predictor of attributions than was the perceived normativeness of the behavior for the situation. In Study 2, with 34 undergraduates, this self-confirmatory attribution pattern was replicated for actual behavior. In both studies, the more an S's behavior was consistent with PSCs, the smaller the percentage of other people he/she expected to act similarly. It is suggested that self-beliefs may be perpetuated in part through this self-confirmatory attribution tendency and through moderation of the egocentric bias. Implications for certain normative attribution formulations such as the discounting principle are discussed. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Causal Attribution and Hindsight Bias for Economic Developments.

Hindsight bias for economic developments was studied, with particular focus on the moderating effects of attitudes and causal attributions. Participants (N = 263) rated the likelihood of several economic developments 6 months before and 6 months after the euro introduction in 2002. Hindsight bias occurred selectively for attitude-consistent economic developments: Euro supporters showed stronger hindsight bias for positive developments than for negative ones; euro opponents showed the opposite pattern. Causal attribution further moderated the hindsight bias: Participants who perceived a strong connection between the euro introduction and specific economic developments showed higher attitude-consistent hindsight bias than participants who perceived those developments as unrelated to the euro. It is argued that hindsight bias serves to stabilize subjective representations of the economy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Terror management and attributions of blame to innocent victims: Reconciling compassionate and defensive responses.

In this article, 4 studies test the hypothesis that reminders of personal death bias the normative attribution process and increase the motivation to blame severely injured, innocent victims. In Studies 1 and 2, primes of death led to greater attributions of blame to severely injured victims but did not significantly influence attributions of blame to either mildly injured victims or negatively portrayed others. In Study 3, primes of death led to greater attributions of blame to victims of circumstance but did not influence attributions of blame to victims who were explicitly responsible for their condition. In Study 4, innocent victims who were severely injured elicited more death-related cognitions than did victims who were responsible for their condition or who were only mildly injured. These findings indicate that the predictions of normative models of attribution may be moderated, and even overturned, when observers are reminded of their personal death such that defensive needs override rational inferential processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Auditory hallucinations inhibit exogenous activation of auditory association cortex

Percepts unaccompanied by a veridical stimulus, such as hallucinations, provide an opportunity for mapping the neural correlates of conscious perception. Functional magnetic resonance imaging (fMRI) can reveal localized changes in blood oxygenation in response to actual as well as imagined sensory stimulation. The safe repeatability of fMRI enabled us to study a patient with schizophrenia while he was experiencing auditory hallucinations and when hallucination-free (with supporting data from a second case). Cortical activation was measured in response to periodic exogenous auditory and visual stimulations using time series regression analysis. Functional brain images were obtained in each hallucination condition both while the patient was on and off antipsychotic drugs. The response of the temporal cortex to exogenous auditory stimulation (speech) was markedly reduced when the patient was experiencing hallucinating voices addressing him, regardless of medication. Visual cortical activation (to flashing lights) remained normal over four scans. From the results of this study and previous work on visual hallucinations we conclude that hallucinations coincide with maximal activation of the sensory and association cortex, specific to the modality of the experience.