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1.  Report on the 2nd International Consortium on Hallucination Research: Evolving Directions and Top-10 “Hot Spots” in Hallucination Research 
Schizophrenia Bulletin  2013;40(1):24-27.
This article presents a report on the 2nd meeting of the International Consortium on Hallucination Research, held on September 12th and 13th 2013 at Durham University, UK. Twelve working groups involving specialists in each area presented their findings and sought to summarize the available knowledge, inconsistencies in the field, and ways to progress. The 12 working groups reported on the following domains of investigation: cortical organisation of hallucinations, nonclinical hallucinations, interdisciplinary approaches to phenomenology, culture and hallucinations, subtypes of auditory verbal hallucinations, a Psychotic Symptoms Rating Scale multisite study, visual hallucinations in the psychosis spectrum, hallucinations in children and adolescents, Research Domain Criteria behavioral constructs and hallucinations, new methods of assessment, psychological therapies, and the Hearing Voices Movement approach to understanding and working with voices. This report presents a summary of this meeting and outlines 10 hot spots for hallucination research, which include the in-depth examination of (1) the social determinants of hallucinations, (2) translation of basic neuroscience into targeted therapies, (3) different modalities of hallucination, (4) domain convergence in cross-diagnostic studies, (5) improved methods for assessing hallucinations in nonclinical samples, (6) using humanities and social science methodologies to recontextualize hallucinatory experiences, (7) developmental approaches to better understand hallucinations, (8) changing the memory or meaning of past trauma to help recovery, (9) hallucinations in the context of sleep and sleep disorders, and (10) subtypes of hallucinations in a therapeutic context.
doi:10.1093/schbul/sbt167
PMCID: PMC3885309  PMID: 24282321
meeting report; hallucinations; psychosis
2.  Inner experience in the scanner: can high fidelity apprehensions of inner experience be integrated with fMRI? 
Frontiers in Psychology  2014;5:1393.
To provide full accounts of human experience and behavior, research in cognitive neuroscience must be linked to inner experience, but introspective reports of inner experience have often been found to be unreliable. The present case study aimed at providing proof of principle that introspection using one method, descriptive experience sampling (DES), can be reliably integrated with fMRI. A participant was trained in the DES method, followed by nine sessions of sampling within an MRI scanner. During moments where the DES interview revealed ongoing inner speaking, fMRI data reliably showed activation in classic speech processing areas including left inferior frontal gyrus. Further, the fMRI data validated the participant’s DES observations of the experiential distinction between inner speaking and innerly hearing her own voice. These results highlight the precision and validity of the DES method as a technique of exploring inner experience and the utility of combining such methods with fMRI.
doi:10.3389/fpsyg.2014.01393
PMCID: PMC4260673  PMID: 25538649
inner speech; inner speaking; inner hearing; inner experience; introspection; fMRI; descriptive experience sampling; mind wandering
3.  The role of the superior temporal lobe in auditory false perceptions: A transcranial direct current stimulation study 
Neuropsychologia  2014;62:202-208.
Neuroimaging has shown that a network of cortical areas, which includes the superior temporal gyrus, is active during auditory verbal hallucinations (AVHs). In the present study, healthy, non-hallucinating participants (N=30) completed an auditory signal detection task, in which participants were required to detect a voice in short bursts of white noise, with the variable of interest being the rate of false auditory verbal perceptions. This paradigm was coupled with transcranial direct current stimulation, a noninvasive brain stimulation technique, to test the involvement of the left posterior superior temporal gyrus in the creation of auditory false perceptions. The results showed that increasing the levels of excitability in this region led to a higher rate of ‘false alarm’ responses than when levels of excitability were decreased, with false alarm responses under a sham stimulation condition lying at a mid-point between anodal and cathodal stimulation conditions. There were also corresponding changes in signal detection parameters. These results are discussed in terms of prominent cognitive neuroscientific theories of AVHs, and potential future directions for research are outlined.
Highlights
•Investigated role of left STG in false perceptions of voices in white noise.•Used noninvasive brain stimulation whilst participants listened to white noise.•Tested whether number of false perceptions was affected by stimulation of STG.•Higher false alarm rate when excitability increased than when decreased.
doi:10.1016/j.neuropsychologia.2014.07.032
PMCID: PMC4179889  PMID: 25107678
Auditory verbal hallucinations; Signal detection; Superior temporal gyrus; tDCS
4.  Shot through with voices: Dissociation mediates the relationship between varieties of inner speech and auditory hallucination proneness 
Consciousness and Cognition  2014;27(100):288-296.
Highlights
•Inner speech, self-esteem, dissociation and hallucination proneness were examined.•Self-esteem was linked to inner speech but not hallucination proneness.•Dissociation mediated links between inner speech and hallucination proneness.
Inner speech is a commonly experienced but poorly understood phenomenon. The Varieties of Inner Speech Questionnaire (VISQ; McCarthy-Jones & Fernyhough, 2011) assesses four characteristics of inner speech: dialogicality, evaluative/motivational content, condensation, and the presence of other people. Prior findings have linked anxiety and proneness to auditory hallucinations (AH) to these types of inner speech. This study extends that work by examining how inner speech relates to self-esteem and dissociation, and their combined impact upon AH-proneness. 156 students completed the VISQ and measures of self-esteem, dissociation and AH-proneness. Correlational analyses indicated that evaluative inner speech and other people in inner speech were associated with lower self-esteem and greater frequency of dissociative experiences. Dissociation and VISQ scores, but not self-esteem, predicted AH-proneness. Structural equation modelling supported a mediating role for dissociation between specific components of inner speech (evaluative and other people) and AH-proneness. Implications for the development of “hearing voices” are discussed.
doi:10.1016/j.concog.2014.05.010
PMCID: PMC4111865  PMID: 24980910
Inner speech; Dissociation; Self-esteem; Hallucination; Psychosis; Dialogicality
5.  From Phenomenology to Neurophysiological Understanding of Hallucinations in Children and Adolescents 
Schizophrenia Bulletin  2014;40(Suppl 4):S221-S232.
Typically reported as vivid, multisensory experiences which may spontaneously resolve, hallucinations are present at high rates during childhood. The risk of associated psychopathology is a major cause of concern. On the one hand, the risk of developing further delusional ideation has been shown to be reduced by better theory of mind skills. On the other hand, ideas of reference, passivity phenomena, and misidentification syndrome have been shown to increase the risk of self-injury or heteroaggressive behaviors. Cognitive psychology and brain-imaging studies have advanced our knowledge of the mechanisms underlying these early-onset hallucinations. Notably, specific functional impairments have been associated with certain phenomenological characteristics of hallucinations in youths, including intrusiveness and the sense of reality. In this review, we provide an update of associated epidemiological and phenomenological factors (including sociocultural context, social adversity, and genetics, considered in relation to the psychosis continuum hypothesis), cognitive models, and neurophysiological findings concerning hallucinations in children and adolescents. Key issues that have interfered with progress are considered and recommendations for future studies are provided.
doi:10.1093/schbul/sbu029
PMCID: PMC4141307  PMID: 24936083
hallucinations; childhood; review; adolescence
6.  Auditory Verbal Hallucinations in Persons With and Without a Need for Care 
Schizophrenia Bulletin  2014;40(Suppl 4):S255-S264.
Auditory verbal hallucinations (AVH) are complex experiences that occur in the context of various clinical disorders. AVH also occur in individuals from the general population who have no identifiable psychiatric or neurological diagnoses. This article reviews research on AVH in nonclinical individuals and provides a cross-disciplinary view of the clinical relevance of these experiences in defining the risk of mental illness and need for care. Prevalence rates of AVH vary according to measurement tool and indicate a continuum of experience in the general population. Cross-sectional comparisons of individuals with AVH with and without need for care reveal similarities in phenomenology and some underlying mechanisms but also highlight key differences in emotional valence of AVH, appraisals, and behavioral response. Longitudinal studies suggest that AVH are an antecedent of clinical disorders when combined with negative emotional states, specific cognitive difficulties and poor coping, plus family history of psychosis, and environmental exposures such as childhood adversity. However, their predictive value for specific psychiatric disorders is not entirely clear. The theoretical and clinical implications of the reviewed findings are discussed, together with directions for future research.
doi:10.1093/schbul/sbu005
PMCID: PMC4141313  PMID: 24936085
nonclinical; need for care; psychosis; prevalence
7.  Special Supplement Introduction: Hallucinations 
Schizophrenia Bulletin  2014;40(Suppl 4):S195-S197.
This Special Supplement presents reports from 11 working groups of the interdisciplinary International Consortium on Hallucination Research meeting in Durham, UK, September 2013. Topics include psychological therapies for auditory hallucinations, culture and hallucinations, hallucinations in children and adolescents, visual hallucinations, interdisciplinary approaches to the phenomenology of auditory verbal hallucinations (AVHs), AVHs in persons without need for care, a multisite study of the PSYRATS instrument, subtypes of AVHs, the Hearing Voices Movement, Research Domain Criteria for hallucinations, and cortical specialization as a route to understanding hallucinations.
doi:10.1093/schbul/sbu043
PMCID: PMC4141322  PMID: 24936079
hallucinations; psychosis; interdisciplinary
8.  Culture and Hallucinations: Overview and Future Directions 
Schizophrenia Bulletin  2014;40(Suppl 4):S213-S220.
A number of studies have explored hallucinations as complex experiences involving interactions between psychological, biological, and environmental factors and mechanisms. Nevertheless, relatively little attention has focused on the role of culture in shaping hallucinations. This article reviews the published research, drawing on the expertise of both anthropologists and psychologists. We argue that the extant body of work suggests that culture does indeed have a significant impact on the experience, understanding, and labeling of hallucinations and that there may be important theoretical and clinical consequences of that observation. We find that culture can affect what is identified as a hallucination, that there are different patterns of hallucination among the clinical and nonclinical populations, that hallucinations are often culturally meaningful, that hallucinations occur at different rates in different settings; that culture affects the meaning and characteristics of hallucinations associated with psychosis, and that the cultural variations of psychotic hallucinations may have implications for the clinical outcome of those who struggle with psychosis. We conclude that a clinician should never assume that the mere report of what seems to be a hallucination is necessarily a symptom of pathology and that the patient’s cultural background needs to be taken into account when assessing and treating hallucinations.
doi:10.1093/schbul/sbu012
PMCID: PMC4141319  PMID: 24936082
hallucination; culture; ethnography; psychosis; religion
9.  Interdisciplinary Approaches to the Phenomenology of Auditory Verbal Hallucinations 
Schizophrenia Bulletin  2014;40(Suppl 4):S246-S254.
Despite the recent proliferation of scientific, clinical, and narrative accounts of auditory verbal hallucinations (AVHs), the phenomenology of voice hearing remains opaque and undertheorized. In this article, we outline an interdisciplinary approach to understanding hallucinatory experiences which seeks to demonstrate the value of the humanities and social sciences to advancing knowledge in clinical research and practice. We argue that an interdisciplinary approach to the phenomenology of AVH utilizes rigorous and context-appropriate methodologies to analyze a wider range of first-person accounts of AVH at 3 contextual levels: (1) cultural, social, and historical; (2) experiential; and (3) biographical. We go on to show that there are significant potential benefits for voice hearers, clinicians, and researchers. These include (1) informing the development and refinement of subtypes of hallucinations within and across diagnostic categories; (2) “front-loading” research in cognitive neuroscience; and (3) suggesting new possibilities for therapeutic intervention. In conclusion, we argue that an interdisciplinary approach to the phenomenology of AVH can nourish the ethical core of scientific enquiry by challenging its interpretive paradigms, and offer voice hearers richer, potentially more empowering ways to make sense of their experiences.
doi:10.1093/schbul/sbu003
PMCID: PMC4141308  PMID: 24903416
auditory verbal hallucinations; phenomenology; interdisciplinarity; research collaboration; psychosis
10.  Individual differences in children’s private speech: The role of imaginary companions 
Journal of experimental child psychology  2013;116(3):10.1016/j.jecp.2013.06.010.
Relations between children’s imaginary companion status and their engagement in private speech during free play were investigated in a socially diverse sample of 5-year-olds (N = 148). Controlling for socioeconomic status, receptive verbal ability, total number of utterances, and duration of observation, there was a main effect of imaginary companion status on type of private speech. Children who had imaginary companions were more likely to engage in covert private speech compared with their peers who did not have imaginary companions. These results suggest that the private speech of children with imaginary companions is more internalized than that of their peers who do not have imaginary companions and that social engagement with imaginary beings may fulfill a similar role to social engagement with real-life partners in the developmental progression of private speech.
doi:10.1016/j.jecp.2013.06.010
PMCID: PMC3870270  PMID: 23978382
Private speech; Imaginary companions; Play; Internalization; Social interaction; Imagination
11.  Auditory verbal hallucinations as atypical inner speech monitoring, and the potential of neurostimulation as a treatment option 
Neuroscience and biobehavioral reviews  2013;37(10 0 2):10.1016/j.neubiorev.2013.10.001.
Auditory verbal hallucinations (AVHs) are the experience of hearing voices in the absence of any speaker, often associated with a schizophrenia diagnosis. Prominent cognitive models of AVHs suggest they may be the result of inner speech being misattributed to an external or non-self source, due to atypical self- or reality monitoring. These arguments are supported by studies showing that people experiencing AVHs often show an externalising bias during monitoring tasks, and neuroimaging evidence which implicates superior temporal brain regions, both during AVHs and during tasks that measure verbal self-monitoring performance. Recently, efficacy of noninvasive neurostimulation techniques as a treatment option for AVHs has been tested. Meta-analyses show a moderate effect size in reduction of AVH frequency, but there has been little attempt to explain the therapeutic effect of neurostimulation in relation to existing cognitive models. This article reviews inner speech models of AVHs, and argues that a possible explanation for reduction in frequency following treatment may be modulation of activity in the brain regions involving the monitoring of inner speech.
doi:10.1016/j.neubiorev.2013.10.001
PMCID: PMC3870271  PMID: 24125858
Auditory verbal hallucinations; Inner speech; Self-monitoring; Reality monitoring; Neurostimulation; TMS; tDCS
12.  Auditory verbal hallucinations as atypical inner speech monitoring, and the potential of neurostimulation as a treatment option☆ 
Neuroscience and Biobehavioral Reviews  2013;37(10):2794-2805.
Highlights
•We discuss ‘inner speech’ theories of auditory verbal hallucinations.•Atypical self-monitoring may lead to the experience of inner speech as external.•We summarize research into the use of neurostimulation to treat hallucinations.•Effects of neurostimulation may be due to modulation of self-monitoring networks.
Auditory verbal hallucinations (AVHs) are the experience of hearing voices in the absence of any speaker, often associated with a schizophrenia diagnosis. Prominent cognitive models of AVHs suggest they may be the result of inner speech being misattributed to an external or non-self source, due to atypical self- or reality monitoring. These arguments are supported by studies showing that people experiencing AVHs often show an externalising bias during monitoring tasks, and neuroimaging evidence which implicates superior temporal brain regions, both during AVHs and during tasks that measure verbal self-monitoring performance. Recently, efficacy of noninvasive neurostimulation techniques as a treatment option for AVHs has been tested. Meta-analyses show a moderate effect size in reduction of AVH frequency, but there has been little attempt to explain the therapeutic effect of neurostimulation in relation to existing cognitive models. This article reviews inner speech models of AVHs, and argues that a possible explanation for reduction in frequency following treatment may be modulation of activity in the brain regions involving the monitoring of inner speech.
doi:10.1016/j.neubiorev.2013.10.001
PMCID: PMC3870271  PMID: 24125858
Auditory verbal hallucinations; Inner speech; Self-monitoring; Reality monitoring; Neurostimulation; TMS; tDCS
13.  Cognitive Styles and Psychotic Experiences in a Community Sample 
PLoS ONE  2013;8(11):e80055.
Introduction
In clinical populations paranoid delusions are associated with making global, stable and external attributions for negative events. Paranoia is common in community samples but it is not known whether it is associated with a similar cognitive style. This study investigates the association between cognitive style and paranoia in a large community sample of young adults.
Methods
2694 young adults (mean age 17.8, SD 4.6) from the ALSPAC cohort provided data on psychotic experiences and cognitive style. Psychotic experiences were assessed using a semi-structured interview and cognitive style was assessed using the Cognitive Styles Questionnaire-Short Form (CSQ-SF) on the same occasion. Logistic regression was used to investigate associations between paranoia and CSQ-SF scores, both total and domain-related (global, stable, self, external). The role of concurrent self-reported depressive symptoms in the association was explored.
Results
Paranoia was associated with Total CSQ-SF scores (adjusted OR 1.69 95% CI 1.29, 2.22), as well as global (OR 1.56 95% CI 1.17, 2.08), stable (OR 1.56 95% CI 1.17, 2.08) and self (OR 1.37 95% CI 1.05, 1.79) domains, only Total score and global domain associations remained after additional adjustment for self-reported depression. There was no association between paranoia and external cognitive style (OR 1.10 95% CI 0.83, 1.47).
Conclusion
Paranoid ideation in a community sample is associated with a global rather than an external cognitive style. An external cognitive style may be a characteristic of more severe paranoid beliefs. Further work is required to determine the role of depression in the association between cognitive style and paranoia.
doi:10.1371/journal.pone.0080055
PMCID: PMC3828222  PMID: 24244608
14.  The Characteristic Features of Auditory Verbal Hallucinations in Clinical and Nonclinical Groups: State-of-the-Art Overview and Future Directions 
Schizophrenia Bulletin  2012;38(4):724-733.
Despite a growing interest in auditory verbal hallucinations (AVHs) in different clinical and nonclinical groups, the phenomenological characteristics of such experiences have not yet been reviewed and contrasted, limiting our understanding of these phenomena on multiple empirical, theoretical, and clinical levels. We look at some of the most prominent descriptive features of AVHs in schizophrenia (SZ). These are then examined in clinical conditions including substance abuse, Parkinson’s disease, epilepsy, dementia, late-onset SZ, mood disorders, borderline personality disorder, hearing impairment, and dissociative disorders. The phenomenological changes linked to AVHs in prepsychotic stages are also outlined, together with a review of AVHs in healthy persons. A discussion of key issues and future research directions concludes the review.
doi:10.1093/schbul/sbs061
PMCID: PMC3406519  PMID: 22499783
hallucinations; hallucinosis; hearing voices; psychosis; transdiagnostic
15.  Auditory Hallucinations in Schizophrenia and Nonschizophrenia Populations: A Review and Integrated Model of Cognitive Mechanisms 
Schizophrenia Bulletin  2012;38(4):683-693.
While the majority of cognitive studies on auditory hallucinations (AHs) have been conducted in schizophrenia (SZ), an increasing number of researchers are turning their attention to different clinical and nonclinical populations, often using SZ findings as a model for research. Recent advances derived from SZ studies can therefore be utilized to make substantial progress on AH research in other groups. The objectives of this article were to (1) present an up-to-date review regarding the cognitive mechanisms of AHs in SZ, (2) review findings from cognitive research conducted in other clinical and nonclinical groups, and (3) integrate these recent findings into a cohesive framework. First, SZ studies show that the cognitive underpinnings of AHs include self-source-monitoring deficits and executive and inhibitory control dysfunctions as well as distortions in top-down mechanisms, perceptual and linguistic processes, and emotional factors. Second, consistent with SZ studies, findings in other population groups point to the role of top-down processing, abnormalities in executive inhibition, and negative emotions. Finally, we put forward an integrated model of AHs that incorporates the above findings. We suggest that AHs arise from an interaction between abnormal neural activation patterns that produce salient auditory signals and top-down mechanisms that include signal detection errors, executive and inhibition deficits, a tapestry of expectations and memories, and state characteristics that influence how these experiences are interpreted. Emotional factors play a particular prominent role at all levels of this hierarchy. Our model is distinctively powerful in explaining a range of phenomenological characteristics of AH across a spectrum of disorders.
doi:10.1093/schbul/sbs045
PMCID: PMC3406530  PMID: 22446568
symptoms; psychosis; hallucinosis; research; domain; criteria; auditory network; model
16.  Report on the Inaugural Meeting of the International Consortium on Hallucination Research: A Clinical and Research Update and 16 Consensus-Set Goals for Future Research 
Schizophrenia Bulletin  2012;38(2):258-262.
This article presents a report on the first meeting of the International Consortium on Hallucination Research, which took place on September 13–14, 2011 at the Institute of Psychiatry, London. The first day of the meeting served to reflect on the current state of knowledge regarding auditory hallucinations in different diagnostic groups, based on the presentations from the phenomenology, cognition, emotion, electrophysiology, neurochemical, neuroimaging, genetics, treatment, and computational modeling working groups. The second day comprised a discussion forum where the most important and urgent questions for future research were identified. The meeting recognized that a lot has been achieved in auditory hallucination research but that much still remains to be done. Here, we outline the top 16 goals for research on auditory hallucinations, which cover topics of conceptual importance, academic and treatment issues, scientific rigor, and cross-disciplinary collaboration. Concerted and coordinated actions will be required to make substantial research progress.
doi:10.1093/schbul/sbr181
PMCID: PMC3283162  PMID: 22223735
auditory hallucinations; meeting; phenomenology; cognition; electrophysiology; neuroimaging; treatment
17.  Stop, look, listen: the need for philosophical phenomenological perspectives on auditory verbal hallucinations 
One of the leading cognitive models of auditory verbal hallucinations (AVHs) proposes such experiences result from a disturbance in the process by which inner speech is attributed to the self. Research in this area has, however, proceeded in the absence of thorough cognitive and phenomenological investigations of the nature of inner speech, against which AVHs are implicitly or explicitly defined. In this paper we begin by introducing philosophical phenomenology and highlighting its relevance to AVHs, before briefly examining the evolving literature on the relation between inner experiences and AVHs. We then argue for the need for philosophical phenomenology (Phenomenology) and the traditional empirical methods of psychology for studying inner experience (phenomenology) to mutually inform each other to provide a richer and more nuanced picture of both inner experience and AVHs than either could on its own. A critical examination is undertaken of the leading model of AVHs derived from phenomenological philosophy, the ipseity disturbance model. From this we suggest issues that future work in this vein will need to consider, and examine how interdisciplinary methodologies may contribute to advances in our understanding of AVHs. Detailed suggestions are made for the direction and methodology of future work into AVHs, which we suggest should be undertaken in a context where phenomenology and physiology are both necessary, but neither sufficient.
doi:10.3389/fnhum.2013.00127
PMCID: PMC3620561  PMID: 23576974
hallucination; phenomenology; psychosis; schizophrenia; interdisciplinary
18.  Assessing negative cognitive style: Development and validation of a Short-Form version of the Cognitive Style Questionnaire 
The Cognitive Style Questionnaire (CSQ) is a frequently employed measure of negative cognitive style, associated with vulnerability to anxiety and depression. However, the CSQ's length can limit its utility in research. We describe the development of a Short-Form version of the CSQ. After evaluation and modification of two pilot versions, the 8-item CSQ Short Form (CSQ-SF) was administered to a convenience sample of adults (N = 278). The CSQ-SF was found to have satisfactory internal reliability and test-retest reliability. It also exhibited construct validity by demonstrating predicted correlations with measures of depression and anxiety. Results suggest that the CSQ-SF is suitable for administration via the Internet.
doi:10.1016/j.paid.2011.11.026
PMCID: PMC3289144  PMID: 22389545
Cognitive style; Depression; Anxiety
19.  Assessing negative cognitive style: Development and validation of a Short-Form version of the Cognitive Style Questionnaire 
Highlights
► We developed a Short-Form version of the Cognitive Style Questionnaire (CSQ). ► The CSQ Short Form (CSQ-SF) demonstrated satisfactory internal reliability. ► Test–retest reliability was also satisfactory. ► Scores demonstrated predicted correlations with measures of depression and anxiety. ► The CSQ-SF may be a useful research tool in assessing vulnerability to depression.
The Cognitive Style Questionnaire (CSQ) is a frequently employed measure of negative cognitive style, associated with vulnerability to anxiety and depression. However, the CSQ’s length can limit its utility in research. We describe the development of a Short-Form version of the CSQ. After evaluation and modification of two pilot versions, the 8-item CSQ Short Form (CSQ-SF) was administered to a convenience sample of adults (N = 278). The CSQ-SF was found to have satisfactory internal reliability and test–retest reliability. It also exhibited construct validity by demonstrating predicted correlations with measures of depression and anxiety. Results suggest that the CSQ-SF is suitable for administration via the Internet.
doi:10.1016/j.paid.2011.11.026
PMCID: PMC3289144  PMID: 22389545
Cognitive style; Depression; Anxiety
20.  Social Predictors of Psychotic Experiences: Specificity and Psychological Mechanisms 
Schizophrenia Bulletin  2008;34(6):1012-1020.
It has become widely accepted that the psychotic disorders are endpoints of atypical developmental trajectories indexed by abnormal emotional and cognitive development early in life. However, the role of environmental factors in determining these trajectories has received relatively little attention. In this article, we argue that (1) the influence of environment on psychosis can best be understood if we focus on specific types of psychotic experiences such as hallucinations and delusions, (2) these symptoms are the products of specific cognitive biases and deficits, and (3) the development of these particular patterns of cognitive functioning is influenced by specific kinds of environmental adversity. This approach is at variance with more conventional approaches because it suggests that each type of experience, rather than being the manifestation of a common underlying illness process, is a product of a specific set of causal variables. Importantly, these variables include environmental determinants, although not to the exclusion of endogenous factors such as neurodevelopmental impairment or genetic vulnerability. We discuss the implications of this approach for neurobiological and genetic research into psychosis, as well as clinical practice.
doi:10.1093/schbul/sbn103
PMCID: PMC2632492  PMID: 18703667
hallucinations; delusions; trauma; victimization; sexual abuse
21.  A New Look at the Neural Diathesis–Stress Model of Schizophrenia: The Primacy of Social-Evaluative and Uncontrollable Situations 
Schizophrenia Bulletin  2006;33(5):1171-1177.
The neural diathesis–stress model of schizophrenia proposes that stress, through its effects on cortisol production, acts upon a preexisting vulnerability to trigger and/or worsen the symptoms of schizophrenia. In line with its focus on the neurobiology of stress response in schizophrenia, this model treats stressors as a homogeneous category. Recent research has shown that, in healthy individuals, cortisol is most strongly produced in response to stressors that result from perceived uncontrollable threats to important goals and/or social-evaluative threats. We hypothesize that it is specifically these stressors that trigger and/or worsen the symptoms of schizophrenia in those with a preexisting vulnerability. This hypothesis may provide a way of making sense of contradictory findings on the relations between stress and schizophrenia. We propose some empirical tests of this hypothesis and explore implications for the treatment and management of the disorder.
doi:10.1093/schbul/sbl058
PMCID: PMC2632355  PMID: 17105966
cortisol; psychosis; stressors; vulnerability
22.  Children with Imaginary Companions Focus on Mental Characteristics When Describing Their Real-Life Friends 
Infant and Child Development  2014;23(6):622-633.
Relations between having an imaginary companion (IC) and (i) descriptions of a real-life friend, (ii) theory of mind performance, and (iii) reported prosocial behaviour and behavioural difficulties were investigated in a sample of 5-year-olds (N = 159). Children who had an IC were more likely than their peers without an IC to describe their best friends with reference to their mental characteristics, but IC status was unrelated to children's theory of mind performance and reported prosocial behaviour and behavioural difficulties. These findings are discussed in the context of the proposal that there is a competence–performance gap in children's mentalizing abilities. © 2014 The Authors. Infant and Child Development published by John Wiley & Sons Ltd.
doi:10.1002/icd.1869
PMCID: PMC4321191
imaginary companions; friendship; mind-mindedness; theory of mind; peer relationships

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