Thought as action: Inner speech, self-monitoring, and auditory verbal hallucinations

doi:10.1016/j.concog.2005.12.003

Consciousness and Cognition

Volume 16, Issue 2, June 2007, Pages 391-399

https://doi.org/10.1016/j.concog.2005.12.003 Get rights and content

Abstract

Passivity experiences in schizophrenia are thought to be due to a failure in a neurocognitive action self-monitoring system (NASS). Drawing on the assumption that inner speech is a form of action, a recent model of auditory verbal hallucinations (AVHs) has proposed that AVHs can be explained by a failure in the NASS. In this article, we offer an alternative application of the NASS to AVHs, with separate mechanisms creating the emotion of self-as-agent and other-as-agent. We defend the assumption that inner speech can be considered as a form of action, and show how a number of previous criticisms of applying the NASS to AVHs can be refuted. This is achieved in part through taking a Vygotskian developmental perspective on inner speech. It is suggested that more research into the nature and development of inner speech is needed to further our understanding of AVHs.

Introduction

The phenomenon of auditory verbal hallucinations (AVHs), where individuals report hearing speech in the absence of any external stimulation, continues to puzzle psychiatrists and psychologists. Schneider (1959) classified AVHs as a first-rank symptom of schizophrenia, reflecting the approximately 60–74% of those with schizophrenia who report experiencing them (Slade and Bentall, 1988, Wing et al., 1974). However, a movement has developed away from understanding AVHs as necessarily signifying pathology, and towards an acceptance that voice-hearing can be a part of normal experience (Johns & van Os, 2001). Furthermore, there do not seem to be radical differences in the structure and functions of AVHs between voice-hearers with a diagnosis of schizophrenia and those without (Leudar, Thomas, McNally, & Glinski, 1997). Whether in a clinical or non-clinical sample, one of the fundamental characteristics of AVHs is their alien quality. In this article, we take a new look at the question of how it is possible that a self-generated cognition may come to be experienced as produced and performed by an agent other than the self.

Section snippets

Explaining agency: Is it me?

Frith and colleagues (e.g., Frith, Blakemore, & Wolpert, 2000) have developed an elegant model of the passivity experiences, such as delusions of control, found in schizophrenia. This model attributes such experiences to deficits in a postulated neurocognitive action self-monitoring system (NASS), and has had its predictions supported by empirical research (e.g., Blakemore, Wolpert, & Frith, 1998). The NASS model is based on Miall and Wolpert’s (1995) forward model which was developed to model

The application of the forward model to AVHs

Somewhat surprisingly Frith and colleagues have only applied this version of their forward model to abnormalities involving overt actions such as delusions of control and anarchic hand (e.g., Blakemore and Frith, 2003, Frith, 2002, Frith et al., 2000). Frith and colleagues have not attempted to use it to explain phenomena not involving overt movements, such as AVHs. One reason for this may be criticisms (e.g., Gallagher, 2004, Stephens and Graham, 2000) of Frith’s previous attempt to apply his

Inner speech as a kind of action

One potentially problematic aspect of Seal et al.’s (2004) account is the unexamined assumption that it is possible to transpose Frith et al.’s (2000) model from overt actions to the process of thinking in inner speech. Gallagher (2004) has made a strong case that it is incorrect simply to transpose Frith’s forward model from its successful explanation of passivity experiences, involving overt actions, to cognitive phenomena such as AVHs where there is no overt behavior. Gallagher suggests that

References (43)

S-J. Blakemore
Deluding the motor system
Consciousness and Cognition
(2003)
S-J. Blakemore et al.
Self-awareness and action
Current Opinion in Neurobiology
(2003)
F. de Vignemont et al.
The sense of agency: A philosophical and empirical review of the “Who” system
Consciousness and Cognition
(2004)
S. Della Sala et al.
Right-sided anarchic (alien) hand: A longitudinal study
Neuropsychologia
(1991)
C. Fernyhough
The dialogic mind: A dialogic approach to the higher mental functions
New Ideas in Psychology
(1996)
C. Fernyhough
Alien voices and inner dialogue: Towards a developmental account of auditory verbal hallucinations
New Ideas in Psychology
(2004)
C.D. Frith
Attention to action and awareness of other minds
Consciousness and Cognition
(2002)
C.D. Frith et al.
Explaining the symptoms of schizophrenia: Abnormalities in the awareness of action
Brain Research Reviews
(2000)
T. Giovannetti et al.
Reduced endogenous control in alien hand syndrome: Evidence from naturalistic action
Neuropsychologia
(2005)
L.C. Johns et al.
The continuity of psychotic experiences in the general population
Clinical Psychology Review
(2001)

D.T. Leube et al.

The neural correlates of perceiving one’s own movements

Neuroimage

(2003)

K.A. Akins et al.

Who may I say is calling?

Behavioral and Brain Sciences

(1986)

R.P. Bentall

The illusion of reality: A review and integration of psychological research on hallucinations

Psychological Bulletin

(1990)

R.P. Bentall

Madness explained

(2003)

L.E. Berk

Children’s private speech: An overview of theory and the status of research

P.A. Bick et al.

Auditory hallucinations and subvocal speech in schizophrenic patients

American Journal of Psychiatry

(1987)

S-J. Blakemore et al.

The cerebellum is involved in predicting the sensory consequences of action

Neuroreport

(2001)

S-J. Blakemore et al.

Central cancellation of self-produced tickle sensation

Nature Neuroscience

(1998)

A. Clark

Being there: Putting brain, body and world together again

(1997)

A. Clark

Magic words: How language augments human cognition

A. Clark et al.

The extended mind (Active externalism)

Analysis

(1998)

Cited by (130)

‘Are these my thoughts?’: A 20-year prospective study of thought insertion, thought withdrawal, thought broadcasting, and their relationship to auditory verbal hallucinations
2024, Schizophrenia Research
The co-occurrence of delusions and other symptoms at the onset of psychosis is a challenge for theories about the aetiology of psychosis. This paper explores the relatedness of delusions about the experience of thinking (thought insertion, thought withdrawal, and thought broadcasting) and auditory verbal hallucinations by describing their trajectories over a 20-year period in individuals diagnosed with schizophrenia, affective and other psychosis, and unipolar depression nonpsychosis. The sample consisted of 407 participants who were recruited at index hospitalization and evaluated over six follow-ups over 20 years. The symptom structure associated with thought insertion included auditory verbal hallucinations, somatic hallucinations, other hallucinations, delusions of thought-dissemination, delusions of control, delusion of self-depreciation, depersonalization and anxiety. The symptom constellation of thought withdrawal included somatic hallucinations, other hallucinations, delusions of thought dissemination, delusions of control, sexual delusions, depersonalization, negative symptoms, depression, and anxiety. The symptom constellation of thought broadcasting included auditory verbal hallucinations, somatic hallucinations, delusions of thought-dissemination, delusion of self-depreciation, fantastic delusions, sexual delusions, and depersonalization. Auditory verbal hallucinations and delusions of self-depreciation were significantly associated with both thought insertion and thought broadcasting. Thought insertion and thought withdrawal were significantly associated with other hallucinations, delusions of control, and anxiety; thought withdrawal and thought broadcasting were significantly related to sexual delusions. We hypothesize that specific symptom constellations over time might be explained as the product of pseudo-coherent realities created to give meaning to the experience of the world and the self of individuals in psychosis based on both prior top-down and ongoing bottom-up elements.
Theories of consciousness and psychiatric disorders – A comparative analysis
2023, Neuroscience and Biobehavioral Reviews
Disorders of consciousness represent an efficient way to test theories of consciousness’ (ToCs) predictions. So far, ToCs have mostly focused on disorders of quantitative awareness such as coma, vegetative state, spatial neglect and hemianopia. Psychiatric disorders, by contrast, have received little attention, leaving their contribution to consciousness research almost unexplored. Therefore, this paper aims to assess the relation between ToCs and psychiatric disorders – that is, the extent to which current ToCs can account for psychiatric symptomatology. First, I review direct and indirect evidence linking each ToC to psychiatry disorders. Next, I differentiate ToCs based on their theoretical and methodological ground, highlighting how they distinctively address neural, cognitive, and phenomenological aspects of conscious experience and, in turn, psychiatric symptoms. Finally, I refer to one specific symptom to directly compare ToCs’ explanatory power. Overall, Temporospatial Theory of Consciousness (TTC) appears to provide a more comprehensive account of psychiatric disorders, suggesting that a novel dimension of consciousness (i.e., form of consciousness) may be needed to address more qualitative alterations in conscious experience.
Auditory verbal hallucination can be evoked by prefrontal epileptic seizure
2022, Epilepsy and Behavior
Auditory verbal hallucinations (AVHs) have been reported in neocortical temporal epileptic seizures and have been considered highly associated with implication of auditory cortex by epileptic discharges or electrical stimulation. Herein, we report two rare frontal epilepsy cases in which AVHs featured the habitual seizures. The epileptogenic zones of these two patients were localized in the dorsal and orbitomedial prefrontal cortex, respectively by stereoelectroencephalography (SEEG) monitoring. Comparing with the AVHs in schizophrenia, we postulated that the phenomenological similarities between the two sets of AVHs imply homology in mechanisms. Ictal SEEG confirmed that the wide involvement of prefrontal–cingulate–auditory cortical network by low-voltage fast activity corresponded the occurrence with AVHs during frontal epileptic seizures. Electrical stimulation study of one of the two cases highlighted the causal role of prefrontal–cingulate cortex in the emergence of AVHs. Based on our clinical observation, SEEG findings, and electrical cortical stimulation, we supposed that wide implication of prefrontal–cingulate–auditory cortical network during epileptic seizure underlie the emergence of AVHs, and further hypothesized that AVHs could be yielded by transient deficit of self-monitoring for inner speech in focal epileptic seizures.
Depressive traits are associated with a reduced effect of choice on intentional binding
2022, Consciousness and Cognition
A sense of agency (SoA) over wilful actions is thought to be dependent on the level of choice and the nature of the outcome. In a preregistered study, we manipulated choice and valence of outcome to assess the relationship between SoA across the depression and psychosis continuum. Participants (N = 151) completed a Libet Clock task, in which they had either a free or forced choice to press one of two buttons and received either a rewarding or punishing outcome. Participants also completed questionnaires on depressive and psychosis-like traits. Rewarding outcomes increased intentional binding. The evidence favoured no effect of choice on average, but this was influenced by inter-individual differences. Individuals reporting more depressive traits had less of a difference in intentional binding between free and forced choice conditions. We show that implicit SoA is sensitive to outcome valence and the effect of choice differs across the depression continuum.
Ideomotor learning: Time to generalize a longstanding principle
2022, Neuroscience and Biobehavioral Reviews
The ideomotor principle holds that anticipating the sensory consequences of a movement triggers an associated motor response. Even though this framework dates back to the 19th century, it continues to lie at the heart of many contemporary approaches to human action control. Here we specifically focus on the ideomotor learning mechanism that has to precede action initiation via effect anticipation. Traditional approaches to this learning mechanism focused on establishing novel action-effect (or response-effect) associations. Here we apply the theoretical concept of common coding for action and perception to argue that the same learning principle should result in response-response and stimulus-stimulus associations just as well. Generalizing ideomotor learning in such a way results in a powerful and general framework of ideomotor action control, and it allows for integrating the two seemingly separate fields of ideomotor approaches and hierarchical learning.
A voice without a mouth no more: The neurobiology of language and consciousness
2022, Neuroscience and Biobehavioral Reviews
Most research on the neurobiology of language ignores consciousness and vice versa. Here, language, with an emphasis on inner speech, is hypothesised to generate and sustain self-awareness, i.e., higher-order consciousness. Converging evidence supporting this hypothesis is reviewed. To account for these findings, a ‘HOLISTIC’ model of neurobiology of language, inner speech, and consciousness is proposed. It involves a ‘core’ set of inner speech production regions that initiate the experience of feeling and hearing words. These take on affective qualities, deriving from activation of associated sensory, motor, and emotional representations, involving a largely unconscious dynamic ‘periphery’, distributed throughout the whole brain. Responding to those words forms the basis for sustained network activity, involving ‘default mode’ activation and prefrontal and thalamic/brainstem selection of contextually relevant responses. Evidence for the model is reviewed, supporting neuroimaging meta-analyses conducted, and comparisons with other theories of consciousness made. The HOLISTIC model constitutes a more parsimonious and complete account of the ‘neural correlates of consciousness’ that has implications for a mechanistic account of mental health and wellbeing.

View all citing articles on Scopus

View full text

Thought as action: Inner speech, self-monitoring, and auditory verbal hallucinations

Abstract

Introduction

Section snippets

Explaining agency: Is it me?

The application of the forward model to AVHs

Inner speech as a kind of action

Consciousness and Cognition

Current Opinion in Neurobiology

Consciousness and Cognition

Neuropsychologia

New Ideas in Psychology

New Ideas in Psychology

Consciousness and Cognition

Brain Research Reviews

Neuropsychologia

Clinical Psychology Review

Neuroimage

Who may I say is calling?

Behavioral and Brain Sciences

The illusion of reality: A review and integration of psychological research on hallucinations

Psychological Bulletin

Madness explained

Children’s private speech: An overview of theory and the status of research

Auditory hallucinations and subvocal speech in schizophrenic patients

American Journal of Psychiatry

The cerebellum is involved in predicting the sensory consequences of action

Neuroreport

Central cancellation of self-produced tickle sensation

Nature Neuroscience

Being there: Putting brain, body and world together again

Magic words: How language augments human cognition

The extended mind (Active externalism)

Analysis