Moment-to-moment dynamics between auditory verbal hallucinations and negative affect and the role of beliefs about voices

Background and aims.– Auditory verbal hallucinations (AVH) constitute a major source of emotional distress for patients with psychosis. Previous studies suggested that negative affect (NA) is both an antecedent and consequence of AVH. Furthermore, it has been theorized that negative appraisals of voices contribute to the maintenance of AVH. However, the temporal interplay between NA and AVH has not been formally tested. 
This study examined the direction of association between NA and AVH using a real-time ecologically valid method and the effect of negative beliefs about voices on the association. 
Methods.– Thirty-four patients diagnosed with schizophrenia spectrum disorders with present AVH (PANSS P3 item ≥3) completed a clinical interview, followed by experience sampling assessment for ten times a day over six days on an iPod Touch. 
Results.– Multilevel modelling revealed that level of NA was significantly associated with intensity of AVH (β = 0.127, SE = 0.024, p < .001) at the same moment. Time-lagged analyses revealed that level of NA at moment t significantly predicted intensity of, and increase in, AVH at moment t +1 (β = 0.124, SE = 0.036, p < .001). Intensity of AVH at moment t also significantly predicted level of, and increase in, NA at moment t +1 (β = 0.064, SE = 0.029, p = 0.027). Malevolent (β = 0.019, SE = 0.005, p < .001) and omnipotent (β = 0.017, SE = 0.006, p = .010) beliefs about voices significantly strengthened the same-moment association between AVH and NA, but not their cross-moment associations. 
Conclusions.– Experiences of NA and AVH drove each other, leading to a feedback loop that maintained voices. The within-moment association between NA and AVH was exacerbated by negative beliefs about voices. 
Disclosure of interest.– The authors have not supplied a conflict of interest statement.