Influence of current voice-hearing on modality-specific intentional inhibitory control

Individuals with schizophrenia spectrum disorders (SSD) and a history of auditory verbal hallucinations (AVH) reportedly exhibit poor intentional inhibitory control relative to those with SSD but no AVH history. It has been theorised that these exacerbated intentional inhibitory deficits may contribute to the formation of AVH, impairing healthy sensory perception via an intrusive, internally orientated bias for auditory information. The present study extended this research, addressing if both the lifetime history, and the current status, of AVH exacerbated intentional inhibitory challenges in those with SSD. We further examined the influence of auditory and visual stimuli.

Participants completed a Go/NoGo task, using tones or shapes as auditory or visual stimuli, respectively. Intentional inhibitory accuracy, false alarms and reaction time (RT) were examined in individuals with SSD and a history of AVHs (AVH+; n=41), or no AVH history (AVH-; n=15), major depressive disorder (MDD; n=29) and healthy controls (HC; n=36). Secondary analyses split the AVH+ group into state (i.e., actively experiencing AVH; n=25) and trait hallucinators (i.e., a history, but not actively experiencing, AVH; n=16). Hierarchical linear modelling was used in analyses to mitigate any ceiling effects.

In the auditory condition, AVH+ participants showed significantly more false alarms than AVH- and HC (all p <0.001, all d >0.64), with no differences between other groups (all p >0.164, all d <0.42). Significantly different accuracy was observed between all groups, being lowest in AVH+, followed by MDD, HC, then AVH- (all p <0.044, all d >0.46). No group differences were observed for RT (all p >0.661, all d <0.25). Comparisons between state and trait participants indicated that false alarms in AVH+ participants was driven by state AVH (p <0.001, d=0.89), with accuracy also significantly poorer in those currently hallucinating (p <0.001, d=0.80). Conversely, in the visual condition, trait hallucinators performed significantly more accurately than all other groups (all p <0.004, all d >0.56), who did not differ (all p =1.00, all d >0.21). No other group differences were observed (all p >0.054, all d >0.40).

Poorer intentional inhibitory control (i.e., greater false alarms) was unique to those with current AVH, evident only in the auditory condition. This indicates that deficits in intentional inhibitory control represent a state-dependent and modality-specific cognitive disruption associated with active hallucinations, potentially contributing to the formation and maintenance of AVH by impairing healthy sensory perception through an internally oriented biases. Findings of superior visual accuracy in trait hallucinators may reflect intact or enhanced sensitivity in non-auditory modalities during periods of symptom remission, possibly via compensatory allocation of attentional resources (replication is warranted). These results underscore the value of state-trait distinctions in AVH research and support modality-specific models of sensory processing in hallucinations.

Clinically, the state-dependent auditory inhibitory deficit suggests that interventions targeting intentional inhibition, such as cognitive training paradigms (e.g., adaptive Go/NoGo or auditory inhibitory control training), mindfulness-based approaches to enhance reality monitoring, or neuromodulation techniques (e.g., tDCS over prefrontal areas), could be particularly beneficial when AVH are active. Such targeted strategies may help reduce hallucination severity and warrant evaluation in future treatment trials.

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