Neural Mechanisms of Voluntary Control Over Hallucinations

听觉语言幻觉(AVH)是最常见的 精神错乱的令人痛苦的症状，高达30%的患者对电流几乎没有反应 治疗。这一点尤其令人担忧，因为幻觉的存在本身就会增加风险 精神病患者自杀的可能性。开发新的治疗方法的一个潜在途径 AVH是基于新的证据，即许多AVH患者从未发展出寻求治疗的需要， 尽管寻求治疗和不寻求治疗的个体的AVH往往是相似的 在低级音质方面，例如声音的响度、持续时间和位置。一 特别有希望的预测来自于这样一个事实，即不寻求治疗的声音听力 与寻求治疗相比，人们始终支持对他们的经历进行更高程度的控制 对口单位。也许最引人注目的是，一些人报告说有能力完全控制 他们声音的开始和抵消，这可能会使与这些声音生活在一起的体验显著 更少的颠覆性和痛苦。此外，新的证据表明，自愿抑制AVH可能 在寻求治疗和不寻求治疗的声音听者中都应得到培养。了解 具体驱动对AVH的自愿控制的机制可能会导致对潜在 强化这些能力的治疗策略。我们和其他人提出了假设 AVH的自愿控制可能源于认知抑制、知觉推理的改变或 这些进程之间的交互作用。我们建议确定潜在的抑制机制 控制幻觉。我们将招聘102名临床和非临床听音人员，包括 参与设计的一系列行为、成像和电生理任务的控制能力 以确定语音听力的自愿控制是如何发生的。控制关键混淆，我们将联系 我们建议的控制能力的措施，根据新确认的耶鲁控制 知觉体验(COPE)量表。我们还将跟踪这些参与者中的60个子集，超过两个 几年的时间来确定控制能力变化的预测因素和相关性。控制…的存在 幻觉和精神病，我们还将招募51名匹配的健康对照和51名 有精神病但无听力障碍的受试者参加横断面研究。原则上， 我们假设，对AVH施加控制将导致：1)可分离的AVH-和 与控制相关的大脑网络，它们之间的相互作用将与施加控制的能力有关 AVH；2)由条件幻觉任务所证明的知觉的特定变化 脑电测量，对应于知觉先验精确度的降低，增加了知觉 信念更新，或两者兼而有之；3)双任务对思维/不思维任务的干扰，这是一种认知测试 抑制技能。我们的目标是将获得的洞察力转化为新的、机械知情的治疗方法 加强对AVH的管控。

Auditory verbal hallucinations (AVH) are among the most distressing symptoms in psychosis, and up to 30% of patients exhibit little to no response to current treatments. This is especially concerning given that the presence of hallucinations alone increases risk of suicide in patients with psychosis. One potential route toward development of new treatments for AVH is based on new evidence that many people with AVH never develop the need to seek treatment, despite the fact that AVH in treatment-seeking and non-treatment-seeking individuals tend to be similar in terms of low-level acoustic qualities such as loudness, duration, and location of voices. One particularly promising predictor comes from the fact that non-treatment-seeking voice-hearing populations consistently endorse a higher degree of control over their experiences than their treatmentseeking counterparts. Perhaps most strikingly, some individuals report an ability to fully control the onset and offset of their voices, which may make the experience of living with these voices significantly less disruptive and distressing. Moreover, new evidence indicates that voluntary inhibition of AVH may be developed in both treatment-seeking and non-treatment-seeking voice-hearers. Understanding the mechanisms specifically driving voluntary control over AVH could lead to new insights into potential treatment strategies to bolster these abilities. We and others have proposed hypotheses for how voluntary control of AVH might arise from cognitive inhibition, alterations in perceptual inference, or interactions between these processes. We propose to identify the mechanisms underlying inhibitory control of hallucinations. We will recruit 102 clinical and non-clinical voice-hearers with a range of control abilities for participation in a set of behavioral, imaging, and electrophysiological tasks designed to identify how voluntary control over voice-hearing occurs. Controlling for key confounds, we will relate our proposed measures to control abilities as measured on the newly-validated Yale Control Over Perceptual Experiences (COPE) Scale. We will also follow a subset of 60 of these participants over two years to identify predictors and correlates of changes in control abilities. To control for presence of hallucinations and psychosis, respectively, we will also recruit 51 matched healthy controls and 51 participants with psychosis but no voice-hearing to participate in the cross-sectional study. Principally, we hypothesize that exertion of control over AVH will result in: 1) activation of separable AVH- and control-related brain networks, the interaction between which will relate to abilities to exert control over AVH; 2) specific alterations in perception as demonstrated by the Conditioned Hallucinations task and EEG measures, corresponding to a decreased precision of perceptual priors, increased perceptual belief updating, or both; and 3) dual-task interference on the Think/No-Think task, an assay of cognitive inhibitory skills. Our goal is to translate the insights gained to new, mechanistically-informed treatments to enhance control over AVH.