Experiencing Hallucinations in Daily Life:
The role of thinking about thinking.
Hallucinations refer to unusual experiences, such as hearing or seeing things that are not actually there. These experiences are common in mental health challenges like schizophrenia, and best-practice treatment involves combining antipsychotics and cognitive behavioral therapy. Both are effective but only for a proportion of people experiencing these distressing symptoms. A new, therapeutic mechanism suggests hallucinations may result from failures in metacognition. Metacognition is defined as the ability to “think about thinking” or the way one thinks about one’s experience. Studies have shown that those with mental health challenges have poorer metacognition, and there may be a relationship with hallucinatory experiences. Understanding the relationship between metacognition and hallucinations could lead to improved therapeutic interventions.
PROJECT STATUS
Wright AC, Palmer-Cooper E, Cella M, McGuire N, Montagnese M, Dlugunovych V, Liu CJ, Wykes T, Cather C. (2024). Experiencing hallucinations in daily life: The role of metacognition. Schizophrenia Research, 265, 74–82.
AIMS
The main goal of this pilot project is to understand more about the experience of hallucinations (e.g. hearing a voice or seeing something that others cannot), for individuals who hallucinate daily. We want to understand whether hallucinations may be associated with the way people think about themselves and their thinking and abilities within the moment.
METHODS
This pilot study is being conducted through the International Consortium on Hallucination Research. The project, Metacognition and Predictive Processing, is in collaboration with researchers from the UK and US. It has two parts (outlined below) and will be completed online and remotely to enable efficient recruitment of 30 US participants who experience daily hallucinations.
Part 1
We will ask participants to complete several questionnaires about their unusual experiences/hallucinations, mood, and thinking processes. This phase will take around 30 minutes.
Part 2
We will ask people to complete short surveys on their mobile phone across a 14-day period. The short surveys will take around 1-2 minutes to complete each time and ask questions about the participant’s current mood, thinking, behaviors, and experience of hallucinations. The surveys will also have people to respond to metacognition prompts asking about future tasks, and their perception about these tasks.
We will use a mobile application called MindLAMP, which is a measurement-based care platform for research and clinical use. This gives participants the opportunity to not only answer questions for the study but to review changes in the reporting of their own experience across the study period.
RESULTS
This study demonstrated the existence of specific predictive associations between metacognition and hallucinations in daily life. Numerous aspects of metacognition were linked to hallucination intensity, control, and rate of occurrence. Momentary metacognition ability was beneficial to controlling hallucinations and reducing intensity. Poor metacognition abilities about future tasks also predicted increased intensity of hallucinations. Surprisingly, better metacognition about future tasks was correlated to increased occurrences of hallucinations.
The results from this novel study suggest that interventions aiming to improve metacognition may help people experience less intense hallucinations, as well as have more control over their hallucinations.
COE PROJECT STAFF
Corinne Cather, PhD
PRINCIPAL INVESTIGATOR
Abigail Wright, PhD
RESEARCH FELLOW
Additional Collaborators
Matteo Cella, PhD; Geoff Davies, PhD; Viktor Dlugunovych, MBA; Kathryn Greenwood, PhD; Nicola McGuire, MSc; Jamie Moffatt, MSc; Marcella Montagnese, MPhil; Emma Palmer-Cooper, PhD; Til Wykes, DBE, FAcMedSci, FAcSocSci, DSc.
Funding
Funding for this project was provided by the MGH COE/Massachusetts Department of Mental Health.