Send to

Choose Destination
Clin Psychol Rev. 2019 Feb;67:1-10. doi: 10.1016/j.cpr.2018.11.001. Epub 2018 Nov 14.

The ice in voices: Understanding negative content in auditory-verbal hallucinations.

Author information

Department of Biological and Medical Psychology, University of Bergen, Jones Lies vei 91, Bergen 5009, Norway; Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium; NORMENT - Norwegian Centre of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway. Electronic address:
Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, Australia.
Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Psychology, Durham University, Durham, UK.
Department of Sociology, Philosophy and Anthropology, University of Exeter, Exeter, UK.
Department of Philosophy, Durham University, Durham, UK.
Department of Psychiatry, Trinity College Dublin, Dublin, Ireland.


Negative voice-content is the best sole predictor of whether the hearer of an auditory-verbal hallucination will experience distress/impairment necessitating contact with mental health services. Yet, what causes negative voice-content and how interventions may reduce it remains poorly understood. This paper offers definitions of negative voice content and considers what may cause negative voice-content. We propose a framework in which adverse life-events may underpin much negative voice-content, a relation which may be mediated by mechanisms including hypervigilance, reduced social rank, shame and self-blame, dissociation, and altered emotional processing. At a neurological level, we note how the involvement of the amygdala and right Broca's area could drive negative voice-content. We observe that negative interactions between hearers and their voices may further drive negative voice-content. Finally, we consider the role of culture in shaping negative voice-content. This framework is intended to deepen and extend cognitive models of voice-hearing and spur further development of psychological interventions for those distressed by such voices. We note that much of the relevant research in this area remains to be performed or replicated. We conclude that more attention needs to be paid to methods for reducing negative voice-content, and urge further research in this important area.


Abuse; Adverse life experiences; Attribution; Intention; Psychosis; Schizophrenia; Threat

Free full text

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center