The Ice in Voices: Understanding negative content in auditory-verbal hallucinations

Frank Laroi, Neil Thomas, Andre Aleman, Charles Fernyhough, Sam Wilkinson, Felicity Deamer, Simon McCarthy-Jones

Research output: Contribution to journalReview articlepeer-review


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 me- chanisms including hypervigilance, reduced social rank, shame and self-blame, dissociation, and altered emo- tional 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 devel- opment 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.
Original languageEnglish
Pages (from-to)1-10
Number of pages10
JournalClinical Psychology Review
Early online date14 Nov 2018
Publication statusPublished - 1 Feb 2019

Bibliographical note

© 2018 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (


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


Dive into the research topics of 'The Ice in Voices: Understanding negative content in auditory-verbal hallucinations'. Together they form a unique fingerprint.

Cite this