The effect of voice content and social context on shame: a simulation and vignette paradigm to evaluate auditory verbal hallucinations.

Introduction: Recent theoretical models and preliminary data suggest that shame is a central emotion in the context of auditory verbal hallucinations (AVH or voice-hearing). Nevertheless, all previous studies were correlational. Thus, the present study sought to explore whether simulated AVH experiences can trigger shame using an experimental design.

Methods: 346 participants from the general population were randomised to one of 6 conditions. They had to read a vignette describing a character who was either in a situation alone or with a close friend. While reading the vignettes, participants also heard either negative or neutral simulated voices or non-voice neutral sounds. Subsequently, participants completed different measures, including shame.

Results: Our results showed that both the negative and neutral simulated voice-hearing triggered higher levels of shame, but also other negative emotions when compared to ambient sound, regardless of the social context. Participants in the simulated voice-hearing conditions reported higher levels of maladaptive coping strategies and negative beliefs about voices than in the ambient sound condition.

Conclusions: The simulation of neutral and negative voices trigger similar levels of subjective shame, indicating the effect is not specific to negative voices but rather associated with the experience per se. Nevertheless, it can also trigger other negative emotions.