Continuities and discontinuities in the cognitive mechanisms associated with clinical and non-clinical auditory verbal hallucinations

Auditory verbal hallucinations (AVH) are typically associated with schizophrenia but also occur in individuals without any need for care (non-clinical voice-hearers; NCVH). Cognitive models of AVH posit potential biases in source-monitoring, top-down processes, or a failure to inhibit intrusive memories. However, research across clinical/non-clinical groups is limited, and the extent to which there may be continuity in cognitive mechanism across groups, as predicted by the psychosis continuum hypothesis, is unclear. We report two studies in which voice-hearers recruited from Early Intervention in Psychosis (EIP) services (n = 31) and NCVH participants reporting regular spiritual voices (n = 26) completed the same cognitive task battery. Compared to controls (n = 33 and 28), EIP patients showed atypical signal detection, dichotic listening, and memory inhibition performance, but intact source-monitoring. NCVH participants only showed atypical signal detection, suggesting differences between clinical and non-clinical voices potentially related to attentional control and inhibition.