Linguistic analysis of the valence, arousal and dominance of auditory hallucinations and internal thoughts in schizophrenia: Implications for psychoeducation and CBT

70% of patients with schizophrenia suffer from auditory verbal hallucinations (AVH) which are frequently described as distressing and disabling. The content of AVH, in relation to internal thought, has never been linguistically tested in a self-monitoring study. The aim of this preliminary study was to establish if there was a significant difference between AVH and inner thoughts on the key linguistic parameters of valence (pleasantness), dominance (control) and arousal (intensity of emotion produced). Six volunteers with a diagnosis of schizophrenia from voice hearing support groups produced real-time, detailed diaries of AVH and inner thoughts using randomised/fixed timers. Analysis of content was completed using an established linguistic database. AVH were significantly more unpleasant and controlling but not more emotionally arousing than inner thoughts. Psychoeducation around the experience of hallucination in schizophrenia should include information that the voices will be significantly more unpleasant and controlling than their own thoughts but not more emotionally arousing. CBT might therefore include the use of compassion focussed techniques to help with the unpleasantness of AVH and schema level techniques to improve coping with the dominance of AVH.