A cognitive model of hallucinations

Auditory hallucinations in patients with schizophrenia can be understood within a cognitive framework that incorporates relevant biological constructs. The formation, fixation, and maintenance of hallucinations are dependent on multiple determinants: Hypervalent ("hot") cognitions of sufficient energy to exceed perceptual threshold and consequently to be transformed into hallucinations, a low threshold for auditory perceptualization exacerbated by stress, isolation, or fatigue, an externalizing bias that reinforces the purported external origin of the voices and resource-sparing strategies that help to fix belief in external origin and diminished reality-testing: detecting and correcting errors; suspending judgment; collecting more data, reappraisal, and alternative explanations. The maintenance of hallucinations is, in turn, determined by a range of beliefs: delusions regarding an external agent, underlying core beliefs, and the perceived "relationship" with the voices. Specific coping responses and safety-seeking behaviors are also implicated. Biological factors that contribute to hallucinations are the hypoconnectivity resulting from excessive priming of neurons during adolescence, which reduces resources available for higher level cognitive functioning. This results in reduced reality testing and reliance on low-level dysfunctional reasoning strategies. In addition, the cerebral flooding with dopamine and other transmitters (possibly in reaction to the neuronal loss) starts to "hyperprime" the salient cognitions (self-evaluative, intrusive, or obsessive) and leads to their crossing the perceptual threshold to hallucinations.