Beyond trauma: the contribution of characteristics of shame memories, shame, and self-criticism to voice-hearing proneness

Past adverse experiences and negative self-schemas have been found to be a vulnerability factor to voice-hearing and also shape the content and emotional salience of these experiences. Past shameful experiences and their consequences (e.g., traumatic characteristics, self-criticism, shame) may also be relevant in the context of voice-hearing. This study investigates whether the centrality of shame memories is associated with voice-hearing proneness and whether the traumatic characteristics of these memories, external shame and self-criticism mediate this association. Centrality of shame memory, traumatic impact of shame memory, self-criticism, external shame, voice-hearing proneness and negative affect (depression and anxiety) were assessed using self-report questionnaires in 390 participants recruited from the general population. Results from path analyses show the centrality of shame memories is indirectly associated with voice-hearing proneness via three different mediated pathways: (1) via traumatic characteristics of shame memories alone (i.e. intrusions, hyperarousal and avoidance); (2) via both traumatic memory characteristics and self-criticism; as well as (3) via the traumatic qualities of shame memories, self-criticism and external shame. Our model only explained a small proportion (8%) of the variance in voice-hearing proneness. In conclusion, our study partially supports the model of shame memories as well as cognitive models of voice-hearing suggesting that autobiographical (i.e., shame memory) and personal semantic (self-criticism) memory plays a role in the emergence and shaping of voice-hearing experiences. Researchers and clinicians should further explore the role of shame memories in clinical voice-hearing samples.