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. 2025 May 8;51(3):780-791.
doi: 10.1093/schbul/sbae115.

Associations of Cognitive Expectancies With Auditory Hallucinations and Hallucinatory-Like Experiences in Patients With Schizophrenia

Joachim Kowalski  1   2 , Małgorzata Dąbkowska  1 , Adrianna Aleksandrowicz  1 , Michał Jarkiewicz  3 , Frank Larøi  2   4 , Łukasz Gawęda  1
Affiliations

Associations of Cognitive Expectancies With Auditory Hallucinations and Hallucinatory-Like Experiences in Patients With Schizophrenia

Joachim Kowalski et al. Schizophr Bull. .

Abstract

Background: Various neurocognitive models explore perceptual distortions and hallucinations in schizophrenia and the general population. A variant of predictive coding account suggests that strong priors, like cognitive expectancy, may influence perception. This study examines if stronger cognitive expectancies result in more auditory false percepts in clinical and healthy control groups, investigates group differences, and explores the association between false percepts and hallucinations.

Study design: Patients diagnosed with schizophrenia with current auditory hallucinations (n = 51) and without hallucinations (n = 66) and healthy controls (n = 51) underwent the False Perception Task under various expectancy conditions. All groups were examined for the presence and severity of hallucinations or hallucinatory-like experiences.

Study results: We observed a main effect of condition across all groups, ie, the stronger the cognitive expectancy, the greater the ratio of auditory false percepts. However, there was no group effect for the ratio of auditory false percepts. Despite modest pairwise correlations in the hallucinating group, the ratio of auditory false percepts was not predicted by levels of hallucinations and hallucinatory-like experiences in a linear mixed model.

Conclusions: The current study demonstrates that strong priors in the form of cognitive expectancies affect perception and play a role in perceptual disturbances. There is also a tentative possibility that overreliance on strong priors may be associated with hallucinations in currently hallucinating subjects. Possible, avoidable confounding factors are discussed in detail.

Keywords: auditory verbal hallucinations; predictive coding; psychosis; strong priors; top-down.

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Figures

Fig. 1.
Fig. 1.
Design of the False Perception Task. The task consists of 3 conditions with varying levels of cognitive expectancy. Sixty percent of the trials consisted of audible or barely audible words, and 40% were inaudible/absent. All stimuli were presented with a white noise background. Participants had to respond whether they heard a word or not. False auditory perceptions were operationalized as false positives of heard words when target stimuli were absent. In condition A, the content of a trial was not introduced by any clue. In the condition B, the content of the target stimulus was presented (the same word as the target stimulus) before the trial. In condition C, participants were presented with a video recording of an actor mouthing the target stimulus word.
Fig. 2.
Fig. 2.
Results of the False Perception Task. (a) Mean reaction times, (b) ratio of true positives (hits), (c) ratio of false percepts. Note: error bars represent standard errors; for presentation purposes, y-axes do not start at a 0.
See this image and copyright information in PMC

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