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Susceptibility to auditory hallucinations is associated with spontaneous but not directed modulation of top-down expectations for speech

Alderson-Day, Ben and Moffatt, Jamie and Lima, César F and Krishnan, Saloni and Fernyhough, Charles and Scott, Sophie K and Denton, Sophie and Leong, Ivy Yi Ting and Oncel, Alena D and Wu, Yu-Lin and Gurbuz, Zehra and Evans, Samuel (2022) 'Susceptibility to auditory hallucinations is associated with spontaneous but not directed modulation of top-down expectations for speech.', Neuroscience of Consciousness, 2022 (1). niac002.


Auditory verbal hallucinations (AVHs)—or hearing voices—occur in clinical and non-clinical populations, but their mechanisms remain unclear. Predictive processing models of psychosis have proposed that hallucinations arise from an over-weighting of prior expectations in perception. It is unknown, however, whether this reflects (i) a sensitivity to explicit modulation of prior knowledge or (ii) a pre-existing tendency to spontaneously use such knowledge in ambiguous contexts. Four experiments were conducted to examine this question in healthy participants listening to ambiguous speech stimuli. In experiments 1a (n = 60) and 1b (n = 60), participants discriminated intelligible and unintelligible sine-wave speech before and after exposure to the original language templates (i.e. a modulation of expectation). No relationship was observed between top-down modulation and two common measures of hallucination-proneness. Experiment 2 (n = 99) confirmed this pattern with a different stimulus—sine-vocoded speech (SVS)—that was designed to minimize ceiling effects in discrimination and more closely model previous top-down effects reported in psychosis. In Experiment 3 (n = 134), participants were exposed to SVS without prior knowledge that it contained speech (i.e. naïve listening). AVH-proneness significantly predicted both pre-exposure identification of speech and successful recall for words hidden in SVS, indicating that participants could actually decode the hidden signal spontaneously. Altogether, these findings support a pre-existing tendency to spontaneously draw upon prior knowledge in healthy people prone to AVH, rather than a sensitivity to temporary modulations of expectation. We propose a model of clinical and non-clinical hallucinations, across auditory and visual modalities, with testable predictions for future research.

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Publisher statement:© The Author(s) 2022. Published by Oxford University Press. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Date accepted:13 January 2022
Date deposited:30 June 2022
Date of first online publication:01 February 2022
Date first made open access:30 June 2022

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