Dissociative and metacognitive factors in hallucination-proneness when controlling for comorbid symptoms

Abstract

Introduction. Recent studies have linked hallucination-proneness to dysfunctional metacognitive beliefs, dissociation, and disrupted capacity to discriminate between internal and external cognitive events (reality discrimination). This study addressed a number of methodological limitations of previous research by investigating the relationship between hallucination-proneness and the aforementioned variables while controlling for comorbid symptoms.

Method. A large sample of nonclinical participants was screened on measures of hallucination-proneness, cognitive intrusions, paranoid ideation, metacognitive beliefs, and dispositional mindfulness (including measures of dissociation-like experiences). In addition, a signal detection task was used to investigate reality discrimination in four subgroups of participants selected on the basis of their scores on hallucination-proneness and intrusions.

Results. Regression analyses for the self-report data were conducted to investigate the predictors of hallucination-proneness and paranoia when controlling for comorbid symptoms. Also, between-group differences on the behavioural data were tested to determine whether perturbed reality discrimination is specifically associated with hallucination-proneness rather than cognitive intrusions. Results revealed that metacognitive beliefs are more strongly associated with intrusions and paranoia than hallucination-proneness, whereas hallucination-proneness is related to perturbed reality discrimination and dissociation.

Conclusions. These results clarify previous research on metacognitive dysfunction in hallucination-proneness, and highlight the importance of controlling for the covariation among symptoms when investigating the cognitive processes underlying psychotic experiences.

Keywords:

• Dissociation
• Hallucinations
• Intrusive thoughts
• Metacognitive beliefs
• Paranoia
• Signal detection

Notes

¹To establish the impact of the contemporary inclusion of transformed as well as nontransformed variables, hierarchical regression analyses were also carried out including only nontransformed measures. This had no substantial effect on the pattern of the results reported.