Department of Psychiatry, Connecticut Mental Health Center, Yale University.
J Abnorm Psychol. 2020 Aug;129(6):534-543. doi: 10.1037/abn0000531. Epub 2020 May 21.
Although hallucinations are not one of the criteria for posttraumatic stress disorder (PTSD), they are increasingly documented in PTSD. They are noted in the absence of clear delusions, formal thought disorganization, disorganized speech, or behavior, ruling out a comorbid psychotic disorder like schizophrenia as a better explanation for these hallucinations. Hallucinations in both PTSD and schizophrenia share phenomenological features. We propose that hallucinations in PTSD, like those in schizophrenia, might be explained in terms of aberrant predictive coding, specifically the misapplication of strong prior beliefs that vitiate perceptual inference. This approach highlights the broader relationship between trauma and psychosis. Under predictive coding, the nervous system organizes past sensory data into an internal model of the world. Under stress, the brain prioritizes speed over accurate encoding. However, memories for traumatic experiences are typically strongly consolidated, to avoid similar experiences in future. In PTSD, this could lead to a world model comprised of inaccurate but overly precise prior beliefs, that can be triggered by stimuli tangentially related to the index trauma, resulting in hallucinations. Crucially, this evidence accumulation depends upon the relative precision of prior beliefs and sensory evidence (supplied in the form of prediction errors). Our basic argument is that stressful situations induce belief updating, in terms of precise prior beliefs, that are difficult to undo. These unduly precise, trauma-related beliefs then constitute perceptual hypotheses, memories, or narratives that bias subsequent experience. This prior bias may be so severe that sensory evidence is effectively ignored; that is, treated as very imprecise, in relation to prior beliefs. Such an account may lead to cognitive therapies for hallucinations aimed at strong prior beliefs, and the exciting prospect of combining such therapies with drugs that modulate neuroplasticity and enhance the adaptive consolidation of more appropriate priors. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
虽然幻觉不是创伤后应激障碍（PTSD）的标准之一，但它们在 PTSD 中越来越多地被记录下来。这些幻觉是在没有明确妄想、形式思维紊乱、思维混乱或行为紊乱的情况下出现的，排除了精神分裂症等合并的精神病性障碍可以更好地解释这些幻觉。PTSD 和精神分裂症中的幻觉都具有现象学特征。我们提出，PTSD 中的幻觉，就像精神分裂症中的幻觉一样，可以用异常的预测编码来解释，特别是错误地应用了强烈的先验信念，从而破坏了感知推断。这种方法强调了创伤和精神病之间的更广泛关系。在预测编码中，神经系统将过去的感觉数据组织成一个世界的内部模型。在压力下，大脑优先考虑速度而不是准确的编码。然而，创伤经历的记忆通常是强烈巩固的，以避免未来类似的经历。在 PTSD 中，这可能导致一个由不准确但过于精确的先验信念组成的世界模型，这些信念可以被与索引创伤有间接关系的刺激触发，从而导致幻觉。至关重要的是，这种证据积累取决于先验信念和感觉证据（以预测误差的形式提供）的相对精度。我们的基本论点是，压力情境会导致基于精确先验信念的信念更新，而这种更新很难撤销。这些过度精确的、与创伤相关的信念构成了随后经验的感知假设、记忆或叙述的偏见。这种先验偏见可能非常严重，以至于感觉证据被有效地忽略；也就是说，相对于先验信念，它被视为非常不精确的。这样的解释可能会导致针对幻觉的认知疗法，旨在针对强烈的先验信念，以及令人兴奋的前景，即结合这种疗法与调节神经可塑性和增强更合适先验的适应性巩固的药物。（PsycInfo 数据库记录（c）2020 APA，保留所有权利）。
