Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123, Milan, Italy.
IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.
BMC Psychiatry. 2022 Apr 20;22(1):281. doi: 10.1186/s12888-022-03902-6.
Despite Auditory Verbal Hallucinations (AVHs) having been long associated with mental illness, they represent a common experience also in the non-clinical population, yet do not exhibit distress or need for care. Shame and guilt are emotions related to one's perception of oneself and one's responsibility. As such, they direct our attention to aspects of AVHs that are under-researched and elusive, particularly about the status of voices as others, their social implications and the constitution and conceptualisation of the self.
This paper aims to provide a systematic review of studies that investigated the relationship between auditory hallucinations, shame, and guilt in people without relevant signs of psychiatric issues.
We searched studies reporting information about voices characteristics, the relationship between voices and hearers, hearer's reactions, and beliefs, paying peculiar attention to shame and guilt issues. Included papers were evaluated for risk of bias.
Eleven studies that explored the relationship between AVHs, shame and guilt, were extracted. Phenomenological, pragmatic, as well as neuropsychological features of hearing voices in non-clinical populations, allowed us to note a dynamic relationship and the constellation of subjective experiences that can occur. The role of guilt was characterized by few studies and mixed results, while shame was mainly common.
Due to the high heterogeneity detected and the scarce sources available, further studies should focus on both the aetiology and the bidirectional relationship between hearing voices, shame, and guilt in non-clinical people. This can be helpful in therapies for non-clinical populations who are distressed by their voices (e.g., psychotherapy), and for whom shame, and guilt may contribute to negative consequences such as isolation, anxiety or future depression. Moreover, it might favour the development and implication of different treatments considering emotion regulation, distress tolerance and interpersonal sensitivity on the clinical populations.
尽管听觉幻觉（AVHs）长期以来与精神疾病有关，但它们也代表了非临床人群中的一种常见体验，而且这些人没有表现出痛苦或需要护理。羞耻感和内疚感与一个人对自己的看法和自己的责任有关。因此，它们引导我们关注听觉幻觉中那些研究不足和难以捉摸的方面，特别是关于声音作为他人的地位、它们的社会含义以及自我的构成和概念化。
本文旨在对研究听觉幻觉、羞耻感和内疚感在没有相关精神问题迹象的人群中的关系的研究进行系统回顾。
我们搜索了报告有关声音特征、声音与听者之间关系、听者反应和信念信息的研究，特别关注羞耻感和内疚感问题。纳入的论文进行了偏倚风险评估。
共提取了 11 项探讨听觉幻觉、羞耻感和内疚感之间关系的研究。非临床人群中听到声音的现象学、语用学和神经心理学特征，使我们注意到可以发生的动态关系和主观体验的组合。内疚感的作用在少数研究中被描述，且结果不一，而羞耻感则更为常见。
由于检测到的高度异质性和可用资源有限，进一步的研究应集中在非临床人群中听觉幻觉、羞耻感和内疚感的病因以及两者之间的双向关系上。这对于因声音而感到痛苦的非临床人群（例如心理治疗）的治疗可能会有所帮助，对于这些人群，羞耻感和内疚感可能会导致孤立、焦虑或未来抑郁等负面后果。此外，它可能有助于考虑情绪调节、痛苦耐受力和人际敏感性的不同治疗方法在临床人群中的发展和应用。
