Momentary dynamics of inner speech varieties, auditory verbal hallucinations, and affect in schizophrenia spectrum disorders: an experience sampling study.
Lawrence Kin-hei Chung, Thomas J Whitford, Anson Kai Chun Chau, Sandra Sau-man Chan, George Heung-chuen Chong, Suzanne Ho-wai So
Psychological medicine January 12, 2026 Peer reviewed DOI: 10.1017/s0033291725102985 via PubMed
Summary
People with schizophrenia who hear voices experience more frequent inner speech and a distinct pattern of inner speech types compared to healthy individuals. Using experience sampling over six days, the study found that moments of evaluative, other people, condensed, and positive inner speech were more intense in voice-hearers, while dialogic inner speech did not differ. Within the voice-hearing group, higher intensities of several inner speech varieties were linked to more severe auditory hallucinations. Negative emotions strengthened the connection between evaluative inner speech and hallucination severity, suggesting emotional state as a potential target for therapy.
Study at a glance
| Design | observational cohort |
|---|---|
| Sample size | 66 |
| Population | individuals with schizophrenia spectrum disorders with current auditory verbal hallucinations and healthy controls |
| Key finding | Individuals with schizophrenia who hear voices report more frequent and intense evaluative, other people, condensed, and positive inner speech than healthy controls, and several inner speech varieties are momentarily linked to hallucination severity, with negative affect moderating the association for evaluative inner speech. |
Abstract
Auditory verbal hallucinations (AVH) in schizophrenia spectrum disorders (SSDs) may arise from misattributed inner speech. However, it is unclear if inner speech frequency and phenomenology differ in schizophrenia-spectrum voice-hearers compared with healthy individuals, and how different inner speech varieties relate to AVH and affect. Using experience sampling methodology (ESM), this study examined the moment-to-moment dynamics between inner speech varieties, AVH, and affect. Participants completed 6 days of ESM on an electronic device, responding to 10 daily prompts on inner speech varieties (i.e. dialogic, evaluative, other people, condensed, and positive), AVH, and affect. Responses from 32 individuals with SSDs with current AVH ('SSD') and 34 healthy controls ('HC') were analyzed using linear mixed modeling. SSD reported significantly more inner speech moments and higher momentary intensity of evaluative, other people, condensed, and positive inner speech compared with HC, but not for dialogic inner speech. Within SSD, higher momentary intensities of dialogic, evaluative, other people, and condensed inner speech were associated with higher AVH levels. Momentary negative affect (NA) moderated the association between evaluative inner speech and AVH, with a stronger association at higher NA levels. SSDs with current AVH experience more frequent inner speech and exhibit a distinct phenomenological profile compared with healthy individuals. Several inner speech varieties are associated with AVH severity momentarily, supporting the hypothesis that inner speech contributes to AVH at the phenomenological level. This study highlights the emotional state as an important moderator of the inner speech-AVH relationship and as a potential therapeutic target.