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The relationship between metacognitive beliefs, auditory hallucinations, and hallucination-related distress in clinical and non-clinical voice-hearers


David Linden, MRC Centre for Neuropsychiatric Genetics & Genomics, Institute of Psychological Medicine and Clinical Neuroscience, School of Medicine, Cardiff University, Henry Wellcome, Building, Heath Park, Cardiff CF14 4XN, UK (e-mail:


Objectives: To test the hypothesis that metacognitive beliefs are implicated in the development of distress associated with auditory verbal hallucinations (AVHs) rather than in their aetiology.

Design: A cross sectional questionnaire design was used.

Methods: Three groups of participants were recruited (n= 20 in each group); clinical voice-hearers diagnosed with psychiatric disorders; non-clinical voice-hearers with no psychiatric history; and non-clinical participants with no history of voices or psychiatric disorder. All participants were screened for psychiatric symptomatology and completed a self-report measure of their metacognitive beliefs (MCQ-30). In addition, the two groups of voice-hearers were interviewed about dimensions of their voices (i.e., content, frequency, distress, and disruption).

Results: The clinical group scored significantly higher than the two non-clinical groups on two subscales of the MCQ-30 (negative beliefs about worry concerning controllability and danger and negative beliefs about thoughts concerning need for control). There were no significant differences between the two non-clinical groups on MCQ-30 scores. Regression analyses revealed that the negative beliefs about need for control subscale of the MCQ-30 was the only significant predictor of voice-related distress, although this effect was no longer significant after controlling for the effect of group.

Conclusions: These results are consistent with previous findings suggesting that metacognitive beliefs are not directly implicated in the aetiology of AVHs, but may be associated with psychological distress. Further research is however needed to determine whether metacognitive style may directly impact upon voice-related distress.