Exploring the Working Mechanisms between Anxiety, Mental Imagery, and Auditory Verbal Hallucinations: A Longitudinal...

Auditory verbal hallucinations (AVHs) are the most common hallucinations within the psychosis spectrum and are often accompanied by anxiety. Integrating mental imagery into current psychological theories may increase the understanding of working mechanisms and effectiveness of cognitive behavioral therapy for AVHs. Therefore, the current study examined associations over time between levels of anxiety, mental imagery, and AVHs in individuals with psychosis spectrum disorders.

Baseline data were analyzed from a replicated single-case series study using a within person mediation model approach and time-lagged multilevel analyses to examine associations over time between levels of anxiety, mental imagery, and AVHs. The baseline comprised a 2-week period before starting with an imagery intervention in 32 individuals diagnosed with psychosis spectrum disorders.

There was a positive but non-significant association between anxiety and subsequent mental imagery (P = .061, [Formula: see text] = 0.044). There was a significant positive association between mental imagery and AVHs (P < .001, [Formula: see text] = 0.042), and between anxiety and AVHs (P < .001, [Formula: see text] = 0.157). Additionally, anxiety was found to mediate the association between mental imagery and AVHs (P < .001 [Formula: see text] = 0.034).

The present findings suggest that mental imagery may play a role in the development and the maintenance of AVHs by intensifying anxiety, which then precedes an increase in AVHs. Capturing mental imagery alongside verbal interpretations of AVHs may help to understand the dynamic interplay between mental imagery, anxiety, and AVHs and to refine cognitive frameworks for more effective psychological treatments.