# Neural Mechanisms of Voluntary Control Over Hallucinations

> **NIH NIH R01** · YALE UNIVERSITY · 2023 · $819,904

## Abstract

Auditory verbal hallucinations (AVH) are among the most
distressing symptoms in psychosis, and up to 30% of patients exhibit little to no response to current
treatments. This is especially concerning given that the presence of hallucinations alone increases risk
of suicide in patients with psychosis. One potential route toward development of new treatments for
AVH is based on new evidence that many people with AVH never develop the need to seek treatment,
despite the fact that AVH in treatment-seeking and non-treatment-seeking individuals tend to be similar
in terms of low-level acoustic qualities such as loudness, duration, and location of voices. One
particularly promising predictor comes from the fact that non-treatment-seeking voice-hearing
populations consistently endorse a higher degree of control over their experiences than their treatmentseeking
counterparts. Perhaps most strikingly, some individuals report an ability to fully control the
onset and offset of their voices, which may make the experience of living with these voices significantly
less disruptive and distressing. Moreover, new evidence indicates that voluntary inhibition of AVH may
be developed in both treatment-seeking and non-treatment-seeking voice-hearers. Understanding the
mechanisms specifically driving voluntary control over AVH could lead to new insights into potential
treatment strategies to bolster these abilities. We and others have proposed hypotheses for how
voluntary control of AVH might arise from cognitive inhibition, alterations in perceptual inference, or
interactions between these processes. We propose to identify the mechanisms underlying inhibitory
control of hallucinations. We will recruit 102 clinical and non-clinical voice-hearers with a range of
control abilities for participation in a set of behavioral, imaging, and electrophysiological tasks designed
to identify how voluntary control over voice-hearing occurs. Controlling for key confounds, we will relate
our proposed measures to control abilities as measured on the newly-validated Yale Control Over
Perceptual Experiences (COPE) Scale. We will also follow a subset of 60 of these participants over two
years to identify predictors and correlates of changes in control abilities. To control for presence of
hallucinations and psychosis, respectively, we will also recruit 51 matched healthy controls and 51
participants with psychosis but no voice-hearing to participate in the cross-sectional study. Principally,
we hypothesize that exertion of control over AVH will result in: 1) activation of separable AVH- and
control-related brain networks, the interaction between which will relate to abilities to exert control over
AVH; 2) specific alterations in perception as demonstrated by the Conditioned Hallucinations task and
EEG measures, corresponding to a decreased precision of perceptual priors, increased perceptual
belief updating, or both; and 3) dual-task interference on the Think/No-Think task, an assay of ...

## Key facts

- **NIH application ID:** 10705241
- **Project number:** 5R01MH129721-02
- **Recipient organization:** YALE UNIVERSITY
- **Principal Investigator:** Albert R Powers
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $819,904
- **Award type:** 5
- **Project period:** 2022-09-15 → 2027-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10705241

## Citation

> US National Institutes of Health, RePORTER application 10705241, Neural Mechanisms of Voluntary Control Over Hallucinations (5R01MH129721-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10705241. Licensed CC0.

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