April 3, 2018
Archie Carfrae discusses a recent crucial development in the treatment of schizophrenia.
A team of researchers, led by Dr Natasza Orlov of Kings College London, have recently published an article in Nature which outlines a potential breakthrough in the treatment of auditory verbal hallucinations (AVH) in people with schizophrenia, and most likely anyone who experiences AVHs.
Delusions or Hallucinations
To clarify what this means, it is important to delineate what an AVH is, especially in the context of schizophrenia. One common misconception with schizophrenia is that delusions and hallucinations are the same, however, this isn’t true. Delusions are false beliefs; beliefs which contradict reality. The most common delusions are feelings of being persecuted, spied on, monitored/followed etc., although they can be more severe/elaborate. To the person with the delusions, the experience is very real, and being empathetic toward their reality is extremely important if you want to understand what they are going through. By definition, delusions are not real, they contradict reality.
However, hallucinations are different. Hallucinations are real and occur in the brain. When an auditory verbal hallucination occurs, it activates a number of sensory areas in the brain – most notably the superior temporal gyrus (STG), the area of the brain involved in auditory processing and language comprehension. Auditory hallucinations are registered and ‘heard’, despite not actually being processed in the normal way a sound is (via the ear). These ‘voices’ can range from being entirely innocuous, such as a narration, to being accusatory, tormenting etc. This is beautifully explained in Eleanor Longdon’s TED talk.
This distinction is important to understand in the context of the present study which focuses on reducing verbal hallucinations.
The actual methodology of the study is relatively complicated, but in essence, participants were asked to take part in a computer game-like-task which involved landing a rocket. The rocket was a visual representation of neural activity in their superior temporal gyrus, and thus would move according to the activity. Participants were instructed to create strategies to land the rocket but given no information how to do so. In the first three trials, participants used the video game to create strategies and were able to land the rocket; they were altering their own neural activity. However, the fourth trial was slightly different. Participants were given only a static image of a rocket, meaning they could not see their neural activity move. Participants were still asked to land the rocket using their new self-made strategies despite no longer having a visual cue. The participants succeeded in the fourth trial meaning they independently influenced their neural activity.
What does this mean?
Basically, participants were able to reduce activity in the brain regions where verbal hallucinations are thought to occur. They did this through strategies they can execute independently, as shown in the fourth trial. As people who experience AVHs can normally feel when the hallucinations are about to occur, they should be able pre-emptively use the strategies to reduce or eliminate the voices. It seems all the more exciting because it was done in four one-hour sessions, meaning that it could become a viable therapeutic option in the future.
However, the study wasn’t perfect. The study did not have a randomised control trial which would help eliminate the possible biases. Similarly, the sample size was small, which is to be accepted considering the participants and machinery needed. These are not unusual issues though, and researchers are looking to amend this in the future with a large-scale study. It is definitely early days for this research, and people should take the information with a pinch of salt, but if successful it could lead to the first successful treatment which reduces verbal hallucinations without the use of prescription drugs, which could be huge.