Neuroimaging and Functional Mechanisms of Auditory Hallucinations

Auditory verbal hallucinations—the experience of “hearing voices” without an external source—are a core symptom in a range of neuropsychiatric conditions, most notably schizophrenia. Neuroimaging research over the past decade has revealed a complex interplay between structural abnormalities and functional dysconnectivity within language, memory and self‐monitoring networks. Structural studies have highlighted reductions in grey matter volume and cortical thickness in regions such as the superior temporal gyrus and thalamus, suggesting a neuroanatomical substrate for aberrant sensory processing. Functional investigations using resting‐state and task‐based fMRI have demonstrated disrupted connectivity within the default mode, salience and auditory networks, as well as altered interactions between frontal executive regions and temporal speech areas. Contemporary models propose that hallucinations arise from a failure of inner speech monitoring or from spontaneous activation of sensory cortices, compounded by atypical engagement of memory circuits. Advances in real‐time neurofeedback and connectivity‐based analyses are refining our understanding of how dynamic network alterations give rise to the vivid perceptual qualities of hallucinatory voices and pointing towards novel therapeutic avenues.

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Neuroimaging and Functional Mechanisms of Auditory Hallucinations publication trend

The graph below shows the total number of articles in neuroimaging and functional mechanisms of auditory hallucinations across all publications each year (not limited to Nature Index journals).

Technical terms

Auditory verbal hallucinations: Perceptual experiences of hearing speech without an external auditory stimulus.

Functional connectivity: Statistical dependencies between activity patterns in distinct brain regions, often measured by correlations in fMRI time series.

Resting‐state network: Brain circuits exhibiting spontaneous, synchronous activity when a subject is not engaged in a goal-directed task; includes the default mode network.

Default mode network (DMN): A set of midline and parietal regions active during internally focused cognition, implicated in self‐referential thought.

Salience network (SN): A system anchored in the anterior insula and anterior cingulate cortex that detects and filters behaviourally relevant stimuli.

Superior temporal gyrus (STG): A region in the temporal lobe critical for auditory processing and aspects of language perception.

Real‐time fMRI neurofeedback: A technique that provides participants with immediate feedback on regional brain activity, enabling voluntary modulation of neural signals.

References

1. Hearing voices in the resting brain: A review of intrinsic functional connectivity research on auditory verbal hallucinations. Neuroscience & Biobehavioral Reviews (2015).
2. Real-time fMRI neurofeedback to down-regulate superior temporal gyrus activity in patients with schizophrenia and auditory hallucinations: a proof-of-concept study. Translational Psychiatry (2018).
3. Aberrant salience network functional connectivity in auditory verbal hallucinations: a first episode psychosis sample. Translational Psychiatry (2018).
4. Auditory verbal hallucinations as atypical inner speech monitoring, and the potential of neurostimulation as a treatment option. Neuroscience & Biobehavioral Reviews (2013).
5. Decreased bilateral thalamic gray matter volume in first-episode schizophrenia with prominent hallucinatory symptoms: A volumetric MRI study. Scientific Reports (2015).