Relationship of metacognition, absorption, and depersonalization in patients with auditory hallucinations

Objectives. The purpose of this work was to study the relationship of metacognition, absorption, and depersonalization in hallucinating patients. Design. A within-subjects correlational design was employed. Methods. We formed four groups from a clinical population (schizophrenic patients with hallucinations, schizophrenic patients with no hallucinations but with delusions, schizophrenic patients recovered from positive symptoms, and patients with a nonpsychotic psychiatric disorder) and a non-clinical control group. All participants were given the Metacognitions Questionnaire (MCQ-30, Wells & Cartwright-Hatton, 2004), the Tellegen Absorption Scale (TAS, Tellegen & Atkinson, 1974) and the Cambridge Depersonalization Scale (CDS, Sierra & Berrios, 2000). Results. Schizophrenic subjects with hallucinations scored significantly higher on the depersonalization scale than any other group, and significantly higher on the absorption scale than any group except for the clinical patient controls. Schizophrenic patients with hallucinations also had significantly more dysfunctional metacognitive beliefs than subjects with no psychiatric pathology. It was further found that the metacognition variable correlated positively with the absorption and depersonalization variables, and that these variables in turn correlated positively with each other. Finally, it should be stressed that the variables that best predict hallucination severity are depersonalization and the MCQ-30 subscale 'Need to control thoughts'. Conclusions. We discuss the role of metacognitive and dissociative variables in understanding hallucinations and suggest some approaches to their treatment.