Auditory hallucinations, source monitoring, and the belief that voices are real

The term source monitoring refers to a variety of cognitive processes individuals use to determine whether an experience originated within the self or came from an external source. A belief that auditory hallucinations are real entities independent of the self may be considered an error in source monitoring. The Source Monitoring Framework (SMF) is the most developed and empirically validated model of how ordinary individuals judge whether an event was self-generated or occurred in the outside world. This study of 41 acute inpatients is a first attempt to apply the SMF to autobiographical reports of auditory hallucinations in a clinical setting. Consistent with the SMF, results suggest that similarities between voices and real speakers may offer a partial explanation of why patients believe the voices are real. While the SMF provides a useful conceptual background for examining the phenomenology of these voices, the types of source monitoring errors typically encountered in normal individuals do not fully account for this belief as it occurs in psychotic individuals.