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Recent theoretical models and preliminary data suggest that shame is a central emotion in the context of auditory verbal hallucinations (AVH or voice-hearing). Nevertheless, all previous studies were correlational. Thus, the present study sought to explore whether simulated AVH experiences can trigger shame using an experimental design. Methods: 346 participants from the general population were randomised to one of 6 conditions. They had to read a vignette describing a character who was either in a situation alone or with a close friend. While reading the vignettes, participants also heard either negative or neutral simulated voices or non-voice neutral sounds. Subsequently, participants completed different measures, including shame. Results: Our results showed that both the negative and neutral simulated voice-hearing triggered higher levels of shame, but also other negative emotions when compared to ambient sound, regardless of the social context. Participants in the simulated voice-hearing conditions reported higher levels of maladaptive coping strategies and negative beliefs about voices than in the ambient sound condition. Conclusions: The simulation of neutral and negative voices trigger similar levels of subjective shame, indicating the effect is not specific to negative voices but rather associated with the experience  per se . Nevertheless, it can also trigger other negative emotions.

The effect of voice content and social context on shame: a simulation and vignette paradigm to evaluate auditory verbal hallucinations