Skip to main content Accessibility help

Modality-general and modality-specific processes in hallucinations

  • Charles Fernyhough (a1)


There is a growing recognition in psychosis research of the importance of hallucinations in modalities other than the auditory. This has focused attention on cognitive and neural processes that might be shared by, and which might contribute distinctly to, hallucinations in different modalities. In this article, I address some issues around the modality-generality of cognitive and neural processes in hallucinations, including the role of perceptual and reality-monitoring systems, top-down and bottom-up processes in relation to the psychological and neural substrates of hallucinations, and the phenomenon of simultaneous multimodal hallucinations of the same entity. I suggest that a functional systems approach, inspired by some neglected aspects of the writings of A. R. Luria, can help us to understand patterns of hallucinatory experience across modalities and across clinical and non-clinical groups. Understanding the interplay between modality-general and modality-specific processes may bear fruit for improved diagnosis and therapeutic approaches to dealing with distressing hallucinations.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Modality-general and modality-specific processes in hallucinations
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Modality-general and modality-specific processes in hallucinations
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Modality-general and modality-specific processes in hallucinations
      Available formats


This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Author for correspondence: Charles Fernyhough, E-mail:


Hide All
Alderson-Day, B and Fernyhough, C (2015) Inner speech: development, cognitive functions, phenomenology, and neurobiology. Psychological Bulletin 141, 931965.
Alderson-Day, B and Fernyhough, C (2016) Auditory verbal hallucinations: social but how? Journal of Consciousness Studies 23, 163194.
Alderson-Day, B, McCarthy-Jones, S and Fernyhough, C (2015) Hearing voices in the resting brain: a review of intrinsic functional connectivity research on auditory verbal hallucinations. Neuroscience and Biobehavioral Reviews 55, 7887.
Alderson-Day, B, Weis, S, McCarthy-Jones, S, Moseley, P, Smailes, D and Fernyhough, C (2016) The brain's conversation with itself: neural substrates of dialogic inner speech. Social Cognitive and Affective Neuroscience 11, 110120.
Alderson-Day, B, Lima, CF, Evans, S, Krishnan, S, Shanmugalingam, P, Fernyhough, C and Scott, SK (2017) Distinct processing of ambiguous speech in people with non-clinical auditory verbal hallucinations. Brain 140, 24752489.
Alderson-Day, B, Smailes, D, Moffatt, J, Mitrenga, K, Moseley, P and Fernyhough, C (2019) Intentional inhibition but not source memory is related to hallucination-proneness and intrusive thoughts in a university sample. Cortex 113, 267278.
Amad, A, Cachia, A, Gorwood, P, Pins, D, Delmaire, C, Rolland, B, Mondino, M, Thomas, P and Jardri, R (2014) The multimodal connectivity of the hippocampal complex in auditory and visual hallucinations. Molecular Psychiatry 19, 184191.
Atkinson, JR, Gleeson, K, Cromwell, J and O'Rourke, S (2007) Exploring the perceptual characteristics of voice-hallucinations in deaf people. Cognitive Neuropsychiatry 12, 339361.
Aynsworth, C, Nemat, N, Collerton, D, Smailes, D and Dudley, R (2017) Reality monitoring performance and the role of visual imagery in visual hallucinations. Behaviour Research and Therapy 97, 115122.
Bell, V (2013) A community of one: social cognition and auditory verbal hallucinations. PLoS Biology 11, e1001723.
Bentall, RP (1990) The illusion of reality: a review and integration of psychological research on hallucinations. Psychological Bulletin 107, 8295.
Brébion, G, Amador, X, David, A, Malaspina, D, Sharif, Z and Gorman, JM (2000) Positive symptomatology and source-monitoring failure in schizophrenia – an analysis of symptom-specific effects. Psychiatry Research 95, 119131.
Brébion, G, Ohlsen, RI, Pilowsky, LS and David, AS (2008) Visual hallucinations in schizophrenia: confusion between imagination and perception. Neuropsychology 22, 383389.
Bressler, SL and Menon, V (2010) Large-scale brain networks in cognition: emerging methods and principles. Trends in Cognitive Sciences 14, 277290.
Buda, M, Fornito, A, Bergström, ZM and Simons, JS (2011) A specific brain structural basis for individual differences in reality monitoring. Journal of Neuroscience 31, 1430814313.
Bullmore, E and Sporns, O (2009) Complex brain networks: graph theoretical analysis of structural and functional systems. Nature Reviews Neuroscience 10, 186198.
Cachia, A, Amad, A, Brunelin, J, Krebs, M-O, Plaze, M, Thomas, P and Jardri, R (2015) Deviations in cortex sulcation associated with visual hallucinations in schizophrenia. Molecular Psychiatry 20, 11011107.
Ćurčić-Blake, B, Ford, JM, Hubl, D, Orlov, ND, Sommer, IE, Waters, F, Allen, P, Jardri, R, Woodruff, PW, David, O, Mulert, C, Woodward, TS and Aleman, A (2017) Interaction of language, auditory and memory brain networks in auditory verbal hallucinations. Progress in Neurobiology 148, 120.
Daalman, K, Verkooijen, S, Derks, EM, Aleman, A and Sommer, IEC (2012) The influence of semantic top-down processing in auditory verbal hallucinations. Schizophrenia Research 139, 8286.
David, AS (1993) Cognitive neuropsychiatry? Psychological Medicine 23, 15.
Dudley, R, Aynsworth, C, Cheetham, R, McCarthy-Jones, S and Collerton, D (2018) Prevalence and characteristics of multi-modal hallucinations in people with psychosis who experience visual hallucinations. Psychiatry Research 269, 2530.
Feinberg, I (1978) Efference copy and corollary discharge: implications for thinking and its disorders. Schizophrenia Bulletin 4, 636640.
Fernyhough, C (2004) Alien voices and inner dialogue: towards a developmental account of auditory verbal hallucinations. New Ideas in Psychology 22, 4968.
Fernyhough, C (2010) Vygotsky, Luria, and the social brain. In Sokol, B, Müller, U, Carpendale, J, Young, A and Iarocci, G (eds.), Self and Social Regulation: Social Interaction and the Development of Social Understanding and Executive Functions. New York, NY, USA: Oxford University Press, pp. 5679.
Fernyhough, C (2016) The Voices Within: The History and Science of how we Talk to Ourselves. New York: Basic Books.
ffytche, DH (2009) Visual hallucinations in eye disease. Current Opinion in Neurology 22, 2835.
Fletcher, PC and Frith, CD (2009) Perceiving is believing: a Bayesian approach to explaining the positive symptoms of schizophrenia. Nature Reviews Neuroscience 10, 4858.
Ford, JM and Mathalon, DH (2005) Corollary discharge dysfunction in schizophrenia: can it explain auditory hallucinations? International Journal of Psychophysiology 58, 179189.
Ford, JM, Palzes, VA, Roach, BJ, Potkin, SG, van Erp, TGM, Turner, JA, Mueller, BA, Calhoun, VD, Voyvodic, J, Belger, A, Bustillo, J, Vaidya, JG, Preda, A, McEwen, SC, Functional Imaging Biomedical Informatics Research Network and Mathalon, DH (2015) Visual hallucinations are associated with hyperconnectivity between the amygdala and visual cortex in people with a diagnosis of schizophrenia. Schizophrenia Bulletin 41, 223232.
Frith, CD (1992) The Cognitive Neuropsychology of Schizophrenia, The Cognitive Neuropsychology of Schizophrenia. Hillsdale, NJ, USA: Lawrence Erlbaum Associates, Inc.
Garrison, J, Fernyhough, C, McCarthy-Jones, S, Haggard, M, The Australian Schizophrenia Research Bank and Simons, JS (2015) Paracingulate sulcus morphology is associated with hallucinations in the human brain. Nature Communications 6, 8956.
Garrison, JR, Moseley, P, Alderson-Day, B, Smailes, D, Fernyhough, C and Simons, JS (2017) Testing continuum models of psychosis: no reduction in source monitoring ability in healthy individuals prone to auditory hallucinations. Cortex 91, 197207.
Garrison, J, Fernyhough, C, McCarthy-Jones, S, Simons, J and Sommer, IE (2019) Paracingulate sulcus morphology and hallucinations in clinical and non-clinical groups. Schizophrenia Bulletin 45, 733741.
Goodwin, DW, Alderson, P and Rosenthal, R (1971) Clinical significance of hallucinations in psychiatric disorders: a study of 116 hallucinatory patients. Archives of General Psychiatry 24, 7680.
Griffin, JD and Fletcher, PC (2017) Predictive processing, source monitoring, and psychosis. Annual Review of Clinical Psychology 13, 265289.
Halligan, PW and David, AS (2001) Cognitive neuropsychiatry: towards a scientific psychopathology. Nature Reviews Neuroscience 2, 209215.
Hoffman, RE and Varanko, M (2006) “Seeing voices”: Fused visual/auditory verbal hallucinations reported by three persons with schizophrenia-spectrum disorder. Acta Psychiatrica Scandinavica 114, 290292. discussion 292.
Horga, G, Schatz, KC, Abi-Dargham, A and Peterson, BS (2014) Deficits in predictive coding underlie hallucinations in schizophrenia. Journal of Neuroscience 34, 80728082.
Hunter, MD, Eickhoff, SB, Miller, TWR, Farrow, TFD, Wilkinson, ID and Woodruff, PWR (2006) Neural activity in speech-sensitive auditory cortex during silence. Proceedings of the National Academy of Sciences 103, 189194.
Janet, P (1891) Étude sur un cas d'aboulie et d'idées fixes. Revue Philosophique de la France et de l’Étranger 31, 258287.
Jardri, R, Thomas, P, Delmaire, C, Delion, P and Pins, D (2013) The neurodynamic organization of modality-dependent hallucinations. Cerebral Cortex 23, 11081117.
Jardri, R, Hugdahl, K, Hughes, M, Brunelin, J, Waters, F, Alderson-Day, B, Smailes, D, Sterzer, P, Corlett, PR, Leptourgos, P, Debbané, M, Cachia, A and Denève, S (2016) Are hallucinations due to an imbalance between excitatory and inhibitory influences on the brain? Schizophrenia Bulletin 42, 11241134.
Jones, SR and Fernyhough, C (2007) Neural correlates of inner speech and auditory verbal hallucinations: a critical review and theoretical integration. Clinical Psychology Review 27, 140154.
Langdon, R, McGuire, J, Stevenson, R and Catts, SV (2011) Clinical correlates of olfactory hallucinations in schizophrenia. British Journal of Clinical Psychology 50, 145163.
Larøi, F, Van der Linden, M and Marczewski, P (2004) The effects of emotional salience, cognitive effort and meta-cognitive beliefs on a reality monitoring task in hallucination-prone subjects. British Journal of Clinical Psychology 43, 221233.
Lim, A, Hoek, HW, Deen, ML, Blom, JD and GROUP Investigators (2016) Prevalence and classification of hallucinations in multiple sensory modalities in schizophrenia spectrum disorders. Schizophrenia Research 176, 493499.
Linszen, MMJ, van Zanten, GA, Teunisse, RJ, Brouwer, RM, Scheltens, P and Sommer, IE (2018) Auditory hallucinations in adults with hearing impairment: a large prevalence study. Psychological Medicine 49, 132139.
Luria, AR (1965) L.S. Vygotsky and the problem of localization of functions. Neuropsychologia 3, 387392.
McCarthy-Jones, S, Smailes, D, Corvin, A, Gill, M, Morris, DW, Dinan, TG, Murphy, KC, Anthony O Neill, F, Waddington, JL, Australian Schizophrenia Research Bank, Donohoe, G and Dudley, R (2017) Occurrence and co-occurrence of hallucinations by modality in schizophrenia-spectrum disorders. Psychiatry Research 252, 154160.
Mecacci, L (2005) Luria: a unitary view of human brain and mind. Cortex 41, 816822.
Miller, L (1986) ‘Narrow localizationalism’ in psychiatric neuropsychology. Psychological Medicine 16, 729734.
Mitchell, KJ and Johnson, MK (2009) Source monitoring 15 years later: what have we learned from fMRI about the neural mechanisms of source memory? Psychological Bulletin 135, 638677.
Moseley, P, Fernyhough, C and Ellison, A (2014) The role of the superior temporal lobe in auditory false perceptions: a transcranial direct current stimulation study. Neuropsychologia 62, 202208.
Moseley, P, Alderson-Day, B, Kumar, S and Fernyhough, C (2018) Musical hallucinations, musical imagery, and earworms: a new phenomenological survey. Consciousness and Cognition 65, 8394.
Paulik, G, Badcock, JC and Maybery, MT (2007) Poor intentional inhibition in individuals predisposed to hallucinations. Cognitive Neuropsychiatry 12, 457470.
Peters, E, Ward, T, Jackson, M, Woodruff, P, Morgan, C, McGuire, P and Garety, PA (2017) Clinical relevance of appraisals of persistent psychotic experiences in people with and without a need for care: an experimental study. The Lancet. Psychiatry 4, 927936.
Powers, AR, Kelley, M and Corlett, PR (2016) Hallucinations as top-down effects on perception. Biological Psychiatry 1, 393400.
Powers, AR, Kelley, MS and Corlett, PR (2017) Varieties of voice-hearing: psychics and the psychosis continuum. Schizophrenia Bulletin 43, 8498.
Raij, TT and Riekki, TJJ (2012) Poor supplementary motor area activation differentiates auditory verbal hallucination from imagining the hallucination. NeuroImage: Clinical 1, 7580.
Shine, JM, Keogh, R, O'Callaghan, C, Muller, AJ, Lewis, SJG and Pearson, J (2015) Imagine that: elevated sensory strength of mental imagery in individuals with Parkinson's disease and visual hallucinations. Proceedings of the Royal Society B: Biological Sciences 282, 20142047.
Simons, JS, Garrison, JR and Johnson, MK (2017) Brain mechanisms of reality monitoring. Trends in Cognitive Sciences 21, 462473.
Stephens, GL and Graham, G (2000) When Self-Consciousness Breaks: Alien Voices and Inserted Thoughts. Cambridge, MA: MIT Press.
Teufel, C, Subramaniam, N, Dobler, V, Perez, J, Finnemann, J, Mehta, PR, Goodyer, IM and Fletcher, PC (2015) Shift toward prior knowledge confers a perceptual advantage in early psychosis and psychosis-prone healthy individuals. Proceedings of the National Academy of Sciences 112, 1340113406.
Vygotsky, LS (1987) Thinking and Speech. The Collected Works of L. S. Vygotsky, vol. 1. New York: Plenum Press.
Waters, F and Fernyhough, C (2017) Hallucinations: a systematic review of points of similarity and difference across diagnostic classes. Schizophrenia Bulletin 43, 3243.
Waters, F and Fernyhough, C (2019) Auditory hallucinations: does a continuum of severity entail continuity in mechanism? Schizophrenia Bulletin 45, 717719.
Waters, F, Badcock, JC, Maybery, MT and Michie, PT (2003) Inhibition in schizophrenia: association with auditory hallucinations. Schizophrenia Research 62, 275280.
Waters, FAV, Maybery, MT, Badcock, JC and Michie, PT (2004) Context memory and binding in schizophrenia. Schizophrenia Research 68, 119125.
Waters, FAV, Badcock, JC, Michie, PT and Maybery, MT (2006) Auditory hallucinations in schizophrenia: intrusive thoughts and forgotten memories. Cognitive Neuropsychiatry 11, 6583.
Waters, F, Collerton, D, ffytche, DH, Jardri, R, Pins, D, Dudley, R, Blom, JD, Mosimann, UP, Eperjesi, F, Ford, S and Larøi, F (2014) Visual hallucinations in the psychosis spectrum and comparative information from neurodegenerative disorders and eye disease. Schizophrenia Bulletin 40, 233245.
Wilkinson, S and Bell, V (2016) The representation of agents in auditory verbal hallucinations. Mind and Language 31, 104126.
Woodruff, PWR (2004) Auditory hallucinations: insights and questions from neuroimaging. Cognitive Neuropsychiatry 9, 7391.
Woods, A, Jones, N, Alderson-Day, B, Callard, F and Fernyhough, C (2015) Experiences of hearing voices: analysis of a novel phenomenological survey. The Lancet. Psychiatry 2, 323331.


Modality-general and modality-specific processes in hallucinations

  • Charles Fernyhough (a1)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed