Two critical barriers in understanding the expression of mental disorders:
1) Point of view: Quantification of loadings on symptom dimensions is almost exclusively recorded from the perspective of the therapist through structured interview scales, such as PANSS, PSYRATS etc., where data are collected typically in a single therapeutic session by interviewing the patient on several symptom dimensions, which include both positive, e.g. hallucinations, delusions, and negative, e.g. affective flattening, emotional withdrawal symptoms. Such a situation is not without problems, since there is a long "distance" from the phenomenological experience of the "voice", which is interpreted by the therapist, and converted to a score on a restricted range scale and then forwarded to the researcher for statistical analysis.
2) Time and context: The clinical interview is detached from the every-day experience of AVHs, which may occur at any time and place. Thus the patient needs to recall and summarize his/her experience of the events and do so in an artificial environment. Such a situation may not allow a complete reconstruction of the events that accounts for the ebb and flow of symptoms and the contexts in which they occur (see also, Kimhy et al., 2012, Trull and Ebner-Priemer, 2013).
New app, new solutions
The use of a mobile application for sampling of AVH experiences would offer new solutions for the study of psychiatric symptoms, by 1) moving data collection from the therapist to the patient; and by 2) moving closer in time and place to the expression of symptoms as they occur in real-life. This method of monitoring symptoms also has an immediate ecological aspect, in that the patient would look like any other young person playing with his/her smartphone, when recording the experiences in public, thus also avoiding the stigma of mental illness.
App addresses three principal dimensions of AVHs
a) perceptual dimension, i.e. whether the "voices" are perceived as coming from the inside or outside of the head, b) cognitive dimension, that the "voices" drain attention capacity and are outside of cognitive control once they occur, and c) emotional dimension, that the "voices" typically have a negative affective or emotional load (see Hugdahl et al., 2013). We are currently working on developing the concept from an idea-phase to a concrete application phase as a NORMENT synergy-project, toghether with Ingrid Agartz and Ingrid Melle.
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Previous mobile app study: New brain-test app (UiB)
Hugdahl, K., Nygard, M., Falkenberg, L. E., Kompus, K., Westerhausen, R., Kroken, R., Johnsen, E. & Loberg, E. M. 2013. Failure of attention focus and cognitive control in schizophrenia patients with auditory verbal hallucinations: evidence from dichotic listening. Schizophr Res, 147, 301-9.
Kimhy, D., Myin-Germeys, I., Palmier-Claus, J. & Swendsen, J. 2012. Mobile assessment guide for research in schizophrenia and severe mental disorders. Schizophr Bull, 38, 386-95.
Trull, T. J. & Ebner-Priemer, U. 2013. Ambulatory assessment. Annu Rev Clin Psychol, 9, 151-76.