Evidence suggests that auditory hallucinations may result from abnormally enhanced auditory sensitivity.

To investigate whether there is an auditory processing bias in healthy individuals who are prone to experiencing auditory hallucinations.

Two hundred healthy volunteers performed a temporal order judgement task in which they determined whether an auditory or a visual stimulus came first under conditions of directed attention (‘attend-auditory’ and ‘attend-visual’ conditions). The Launay–Slade Hallucination Scale was used to divide the sample into high and low hallucination-proneness groups.

The high hallucination-proneness group exhibited a reduced sensitivity to auditory stimuli under the attend-auditory condition. By contrast, attention-directed visual sensitivity did not differ significantly between groups.

Healthy individuals prone to hallucinatory experiences may possess a bias in attention towards internal auditory stimuli at the expense of external sounds. Interventions involving the redistribution of attentional resources would have therapeutic benefit in patients experiencing auditory hallucinations.

Forensic patients with psychosis often engage in violent behaviour. There has been significant progress in understanding risk factors for violence, but identification of causal mechanisms of violence is limited.

To develop a testable psychological framework explaining violence in psychosis – grounded in patient experience – to guide targeted treatment development.

We conducted in-depth interviews with 20 patients with psychosis using forensic psychiatric services across three regions in England. Interviews were analysed using reflexive thematic analysis. People with lived experience contributed to the analysis.

Analysis of interviews identified several psychological processes involved in the occurrence of violence. Violence was the dominant response mode to difficulties that was both habitual and underpinned by rules that engaged and justified an attack. Violence was triggered by a trio of sensitivities to other people: sensitivity to physical threat, from which violence protected; sensitivity to social disrespect, by which violence increased status; and sensitivity to unfairness, by which violence delivered revenge. Violence was an attempt to regulate difficult internal states: intense emotions were released through aggression and violence was an attempt to escape being overwhelmed by voices, visions or paranoia. There were different patterns of emphasis across these processes when explaining an individual participant's offending behaviour.

The seven-factor model of violence derived from our analysis of patient accounts highlights multiple modifiable psychological processes that can plausibly lead to violence. The model can guide the research and development of targeted treatments to reduce violence by individuals with psychosis.

None.