# The associations of stress, pleasure and emotion to voice‐hearing: An ecological momentary assessment study

## TL;DR

This study explores how stress, pleasure, and emotions relate to voice-hearing in daily life using real-time smartphone surveys.

## Contribution

The study provides new insights into how stressful events, not emotions, predict voice-hearing in real time.

## Key findings

- Stressful events, but not pleasurable ones, predict voice-hearing both immediately and shortly afterward.
- Emotion intensity, whether negative or positive, does not predict voice-hearing.
- Negative perceptions of external stressors may be key targets for intervention.

## Abstract

Negative emotions and stress are theorised to play a role in the onset and maintenance of voice‐hearing experiences. However, previous research has not explored these temporal relationships in daily life using differentiated psychological constructs.

Using ecological momentary assessment, this study examined the moment‐to‐moment relationships between negative and positive emotion valence and intensity, stressful and pleasurable events, and voice‐hearing onset.

Forty voice‐hearers completed seven days of smartphone‐based surveys, rating their emotions and their intensity, perceived stress and pleasure of life events, and presence of voice‐hearing.

Multilevel modelling showed that stressful events, but not pleasurable events, were significantly predictive of voice‐hearing, both concurrently and in the next time point. Neither negative nor positive emotion intensity predicted voice‐hearing, nor did they moderate the relationship between voice‐hearing onset and stressful or pleasurable events, respectively.

These findings suggest that factors which differentiate perception of stressful events from self‐reported negative emotions may be useful intervention targets, such as mitigating prolonged external stressors, reducing sensitivity to external stressors and targeting negative perceptions or resistance to these stressors.

Clinically, our findings underscore the relevance of stress and a negative perception of externally oriented events, with further research needed to explore useful interventions for targeting these mechanisms.