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Hallucinated voices are a common feature of psychosis and can cause high levels of distress and disability. Current theories suggest that insight-related beliefs, about internal or external origin and perceived source location, and appraisals of controllability are important in mediating the personal impact of these experiences but previous findings have been mixed. We report two network analytic studies of items in the Psychotic Symptoms Ratings Scale for auditory verbal hallucinations (PSYRATS-AH) in a large sample of patients with psychosis to examine the network structure of items at i) first assessment, and ii) differences over two consecutive assessments during a wait-list period. Networks were generated using Least Absolute Shrinkage and Selection Operator (LASSO) and Extended Bayesian Information Criterion (EBIC) with node predictability. In Study 1 (N = 386), we report that insight-related items made a negligible contribution to the hallucinated voice network and the controllability appraisal made at most a modest contribution. Items relating to distress and negative content were the most central and most predicted by the wider network. In Study 2 (N = 196), we tested the longitudinal stability of the structure of hallucinated voices over a period of several months, reporting a small change in total hallucination score and global strength but no clear evidence for an alteration in the structural relationship between components. The insight-related and controllability items remained as least influential over time. We conclude that insight-related beliefs and controllability appraisals may contribute less than previously thought to distressing hallucinated voices although we do not discount that other appraisals may remain important.
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