The Voice of Depression: Prevalence and Stability Across Time of Perception-Laden Intrusive Thoughts in Depression

  • Steffen MoritzEmail author
  • Jan Philipp Klein
  • Thomas Berger
  • Frank Larøi
  • Björn Meyer
Original Article


Intrusive depressive thoughts are typically defined in terms of their content, frequency, and pervasiveness. The extent to which they carry sensory properties is largely unexplored. In a pilot study, 56.5% of individuals with mild to moderate depressive symptoms experienced depressive thoughts with sensory features. The present study explored the prevalence of sensory thoughts in patients with severe depression and examined the stability of the sensory phenomena across time. A total of 163 participants with severe depression completed an online assessment at baseline and 3 months later. Diagnostic status was established at baseline over the telephone. The primary outcome was the Sensory Properties of Depressive Thoughts Questionnaire (SPD). The frequency of sensory properties of negative thoughts was similar (60.7% reported at least one sensory irritation; thus, 39.3% of the sample reported not a single, even mild sensory irritation) to the pilot study. The highest prevalence was observed for bodily sensations (41.1%; pilot: 39.6%) followed by auditory (37.4%; pilot: 30.6%) and visual (31.3%; pilot: 27.2%) perceptions. Prevalence remained essentially unchanged over time, but test–retest reliability was weak to moderate (r = .56). Unlike in the pilot study, no association emerged with quality of life and suicidality. Yet, those reporting sensory phenomena were prescribed more medication, had a similar number of prior hospitalizations despite their younger age, were more frequently in psychotherapy (statistical trend), and had more pain symptoms, which tentatively suggests a more complicated course of illness. Replication in independent samples is needed. Our findings support the notion that depressive thoughts are not “silent” but are commonly accompanied by sensory experiences.


Depression Hallucinations Intrusions Sensory irritations 


Compliance with Ethical Standards

Conflict of interest

Steffen Moritz, Jan Philipp Klein, Thomas Berger, Frank Larøi and Björn Meyer declare that they have no conflict of interest.

Informed Consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the University Medical Center Hamburg, Germany and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Animal Rights

No animal studies were carried out by the authors for this article.

Supplementary material

10608_2019_10030_MOESM1_ESM.docx (47 kb)
Supplementary material 1 (DOCX 46 kb)


  1. American Psychiatry Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA, USA: American Psychiatric Association.Google Scholar
  2. Boyette, L., Swets, M., Meijer, C., Wouters, L., Kahna, R., Linszenb, D., … Myin-Germeysc, I. (2011). Factor structure of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) in a large sample of patients with schizophrenia or related disorders and comorbid obsessive-compulsive symptoms. Psychiatry Research, 186(2–3), 409–413.
  3. Cahoon, C. G. (2012). Depression in older adults. AJN, American Journal of Nursing, 112(11), 22–30. Scholar
  4. Donker, T., Van Straten, A., Marks, I., & Cuijpers, P. (2009). A brief web-based screening questionnaire for common mental disorders: Development and validation. Journal of Medical Internet Research, 11(3), e19. Scholar
  5. Gandek, B., Ware, J. E., Aaronson, N. K., Apolone, G., Bjorner, J. B., Brazier, J. E., … Sullivan, M. (1998). Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: Results from the IQOLA Project. International Quality of Life Assessment. Journal of Clinical Epidemiology, 51(11), 1171–1178.
  6. Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., … Charney, D. S. (1989). The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Archives of General Psychiatry, 46(11), 1006–1011.
  7. Gräfe, K., Zipfel, S., Herzog, W., & Löwe, B. (2004). Screening psychischer Störungen mit dem “Gesundheitsfragebogen für Patienten (PHQ-D)“. Diagnostica, 50(4), 171–181. Scholar
  8. Holmes, E. A., Blackwell, S. E., Burnett Heyes, S., Renner, F., & Raes, F. (2016). Mental imagery in depression: Phenomenology, potential mechanisms, and treatment implications. Annual Review of Clinical Psychology, 12(1), 249–280. Scholar
  9. Holmes, E. A., Crane, C., Fennell, M. J. V., & Williams, J. M. G. (2007). Imagery about suicide in depression—“Flash-forwards”? Journal of Behavior Therapy and Experimental Psychiatry, 38(4), 423–434. Scholar
  10. Holmes, E. A., & Mathews, A. (2010). Mental imagery in emotion and emotional disorders. Clinical Psychology Review, 30(3), 349–362. Scholar
  11. Holmes, E. A., Mathews, A., Dalgleish, T., & Mackintosh, B. (2006). Positive interpretation training: Effects of mental imagery versus verbal training on positive mood. Behavior Therapy, 37(3), 237–247. Scholar
  12. Jenkinson, C., Layte, R., Jenkinson, D., Lawrence, K., Petersen, S., Paice, C., et al. (1997). A shorter form health survey: Can the SF-12 replicate results from the SF-36 in longitudinal studies? Journal of Public Health, 19(2), 179–186. Scholar
  13. Ji, J. L., Holmes, E. A., & Blackwell, S. E. (2017). Seeing light at the end of the tunnel: Positive prospective mental imagery and optimism in depression. Psychiatry Research, 247, 155–162. Scholar
  14. Kim, S. W., Dysken, M. W., Pheley, A. M., & Hoover, K. M. (1994). The Yale-Brown Obsessive-Compulsive Scale: Measures of internal consistency. Psychiatry Research, 51(2), 203–211. Scholar
  15. Klein, J. P., Berger, T., Schröder, J., Späth, C., Meyer, B., Caspar, F., … Hohagen, F. (2016). Effects of a psychological internet intervention in the treatment of mild to moderate depressive symptoms: Results of the evident study, a randomized controlled trial. Psychotherapy and Psychosomatics, 85(4), 218–228.
  16. Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. Scholar
  17. Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2002). The PHQ-15: Validity of a new measure for evaluating the severity of somatic symptoms. Psychosomatic Medicine, 64(2), 258–266. Scholar
  18. Kroenke, K., Spitzer, R. L., Williams, J. B. W., & Löwe, B. (2010). The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: A systematic review. General Hospital Psychiatry, 32(4), 345–359. Scholar
  19. Löwe, B., Kroenke, K., Herzog, W., & Gräfe, K. (2004). Measuring depression outcome with a brief self-report instrument: Sensitivity to change of the Patient Health Questionnaire (PHQ-9). Journal of Affective Disorders, 81(1), 61–66. Scholar
  20. Maijer, K., Begemann, M. J. H., Palmen, S. J. M. C., Leucht, S., & Sommer, I. E. C. (2018). Auditory hallucinations across the lifespan: A systematic review and meta-analysis. Psychological Medicine, 48(6), 879–888. Scholar
  21. Martin, A., Rief, W., Klaiberg, A., & Braehler, E. (2006). Validity of the Brief Patient Health Questionnaire Mood Scale (PHQ-9) in the general population. General Hospital Psychiatry, 28(1), 71–77. Scholar
  22. Meyer, B., Berger, T., Caspar, F., Beevers, C. G., Andersson, G., & Weiss, M. (2009). Effectiveness of a novel integrative online treatment for depression (Deprexis): Randomized controlled trial. Journal of Medical Internet Research, 11(2), e15. Scholar
  23. Meyer, B., Bierbrodt, J., Schröder, J., Berger, T., Beevers, C. G., Weiss, M., … Klein, J. P. (2015). Effects of an internet intervention (Deprexis) on severe depression symptoms: Randomized controlled trial. Internet Interventions, 2(1), 48–59.
  24. Miegel, F., Jelinek, L., & Moritz, S. (2019). Dysfunctional beliefs in patients with obsessive-compulsive disorder and depression as assessed with the Beliefs Questionnaire (BQ). Psychiatry Research, 272, 265–274.Google Scholar
  25. Moritz, S., Ahlf-Schumacher, J., Hottenrott, B., Peter, U., Franck, S., Schnell, T., … Jelinek, L. (2018a). We cannot change the past, but we can change its meaning. A randomized controlled trial on the effects of self-help imagery rescripting on depression. Behaviour Research and Therapy, 104, 74–83.
  26. Moritz, S., Claussen, M., Hauschildt, M., & Kellner, M. (2014a). Perceptual properties of obsessive thoughts are associated with low insight in obsessive-compulsive disorder. The Journal of Nervous and Mental Disease, 202(7), 562–565. Scholar
  27. Moritz, S., Hörmann, C. C., Schröder, J., Berger, T., Jacob, G. A., Meyer, B., … Klein, J. P. (2014b). Beyond words: Sensory properties of depressive thoughts. Cognition and Emotion, 28(6), 1047–1056.
  28. Moritz, S., & Larøi, F. (2008). Differences and similarities in the sensory and cognitive signatures of voice-hearing, intrusions and thoughts. Schizophrenia Research, 102(1–3), 96–107. Scholar
  29. Moritz, S., Meier, B., Kloss, M., Jacobsen, D., Wein, C., Fricke, S., et al. (2002). Dimensional structure of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Psychiatry Research, 109(2), 193–199. Scholar
  30. Moritz, S., Purdon, C., Jelinek, L., Chiang, B., & Hauschildt, M. (2018b). If it is absurd, then why do you do it? The richer the obsessional experience, the more compelling the compulsion. Clinical Psychology & Psychotherapy, 25(2), 210–216. Scholar
  31. Newby, J. M., & Moulds, M. L. (2012). A comparison of the content, themes, and features of intrusive memories and rumination in major depressive disorder. British Journal of Clinical Psychology, 51(2), 197–205. Scholar
  32. Osman, A., Bagge, C. L., Gutierrez, P. M., Konick, L. A., Kopper, B. A., & Barrios, F. X. (2001). The Suicidal Behaviors Questionnaire-Revised (SBQ-R): Validation with clinical and nonclinical samples. Assessment, 8(4), 443–454. Scholar
  33. Patel, T., Brewin, C. R., Wheatley, J., Wells, A., Fisher, P., & Myers, S. (2007). Intrusive images and memories in major depression. Behaviour Research and Therapy, 45(11), 2573–2580. Scholar
  34. Pearson, M., Brewin, C. R., Rhodes, J., & McCarron, G. (2008). Frequency and nature of rumination in chronic depression: A preliminary study. Cognitive Behaviour Therapy, 37(3), 160–168. Scholar
  35. Röhlinger, J., Wulf, F., Fieker, M., & Moritz, S. (2015). Sensory properties of obsessive thoughts in OCD and the relationship to psychopathology. Psychiatry Research, 230(2), 592–596. Scholar
  36. Rush, A. J., Trivedi, M. H., Ibrahim, H. M., Carmody, T. J., Arnow, B., Klein, D. N., … Keller, M. B. (2003). The 16-Item quick inventory of depressive symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): A psychometric evaluation in patients with chronic major depression. Biological Psychiatry, 54(5), 573–583.
  37. Sheehan, D. V, Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., … Dunbar, G. (1998). The MINI International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview. Journal of Clinical Psychiatry, 59(suppl. 20), 22–33.Google Scholar
  38. Smucker, M. R., Dancu, C., Foa, E. B., & Niederee, J. L. (1995). Imagery rescripting: A new treatment for survivors of childhood sexual abuse suffering from posttraumatic stress. Journal of Cognitive Psychotherapy, 9(1), 3–17.Google Scholar
  39. Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Lo, B. (2006). A brief measure for assessing generalized anxiety disorder. Archives of Internal Medicine, 166, 1092–1097. Scholar
  40. Twomey, C., O’Reilly, G., & Meyer, B. (2017). Effectiveness of an individually-tailored computerised CBT programme (Deprexis) for depression: A meta-analysis. Psychiatry Research, 256, 371–377. Scholar
  41. Ware, J., Kosinski, M., & Keller, S. D. (1996). A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233. Scholar
  42. Williams, A. D., & Moulds, M. L. (2008). Negative appraisals and cognitive avoidance of intrusive memories in depression: A replication and extension. Depression and Anxiety, 25(7), 26–33. Scholar
  43. Woods, A., Jones, N., Alderson-Day, B., Callard, F., & Fernyhough, C. (2015). Experiences of hearing voices: Analysis of a novel phenomenological survey. The Lancet Psychiatry, 2(4), 323–331. Scholar
  44. Xu, Z., Mayer, B., Müller, M., Heekeren, K., Theodoridou, A., Dvorsky, D., … Rüsch, N. (2016). Stigma and suicidal ideation among young people at risk of psychosis after one year. Psychiatry Research, 243, 219–224.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Psychiatry and PsychotherapyUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.Department of Psychiatry and PsychotherapyUniversity of LuebeckLübeckGermany
  3. 3.Department of Clinical Psychology and PsychotherapyUniversity of BernBernSwitzerland
  4. 4.Department of Biological and Medical Psychology, Faculty of PsychologyUniversity of BergenBergenNorway
  5. 5.Psychology and Neuroscience of Cognition Research UnitUniversity of LiègeLiègeBelgium
  6. 6.NORMENT – Norwegian Center of Excellence for Mental Disorders ResearchUniversity of OsloOsloNorway
  7. 7.Research DepartmentGaiaHamburgGermany
  8. 8.Department of PsychologyCity University of LondonLondonUK

Personalised recommendations