Psychological And Behavioral Mechanisms Linking Childhood Trauma Profiles To Voice-related Distress In Schizophrenia Spectrum Disorders: Preregistration For Latent Class, Mediation, And Conditional Process Analyses In The Challenge Trial - Info and Reading Options

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Accumulated childhood trauma and specific trauma subtypes have been linked to increased risk of general psychopathology in adulthood, particularly psychosis (e.g., Kelleher et al., 2013) and voice-hearing (e.g., Sitko et al., 2014; Trauelsen et al., 2015). Identifying the psychological and behavioral mechanisms that mediate the relationship between trauma and psychosis is essential for developing effective interventions (Alameda et al., 2020). Several studies have investigated these processes (Alameda et al., 2021; Bloomfield et al., 2021), yet most have focused on broad outcomes such as overall severity of psychosis or voice-hearing. Far less attention has been given to more specific outcomes, such as voice-related distress, despite its importance as a treatment target (e.g., Lincoln et al., 2024). Consequently, the mechanisms underlying distress in voice-hearers with a history of trauma remain insufficiently understood. Additionally, the majority of mediation studies have categorized trauma using theory-driven frameworks and taxonomies, often based on predefined trauma subtypes. This approach may overlook the frequent co-occurrence and clustering of traumatic experiences. In contrast, data-driven methods such as cluster analysis or latent class analysis (Roesch et al., 2010) allow for bottom-up identification of trauma profiles based on patterns within the sample itself, offering a more nuanced understanding of trauma typologies. Following this approach, recent studies have provided new insights into the distribution and the voice-related characertistics of various trauma types, suggesting the existence of different trauma profiles (Barnes et al., 2021; Begemann et al., 2022; Marotti et al., 2025). While voice-hearing is not inherently a psychopathological phenomenon (Johns et al., 2014), the distress associated with hearing voices is clinically significant (e.g. Birchwood & Trower, 2004). Voice-related distress has been associated with several psychological factors, including maladaptive voice appraisals - particularly persecutory beliefs - or relating styles (e.g. Rammou et al., 2022; Tsang et al., 2021), voice content (e.g. Larøi et al., 2019; Rosen et al., 2018; Silver et al., 2023), depression (e.g. Hartley et al., 2013; Kusztrits et al., 2022), insecure attachment styles and negative core beliefs about the self or others (e.g. Cole et al., 2017; Jorovat et al., 2025; Kusztrits et al., 2022; Thomas et al., 2015). Sleep disturbances may also contribute, as they are prevalent across the course of psychosis (Bagautdinova et al., 2023), could mediate the relationship between interpersonal trauma and paranoia-related distress in a transdiagnostic sample (Herms et al., 2024), and improving sleep has been shown to reduce positive psychotic symptoms (Scott et al., 2021). A key next step is to examine whether specific psychological mechanisms mediate the relationship between trauma profiles and voice-related distress, and whether these mechanisms vary across trauma subgroups. In this regard, it is also important to assess whether such mechanisms differ by gender, given evidence of gender-specific associations between childhood trauma and psychosis (e.g., Stanton et al., 2020). Clarifying these relationships could inform the development of more tailored and effective interventions for voice-hearers with trauma histories. Thus, the current study aims to examine potential psychological and behavioral mechanisms linking data-driven childhood trauma profiles to voice-related distress. Specifically, we will investigate the direct and indirect effects, estimate the magnitude of these effects, and evaluate whether they operate under specific conditions.

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