Most people take for granted that their thoughts belong to them — that thinking is private, that thoughts arise within them, and that no one else can hear them. Some of the most distinctive experiences in psychosis involve a breakdown of these basic certainties. Clinicians group these under several names: passivity phenomena, first-rank symptoms (after Kurt Schneider, who described them in 1939), or simply thought broadcasting, thought insertion, and thought withdrawal.
Thought broadcasting, insertion, and withdrawal are experiences in which a person feels that their thoughts can be heard by others, that thoughts have been put into their mind by outside agents, or that thoughts have been removed from their mind against their will.
The three classical experiences
Thought broadcasting
The person experiences their thoughts as audible to other people, as if they are being broadcast aloud. They may feel that strangers can hear what they are thinking, that their thoughts are being transmitted via radio or television, or that nearby people are responding to their internal monologue. The experience is more specific than the everyday feeling that "people can read me" — it is the felt sense that the mental boundary has actually opened.
Thought insertion
Thoughts appear in the person's mind that they experience as not their own. The most striking feature is the sense of foreignness. The person knows the thought happened in their head, but feels with conviction that it was placed there by someone else — an external agent, a technology, a presence. This is different from intrusive thoughts in OCD, where the person experiences the thoughts as their own but unwanted.
Thought withdrawal
Thoughts are felt to be removed from the mind by an outside force, often producing a gap or blank space mid-sentence. The person may feel they were about to think something important and that it was taken from them.
How common are they?
These experiences are most common in schizophrenia and schizoaffective disorder, where they have historically been weighted heavily in diagnosis. The DSM-5-TR has moved away from giving "first-rank symptoms" automatic diagnostic priority, since they also occur in mania, severe depression with psychotic features, and certain organic conditions, and are not as specific to schizophrenia as Schneider originally thought. Still, they remain a strong indicator that something serious is happening.
What is happening in the brain
The leading neuroscience explanation involves a breakdown of the sense of agency — the brain's normal capacity to tag self-generated mental events as belonging to the self. A model proposed by Christopher Frith and others suggests that the brain ordinarily generates a "forward model" of expected sensations whenever it produces an action or a thought. When this forward model is impaired, self-generated thoughts arrive without the usual marker of self-authorship, and the brain has to attribute them somewhere — often to an external agent.
This same model helps explain auditory hallucinations: the inner voice arrives without the usual self-tag and is heard as another's voice. Functional imaging studies have provided partial support for this model, particularly involving the cerebellum and the parietal cortex.
Why these experiences are so distressing
Most other delusions involve beliefs about the world. Thought broadcasting and insertion involve a felt change in the structure of one's own mind. People often describe these as among the most frightening experiences of their illness. They can lead to:
- Withdrawal from conversations, for fear that thoughts will be heard
- Avoidance of crowded places
- Distress about the source of the inserted thoughts (often interpreted as government, technology, or supernatural)
- Confusion about which thoughts to act on, since some no longer feel like one's own
- Difficulty with intimacy and trust
What helps
Medication
These experiences are usually highly responsive to antipsychotic medication. Most people see meaningful reduction within 2–6 weeks of reaching a therapeutic dose. Clozapine is particularly effective when other antipsychotics have not worked.
CBT for psychosis
CBTp adapted for passivity experiences focuses on:
- Normalising the experience as a recognised symptom of a treatable condition
- Working with the meaning the person has attached to the experience (who is doing this, why)
- Practical experiments to test the broadcast belief — for example, recording silent thoughts and asking whether anyone responded
- Reducing safety behaviours like avoiding speech or covering the head
CBTp for delusions covers the broader framework.
Avatar therapy and related approaches
For people whose passivity experiences are accompanied by dominant voices, avatar therapy and CBTp for voices may be relevant adjuncts.
Stress and sleep
Like other psychotic experiences, passivity phenomena are amplified by sleep loss and stress. Restoring sleep often reduces their intensity within days.
The experiences are escalating, are leading to social withdrawal severe enough to interrupt eating or self-care, are accompanied by commands the person feels obliged to act on, or are accompanied by suicidal thinking. Same-day psychiatric evaluation is appropriate.
Recovery and meaning-making
People who recover from these experiences often describe a deeper appreciation for the ordinary feeling of mental privacy — something that was once taken for granted and was painfully missed when it was disrupted. Many describe a particular relief when they learn that what they experienced has a name, a known mechanism, and effective treatment. The strangeness of the experience is part of what makes it so isolating; recognising it as part of a recognised illness can itself be therapeutic.
This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.