BackgroundEven though there is an increasing amount of evidence from behavioral and neuroimaging studies to suggest that pathological inner speech plays a role in the emergence of auditory verbal hallucinations (AVH), studies investigating the mechanisms underlying this relationship are rather scarce. Examining moderators might inform the development of new treatment options for AVH. We sought to extend the existing knowledge by testing the moderating role of cognitive impairment in the association between inner speech and hallucinations in a sample of Lebanese patients with schizophrenia.MethodsA cross-sectional study was conducted from May till August 2022, enrolling 189 chronic patients.ResultsModeration analysis revealed that, after controlling for delusions, the interaction of experiencing voices of other people in inner speech by cognitive performance was significantly associated with AVH. In people having low (Beta = 0.69; t = 5.048;p< .001) and moderate (Beta = 0.45; t = 4.096;p< .001) cognitive performance, the presence of voices of other people in inner speech was significantly associated with more hallucinations. This association was not significant in patients with high cognitive function (Beta = 0.21; t = 1.417;p= .158).ConclusionThis preliminarily study suggests that interventions aiming at improving cognitive performance may also have a beneficial effect in reducing hallucinations in schizophrenia.