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Gawęda Ł, Kowalski J, Aleksandrowicz A, Bagrowska P, Dąbkowska M, Pionke-Ubych R. A systematic review of performance-based assessment studies on cognitive biases in schizophrenia spectrum psychoses and clinical high-risk states: A summary of 40 years of research. Clin Psychol Rev 2024; 108:102391. [PMID: 38301343 DOI: 10.1016/j.cpr.2024.102391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/05/2024] [Accepted: 01/12/2024] [Indexed: 02/03/2024]
Abstract
Cognitive models of psychosis have stimulated empirical studies on cognitive biases involved in schizophrenia spectrum psychoses and their symptoms. This systematic review aimed to summarize the studies on the role of cognitive biases as assessed in different performance-based tasks in schizophrenia spectrum psychoses and clinical high-risk states. We focused on five cognitive biases linked to psychosis, i.e., aberrant salience, attentional biases, source monitoring biases, jumping to conclusions, and bias against disconfirmatory evidence. We identified N = 324 studies published in N = 308 articles fulfilling inclusion criteria. Most studies have been cross-sectional and confirmed that the schizophrenia spectrum psychoses are related to exaggerated cognitive biases compared to healthy controls. On the contrary, less evidence suggests a higher tendency for cognitive biases in the UHR sample. The only exceptions were source monitoring and jumping to conclusions, which were confirmed to be exaggerated in both clinical groups. Hallucinations and delusions were the most frequent symptoms studied in the context of cognitive biases. Based on the findings, we presented a hypothetical model on the role of interactions between cognitive biases or additive effects of biases in shaping the risk of psychosis. Future research is warranted for further development of cognitive models for psychosis.
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Affiliation(s)
- Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland.
| | - Joachim Kowalski
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Adrianna Aleksandrowicz
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Paulina Bagrowska
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Małgorzata Dąbkowska
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Renata Pionke-Ubych
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
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2
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The Effect of Situational Experiment Conditions on Hasty Decision Making in the 'Beads Task'. Brain Sci 2023; 13:brainsci13020359. [PMID: 36831902 PMCID: PMC9953874 DOI: 10.3390/brainsci13020359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
'Jumping to Conclusions', or hasty decision making, is widely studied within clinical and computational psychology. It is typically investigated using the 'beads task', a sequential information sampling paradigm, and defining one or two draws as jumping to conclusion. Situational experimental conditions, e.g., group vs. individual testing, abstract vs. cover story, show-up fee or course credit, frequently vary between studies. Little effort has been dedicated to investigating the potential effects of demand characteristics on hasty decision making. We explored this in four samples of participants (n = 336), in different situational experiment conditions, with two distinct variations of the beads task. An abstract 'Draws to Decision' (DtD) variant, and a cover story combined DtD and probabilistic inferences variant. Situational conditions did not have a significant effect on overall DtD for either variant. However, when using 'extreme scores' (DtD of 1 or 1 to 2) as a measure of hasty decision making, situational conditions had an effect for the abstract variant, with individual testing having the fewest hasty decision makers (DtD1: Mann-Whitney U = 2137.5, p = 0.02; DtD1-2: Mann-Whitney U = 2017.5, p < 0.01), but not for the cover story variant. Our results suggest that the abstract variant is more susceptible to test conditions, especially if a categorisation is used to classify hasty decisions. This does not imply that the cover story variant is better suited to capturing jumping to conclusions behaviour, but highlights the importance of mirroring the situational conditions between different samples. We recommend that testing conditions should be fully disclosed.
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Fouladirad S, Chen LV, Roes M, Chinchani A, Percival C, Khangura J, Zahid H, Moscovitz A, Arreaza L, Wun C, Sanford N, Balzan R, Moritz S, Menon M, Woodward TS. Functional brain networks underlying probabilistic reasoning and delusions in schizophrenia. Psychiatry Res Neuroimaging 2022; 323:111472. [PMID: 35405574 DOI: 10.1016/j.pscychresns.2022.111472] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/20/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
Abstract
Delusions in schizophrenia are false beliefs that are assigned certainty and not afforded the scrutiny that normally gives rise to doubt, even under conditions of weak evidence. The goal of the current functional magnetic resonance imaging (fMRI) study is to identify the brain network(s) involved in gathering information under conditions of weak evidence, in people with schizophrenia experiencing delusions. fMRI activity during probabilistic reasoning in people with schizophrenia experiencing delusions (n = 29) compared to people with schizophrenia not experiencing delusions (n = 41) and healthy controls (n = 41) was observed when participants made judgments based on evidence that weakly or strongly matched (or mismatched) with the focal hypothesis. A brain network involved in visual attention was strongly elicited for conditions of weak evidence for healthy controls and patients not experiencing delusions, but this increase was absent for patients experiencing delusions. This suggests that the state associated with delusions manifests in fMRI as reduced activity in an early visual attentional process whereby weak evidence is incorrectly stamped as conclusive, manifestating as a feeling of fluency and misplaced certainty, short-circuiting the search for evidence, and providing a candidate neural process for 'seeding' delusions.
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Affiliation(s)
- Saman Fouladirad
- BC Mental Health and Substance Use Services, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Linda V Chen
- BC Mental Health and Substance Use Services, Vancouver, BC, Canada; Faculty of Science, University of British Columbia, Vancouver, BC, Canada
| | - Meighen Roes
- BC Mental Health and Substance Use Services, Vancouver, BC, Canada; Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Abhijit Chinchani
- BC Mental Health and Substance Use Services, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Chantal Percival
- BC Mental Health and Substance Use Services, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Jessica Khangura
- BC Mental Health and Substance Use Services, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Hafsa Zahid
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Aly Moscovitz
- BC Mental Health and Substance Use Services, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Leonardo Arreaza
- BC Mental Health and Substance Use Services, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Charlotte Wun
- BC Mental Health and Substance Use Services, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Nicole Sanford
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Ryan Balzan
- College of Education, Psychology & Social Work, Flinders University, Adelaide, SA, Australia
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mahesh Menon
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Todd S Woodward
- BC Mental Health and Substance Use Services, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
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Hauke DJ, Roth V, Karvelis P, Adams RA, Moritz S, Borgwardt S, Diaconescu AO, Andreou C. Increased Belief Instability in Psychotic Disorders Predicts Treatment Response to Metacognitive Training. Schizophr Bull 2022; 48:826-838. [PMID: 35639557 PMCID: PMC9212107 DOI: 10.1093/schbul/sbac029] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND HYPOTHESIS In a complex world, gathering information and adjusting our beliefs about the world is of paramount importance. The literature suggests that patients with psychotic disorders display a tendency to draw early conclusions based on limited evidence, referred to as the jumping-to-conclusions bias, but few studies have examined the computational mechanisms underlying this and related belief-updating biases. Here, we employ a computational approach to understand the relationship between jumping-to-conclusions, psychotic disorders, and delusions. STUDY DESIGN We modeled probabilistic reasoning of 261 patients with psychotic disorders and 56 healthy controls during an information sampling task-the fish task-with the Hierarchical Gaussian Filter. Subsequently, we examined the clinical utility of this computational approach by testing whether computational parameters, obtained from fitting the model to each individual's behavior, could predict treatment response to Metacognitive Training using machine learning. STUDY RESULTS We observed differences in probabilistic reasoning between patients with psychotic disorders and healthy controls, participants with and without jumping-to-conclusions bias, but not between patients with low and high current delusions. The computational analysis suggested that belief instability was increased in patients with psychotic disorders. Jumping-to-conclusions was associated with both increased belief instability and greater prior uncertainty. Lastly, belief instability predicted treatment response to Metacognitive Training at the individual level. CONCLUSIONS Our results point towards increased belief instability as a key computational mechanism underlying probabilistic reasoning in psychotic disorders. We provide a proof-of-concept that this computational approach may be useful to help identify suitable treatments for individual patients with psychotic disorders.
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Affiliation(s)
- D J Hauke
- To whom correspondence should be addressed; 250 College St., 12th Floor, Toronto, ON M5T 1R8, Canada; tel: +1 (416) 535-8501 ext. 30585, fax: +1 416-583-1207, e-mail:
| | - V Roth
- Department of Mathematics and Computer Science, University of Basel, Basel, Switzerland
| | - P Karvelis
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - R A Adams
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK,Max Planck Centre for Computational Psychiatry and Ageing Research, University College London, London, United Kingdom
| | - S Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - S Borgwardt
- Department of Psychiatry and Psychotherapy, Translational Psychiatry Unit, University of Lübeck, Lübeck, Germany,Center of Brain, Behaviour and Metabolism, University of Lübeck, Lübeck, Germany
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Cavieres A, Acuña V, Wachtendorff C, Maldonado R. People with schizophrenia use less information to interpret ambiguous social situations. J Behav Ther Exp Psychiatry 2022; 74:101690. [PMID: 34753052 DOI: 10.1016/j.jbtep.2021.101690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/11/2021] [Accepted: 08/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVES The tendency of people with schizophrenia to gather insufficient information before making decisions or jumping to conclusions has been repeatedly reported. However, criticism has also been expressed regarding the ecological validity of this finding. Here we present the results obtained by a group of people with schizophrenia and a control group in a non-probabilistic task that requires obtaining items of information before interpreting an ambiguous social situation. METHODS Patients with schizophrenia (n = 48) and controls (n = 44) aged 18-50 years participated in the study. All subjects completed the Beads Task and the modified Social Information Preference Task. RESULTS Patients with schizophrenia showed a statistically significant tendency to jump to conclusions, including in the proposed novel social task. Unlike other studies, we were unable to find a relationship between this bias and greater severity of psychotic symptoms. LIMITATIONS We did not include patients with high levels of psychotic symptoms or a clinical control group. CONCLUSIONS The tendency to jump to conclusions in schizophrenia could be present in everyday interpersonal situations.
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Affiliation(s)
- Alvaro Cavieres
- Departamento de Psiquiatría, Universidad de Valparaíso, Valparaíso, Chile.
| | - Vanessa Acuña
- Departamento de Psiquiatría, Universidad de Valparaíso, Valparaíso, Chile
| | | | - Rocío Maldonado
- Departamento de Psiquiatría, Universidad de Valparaíso, Valparaíso, Chile
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6
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Zander-Schellenberg T, Kuhn SAK, Möller J, Meyer AH, Huber C, Lieb R, Andreou C. Is intuition allied with jumping to conclusions in decision-making? An intensive longitudinal study in patients with delusions and in non-clinical individuals. PLoS One 2021; 16:e0261296. [PMID: 34928987 PMCID: PMC8687575 DOI: 10.1371/journal.pone.0261296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/29/2021] [Indexed: 11/18/2022] Open
Abstract
Research suggests that a jumping-to-conclusions (JTC) bias, excessive intuition, and reduced analysis in information processing may favor suboptimal decision-making, both in non-clinical and mentally disordered individuals. The temporal relationship between processing modes and JTC bias, however, remains unexplored. Therefore, using an experience sampling methodology (ESM) approach, this study examines the temporal associations between intuitive/analytical information processing, JTC bias, and delusions in non-clinical individuals and patients with schizophrenia. Specifically, we examine whether a high use of intuitive and/or a low use of analytical processing predicts subsequent JTC bias and paranoid conviction. In a smartphone-based ESM study, participants will be prompted four times per day over three consecutive days to answer questionnaires designed to measure JTC bias, paranoid conviction, and preceding everyday-life intuition/analysis. Our hierarchical data will be analyzed using multilevel modelling for hypothesis testing. Results will further elucidate the role of aberrant human reasoning, particularly intuition, in (non-)clinical delusions and delusion-like experiences, and also inform general information processing models.
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Affiliation(s)
- Thea Zander-Schellenberg
- Faculty of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Sarah A. K. Kuhn
- Faculty of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Julian Möller
- Faculty of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
- Psychiatric University Hospital (UPK), University of Basel, Basel, Switzerland
| | - Andrea H. Meyer
- Faculty of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Christian Huber
- Psychiatric University Hospital (UPK), University of Basel, Basel, Switzerland
| | - Roselind Lieb
- Faculty of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Christina Andreou
- Department of Psychiatry and Psychotherapy, Translational Psychiatry Unit, University of Luebeck, Luebeck, Germany
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7
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Pytlik N, Soll D, Hesse K, Moritz S, Bechdolf A, Herrlich J, Kircher T, Klingberg S, Landsberg MW, Müller BW, Wiedemann G, Wittorf A, Wölwer W, Wagner M, Mehl S. Problems in measuring the JTC-bias in patients with psychotic disorders with the fish task: a secondary analysis of a baseline assessment of a randomized controlled trial. BMC Psychiatry 2020; 20:554. [PMID: 33228583 PMCID: PMC7685639 DOI: 10.1186/s12888-020-02959-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 11/16/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The jumping to conclusions bias (JTC) is considered to be an important causal factor in theoretical models for the formation and maintenance of delusions. However, recent meta-analytic findings show a rather equivocal pattern of results regarding associations between JTC and delusions. Thus, the present study aims to investigate in a large sample whether the JTC-bias is more pronounced in patients with psychotic disorders in comparison to controls and whether the JTC bias is associated with a more severe delusional conviction, persecutory delusions, and positive symptoms in general. METHODS Patients with psychotic disorders (n = 300) enrolled in a therapy trial and healthy controls (n = 51) conducted a variant of the beads task (fish task) as a measure for the JTC-bias at the start of the trial. Further, clinical interviews were used to assess patients' delusional severity and delusional conviction. RESULTS There were no statistically significant differences between patients with psychotic disorders (with 53% displaying the JTC-bias) and controls (41%). Furthermore, there were no statistically significant correlations between JTC measures and persecutory delusions, delusional conviction, and positive symptoms. CONCLUSIONS We found no differences in JTC between patients with psychotic disorders and healthy controls, which is in part in line with meta-analytic findings using a wide range of JTC task variants. Interestingly, patients with psychotic disorders displayed JTC rates commonly found in the literature, while healthy control subjects showed an unexpectedly high level of JTC. The task variant we used in the present study (fish task) is discussed as a potential reason for our results, as it may induce a more deliberative reasoning style in controls as compared to the traditional beads task. Furthermore, possible implications for the measurement of the JTC-bias, in general, are discussed. TRIAL REGISTRATION ISRCTN29242879 ( isrctn.com ), date of registration: April 12th 2006, retrospectively registered.
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Affiliation(s)
- Nico Pytlik
- Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior (MCMBB), Philipps-University, Rudolf-Bultmann-Str. 8, 35039, Marburg, Germany.
| | - Daniel Soll
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior (MCMBB), Philipps-University, Rudolf-Bultmann-Str. 8, 35039 Marburg, Germany
| | - Klaus Hesse
- grid.10392.390000 0001 2190 1447Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Steffen Moritz
- grid.9026.d0000 0001 2287 2617Department of Psychiatry and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - Andreas Bechdolf
- grid.6190.e0000 0000 8580 3777Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany ,grid.433867.d0000 0004 0476 8412Department of Psychiatry and Psychotherapy, Vivantes Klinikum am Urban - Teaching Hospital Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jutta Herrlich
- grid.7839.50000 0004 1936 9721Department of Psychiatry, Psychosomatics and Psychotherapy, University of Frankfurt, Frankfurt, Germany
| | - Tilo Kircher
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior (MCMBB), Philipps-University, Rudolf-Bultmann-Str. 8, 35039 Marburg, Germany
| | - Stefan Klingberg
- grid.10392.390000 0001 2190 1447Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Martin W. Landsberg
- grid.10388.320000 0001 2240 3300Department of Psychiatry and Psychotherapy, Friedrich-Wilhelms University of Bonn, Bonn, Germany
| | - Bernhard W. Müller
- grid.5718.b0000 0001 2187 5445Department of Psychiatry and Psychotherapy, University of Duisburg-Essen, Essen, Germany
| | - Georg Wiedemann
- Departmenf of Psychiatry and Psychotherapy, Hospital Fulda, Fulda, Germany
| | - Andreas Wittorf
- grid.10392.390000 0001 2190 1447Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Wolfgang Wölwer
- grid.411327.20000 0001 2176 9917Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
| | - Michael Wagner
- grid.7839.50000 0004 1936 9721Department of Psychiatry, Psychosomatics and Psychotherapy, University of Frankfurt, Frankfurt, Germany
| | - Stephanie Mehl
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior (MCMBB), Philipps-University, Rudolf-Bultmann-Str. 8, 35039 Marburg, Germany ,grid.7839.50000 0004 1936 9721Department of Psychiatry, Psychosomatics and Psychotherapy, University of Frankfurt, Frankfurt, Germany
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8
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Pytlik N, Soll D, Mehl S. Thinking Preferences and Conspiracy Belief: Intuitive Thinking and the Jumping to Conclusions-Bias as a Basis for the Belief in Conspiracy Theories. Front Psychiatry 2020; 11:568942. [PMID: 33061922 PMCID: PMC7530244 DOI: 10.3389/fpsyt.2020.568942] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/31/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The belief in conspiracy theories and paranoid ideation are often treated as almost synonymous. However, there is to date no research concerning shared underlying cognitive underpinnings of belief in conspiracy theories and paranoid ideation. One potential underlying factor could be the well-known jumping to conclusion (JTC) bias, the tendency of persons with delusions to perform hasty decisions that are sometimes based on little evidence. Furthermore, a preference for a more intuitive general thinking style, as opposed to an analytical thinking style, could be an additional underlying cognitive factor of both conspiracy theories and paranoia. Thus, the aim of the present study is to investigate in a large sample of non-clinical individuals whether the JTC-bias is more pronounced in individuals who display a stronger belief in conspiracy theories and whether both are related to a more intuitive thinking preference. METHODS We assessed the data of 519 non-clinical individuals regarding their respective approval of 20 specific conspiracy theories in an online study. Further, we assessed the JTC-bias by using a computerized variant of the beads task (fish task). Thinking preferences were measured with the Rational-Experiential Interview. RESULTS Subjects who displayed the JTC-bias presented a more pronounced belief in conspiracy theories. In addition, gathering little information in the fish task before performing a decision (less draws to decision) was related to a stronger endorsement of conspiracy theories and a more intuitive thinking style (and a less analytic thinking style). Finally, a preference for intuitive thinking predicted a stronger belief in conspiracy theories in a multiple regression analysis. CONCLUSIONS Our results demonstrate the implication of a preference for an intuitive thinking style accompanied by a propensity to faster decision-making (JTC-bias) as possible cognitive underpinnings of beliefs in conspiracy theories. Furthermore, our study is the first to confirm the notion of the JTC-bias as a reflection of the use of an intuitive thinking style.
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Affiliation(s)
- Nico Pytlik
- Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior (MCMBB), Philipps-University, Marburg, Germany
| | - Daniel Soll
- Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior (MCMBB), Philipps-University, Marburg, Germany
| | - Stephanie Mehl
- Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior (MCMBB), Philipps-University, Marburg, Germany
- Department of Health and Social Work, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
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9
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McLean BF, Mattiske JK, Balzan RP. Jumping to conclusions in the less-delusion-prone? Preliminary evidence from a more reliable beads task. J Behav Ther Exp Psychiatry 2020; 68:101562. [PMID: 32105906 DOI: 10.1016/j.jbtep.2020.101562] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 01/23/2020] [Accepted: 02/16/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Several meta-analyses have shown that people with psychosis tend to gather less information (i.e., they make fewer draws to decision, or DTD) on the beads task than healthy controls. A single meta-analysis has also found a small negative association between delusion-proneness and DTD in healthy samples, but with considerable heterogeneity. METHODS We used the new and more reliable "distractor sequences" beads task to clarify the nature of the relationship between delusion-proneness and DTD in a healthy sample. Healthy participants (N = 203) completed the distractor sequences beads task and the Peters Delusions Inventory (PDI), which measures delusion-proneness. RESULTS PDI and DTD were positively correlated, and those who jumped to conclusions (DTD ≤ 2) had lower PDI than those who did not. Comparing PDI quartiles on DTD provided some evidence the positive association did not extend to the highest PDI quartile. We found that DTD and delusion-proneness were positively related in our non-clinical sample, which was unexpected. LIMITATIONS Results need replication with a clinical sample. CONCLUSIONS Considering the well-established association between the JTC bias and clinical delusions, the current finding may reflect a relationship that differs between non-clinical and clinically significant delusional groups, or one which reverses sign at some level of delusion-proneness.
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Affiliation(s)
- Benjamin F McLean
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia; ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, Australia
| | - Julie K Mattiske
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
| | - Ryan P Balzan
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia; ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, Australia.
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The Effect of Transcutaneous Auricular Vagal Nerve Stimulation (taVNS) on P3 Event-Related Potentials during a Bayesian Oddball Task. Brain Sci 2020; 10:brainsci10060404. [PMID: 32630571 PMCID: PMC7349824 DOI: 10.3390/brainsci10060404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/20/2020] [Accepted: 06/23/2020] [Indexed: 02/05/2023] Open
Abstract
Transcutaneous auricular Vagal Nerve Stimulation (taVNS) is a non-invasive brain stimulation technique associated with possible modulation of norepinephrinergic (NE) activity. NE is suspected to contribute to generation of the P3 event-related potential. Recent evidence has produced equivocal evidence whether taVNS influences the P3 in healthy individuals during oddball tasks. We examined the effect of taVNS on P3 amplitudes using a novel visual Bayesian oddball task, which presented 200 sequences of three stimuli. The three consecutive stimuli in each sequence are labelled Draw 1, Draw 2 and Draw 3. In total, 47 Subjects completed this visual Bayesian oddball task under randomised sham and active taVNS stimulation in parallel with an electroencephalographic (EEG) recording. We conducted exploratory analyses of the effect of taVNS on P3 amplitudes separately for Draws. We found typical oddball effects on P3 amplitudes at Draws 1 and 2, but not Draw 3. At Draw 2, the oddball effect was enhanced during active compared to sham taVNS stimulation. These data provide evidence that taVNS influences parietal P3 amplitudes under specific circumstances. Only P3 amplitudes at Draw 2 were affected, which may relate to closure of Bayesian inference after Draw 2. Our findings seemingly support previously reported links between taVNS and the NE system.
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11
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McLean BF, Balzan RP, Mattiske JK. Jumping to conclusions in the less-delusion-prone? Further evidence from a more reliable beads task. Conscious Cogn 2020; 83:102956. [PMID: 32502909 DOI: 10.1016/j.concog.2020.102956] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/10/2020] [Accepted: 05/20/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND A single meta-analysis has found that healthy people with higher delusion-proneness tend to gather less information (i.e., make fewer draws to decision, or DTD) on the beads task, although the findings of contributing studies were mixed, and the pooled effect size was small. However, using a new and more reliable "distractor sequences" beads task, we recently found a positive relationship between delusion-proneness and DTD in a healthy sample. In the current study, we re-tested this relationship in a new sample, and tested the possibility that the relationship is driven by participant's ability to understand and use odds or likelihood information ("odds literacy"). METHODS Healthy participants (N = 167) completed the distractor sequences beads task, the Peters Delusions Inventory (PDI) which measures delusion-proneness, a measure of odds literacy, and the Depression, Anxiety, and Stress scale. RESULTS PDI and DTD were positively correlated, and comparing PDI quartiles on DTD confirmed a statistically significant trend of increasing DTD with PDI quartile. Odds literacy was positively rather than negatively associated with both DTD and PDI. Anxiety was positively correlated with PDI and DTD. CONCLUSIONS We replicated our earlier finding that DTD and delusion-proneness were positively related in a non-clinical sample, but found that increased odds-literacy did not drive lower PDI and DTD, and hence did not explain their covariance. It is possible however that anxiety and co-occurring risk aversion drive increased delusion-proneness and information-gathering, potentially accounting for the positive relationship between PDI and DTD.
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Affiliation(s)
- Benjamin F McLean
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia; ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, Australia
| | - Ryan P Balzan
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia; ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, Australia.
| | - Julie K Mattiske
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
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Comparelli A, Corigliano V, Montalbani B, Bargagna P, Forcina F, Cocco G, Erbuto D, De Carolis A, Pompili M. Relationship between aberrant salience and positive emotion misrecognition in acute relapse of schizophrenia. Asian J Psychiatr 2020; 49:101975. [PMID: 32114376 DOI: 10.1016/j.ajp.2020.101975] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/14/2020] [Accepted: 02/20/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Aberrant salience is the incorrect assignment of salience or significance to innocuous stimuli, and been hypothesized to be a central mechanism in the development of psychosis. In addition to aberrant salience, social-cognitive models of psychosis suggest that the way people process information about the self is important in all stages of psychosis. The aim of the present study is to explore the relationship between aberrant salience and emotion processing in schizophrenia patients with psychotic relapse. METHODS A sample of 42 patients with relapse was recruited. Aberrant salience was measured with the Aberrant Salience Inventory (ASI). Assessment of social cognition was carried out using the Facial Emotion Identification Test (FEIT). Partial correlations were controlled for possible confounding variables. RESULTS The ASI factors "increase in meaning" and "heightened cognition" positively correlated with impaired recognition of positive emotions, and ASI total score inversely correlated to time to response to task. Most of incorrect answers corresponded to misclassification of positive emotions. CONCLUSION Our findings show that there is evidence for a relationship between aberrant salience and emotion processing during a psychotic episode; we propose that aberrant salience and alterations in emotion processing trigger the loss of modulating feedback from the external world to produce a self-referential mental state.
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Affiliation(s)
- Anna Comparelli
- Department of Psychiatry, Sant'Andrea Hospital, Sapienza University of Rome, Italy.
| | | | - Benedetta Montalbani
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy
| | - Paride Bargagna
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy
| | - Francesca Forcina
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy
| | - Gabriele Cocco
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy
| | - Denise Erbuto
- Department of Psychiatry, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Antonella De Carolis
- Department of Psychiatry, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Maurizio Pompili
- Dept. of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sant'Andrea Hospital, Sapienza University of Rome, Italy
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Nucleus accumbens activation is linked to salience in social decision making. Eur Arch Psychiatry Clin Neurosci 2019; 269:701-712. [PMID: 30361926 DOI: 10.1007/s00406-018-0947-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/19/2018] [Indexed: 10/28/2022]
Abstract
Aberrant salience may explain hasty decision making and psychotic symptoms in schizophrenia. In healthy individuals, final decisions in probabilistic reasoning tasks are related to Nucleus accumbens (Nacc) activation. However, research investigating the Nacc in social decision making is missing. Our study aimed at investigating the role of the Nacc for social decision making and its link to (aberrant) salience attribution. 47 healthy individuals completed a novel social jumping-to-conclusion (JTC) fMRI-paradigm, showing morphed faces simultaneously expressing fear and happiness. Participants decided on the 'current' emotion after each picture, and on the 'general' emotion of series of faces. Nacc activation was stronger during final decisions than in previous trials without a decision, particularly in fear rather than happiness series. A JTC-bias was associated with higher Nacc activation for last fearful, but not last happy faces. Apparently, mechanisms underlying probabilistic reasoning are also relevant for social decision making. The pattern of Nacc activation suggests salience, not reward, drives the final decision. Based on these findings, we hypothesize that aberrant salience might also explain social-cognitive deficits in schizophrenia.
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An Integrative and Mechanistic Model of Impaired Belief Updating in Schizophrenia. J Neurosci 2019; 39:5630-5633. [PMID: 31315964 DOI: 10.1523/jneurosci.0002-19.2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 01/26/2023] Open
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Moritz S, Stojisavlevic M, Göritz AS, Riehle M, Scheunemann J. Does uncertainty breed conviction? On the possible role of compensatory conviction in jumping to conclusions and overconfidence in psychosis. Cogn Neuropsychiatry 2019; 24:284-299. [PMID: 31311460 DOI: 10.1080/13546805.2019.1642863] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Jumping to conclusions (JTC) and overconfidence in errors are well established in individuals with a liability to psychosis. Experimental research suggests that subjecting individuals to dilemmas and doubt prompts a subsequent hardening of attitudes and may foster delusion-like convictions. For the present study, we examined whether this compensatory conviction process is exaggerated in individuals with a liability to psychosis and might in part explain JTC and overconfidence. Methods: A large sample of participants from the general population were screened for psychotic experiences with the Community Assessment of Psychic Experiences scale (CAPE) and then randomly allocated to either a condition in which they should experience doubt or a control condition. Participants (final sample, n = 650) were then tested on JTC and overconfidence. Results: Participants who scored high on the positive subscale of the CAPE made fewer draws to decision, showed greater confidence, and made more errors relative to low scorers. Yet, none of the parameters was modulated by experimental condition. Conclusions: Our results at present do not support the idea that JTC is elevated by a prior experience of a dilemma or doubt. Yet, this possibility should not be entirely dismissed as the presumed process may take time to evolve and perhaps needs to be more pervasive.
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Affiliation(s)
- Steffen Moritz
- a Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Marko Stojisavlevic
- a Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Anja S Göritz
- b Department of Occupational and Consumer Psychology, University of Freiburg , Freiburg , Germany
| | - Marcel Riehle
- a Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Jakob Scheunemann
- a Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
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Bronstein MV, Pennycook G, Joormann J, Corlett PR, Cannon TD. Dual-process theory, conflict processing, and delusional belief. Clin Psychol Rev 2019; 72:101748. [PMID: 31226640 DOI: 10.1016/j.cpr.2019.101748] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/25/2019] [Accepted: 06/11/2019] [Indexed: 01/10/2023]
Abstract
Many reasoning biases that may contribute to delusion formation and/or maintenance are common in healthy individuals. Research indicating that reasoning in the general population proceeds via analytic processes (which depend upon working memory and support hypothetical thought) and intuitive processes (which are autonomous and independent of working memory) may therefore help uncover the source of these biases. Consistent with this possibility, recent studies imply that impaired conflict processing might reduce engagement in analytic reasoning, thereby producing reasoning biases and promoting delusions in individuals with schizophrenia. Progress toward understanding this potential pathway to delusions is currently impeded by ambiguity about whether any of these deficits or biases is necessary or sufficient for the formation and maintenance of delusions. Resolving this ambiguity requires consideration of whether particular cognitive deficits or biases in this putative pathway have causal primacy over other processes that may also participate in the causation of delusions. Accordingly, the present manuscript critically evaluates whether impaired conflict processing is the primary initiating deficit in the generation of reasoning biases that may promote the development and/or maintenance of delusions. Suggestions for future research that may elucidate mechanistic pathways by which reasoning deficits might engender and maintain delusions are subsequently offered.
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Affiliation(s)
- Michael V Bronstein
- Department of Psychology, Yale University, 2 Hillhouse Ave, New Haven, CT, USA.
| | - Gordon Pennycook
- Hill/Levene Schools of Business, University of Regina, Regina, Saskatchewan, Canada
| | - Jutta Joormann
- Department of Psychology, Yale University, 2 Hillhouse Ave, New Haven, CT, USA
| | - Philip R Corlett
- Department of Psychiatry, Yale University, 300 George Street, New Haven, CT, USA
| | - Tyrone D Cannon
- Department of Psychology, Yale University, 2 Hillhouse Ave, New Haven, CT, USA; Department of Psychiatry, Yale University, 300 George Street, New Haven, CT, USA
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Giusti L, Ussorio D, Salza A, Malavolta M, Aggio A, Bianchini V, Casacchia M, Roncone R. Preliminary study of effects on paranoia ideation and jumping to conclusions in the context of group treatment of anxiety disorders in young people. Early Interv Psychiatry 2018; 12:1072-1080. [PMID: 28124444 DOI: 10.1111/eip.12415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 09/22/2016] [Accepted: 10/25/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND People with anxiety disorders tend to focus on unpleasant and threatening stimuli. Our aims were to evaluate: (1) the presence of paranoid ideation, and the jumping to conclusions (JTC) bias in young suffering from an anxiety disorder and (2) the effectiveness of a cognitive-behavioural intervention (CBT) to manage anxiety combined with 2 modules to reduce the JTC bias. METHODS Psychopathology, social functioning, metacognition and the JTC bias were investigated in 60 subjects, randomly assigned to the experimental CBT group + treatment-as-usual (TAU) (n = 35) or to a wait-list group (n = 25) receiving only TAU. Each group was divided into 2 subgroups based on the score of the SCL-90 subscale paranoid ideation (high paranoid ideation, HP; low paranoid ideation, LP). The experimental group received a weekly session of a CBT for a 3-month period. RESULTS At baseline, 46.7% of our sample showed a HP and 38% showed a JTC biasAt the end of the intervention, greater effectiveness in improving anxious symptoms, paranoid ideation, interpersonal sensitivity and interpersonal relationship was reported in the experimental CBT + TAU group, with a statistically significant reduction of the JTC bias, displayed by 14.3% of the experimental group versus the 36% of the TAU group. In the same variables, greater benefits were reported for the HP experimental subgroup. CONCLUSIONS Our study suggests the gains to integrate an anxiety CBT with modules to reduce the JTC bias in subjects with paranoid ideation, which may negatively impact the course of the disease.
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Affiliation(s)
- Laura Giusti
- Department of Life, Health and Environmental Sciences, Early Interventions University Unit, Trattamenti Riabilitativi psicosociali, Interventi Precoci, TRIP, Psychosocial Rehabilitation Treatment, University of L'Aquila, L'Aquila, Italy
| | - Donatella Ussorio
- Department of Life, Health and Environmental Sciences, Early Interventions University Unit, Trattamenti Riabilitativi psicosociali, Interventi Precoci, TRIP, Psychosocial Rehabilitation Treatment, University of L'Aquila, L'Aquila, Italy
| | - Anna Salza
- Department of Life, Health and Environmental Sciences, Early Interventions University Unit, Trattamenti Riabilitativi psicosociali, Interventi Precoci, TRIP, Psychosocial Rehabilitation Treatment, University of L'Aquila, L'Aquila, Italy
| | - Maurizio Malavolta
- Department of Life, Health and Environmental Sciences, Early Interventions University Unit, Trattamenti Riabilitativi psicosociali, Interventi Precoci, TRIP, Psychosocial Rehabilitation Treatment, University of L'Aquila, L'Aquila, Italy
| | - Annalisa Aggio
- Department of Life, Health and Environmental Sciences, Early Interventions University Unit, Trattamenti Riabilitativi psicosociali, Interventi Precoci, TRIP, Psychosocial Rehabilitation Treatment, University of L'Aquila, L'Aquila, Italy
| | - Valeria Bianchini
- Department of Life, Health and Environmental Sciences, Early Interventions University Unit, Trattamenti Riabilitativi psicosociali, Interventi Precoci, TRIP, Psychosocial Rehabilitation Treatment, University of L'Aquila, L'Aquila, Italy
| | - Massimo Casacchia
- Department of Life, Health and Environmental Sciences, Early Interventions University Unit, Trattamenti Riabilitativi psicosociali, Interventi Precoci, TRIP, Psychosocial Rehabilitation Treatment, University of L'Aquila, L'Aquila, Italy
| | - Rita Roncone
- Department of Life, Health and Environmental Sciences, Early Interventions University Unit, Trattamenti Riabilitativi psicosociali, Interventi Precoci, TRIP, Psychosocial Rehabilitation Treatment, University of L'Aquila, L'Aquila, Italy
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Andreou C, Steinmann S, Leicht G, Kolbeck K, Moritz S, Mulert C. fMRI correlates of jumping-to-conclusions in patients with delusions: Connectivity patterns and effects of metacognitive training. NEUROIMAGE-CLINICAL 2018; 20:119-127. [PMID: 30094162 PMCID: PMC6077165 DOI: 10.1016/j.nicl.2018.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/14/2018] [Accepted: 07/03/2018] [Indexed: 12/17/2022]
Abstract
Background Reasoning biases such as the jumping-to-conclusions bias (JTC) are thought to contribute to delusions. Interventions targeting these biases such as metacognitive training (MCT) may improve delusions. So far, it is not clear whether JTC depends on dopaminergic reward areas that constitute the main action locus of antipsychotic drugs, or on additional cortical areas. The present study aimed to investigate fMRI activation and functional connectivity patterns underlying JTC, and their changes following MCT, in patients with delusions. Methods Participants were 25 healthy individuals and 26 patients with current delusions who were either medication-free or on stable medication without sufficient response. We assessed (1) BOLD activity in the task-positive (TPN), task-negative (TNN), and subcortical reward network (RN); (2) Psychophysiological interactions (PPI) of peak activation areas. Results Presence of JTC (irrespective of group) was associated with lower RN activity during conclusion events, and with increased effective connectivity between TPN and TNN during draw events. Following MCT, changes were observed in TPN activity and in effective connectivity of inferior parietal cortex (part of the TPN) with all three target networks. Conclusion JTC is associated not only with reward system areas that constitute the main target of antipsychotic drugs, but also with cortical areas, particularly of the TPN. Faulty evidence gathering (jumping to conclusions, JTC) is associated with delusions. We assessed data gathering with fMRI in patients with delusions vs healthy controls. JTC was associated with abnormal activity and connectivity patterns. Changes in the task-positive network were observed following metacognitive training.
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Affiliation(s)
- Christina Andreou
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland; Neuropsychology Unit, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Saskia Steinmann
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gregor Leicht
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Kolbeck
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Neuropsychology Unit, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Neuropsychology Unit, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Mulert
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Centre for Psychiatry and Psychotherapy, Justus-Liebig-University, Giessen, Germany
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Andreou C, Veckenstedt R, Lüdtke T, Bozikas VP, Moritz S. Differential relationship of jumping-to-conclusions and incorrigibility with delusion severity. Psychiatry Res 2018; 264:297-301. [PMID: 29660572 DOI: 10.1016/j.psychres.2018.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 02/05/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
Abstract
Reasoning biases such as jumping-to-conclusions (JTC) and incorrigibility have been suggested to contribute to the generation and maintenance of delusions. However, it is still debated whether these biases represent stable traits of patients with delusions, or are related to state fluctuations of delusion severity. The present study aimed to elucidate this question by combining a cross-sectional with a longitudinal approach. JTC, incorrigibility and delusion severity were assessed in 79 patients with a history of delusions over a 6-month period. To allow for a differentiated look into effects of time vs. symptom changes, patients were divided into patients with (D+) and without (D-) current delusions at baseline. Significant improvement of delusions was noted in D+ at follow-up. JTC did not differ between the two patient groups either at baseline or over time. In contrast, incorrigibility was significantly higher in D+ than D- at baseline; this difference remained stable throughout the 6-month follow-up period. The two biases did not significantly co-vary over time. Our results suggest a dissociation between incorrigibility and JTC as regards their relation to current presence of delusions, and tentatively support theoretical accounts attributing different roles to the two biases in the generation (JTC) and maintenance (incorrigibility) of delusions.
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Affiliation(s)
- Christina Andreou
- Center for Psychotic Disorders, University of Basel Psychiatric Clinics, Basel, Switzerland; Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Ruth Veckenstedt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thies Lüdtke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vasilis P Bozikas
- 1st Department of Psychiatry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Rüegg N, Moritz S, Westermann S. Metacognitive Training Online. ZEITSCHRIFT FÜR NEUROPSYCHOLOGIE 2018. [DOI: 10.1024/1016-264x/a000213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Abstract. Psychological interventions such as cognitive-behavioral therapy and metacognitive training (MCT) have proven to be effective treatments for schizophrenia, but only a small number of patients actually gain access to them. Internet-based interventions are effective, but hardly explored for schizophrenia. This pilot study created an Online-MCT to investigate the feasibility, efficacy, and possible negative effects of the program. Fifteen patients participated in this uncontrolled study. During the 6-week intervention phase, two-thirds of participants completed the whole program. Only 6.1 % of all possible negative effects were strongly agreed to. Symptom severity did not change significantly, but 80 % of participants were (very) satisfied with the program, suggesting that internet-based interventions could help reduce the gap in psychological treatments of schizophrenia.
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Affiliation(s)
- Nina Rüegg
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Switzerland
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Germany
| | - Stefan Westermann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Switzerland
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Negative affect and a fluctuating jumping to conclusions bias predict subsequent paranoia in daily life: An online experience sampling study. J Behav Ther Exp Psychiatry 2017; 56:106-112. [PMID: 27639287 DOI: 10.1016/j.jbtep.2016.08.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/22/2016] [Accepted: 08/27/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Negative affect and a tendency to "jump to conclusions" (JTC) are associated with paranoia. So far, only negative affect has been examined as a precursor of subsequent paranoia in daily life using experience sampling (ESM). We addressed this research gap and used ESM to test whether JTC fluctuates in daily life, whether it predicts subsequent paranoia, and whether it mediates the effect of negative affect on paranoia. METHODS Thirty-five participants with schizophrenia spectrum disorders repeatedly self-reported negative affect, JTC, and paranoia via online questionnaires on two consecutive days. We measured JTC with a paradigm consisting of ambiguous written scenarios. Multilevel linear models were conducted. RESULTS Most participants showed JTC consistently on two days rather than only on one day. When time was used as a predictor of JTC, significant slope variance indicated that for a subgroup of participants JTC fluctuated over time. For 48% of participants, these fluctuations equaled changes of approximately ±1 point on the four-point JTC scale within one day. There was no mediation. However, negative affect and JTC both significantly predicted subsequent paranoia. LIMITATIONS The ESM assessment period was short and encompassed few assessments (8 in total). CONCLUSIONS Our findings indicate that JTC is both stable (regarding its mere occurrence) and fluctuating simultaneously (regarding its magnitude). Although JTC was not a mediator linking negative affect and paranoia, it did predict paranoia. Further ESM studies on JTC are needed to confirm our findings in longer assessment periods and with other JTC paradigms.
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Abstract
INTRODUCTION Biases in causal attributions and evidence integration have been implicated in delusions, but have not been investigated simultaneously to examine additive or multiplicative effects. It was hypothesised that paranoid delusions would correlate with self-serving and personalising biases ("defence" model of paranoia), particularly when these biases were disconfirmed. METHODS Constrained principal component analysis was used to investigate differences between schizophrenia patients (paranoid vs. non-paranoid), bipolar disorder patients, and healthy controls, as well as to examine the extent to which psychotic symptoms could predict patterns of responding on a novel attributional bias task (Attributional Style BADE, or ASB) that requires integrating contextual information. RESULTS Although no group differences were found, disorganisation and manic symptoms correlated with situation attributions and self-blame when such attributions were unsupported by the available evidence, and depression and anxiety correlated with other-person and self attributions (not situation attributions) when confirmed by the available evidence, regardless of diagnosis. CONCLUSIONS While group differences accounted for little variance in responses on the ASB task, a transdiagnostic association between symptoms of psychosis and the ASB task was observed. This highlights the importance of considering symptom profiles rather than diagnostic groupings when investigating cognitive biases and related non-pharmacological treatments.
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Affiliation(s)
- Nicole Sanford
- a Department of Psychiatry , University of British Columbia , Vancouver , Canada.,b BC Children's Hospital Research Institute , Vancouver , Canada
| | - Todd S Woodward
- a Department of Psychiatry , University of British Columbia , Vancouver , Canada.,b BC Children's Hospital Research Institute , Vancouver , Canada
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McLean BF, Mattiske JK, Balzan RP. Association of the Jumping to Conclusions and Evidence Integration Biases With Delusions in Psychosis: A Detailed Meta-analysis. Schizophr Bull 2017; 43:344-354. [PMID: 27169465 PMCID: PMC5605251 DOI: 10.1093/schbul/sbw056] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We completed a meta-analysis to investigate the relationship between delusions in psychosis and 4 cognitive biases: "jumping to conclusions" (JTC), the "bias against disconfirmatory evidence" (BADE), the "bias against confirmatory evidence" (BACE), and "liberal acceptance" (LA). Building on recent meta-analyses we compared more narrowly defined groups. We identified 35 JTC, 8 BADE, 7 BACE, and 6 LA studies for inclusion. Groups with schizophrenia who were currently experiencing delusions demonstrated greater JTC, BADE, BACE, and LA than groups with schizophrenia who were not currently experiencing delusions, who in turn demonstrated no more JTC than healthy control groups. Hence JTC, BADE, BACE, and LA co-vary with delusions in cross-sectional samples of people with schizophrenia. Groups who were experiencing delusions due to other psychiatric illnesses also demonstrated greater JTC than healthy controls, and equivalent JTC to groups with schizophrenia currently experiencing delusions. Hence JTC is associated with delusions across a range of diagnoses. Groups with other, non-delusional psychiatric illnesses demonstrated less JTC, BADE, BACE, and LA than groups with schizophrenia currently experiencing delusions, less JTC than groups experiencing delusions due to other diagnoses, and no more JTC, BADE, BACE, or LA than healthy control groups. Hence JTC, BADE, BACE, and LA were not associated with psychiatric illnesses in general. Our results indicate all 4 biases are associated with delusions specifically rather than merely with a diagnosis of schizophrenia or with being psychiatrically ill, consistent with the possibility that they contribute to delusional severity.
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Affiliation(s)
- Benjamin F. McLean
- School of Psychology, Flinders University, Adelaide, Australia;,ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, Australia
| | | | - Ryan P. Balzan
- School of Psychology, Flinders University, Adelaide, Australia;,ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, Australia
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Batty RA, Francis A, Thomas N, Hopwood M, Ponsford J, Rossell SL. Who "jumps to conclusions"? A comprehensive assessment of probabilistic reasoning in psychosis following traumatic brain injury (PFTBI), and comparison with TBI, schizophrenia, and nonclinical controls. Cogn Neuropsychiatry 2016; 21:32-44. [PMID: 27031119 DOI: 10.1080/13546805.2015.1127221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The "jumping to conclusions" (JTC) bias has received significant attention in the schizophrenia and delusion literature as an important aspect of cognition characterising psychosis. The JTC bias has not been explored in psychosis following traumatic brain injury (PFTBI). METHODS JTC was investigated in 10 patients with PFTBI using the beads task (ratios 85:15 and 60:40). Probabilistic predictions, draws-to-decision, self-rated decision confidence, and JTC bias were recorded. Responses from 10 patients with traumatic brain injury (TBI), 23 patients with schizophrenia, and 23 nonclinical controls were compared. Relationships were explored between draws-to-decision and current intelligence quotient, affective state, executive function, delusions (severity and type), and illness chronicity (duration). RESULTS Groups were comparable on JTC measures. Delusion severity and type were not related to draws-to-decision for either trial. In the entire sample, executive function (reduced mental flexibility) was significantly related to more draws-to-decision on the 60:40 ratio trial. CONCLUSIONS We found no evidence for an elevated JTC bias in patients with PFTBI or TBI alone. The influence of executive dysfunction should be considered by future studies using the beads tasks in patient populations. These findings need to be replicated in larger PFTBI and TBI samples.
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Affiliation(s)
- Rachel A Batty
- a Brain and Psychological Sciences Research Centre (BPsyC) , Swinburne University of Technology , Melbourne , VIC , Australia.,b Monash-Alfred Psychiatry Research Centre (MAPrc) , Melbourne , VIC , Australia.,c Health Sciences, RMIT University , Bundoora , VIC , Australia
| | - Andrew Francis
- c Health Sciences, RMIT University , Bundoora , VIC , Australia
| | - Neil Thomas
- a Brain and Psychological Sciences Research Centre (BPsyC) , Swinburne University of Technology , Melbourne , VIC , Australia.,b Monash-Alfred Psychiatry Research Centre (MAPrc) , Melbourne , VIC , Australia
| | - Malcolm Hopwood
- d Department of Psychiatry , University of Melbourne , Albert Road Clinic, Melbourne , VIC , Australia
| | - Jennie Ponsford
- e Monash-Epworth Rehabilitation Research Centre , Epworth Hospital , Richmond , VIC , Australia
| | - Susan L Rossell
- a Brain and Psychological Sciences Research Centre (BPsyC) , Swinburne University of Technology , Melbourne , VIC , Australia.,b Monash-Alfred Psychiatry Research Centre (MAPrc) , Melbourne , VIC , Australia
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‘Jumping to conclusions’ data-gathering bias in psychosis and other psychiatric disorders — Two meta-analyses of comparisons between patients and healthy individuals. Clin Psychol Rev 2016; 46:151-67. [DOI: 10.1016/j.cpr.2016.05.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 03/30/2016] [Accepted: 05/11/2016] [Indexed: 11/21/2022]
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Dudley R, Taylor P, Wickham S, Hutton P. Psychosis, Delusions and the "Jumping to Conclusions" Reasoning Bias: A Systematic Review and Meta-analysis. Schizophr Bull 2016; 42:652-65. [PMID: 26519952 PMCID: PMC4838082 DOI: 10.1093/schbul/sbv150] [Citation(s) in RCA: 191] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We did a systematic review and meta-analysis to investigate the magnitude and specificity of the "jumping to conclusions" (JTC) bias in psychosis and delusions. We examined the extent to which people with psychosis, and people with delusions specifically, required less information before making decisions. We examined (1) the average amount of information required to make a decision and (2) numbers who demonstrated an extreme JTC bias, as assessed by the "beads task." We compared people with psychosis to people with and without nonpsychotic mental health problems, and people with psychosis with and without delusions. We examined whether reduced data-gathering was associated with increased delusion severity. We identified 55 relevant studies, and acquired previously unpublished data from 16 authors. People with psychosis required significantly less information to make decisions than healthy individuals (k= 33,N= 1935,g= -0.53, 95% CI -0.69, -0.36) and those with nonpsychotic mental health problems (k= 13,N= 667,g= -0.58, 95% CI -0.80, -0.35). The odds of extreme responding in psychosis were between 4 and 6 times higher than the odds of extreme responding by healthy participants and participants with nonpsychotic mental health problems. The JTC bias was linked to a greater probability of delusion occurrence in psychosis (k= 14,N= 770, OR 1.52, 95% CI 1.12, 2.05). There was a trend-level inverse association between data-gathering and delusion severity (k= 18;N= 794;r= -.09, 95% CI -0.21, 0.03). Hence, nonaffective psychosis is characterized by a hasty decision-making style, which is linked to an increased probability of delusions.
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Affiliation(s)
- Robert Dudley
- School of Psychology, Newcastle University, Newcastle Upon Tyne, UK; Early Intervention in Psychosis Service, Northumberland, Tyne and Wear NHS Foundation Trust, Gateshead, UK;
| | - Peter Taylor
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Sophie Wickham
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Paul Hutton
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
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Banca P, Lange I, Worbe Y, Howell NA, Irvine M, Harrison NA, Moutoussis M, Voon V. Reflection impulsivity in binge drinking: behavioural and volumetric correlates. Addict Biol 2016; 21:504-15. [PMID: 25678093 PMCID: PMC4766871 DOI: 10.1111/adb.12227] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The degree to which an individual accumulates evidence prior to making a decision, also known as reflection impulsivity, can be affected in psychiatric disorders. Here, we study decisional impulsivity in binge drinkers, a group at elevated risk for developing alcohol use disorders, comparing two tasks assessing reflection impulsivity and a delay discounting task, hypothesizing impairments in both subtypes of impulsivity. We also assess volumetric correlates of reflection impulsivity focusing on regions previously implicated in functional magnetic resonance imaging studies. Sixty binge drinkers and healthy volunteers were tested using two different information-gathering paradigms: the beads task and the Information Sampling Task (IST). The beads task was analysed using a behavioural approach and a Bayesian model of decision making. Delay discounting was assessed using the Monetary Choice Questionnaire. Regression analyses of primary outcomes were conducted with voxel-based morphometry analyses. Binge drinkers sought less evidence prior to decision in the beads task compared with healthy volunteers in both the behavioural and computational modelling analysis. There were no group differences in the IST or delay discounting task. Greater impulsivity as indexed by lower evidence accumulation in the beads task was associated with smaller dorsolateral prefrontal cortex and inferior parietal volumes. In contrast, greater impulsivity as indexed by lower evidence accumulation in the IST was associated with greater dorsal cingulate and precuneus volumes. Binge drinking is characterized by impaired reflection impulsivity suggesting a deficit in deciding on the basis of future outcomes that are more difficult to represent. These findings emphasize the role of possible therapeutic interventions targeting decision-making deficits.
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Affiliation(s)
- Paula Banca
- Department of PsychiatryUniversity of CambridgeUK
- PhD Programme in Experimental Biology and BiomedicineCenter for Neuroscience and Cell BiologyUniversity of CoimbraPortugal
- Institute for Biomedical Imaging and Life SciencesFaculty of MedicineUniversity of CoimbraPortugal
| | - Iris Lange
- Department of PsychiatryUniversity of CambridgeUK
| | - Yulia Worbe
- Behavioural and Clinical Neurosciences InstituteUniversity of CambridgeUK
| | | | | | | | - Michael Moutoussis
- The Wellcome Trust Centre for NeuroimagingInstitute of NeurologyUniversity College LondonUK
| | - Valerie Voon
- Department of PsychiatryUniversity of CambridgeUK
- Behavioural and Clinical Neurosciences InstituteUniversity of CambridgeUK
- Cambridgeshire and Peterborough NHS Foundation TrustUK
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Schneider BC, Brüne M, Bohn F, Veckenstedt R, Kolbeck K, Krieger E, Becker A, Drommelschmidt KA, Englisch S, Eisenacher S, Lee-Grimm SI, Nagel M, Zink M, Moritz S. Investigating the efficacy of an individualized metacognitive therapy program (MCT+) for psychosis: study protocol of a multi-center randomized controlled trial. BMC Psychiatry 2016; 16:51. [PMID: 26921116 PMCID: PMC4769526 DOI: 10.1186/s12888-016-0756-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 02/18/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Psychological interventions are increasingly recommended as adjunctive treatments for psychosis, but their implementation in clinical practice is still insufficient. The individualized metacognitive therapy program (MCT+; www.uke.de/mct_plus ) represents a low-threshold psychotherapeutic approach that synthesizes group metacognitive training (MCT) and cognitive behavioral therapy for psychosis, and addresses specific cognitive biases that are involved in the onset and maintenance of psychosis. It aims to "plant the seed of doubt" regarding rigid delusional convictions and to encourage patients to critically reflect, extend and change their approach to problem solving. Its second edition also puts more emphasis on affective symptoms. A recent meta-analysis of metacognitive interventions (MCT, MCT+) indicate small to moderate effects on positive symptoms and delusions, as well as high rates of acceptance. Nonetheless, no long-term studies of MCT+ involving large samples have been conducted. METHODS The goal of the present multi-center, observer-blind, parallel-group, randomized controlled trial is to compare the efficacy of MCT+ against an active control (cognitive remediation; MyBrainTraining(©)) in 328 patients with psychosis at three time points (baseline, immediately after intervention [6 weeks] and 6 months later). The primary outcome is change in psychosis symptoms over the 6-month follow-up period as assessed by the delusion subscale of the Psychotic Symptom Rating Scale. Secondary outcomes include jumping to conclusions, other positive symptoms of schizophrenia, depressive symptoms, self-esteem, quality of life, and cognitive insight. The study also seeks to elucidate mediating factors that promote versus impede symptom improvement across time. DISCUSSION This is the first multi-center randomized controlled trial to test the efficacy of individualized MCT+ in a large sample of patients with psychosis. The rationale for the trial, the design, and the strengths and limitations of the study are discussed. TRIAL REGISTRATION The trial is registered through the German Clinical Trials Register ( www.drks.de ) as DRKS00008001 . Registered 6 May 2015.
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Affiliation(s)
- Brooke C Schneider
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Martin Brüne
- LWL University Hospital Bochum, Department of Psychiatry, Psychotherapy and Preventative Medicine, Division of Cognitive Neuropsychiatry and Psychiatric Preventative Medicine, Ruhr-University Bochum, Bochum, Germany.
| | - Francesca Bohn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Ruth Veckenstedt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Katharina Kolbeck
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- Department of Psychiatry and Psychotherapy, Asklepios North-Wandsbek, Hamburg, Germany.
| | - Eva Krieger
- Department of Psychiatry and Psychotherapy, Asklepios North-Wandsbek, Hamburg, Germany.
| | - Anna Becker
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Kim Alisha Drommelschmidt
- LWL University Hospital Bochum, Department of Psychiatry, Psychotherapy and Preventative Medicine, Division of Cognitive Neuropsychiatry and Psychiatric Preventative Medicine, Ruhr-University Bochum, Bochum, Germany.
| | - Susanne Englisch
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Sarah Eisenacher
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Sie-In Lee-Grimm
- LWL University Hospital Bochum, Department of Psychiatry, Psychotherapy and Preventative Medicine, Division of Cognitive Neuropsychiatry and Psychiatric Preventative Medicine, Ruhr-University Bochum, Bochum, Germany.
| | - Matthias Nagel
- Department of Psychiatry and Psychotherapy, Asklepios North-Wandsbek, Hamburg, Germany.
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany.
| | - Mathias Zink
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Affiliation(s)
- Ryan P. Balzan
- School of Psychology, Flinders University, GPO Box 2100 Adelaide, SA 5001, Australia
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Andreou C, Schneider BC, Braun V, Kolbeck K, Gallinat J, Moritz S. Dopamine effects on evidence gathering and integration. J Psychiatry Neurosci 2015; 40. [PMID: 26197302 PMCID: PMC4622641 DOI: 10.1503/jpn.140306] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Disturbances in evidence gathering and disconfirmatory evidence integration have been associated with the presence of or propensity for delusions. Previous evidence suggests that these 2 types of reasoning bias might be differentially affected by antipsychotic medication. We aimed to investigate the effects of a dopaminergic agonist (L-dopa) and a dopaminergic antagonist (haloperidol) on evidence gathering and disconfirmatory evidence integration after single-dose administration in healthy individuals. METHODS The study used a randomized, double-blind, placebo-controlled, 3-way crossover design. Participants were healthy individuals aged 18-40 years. We administered a new data-gathering task designed to increase sensitivity to change compared with traditional tasks. The Bias Against Disconfirmatory Evidence (BADE) task was used as a measure of disconfirmatory evidence integration. RESULTS We included 30 individuals in our study. In the data-gathering task, dopaminergic modulation had no significant effect on the amount of evidence gathered before reaching a decision. In contrast, the ability of participants to integrate disconfirmatory evidence showed a significant linear dopaminergic modulation pattern (highest with haloperidol, intermediate with placebo, lowest with L-dopa), with the difference between haloperidol and L-dopa marginally reaching significance. LIMITATIONS Although the doses used for haloperidol and L-dopa were similar to those used in previous studies, drug plasma level measurements would have added to the validity of findings. CONCLUSION Evidence gathering and disconfirmatory evidence integration might be differentially influenced by dopaminergic agents. Our findings are in support of a dual-disturbance account of delusions and provide a plausible neurobiological basis for the use of interventions targeted at improving reasoning biases as an adjunctive treatment in patients with psychotic disorders.
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Affiliation(s)
- Christina Andreou
- Correspondence to: C. Andreou, University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistrasse 52, 20246 Hamburg, Germany;
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Anxious but Thoroughly Informed? No Jumping-to-Conclusions Bias in Social Anxiety Disorder. COGNITIVE THERAPY AND RESEARCH 2015. [DOI: 10.1007/s10608-015-9724-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ross RM, McKay R, Coltheart M, Langdon R. Jumping to Conclusions About the Beads Task? A Meta-analysis of Delusional Ideation and Data-Gathering. Schizophr Bull 2015; 41:1183-91. [PMID: 25616503 PMCID: PMC4535629 DOI: 10.1093/schbul/sbu187] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
It has been claimed that delusional and delusion-prone individuals have a tendency to gather less data before forming beliefs. Most of the evidence for this "jumping to conclusions" (JTC) bias comes from studies using the "beads task" data-gathering paradigm. However, the evidence for the JTC bias is mixed. We conducted a random-effects meta-analysis of individual participant data from 38 clinical and nonclinical samples (n = 2,237) to investigate the relationship between data gathering in the beads task (using the "draws to decision" measure) and delusional ideation (as indexed by the "Peters et al Delusions Inventory"; PDI). We found that delusional ideation is negatively associated with data gathering (r(s) = -0.10, 95% CI [-0.17, -0.03]) and that there is heterogeneity in the estimated effect sizes (Q-stat P = .03, I(2) = 33). Subgroup analysis revealed that the negative association is present when considering the 23 samples (n = 1,754) from the large general population subgroup alone (r(s) = -0.10, 95% CI [-0.18, -0.02]) but not when considering the 8 samples (n = 262) from the small current delusions subgroup alone (r(s) = -0.12, 95% CI [-0.31, 0.07]). These results provide some provisional support for continuum theories of psychosis and cognitive models that implicate the JTC bias in the formation and maintenance of delusions.
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Affiliation(s)
- Robert Malcolm Ross
- ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, NSW, Australia; Department of Cognitive Science, Macquarie University, Sydney, NSW, Australia;
| | - Ryan McKay
- ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, NSW, Australia;,Department of Psychology, Royal Holloway, University of London, Egham, Surrey, UK
| | - Max Coltheart
- ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, NSW, Australia;,Department of Cognitive Science, Macquarie University, Sydney, NSW, Australia;
| | - Robyn Langdon
- ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, NSW, Australia;,Department of Cognitive Science, Macquarie University, Sydney, NSW, Australia;
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van der Leer L, Hartig B, Goldmanis M, McKay R. Delusion proneness and 'jumping to conclusions': relative and absolute effects. Psychol Med 2015; 45:1253-1262. [PMID: 25272196 DOI: 10.1017/s0033291714002359] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND That delusional and delusion-prone individuals 'jump to conclusions' is one of the most robust and important findings in the literature on delusions. However, although the notion of 'jumping to conclusions' (JTC) implies gathering insufficient evidence and reaching premature decisions, previous studies have not investigated whether the evidence gathering of delusion-prone individuals is, in fact, suboptimal. The standard JTC effect is a relative effect but using relative comparisons to substantiate absolute claims is problematic. In this study we investigated whether delusion-prone participants jump to conclusions in both a relative and an absolute sense. METHOD Healthy participants (n = 112) completed an incentivized probabilistic reasoning task in which correct decisions were rewarded and additional information could be requested for a small price. This combination of rewards and costs generated optimal decision points. Participants also completed measures of delusion proneness, intelligence and risk aversion. RESULTS Replicating the standard relative finding, we found that delusion proneness significantly predicted task decisions, such that the more delusion prone the participants were, the earlier they decided. This finding was robust when accounting for the effects of risk aversion and intelligence. Importantly, high-delusion-prone participants also decided in advance of an objective rational optimum, gathering fewer data than would have maximized their expected payoff. Surprisingly, we found that even low-delusion-prone participants jumped to conclusions in this absolute sense. CONCLUSIONS Our findings support and clarify the claim that delusion formation is associated with a tendency to 'jump to conclusions'. In short, most people jump to conclusions, but more delusion-prone individuals 'jump further'.
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Affiliation(s)
- L van der Leer
- ARC Centre of Excellence in Cognition and its Disorders,Department of Psychology,Royal Holloway,University of London,Egham,Surrey,UK
| | - B Hartig
- Department of Economics,Royal Holloway,University of London,Egham,Surrey,UK
| | - M Goldmanis
- Department of Economics,Royal Holloway,University of London,Egham,Surrey,UK
| | - R McKay
- ARC Centre of Excellence in Cognition and its Disorders,Department of Psychology,Royal Holloway,University of London,Egham,Surrey,UK
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Andreou C, Schneider BC, Balzan R, Luedecke D, Roesch-Ely D, Moritz S. Neurocognitive deficits are relevant for the jumping-to-conclusions bias, but not for delusions: A longitudinal study. SCHIZOPHRENIA RESEARCH-COGNITION 2015; 2:8-11. [PMID: 29379755 PMCID: PMC5779293 DOI: 10.1016/j.scog.2015.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 02/08/2015] [Accepted: 02/13/2015] [Indexed: 11/28/2022]
Abstract
Patients with delusions exhibit an increased tendency to arrive at decisions based on very limited evidence (jumping-to-conclusions; JTC), making this reasoning bias relevant for the treatment of delusions. Neurocognitive deficits contribute to JTC, but it is not known whether this has any bearing on the clinical syndrome of delusions. We addressed this question by reanalyzing data from an efficacy study of non-pharmacological interventions as adjunctive treatments in schizophrenia. We investigated the longitudinal associations of cognitive functioning, JTC and delusions in patients with psychotic disorders receiving either a metacognitive intervention addressing reasoning biases (n = 59), or cognitive remediation (n = 58). Both interventions improved JTC; in the cognitive remediation group, tentative evidence suggested that better neurocognitive performance contributed to this improvement. However, JTC gains were associated with delusion improvement only in the metacognitive intervention group, suggesting a content-specific mechanism of action.
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Affiliation(s)
- Christina Andreou
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Brooke C Schneider
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Ryan Balzan
- School of Psychology, Flinders University, Sturt Road, Bedford Park 5042, South Australia, Australia
| | - Daniel Luedecke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Daniela Roesch-Ely
- Department of General Adult Psychiatry, University of Heidelberg, Vossstrasse 2, 69115 Heidelberg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Falcone MA, Murray RM, Wiffen BDR, O’Connor JA, Russo M, Kolliakou A, Stilo S, Taylor H, Gardner-Sood P, Paparelli A, Jichi F, Di Forti M, David AS, Freeman D, Jolley S. Jumping to conclusions, neuropsychological functioning, and delusional beliefs in first episode psychosis. Schizophr Bull 2015; 41:411-8. [PMID: 25053654 PMCID: PMC4332946 DOI: 10.1093/schbul/sbu104] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The "jumping to conclusions" (JTC) data-gathering bias is implicated in the development and maintenance of psychosis but has only recently been studied in first episode psychosis (FEP). In this study, we set out to establish the relationship of JTC in FEP with delusions and neuropsychological functioning. METHODS One hundred and eight FEP patients and 101 age-matched controls completed assessments of delusions, general intelligence (IQ), working memory (WM), and JTC (the probabilistic reasoning "beads" task). RESULTS Half the FEP participants jumped to conclusions on at least 1 task, compared with 25% of controls (OR range 2.1 to 3.9; 95% CI range 1.5 to 8.0, P values ≤ .02). JTC was associated with clinical, but not nonclinical delusion severity, and with neuropsychological functioning, irrespective of clinical status. Both IQ and delusion severity, but not WM, were independently associated with JTC in the FEP group. CONCLUSIONS JTC is present in FEP. The specific association of JTC with clinical delusions supports a state, maintaining role for the bias. The associations of JTC with neuropsychological functioning indicate a separable, trait aspect to the bias, which may confer vulnerability to psychosis. The work has potential to inform emerging interventions targeting reasoning biases in early psychosis.
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Affiliation(s)
- M. Aurora Falcone
- Department of Psychology, Institute of Psychiatry, King’s College London, London, UK;,Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK;,*To whom correspondence should be addressed; Department of Psychosis Studies, PO 52, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK; tel: +44-(0)207-848-0100, fax: +44-(0)207848-0287, e-mail:
| | - Robin M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Benjamin D. R. Wiffen
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Jennifer A. O’Connor
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Manuela Russo
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY
| | - Anna Kolliakou
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Simona Stilo
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK;,Department of Health Service and Population Research, Institute of Psychiatry, King’s College London, London, UK
| | - Heather Taylor
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Poonam Gardner-Sood
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Alessandra Paparelli
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Fatima Jichi
- Department of Biostatistics, King’s College London, Institute of Psychiatry, London, UK
| | - Marta Di Forti
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Anthony S. David
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Suzanne Jolley
- Department of Psychology, Institute of Psychiatry, King’s College London, London, UK
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Abstract
Schizophrenia is a mental disorder associated with a variety of symptoms, including hallucinations, delusions, social withdrawal, and cognitive dysfunction. Impairments on decision-making tasks are routinely reported: evidence points to a particular deficit in learning from and revising behavior following feedback. In addition, patients tend to make hasty decisions when probabilistic judgments are required. This is known as "jumping to conclusions" (JTC) and has typically been demonstrated by presenting participants with colored beads drawn from one of two "urns" until they claim to be sure which urn the beads are being drawn from (the proportions of colors vary in each urn). Patients tend to make early decisions on this task, and there is evidence to suggest that a hasty decision-making style might be linked to delusion formation and thus be of clinical relevance. Various accounts have been proposed regarding what underlies this behavior. In this review, we briefly introduce the disorder and the decision-making deficits associated with it. We then explore the evidence for each account of JTC in the context of a wider decision-making deficit and then go on to summarize work exploring JTC in healthy controls using pharmacological manipulations and functional imaging. Finally, we assess whether JTC might have a role in therapy.
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Affiliation(s)
- Simon L Evans
- School of Psychology, University of Sussex, Brighton, East Sussex, UK
| | - Bruno B Averbeck
- Laboratory of Neuropsychology, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Nicholas Furl
- Department of Psychology, Royal Holloway, University of London, Egham, Surrey, UK
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Jolley S, Thompson C, Hurley J, Medin E, Butler L, Bebbington P, Dunn G, Freeman D, Fowler D, Kuipers E, Garety P. Jumping to the wrong conclusions? An investigation of the mechanisms of reasoning errors in delusions. Psychiatry Res 2014; 219:275-82. [PMID: 24958065 PMCID: PMC4118018 DOI: 10.1016/j.psychres.2014.05.051] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 02/15/2014] [Accepted: 05/27/2014] [Indexed: 10/27/2022]
Abstract
Understanding how people with delusions arrive at false conclusions is central to the refinement of cognitive behavioural interventions. Making hasty decisions based on limited data ('jumping to conclusions', JTC) is one potential causal mechanism, but reasoning errors may also result from other processes. In this study, we investigated the correlates of reasoning errors under differing task conditions in 204 participants with schizophrenia spectrum psychosis who completed three probabilistic reasoning tasks. Psychotic symptoms, affect, and IQ were also evaluated. We found that hasty decision makers were more likely to draw false conclusions, but only 37% of their reasoning errors were consistent with the limited data they had gathered. The remainder directly contradicted all the presented evidence. Reasoning errors showed task-dependent associations with IQ, affect, and psychotic symptoms. We conclude that limited data-gathering contributes to false conclusions but is not the only mechanism involved. Delusions may also be maintained by a tendency to disregard evidence. Low IQ and emotional biases may contribute to reasoning errors in more complex situations. Cognitive strategies to reduce reasoning errors should therefore extend beyond encouragement to gather more data, and incorporate interventions focused directly on these difficulties.
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Affiliation(s)
- Suzanne Jolley
- King׳s College London, Institute of Psychiatry, Department of Psychology, London, UK.
| | - Claire Thompson
- King׳s College London, Institute of Psychiatry, Department of Psychology, London, UK
| | - James Hurley
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK
| | - Evelina Medin
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK
| | - Lucy Butler
- King׳s College London, Institute of Psychiatry, Department of Psychology, London, UK
| | | | - Graham Dunn
- Centre for Biostatistics, Institute of Population Health, The University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - David Fowler
- School of Psychology, University of Sussex, Sussex, UK
| | - Elizabeth Kuipers
- King׳s College London, Institute of Psychiatry, Department of Psychology, London, UK
| | - Philippa Garety
- King׳s College London, Institute of Psychiatry, Department of Psychology, London, UK
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Sanford N, Veckenstedt R, Moritz S, Balzan RP, Woodward TS. Impaired integration of disambiguating evidence in delusional schizophrenia patients. Psychol Med 2014; 44:2729-2738. [PMID: 25065271 DOI: 10.1017/s0033291714000397] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND It has been previously demonstrated that a cognitive bias against disconfirmatory evidence (BADE) is associated with delusions. However, small samples of delusional patients, reliance on difference scores and choice of comparison groups may have hampered the reliability of these results. In the present study we aimed to improve on this methodology with a recent version of the BADE task, and compare larger groups of schizophrenia patients with/without delusions to obsessive-compulsive disorder (OCD) patients, a population with persistent and possibly bizarre beliefs without psychosis. METHOD A component analysis was used to identify cognitive operations underlying the BADE task, and how they differ across four groups of participants: (1) high-delusional schizophrenia, (2) low-delusional schizophrenia, (3) OCD patients and (4) non-psychiatric controls. RESULTS As in past studies, two components emerged and were labelled 'evidence integration' (the degree to which disambiguating information has been integrated) and 'conservatism' (reduced willingness to provide high plausibility ratings when justified), and only evidence integration differed between severely delusional patients and the other groups, reflecting delusional subjects giving higher ratings for disconfirmed interpretations and lower ratings for confirmed interpretations. CONCLUSIONS These data support the finding that a reduced willingness to adjust beliefs when confronted with disconfirming evidence may be a cognitive underpinning of delusions specifically, rather than obsessive beliefs or other aspects of psychosis such as hallucinations, and illustrates a cognitive process that may underlie maintenance of delusions in the face of counter-evidence. This supports the possibility of the BADE operation being a useful target in cognitive-based therapies for delusions.
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Affiliation(s)
- N Sanford
- Department of Psychiatry,University of British Columbia,Vancouver, BC,Canada
| | - R Veckenstedt
- Department of Psychiatry and Psychotherapy, Clinical Neuropsychology,University Medical Centre Hamburg-Eppendorf,Germany
| | - S Moritz
- Department of Psychiatry and Psychotherapy, Clinical Neuropsychology,University Medical Centre Hamburg-Eppendorf,Germany
| | - R P Balzan
- School of Psychology,Flinders University,Australia
| | - T S Woodward
- Department of Psychiatry,University of British Columbia,Vancouver, BC,Canada
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Rausch F, Mier D, Eifler S, Esslinger C, Schilling C, Schirmbeck F, Englisch S, Meyer-Lindenberg A, Kirsch P, Zink M. Reduced activation in ventral striatum and ventral tegmental area during probabilistic decision-making in schizophrenia. Schizophr Res 2014; 156:143-9. [PMID: 24831391 DOI: 10.1016/j.schres.2014.04.020] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 03/24/2014] [Accepted: 04/19/2014] [Indexed: 11/29/2022]
Abstract
Patients with schizophrenia suffer from deficits in monitoring and controlling their own thoughts. Within these so-called metacognitive impairments, alterations in probabilistic reasoning might be one cognitive phenomenon disposing to delusions. However, so far little is known about alterations in associated brain functionality. A previously established task for functional magnetic resonance imaging (fMRI), which requires a probabilistic decision after a variable amount of stimuli, was applied to 23 schizophrenia patients and 28 healthy controls matched for age, gender and educational levels. We compared activation patterns during decision-making under conditions of certainty versus uncertainty and evaluated the process of final decision-making in ventral striatum (VS) and ventral tegmental area (VTA). We replicated a pre-described extended cortical activation pattern during probabilistic reasoning. During final decision-making, activations in several fronto- and parietocortical areas, as well as in VS and VTA became apparent. In both of these regions schizophrenia patients showed a significantly reduced activation. These results further define the network underlying probabilistic decision-making. The observed hypo-activation in regions commonly associated with dopaminergic neurotransmission fits into current concepts of disrupted prediction error signaling in schizophrenia and suggests functional links to reward anticipation. Forthcoming studies with patients at risk for psychosis and drug-naive first episode patients are necessary to elucidate the development of these findings over time and the interplay with associated clinical symptoms.
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Affiliation(s)
- Franziska Rausch
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Daniela Mier
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Sarah Eifler
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | | | - Claudia Schilling
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | | | - Susanne Englisch
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Peter Kirsch
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Mathias Zink
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany.
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Bentall RP, de Sousa P, Varese F, Wickham S, Sitko K, Haarmans M, Read J. From adversity to psychosis: pathways and mechanisms from specific adversities to specific symptoms. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1011-22. [PMID: 24919446 DOI: 10.1007/s00127-014-0914-0] [Citation(s) in RCA: 188] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 05/30/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE Although there is considerable evidence that adversities in childhood such as social deprivation, sexual abuse, separation from parents, neglect and exposure to deviant parental communication are associated with psychosis in later life, most studies have considered broad diagnoses as outcomes. In this review we consider evidence for pathways between specific types of adversity and specific symptoms of psychosis. METHODS We present theoretical arguments for expecting some degree of specificity (although by no means perfect specificity) between different kinds of adversity and different symptoms of psychosis. We review studies that have investigated social-environmental risk factors for thought disorder, auditory-verbal hallucinations and paranoid delusions, and consider how these risk factors may impact on specific psychological and biological mechanisms. RESULTS Communication deviance in parents has been implicated in the development of thought disorder in offspring, childhood sexual abuse has been particularly implicated in auditory-verbal hallucinations, and attachment-disrupting events (e.g. neglect, being brought up in an institution) may have particular potency for the development of paranoid symptoms. Current research on psychological mechanisms underlying these symptoms suggests a number of symptom-specific mechanisms that may explain these associations. CONCLUSIONS Few studies have considered symptoms, underlying mechanisms and different kinds of adversity at the same time. Future research along these lines will have the potential to elucidate the mechanisms that lead to severe mental illness, and may have considerable clinical implications.
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Lecomte T, Corbière M, Lysaker P. Une intervention cognitive comportementale de groupe pour les personnes suivies dans le cadre d’un programme de soutien en emploi (TCC-SE). Encephale 2014; 40 Suppl 2:S81-90. [DOI: 10.1016/j.encep.2014.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 04/23/2014] [Indexed: 10/25/2022]
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Whitman JC, Menon M, Kuo SS, Woodward TS. Bias in favour of self-selected hypotheses is associated with delusion severity in schizophrenia. Cogn Neuropsychiatry 2014; 18:376-89. [PMID: 22946553 DOI: 10.1080/13546805.2012.715084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Delusions are typically characterised by idiosyncratic, self-generated explanations used to interpret events, as opposed to the culturally normative interpretations. Thus, a bias in favour of one's own hypotheses may be a fundamental aspect of delusions. METHODS We tested this possibility in the current study by comparing judgements of self-selected hypotheses to judgements of externally selected ones in a probabilistic reasoning task. This allowed us to equate self- and externally selected hypotheses in terms of objectively quantifiable supporting evidence. It is normal to be biased in favour of self-selected hypotheses, but we expected this bias to be exacerbated in schizophrenia patients relative to healthy and psychiatric controls, and to be correlated with the severity of delusions in the schizophrenia sample. RESULTS As expected, all groups showed the self-selection bias. Although this bias was not increased in schizophrenia patients relative to the control groups, it was significantly correlated with the severity of delusions in the schizophrenia sample. CONCLUSIONS These results fit with an account holding that the hypersalience of an individual's own interpretations of events, relative to culturally normative interpretations, may manifest in a self-selection bias, contributing to the delusional state in schizophrenia.
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Affiliation(s)
- Jennifer C Whitman
- a Department of Psychiatry , University of British Columbia , Vancouver , BC , Canada
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43
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van der Leer L, McKay R. "Jumping to conclusions" in delusion-prone participants: an experimental economics approach. Cogn Neuropsychiatry 2014; 19:257-67. [PMID: 24313625 DOI: 10.1080/13546805.2013.861350] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION That delusional and delusion-prone individuals "jump to conclusions" on probabilistic reasoning tasks is a key finding in cognitive neuropsychiatry. Here we focused on a less frequently investigated aspect of "jumping to conclusions" (JTC): certainty judgments. We incorporated rigorous procedures from experimental economics to eliminate potential confounds of miscomprehension and motivation and systematically investigated the effect of incentives on task performance. METHODS Low- and high-delusion-prone participants (n = 109) completed a series of computerised trials; on each trial, they were shown a black or a white fish, caught from one of the two lakes containing fish of both colours in complementary ratios. In the betting condition, participants were given £4 to distribute over the two lakes as they wished; in the control condition, participants simply provided an estimate of how probable each lake was. Deviations from Bayesian probabilities were investigated. RESULTS Whereas high-delusion-prone participants in both the control and betting conditions underestimated the Bayesian probabilities (i.e. were conservative), low-delusion-prone participants in the control condition underestimated but those in the betting condition provided accurate estimates. In the control condition, there was a trend for high-delusion-prone participants to give higher estimates than low-delusion-prone participants, which is consistent with previous reports of "jumping to conclusions" in delusion-prone participants. However, our findings in the betting condition, where high-delusion-prone participants provided lower estimates than low-delusion-prone participants (who were accurate), are inconsistent with the jumping-to-conclusions effect in both a relative and an absolute sense. CONCLUSIONS Our findings highlight the key role of task incentives and underscore the importance of comparing the responses of delusion-prone participants to an objective rational standard as well as to the responses of non-delusion-prone participants.
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Affiliation(s)
- Leslie van der Leer
- a ARC Centre of Excellence in Cognition and its Disorders, Department of Psychology, Royal Holloway , University of London , Egham , TW20 0EX Surrey , UK
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44
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Andreou C, Roesch-Ely D, Veckenstedt R, Bohn F, Aghotor J, Köther U, Pfueller U, Moritz S. Predictors of early stable symptomatic remission after an exacerbation of schizophrenia: the significance of symptoms, neuropsychological performance and cognitive biases. Psychiatry Res 2013; 210:729-34. [PMID: 23998362 DOI: 10.1016/j.psychres.2013.08.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 08/11/2013] [Accepted: 08/12/2013] [Indexed: 11/17/2022]
Abstract
Neuropsychological deficits and severity of initial psychopathology have been repeatedly associated with poor symptomatic outcomes in schizophrenia. The role of higher-order cognitive biases on symptomatic outcomes of the disorder has not yet been investigated. The present study aimed to assess the contribution of cognitive biases, psychopathology and neuropsychological deficits on the probability of achieving early symptomatic remission after a psychotic episode in patients with schizophrenia. Participants were 79 patients with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder undergoing an acute psychotic episode, and 25 healthy controls. According to psychopathology assessments, patients were split into those who had achieved remission after an average follow-up interval of 7 months, and those who had not (NR). Patients who achieved remission exhibited higher premorbid IQ and better performance on the TMT-B, as well as lower baseline positive, disorganized and distress symptoms than NR patients. TMT-B performance and positive symptoms at baseline were the best predictors of remission. Cognitive biases and negative symptoms were not associated with later remission. The findings highlight the significance of initial symptom severity for at least short-term symptomatic outcomes and, thus, the importance of adequate symptomatic treatment and prevention of psychotic outbreaks in patients.
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Affiliation(s)
- Christina Andreou
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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45
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Abstract
BACKGROUND People with psychoses often report fixed, delusional beliefs that are sustained even in the presence of unequivocal contrary evidence. Such delusional beliefs are the result of integrating new and old evidence inappropriately in forming a cognitive model. We propose and test a cognitive model of belief formation using experimental data from an interactive 'Rock Paper Scissors' (RPS) game. METHOD Participants (33 controls and 27 people with schizophrenia) played a competitive, time-pressured interactive two-player game (RPS). Participants' behavior was modeled by a generative computational model using leaky integrator and temporal difference methods. This model describes how new and old evidence is integrated to form a playing strategy to beat the opponent and to provide a mechanism for reporting confidence in one's playing strategy to win against the opponent. RESULTS People with schizophrenia fail to appropriately model their opponent's play despite consistent (rather than random) patterns that can be exploited in the simulated opponent's play. This is manifest as a failure to weigh existing evidence appropriately against new evidence. Furthermore, participants with schizophrenia show a 'jumping to conclusions' (JTC) bias, reporting successful discovery of a winning strategy with insufficient evidence. CONCLUSIONS The model presented suggests two tentative mechanisms in delusional belief formation: (i) one for modeling patterns in other's behavior, where people with schizophrenia fail to use old evidence appropriately, and (ii) a metacognitive mechanism for 'confidence' in such beliefs, where people with schizophrenia overweight recent reward history in deciding on the value of beliefs about the opponent.
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Affiliation(s)
- D W Joyce
- Cognition Schizophrenia and Imaging Laboratory, Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
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46
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Dudley R, Daley K, Nicholson M, Shaftoe D, Spencer H, Cavanagh K, Freeston M. ‘Jumping to conclusions’ in first-episode psychosis: A longitudinal study. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2013; 52:380-93. [DOI: 10.1111/bjc.12023] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 05/15/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Robert Dudley
- Clinical Psychology; Institute of Neuroscience; Newcastle University; Newcastle-upon-Tyne UK
- Early Intervention in Psychosis Service, Northumberland, Tyne and Wear Foundation Trust; Sunderland; UK
| | - Kate Daley
- Clinical Psychology; School of Psychology; Newcastle University; Newcastle-upon-Tyne UK
| | - Marsha Nicholson
- Early Intervention in Psychosis Service, Northumberland, Tyne and Wear Foundation Trust; Sunderland; UK
| | - Debra Shaftoe
- Early Intervention in Psychosis Service, Northumberland, Tyne and Wear Foundation Trust; Sunderland; UK
| | - Helen Spencer
- Early Intervention in Psychosis Service, Northumberland, Tyne and Wear Foundation Trust; Sunderland; UK
| | - Kate Cavanagh
- School of Psychology; University of Sussex; Falmer UK
| | - Mark Freeston
- Clinical Psychology; Institute of Neuroscience; Newcastle University; Newcastle-upon-Tyne UK
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Sanford N, Lecomte T, Leclerc C, Wykes T, Woodward TS. Change in jumping to conclusions linked to change in delusions in early psychosis. Schizophr Res 2013; 147:207-208. [PMID: 23561297 DOI: 10.1016/j.schres.2013.02.042] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 02/27/2013] [Accepted: 02/28/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Nicole Sanford
- Department of Psychiatry, University of British Columbia, Vancouver, Canada; BC Mental Health and Addictions Research Institute, Vancouver, Canada
| | - Tania Lecomte
- Department of Psychology, University of Montreal, Montreal, Canada
| | - Claude Leclerc
- Department of Nursing, University of Trois-Rivières, QC, Canada
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK
| | - Todd S Woodward
- Department of Psychiatry, University of British Columbia, Vancouver, Canada; BC Mental Health and Addictions Research Institute, Vancouver, Canada.
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Esslinger C, Braun U, Schirmbeck F, Santos A, Meyer-Lindenberg A, Zink M, Kirsch P. Activation of midbrain and ventral striatal regions implicates salience processing during a modified beads task. PLoS One 2013; 8:e58536. [PMID: 23484034 PMCID: PMC3590224 DOI: 10.1371/journal.pone.0058536] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Accepted: 02/07/2013] [Indexed: 12/02/2022] Open
Abstract
Introduction Metacognition, i.e. critically reflecting on and monitoring one’s own reasoning, has been linked behaviorally to the emergence of delusions and is a focus of cognitive therapy in patients with schizophrenia. However, little is known about the neural processing underlying metacognitive function. To address this issue, we studied brain activity during a modified beads task which has been used to measure a “Jumping to Conclusions” (JTC) bias in schizophrenia patients. Methods We used functional magnetic resonance imaging to identify neural systems active in twenty-five healthy subjects when solving a modified version of the “beads task”, which requires a probabilistic decision after a variable amount of data has been requested by the participants. We assessed brain activation over the duration of a trial and at the time point of decision making. Results Analysis of activation during the whole process of probabilistic reasoning showed an extended network including the prefronto-parietal executive functioning network as well as medial parieto-occipital regions. During the decision process alone, activity in midbrain and ventral striatum was detected, as well as in thalamus, medial occipital cortex and anterior insula. Conclusions Our data show that probabilistic reasoning shares neural substrates with executive functions. In addition, our finding that brain regions commonly associated with salience processing are active during probabilistic reasoning identifies a candidate mechanism that could underlie the behavioral link between dopamine-dependent aberrant salience and JTC in schizophrenia. Further studies with delusional schizophrenia patients will have to be performed to substantiate this link.
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Affiliation(s)
- Christine Esslinger
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
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Moritz S, Van Quaquebeke N, Lincoln TM. Jumping to conclusions is associated with paranoia but not general suspiciousness: a comparison of two versions of the probabilistic reasoning paradigm. SCHIZOPHRENIA RESEARCH AND TREATMENT 2012; 2012:384039. [PMID: 23125930 PMCID: PMC3483676 DOI: 10.1155/2012/384039] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 09/12/2012] [Indexed: 11/20/2022]
Abstract
Theoretical models ascribe jumping to conclusions (JTCs) a prominent role in the pathogenesis of paranoia. While many earlier studies corroborated this account, some newer investigations have found no or only small associations of the JTC bias with paranoid symptoms. The present study examined whether these inconsistencies in part reflect methodological differences across studies. The study was built upon the psychometric high-risk paradigm. A total of 1899 subjects from the general population took part in an online survey and were administered the Paranoia Checklist as well as one of two different variants of the probabilistic reasoning task: one variant with a traditional instruction (a) and one novel variant that combines probability estimates with decision judgments (b). Factor analysis of the Paranoia Checklist yielded an unspecific suspiciousness factor and a psychotic paranoia factor. The latter was significantly associated with scores indicating hasty decision making. Subjects scoring two standard deviations above the mean of the Paranoia Checklist showed an abnormal data-gathering style relative to subjects with normal scores. Findings suggest that the so-called decision threshold parameter is more sensitive than the conventional JTC index. For future research the specific contents of paranoid beliefs deserve more consideration in the investigation of decision making in schizophrenia as JTC seems to be associated with core psychosis-prone features of paranoia only.
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Niels Van Quaquebeke
- Department of Management and Economics, Kuehne Logistics University, Hamburg, Germany
| | - Tania M. Lincoln
- Department of Psychology, University of Hamburg, Hamburg, Germany
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50
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Moritz S, Burnette P, Sperber S, Köther U, Hagemann-Goebel M, Hartmann M, Lincoln TM. Elucidating the black box from stress to paranoia. Schizophr Bull 2011; 37:1311-7. [PMID: 20513651 PMCID: PMC3196937 DOI: 10.1093/schbul/sbq055] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Sensitivity to stress has long been implicated in the pathogenesis of schizophrenia. It remains unclear, however, which exact mechanisms underlie the progression from vulnerability to psychotic breakdown. For the present study, we hypothesized that the induction of stress would aggravate cognitive biases in schizophrenia. A total of 20 acute and remitted schizophrenia patients and 15 healthy controls were tested with parallel versions of cognitive biases paradigms under 2 laboratory conditions: stress (loud noise, 75 dB) vs no-stress. In the course of both conditions, participants had to fill out a questionnaire that assessed depressive, obsessive-compulsive, and paranoid symptoms. For the patients with acute psychotic symptoms, paranoid but not other psychiatric symptoms were elevated under stress in comparison with no-stress. In contrast, stress somewhat diminished subclinical paranoid symptoms in healthy participants. Jumping to conclusions was evident in schizophrenia under both conditions but significantly more pronounced when stress was applied first in the acute group. A tendency emerged in both acute and remitted patients to attribute events to other people under stress which was not seen in healthy subjects. The present study may serve as a starting point for further research investigating how stress translates vulnerability into acute paranoia and to pinpoint cognitive risk factors that can be modified by treatment.
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center, Hamburg,Germany.
| | - Pia Burnette
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany
| | - Sabine Sperber
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany
| | - Ulf Köther
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany
| | - Marion Hagemann-Goebel
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany
| | - Maike Hartmann
- Section for Clinical Psychology and Psychotherapy, Faculty of Psychology, Philipps-Universität Marburg, Gutenbergstr. 18, D-35037 Marburg, Germany
| | - Tania M. Lincoln
- Section for Clinical Psychology and Psychotherapy, Faculty of Psychology, Philipps-Universität Marburg, Gutenbergstr. 18, D-35037 Marburg, Germany
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