Effect of cognitive function on jumping to conclusion in patients with schizophrenia

The journey within: mental navigation as a novel framework for understanding psychotherapeutic transformation

BACKGROUND

Despite the demonstrated efficacy of psychotherapy, the precise mechanisms that drive therapeutic transformations have posed a challenge and still remain unresolved. Here, we suggest a potential solution to this problem by introducing a framework based on the concept of mental navigation. It refers to our ability to navigate our cognitive space of thoughts, ideas, concepts, and memories, similar to how we navigate physical space. We start by analyzing the neural, cognitive, and experiential constituents intrinsic to mental navigation. Subsequently, we posit that the metaphoric spatial language we employ to articulate introspective experiences (e.g., "unexplored territory" or "going in circles") serves as a robust marker of mental navigation.

METHODS

Using large text corpora, we compared the utilization of spatial language between transcripts of psychotherapy sessions (≈ 12 M. words), casual everyday conversations (≈ 12 M. words), and fictional dialogues in movies (≈ 14 M. words). We also examined 110 psychotherapy transcripts qualitatively to discern patterns and dynamics associated with mental navigation.

RESULTS

We found a notable increase in the utilization of spatial metaphors during psychotherapy compared to casual everyday dialogues (U = 192.0, p = .001, d = 0.549) and fictional conversations (U = 211, p < .001, d = 0.792). In turn, analyzing the usage of non-spatial metaphors, we did not find significant differences between the three datasets (H = 0.682, p = 0.710). The qualitative analysis highlighted specific examples of mental navigation at play.

CONCLUSION

Mental navigation might underlie the psychotherapy process and serve as a robust framework for understanding the transformative changes it brings about.

Jumping to conclusions correlates with negative symptoms, poor response inhibition, and impaired functioning in individuals diagnosed with schizophrenia

BACKGROUND

The jumping to conclusions (JTC) bias is the tendency to make immediate decisions based on little information. There are few studies that have investigated the relationship between JTC and frontal lobe function. We examined the association between JTC and the Brief Psychiatric Rating Scale (BPRS), Frontal Assessment Battery (FAB), and Global Assessment of Functioning (GAF) scale in individuals with schizophrenia.

METHODS

In total, 50 individuals diagnosed with schizophrenia and 50 healthy control individuals were administered the beads task. Individuals diagnosed with schizophrenia were assessed using the FAB, BPRS, and GAF.

RESULTS

There was a significant negative correlation between JTC and the negative symptoms of the BPRS (rs=-.368, p = .008). There was a significant positive correlation between JTC and the Go/No-Go task of the FAB (rs=.319, p = .026), and the GAF (rs=.433, p = .002).

CONCLUSION

JTC in individuals with schizophrenia may be categorized according to several causes, including negative symptoms and poor response inhibition.

The relationship between jumping to conclusions and social cognition in first-episode psychosis

Jumping to conclusions (JTC) and impaired social cognition (SC) affect the decoding, processing, and use of social information by people with psychosis. However, the relationship between them had not been deeply explored within psychosis in general, and in first-episode psychosis (FEP) in particular. Our aim was to study the relationship between JTC and SC in a sample with FEP. We conducted a cross-sectional study with 121 patients with FEP, with measures to assess JTC (easy, hard, and salient probability tasks) and SC (emotional recognition, attributional style, and theory of mind). We performed Student's t-test and logistic regression in order to analyse these associations.We found a statistically significant and consistent relationship of small-moderate effect size between JTC (all three tasks) and impaired emotional recognition. Also, our results suggest a relationship between JTC and internal attributions for negative events. Relationships between JTC and theory of mind were not found. These results highlight the importance of psychological treatments oriented to work on a hasty reasoning style and on improving processing of social information linked to emotional recognition and single-cause attributions.

Do you like cliff-hangers? Objective versus subjective need for closure in the schizophrenia spectrum

Need for closure (NFC) is a cognitive bias that has been implicated in the pathogenesis of delusions. A general population sample (N = 1465) was dichotomized into high versus low schizotypal participants and matched based on core social demographic characteristics (each n = 98). For the first time, we aimed at capturing NFC subjectively (with the NFC Scale) and objectively with a new experimental paradigm, the Ambiguous Movie Scene Task. In this task, participants viewed video scenes with either open or closed endings (i.e., high or low ambiguity) and rated their (emotional) reactions to the clips. Open endings were expected to lead to more frustration (i.e., due to increased need for closure) and to induce greater eagerness to learn about the possible resolution among those high on positive schizotypy. High schizotypal individuals displayed higher scores on the NFC Scale than low schizotypal individuals. Contrary to our expectations, high schizotypal participants did not recognize video scenes with open endings as ambiguous and were less eager to learn about a possible resolution than low schizotypal individuals. In the Ambiguous Movie Scene Task, high schizotypal individuals showed evidence of a jumping to conclusions bias rather than frustration over unresolved storylines. We found an overall stronger emotional response in schizotypal participants and overconfidence in their judgments. The NFC Scale and selected scores of the new task correlated moderately. The study corroborates earlier evidence for a dissociation between objective and subjective biases in the psychosis spectrum.

Functional outcomes and subjective recovery of jumping to conclusions in schizophrenia

This study investigated the effects of the bias known as jumping to conclusions (JTC) on objective functional outcomes as well as subjective assessments of quality of life (QoL) and personal recovery among a sample of patients diagnosed with schizophrenia. Specifically, this study assessed the variables of JTC, psychiatric symptoms, neurocognitive functioning, objective interpersonal and daily activities, vocational domains, subjective QoL, and personal recovery among 94 participants. Results showed that those in the JTC group had significantly lower neurocognitive and functional outcomes (moderate effect sizes); however, subjective measures such as QoL and personal recovery did not differ significantly according to JTC (small effect sizes). After adjusting for attributes, there were no statistically significant differences, but the JTC group demonstrated lower overall functional outcomes and higher individual recovery, each with a moderate effect size. This 'trade-off' is not evidence-guaranteed, and further research is recommended to examine the relationship between social functioning and personal recovery in people with JTC bias.

Taking others into account: combining directly experienced and indirect information in schizophrenia

An abnormality in inference, resulting in distorted internal models of the world, has been argued to be a common mechanism underlying the heterogeneous psychopathology in schizophrenia. However, findings have been mixed as to wherein the abnormality lies and have typically failed to find convincing relations to symptoms. The limited and inconsistent findings may have been due to methodological limitations of the experimental design, such as conflating other factors (e.g. comprehension) with the inferential process of interest, and a failure to adequately assess and model the key aspects of the inferential process. Here, we investigated probabilistic inference based on multiple sources of information using a new digital version of the beads task, framed in a social context. Thirty-five patients with schizophrenia or schizoaffective disorder with a wide range of symptoms and 40 matched healthy control subjects performed the task, where they guessed the colour of the next marble drawn from a jar based on a sample from the jar as well as the choices and the expressed confidence of four people, each with their own independent sample (which was hidden from participant view). We relied on theoretically motivated computational models to assess which model best captured the inferential process and investigated whether it could serve as a mechanistic model for both psychotic and negative symptoms. We found that 'circular inference' best described the inference process, where patients over-weighed and overcounted direct experience and under-weighed information from others. Crucially, overcounting of direct experience was uniquely associated with most psychotic and negative symptoms. In addition, patients with worse social cognitive function had more difficulties using others' confidence to inform their choices. This difficulty was related to worse real-world functioning. The findings could not be easily ascribed to differences in working memory, executive function, intelligence or antipsychotic medication. These results suggest hallucinations, delusions and negative symptoms could stem from a common underlying abnormality in inference, where directly experienced information is assigned an unreasonable weight and taken into account multiple times. By this, even unreliable first-hand experiences may gain disproportionate significance. The effect could lead to false perceptions (hallucinations), false beliefs (delusions) and deviant social behaviour (e.g. loss of interest in others, bizarre and inappropriate behaviour). This may be particularly problematic for patients with social cognitive deficits, as they may fail to make use of corrective information from others, ultimately leading to worse social functioning.

Overestimation of volatility in schizophrenia and autism? A comparative study using a probabilistic reasoning task

BACKGROUND AND OBJECTIVES

A plethora of studies has investigated and compared social cognition in autism and schizophrenia ever since both conditions were first described in conjunction more than a century ago. Recent computational theories have proposed similar mechanistic explanations for various symptoms beyond social cognition. They are grounded in the idea of a general misestimation of uncertainty but so far, almost no studies have directly compared both conditions regarding uncertainty processing. The current study aimed to do so with a particular focus on estimation of volatility, i.e. the probability for the environment to change.

METHODS

A probabilistic decision-making task and a visual working (meta-)memory task were administered to a sample of 86 participants (19 with a diagnosis of high-functioning autism, 21 with a diagnosis of schizophrenia, and 46 neurotypically developing individuals).

RESULTS

While persons with schizophrenia showed lower visual working memory accuracy than neurotypical individuals, no significant group differences were found for metamemory or any of the probabilistic decision-making task variables. Nevertheless, exploratory analyses suggest that there may be an overestimation of volatility in subgroups of participants with autism and schizophrenia. Correlations revealed relationships between different variables reflecting (mis)estimation of uncertainty, visual working memory accuracy and metamemory.

LIMITATIONS

Limitations include the comparably small sample sizes of the autism and the schizophrenia group as well as the lack of cognitive ability and clinical symptom measures.

CONCLUSIONS

The results of the current study provide partial support for the notion of a general uncertainty misestimation account of autism and schizophrenia.

Prolonged rather than hasty decision-making in schizophrenia using the box task. Must we rethink the jumping to conclusions account of paranoia?

Jumping to conclusions (JTC) is the best established cognitive bias in schizophrenia and is increasingly targeted in interventions aimed to improve positive symptoms. To address shortcomings of the standard measure to capture JTC, the beads task, we developed a new variant-the box task-which was subsequently validated in people with elevated psychotic-like experiences. For the first time, the box task was administered in a sample of individuals with manifest schizophrenia. We hypothesized that patients with schizophrenia would display an elevated JTC bias relative to controls.

METHOD

We recruited a large sample of 101 patients with schizophrenia and matched them to an online sample recruited from the general population. In the box task, participants must decide which of two kinds of colored balls are presented more often. Participants are told that the task may end prematurely, and that task performance will be counted as an error if no decision had been made before that point. The primary measure was the number of draws to decision (DTD), where fewer DTD corresponds to greater JTC.

RESULTS

In contrast to expectations, participants with schizophrenia showed significantly higher DTD (i.e., reduced JTC). Consistent with our previous findings, patients also displayed a lowered decision threshold compared to controls. Response confidence for the final decision was lower in patients and correlated with self-esteem and positive symptoms. While there was evidence that previous knowledge of the box task lowered DTD, exclusion of participants with experience on the box task did not substantially change results.

DISCUSSION

The study fits a growing body of experiments casting doubt on the generalizability of the JTC effect in schizophrenia across different tasks. While the study tentatively supports a liberal acceptance account of psychosis, caution is warranted and we recommend that research should explore and control for potentially important mediators (e.g., task difficulty, stress, test-taking attitudes).