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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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Rauschenberg C, Reininghaus U, ten Have M, de Graaf R, van Dorsselaer S, Simons CJP, Gunther N, Henquet C, Pries LK, Guloksuz S, Bak M, van Os J. The jumping to conclusions reasoning bias as a cognitive factor contributing to psychosis progression and persistence: findings from NEMESIS-2. Psychol Med 2021; 51:1696-1703. [PMID: 32174291 PMCID: PMC8327623 DOI: 10.1017/s0033291720000446] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 02/12/2020] [Accepted: 02/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Contemporary models of psychosis implicate the importance of affective dysregulation and cognitive factors (e.g. biases and schemas) in the development and maintenance of psychotic symptoms, but studies testing proposed mechanisms remain limited. This study, uniquely using a prospective design, investigated whether the jumping to conclusions (JTC) reasoning bias contributes to psychosis progression and persistence. METHODS Data were derived from the second Netherlands Mental Health Survey and Incidence Study (NEMESIS-2). The Composite International Diagnostic Interview and an add-on instrument were used to assess affective dysregulation (i.e. depression, anxiety and mania) and psychotic experiences (PEs), respectively. The beads task was used to assess JTC bias. Time series analyses were conducted using data from T1 and T2 (N = 8666), excluding individuals who reported high psychosis levels at T0. RESULTS Although the prospective design resulted in low statistical power, the findings suggest that, compared to those without symptoms, individuals with lifetime affective dysregulation were more likely to progress from low/moderate psychosis levels (state of 'aberrant salience', one or two PEs) at T1 to high psychosis levels ('frank psychosis', three or more PEs or psychosis-related help-seeking behaviour) at T2 if the JTC bias was present [adj. relative risk ratio (RRR): 3.8, 95% confidence interval (CI) 0.8-18.6, p = 0.101]. Similarly, the JTC bias contributed to the persistence of high psychosis levels (adj. RRR: 12.7, 95% CI 0.7-239.6, p = 0.091). CONCLUSIONS We found some evidence that the JTC bias may contribute to psychosis progression and persistence in individuals with affective dysregulation. However, well-powered prospective studies are needed to replicate these findings.
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Affiliation(s)
- Christian Rauschenberg
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ulrich Reininghaus
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Health Service and Population Research Department, Centre for Epidemiology and Public Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Margreet ten Have
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Ron de Graaf
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Saskia van Dorsselaer
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Claudia J. P. Simons
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- GGzE, Institute for Mental Health Care Eindhoven and De Kempen, Eindhoven, The Netherlands
| | - Nicole Gunther
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- School of Psychology, Open University, Heerlen, The Netherlands
| | - Cécile Henquet
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Lotta-Katrin Pries
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Maarten Bak
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Scheunemann J, Fischer R, Moritz S. Probing the Hypersalience Hypothesis-An Adapted Judge-Advisor System Tested in Individuals With Psychotic-Like Experiences. Front Psychiatry 2021; 12:612810. [PMID: 33746792 PMCID: PMC7969715 DOI: 10.3389/fpsyt.2021.612810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/29/2021] [Indexed: 11/13/2022] Open
Abstract
Individuals with psychotic-like experiences and psychosis gather and use information differently than controls; in particular they seek and rely on less information or over-weight currently available information. A new paradigm, the judge-advisor system, has previously been used to investigate these processes. Results showed that psychosis-prone individuals tend to seek less advice but at the same time use the available advice more. Some theoretical models, like the hypersalience of evidence-matching hypothesis, predict that psychosis-prone individuals weight recently available information to a greater extent and thus provide an explanation for increased advice-weighting scores in psychosis-prone individuals. To test this model, we adapted the previously used judge-advisor system by letting participants receive consecutively multiple pieces of advice. To meet this aim, we recruited a large MTurk community sample (N = 1,396), which we split in a group with high levels of psychotic-like experiences (at least 2 SD above the mean, n = 80) and a group with low levels of psychotic-like experiences (maximum 0.5 SD above the mean, n = 1,107), using the Community Assessment of Psychic Experiences' positive subscale. First, participants estimated five people's age based on photographs. Then, they received consecutive advice in the form of manipulated age estimates by allegedly previous participants, with outliers in some trials. After each advice, participants could adjust their estimate. This procedure allowed us to investigate how participants weighted each currently presented advice. In addition to being more confident in their final estimates and in line with our preregistered hypothesis, participants with more frequent psychotic-like experiences did weight currently available advice more than participants with less frequent psychotic-like experiences. This effect was especially pronounced in response to outliers, as fine-grained post-hoc analysis suggested. Result thus support models predicting an overcorrection in response to new incoming information and challenges an assumed general belief inflexibility in people with psychotic experiences.
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Affiliation(s)
- Jakob Scheunemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rabea Fischer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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García-Mieres H, Usall J, Feixas G, Ochoa S. Placing Cognitive Rigidity in Interpersonal Context in Psychosis: Relationship With Low Cognitive Reserve and High Self-Certainty. Front Psychiatry 2020; 11:594840. [PMID: 33324260 PMCID: PMC7725761 DOI: 10.3389/fpsyt.2020.594840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/29/2020] [Indexed: 01/28/2023] Open
Abstract
Introduction: People with psychosis show impairments in cognitive flexibility, a phenomenon that is still poorly understood. In this study, we tested if there were differences in cognitive and metacognitive processes related to rigidity in patients with psychosis. We compared individuals with dichotomous interpersonal thinking and those with flexible interpersonal thinking. Methods: We performed a secondary analysis using two groups with psychosis, one with low levels of dichotomous interpersonal thinking (n = 42) and the other with high levels of dichotomous interpersonal thinking (n = 43). The patients were classified by splitting interpersonal dichotomous thinking (measured using the repertory grid technique) to the median. The groups were administered a sociodemographic questionnaire, a semi-structured interview to assess psychotic symptoms [Positive and Negative Syndrome Scale (PANSS)], a self-report of cognitive insight [Beck Cognitive Insight Scale (BCIS)], neurocognitive tasks [Wisconsin Card Sorting Test (WCST) and Wechsler Adult Intelligence Scale (WAIS)], and the repertory grid technique. We used a logistic regression model to test which factors best differentiate the two groups. Results: The group with high dichotomous interpersonal thinking had earlier age at onset of the psychotic disorder, higher self-certainty, impaired executive functioning, affected abstract thinking, and lower estimated cognitive reserve than the group with flexible thinking. According to the logistic regression model, estimated cognitive reserve and self-certainty were the variables that better differentiated between the two groups. Conclusion: Cognitive rigidity may be a generalized bias that affects not only neurocognitive and metacognitive processes but also the sense of self and significant others. Patients with more dichotomous interpersonal thinking might benefit from interventions that target this cognitive bias on an integrative way and that is adapted to their general level of cognitive abilities.
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Affiliation(s)
- Helena García-Mieres
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain.,Mental Health Networking Biomedical Research Center, CIBERSAM, Madrid, Spain
| | - Judith Usall
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain.,Mental Health Networking Biomedical Research Center, CIBERSAM, Madrid, Spain
| | - Guillem Feixas
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.,The Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain.,Mental Health Networking Biomedical Research Center, CIBERSAM, Madrid, Spain
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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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Jacobsen P, Peters E, Ward T, Garety PA, Jackson M, Chadwick P. Overgeneral autobiographical memory bias in clinical and non-clinical voice hearers. Psychol Med 2019; 49:113-120. [PMID: 29536827 PMCID: PMC6004309 DOI: 10.1017/s0033291718000570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hearing voices can be a distressing and disabling experience for some, whilst it is a valued experience for others, so-called 'healthy voice-hearers'. Cognitive models of psychosis highlight the role of memory, appraisal and cognitive biases in determining emotional and behavioural responses to voices. A memory bias potentially associated with distressing voices is the overgeneral memory bias (OGM), namely the tendency to recall a summary of events rather than specific occasions. It may limit access to autobiographical information that could be helpful in re-appraising distressing experiences, including voices. METHODS We investigated the possible links between OGM and distressing voices in psychosis by comparing three groups: (1) clinical voice-hearers (N = 39), (2) non-clinical voice-hearers (N = 35) and (3) controls without voices (N = 77) on a standard version of the autobiographical memory test (AMT). Clinical and non-clinical voice-hearers also completed a newly adapted version of the task, designed to assess voices-related memories (vAMT). RESULTS As hypothesised, the clinical group displayed an OGM bias by retrieving fewer specific autobiographical memories on the AMT compared with both the non-clinical and control groups, who did not differ from each other. The clinical group also showed an OGM bias in recall of voice-related memories on the vAMT, compared with the non-clinical group. CONCLUSIONS Clinical voice-hearers display an OGM bias when compared with non-clinical voice-hearers on both general and voices-specific recall tasks. These findings have implications for the refinement and targeting of psychological interventions for psychosis.
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Affiliation(s)
- Pamela Jacobsen
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Department of Psychology, London, UK
| | - Emmanuelle Peters
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Department of Psychology, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Thomas Ward
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Department of Psychology, London, UK
| | - Philippa A. Garety
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Department of Psychology, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Mike Jackson
- Bangor University, School of Psychology, North Wales, UK
- Betsi Cadwaladr University Health Board, North Wales, UK
| | - Paul Chadwick
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Department of Psychology, London, UK
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Ward T, Garety PA. Fast and slow thinking in distressing delusions: A review of the literature and implications for targeted therapy. Schizophr Res 2019; 203:80-87. [PMID: 28927863 PMCID: PMC6336980 DOI: 10.1016/j.schres.2017.08.045] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/16/2017] [Accepted: 08/21/2017] [Indexed: 12/21/2022]
Abstract
The recent literature on reasoning biases in psychosis and delusions is reviewed. The state-of-the-art knowledge from systematic reviews and meta-analyses on the evidence for jumping to conclusions is briefly summarised, before a fuller discussion of the more recent empirical literature on belief flexibility as applied to delusions. The methodology and evidence in relation to studies of belief flexibility and the Bias Against Disconfirmatory Evidence (BADE) across the delusional continuum will be critically appraised, and implications drawn for improving cognitive therapy. It will be proposed that dual process models of reasoning, which Kahneman (Kahneman, 2011) popularised as 'fast and slow thinking', provide a useful theoretical framework for integrating further research and informing clinical practice. The emergence of therapies which specifically target fast and slow thinking in people with distressing delusions will be described.
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Affiliation(s)
- Thomas Ward
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, United Kingdom; South London and Maudsley NHS Foundation Trust, United Kingdom
| | - Philippa A Garety
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, United Kingdom; South London and Maudsley NHS Foundation Trust, United Kingdom.
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Takeda T, Nakataki M, Ohta M, Hamatani S, Matsuura K, Ohmori T. Effect of cognitive function on jumping to conclusion in patients with schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2018; 12:50-55. [PMID: 29928597 PMCID: PMC6007052 DOI: 10.1016/j.scog.2018.04.002] [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: 02/01/2018] [Revised: 04/25/2018] [Accepted: 04/27/2018] [Indexed: 11/01/2022]
Abstract
The "jumping to conclusion" (JTC) bias is related to the formation and maintenance of delusions. Higher JTC bias can be based on both neurocognitive dysfunction and social cognitive dysfunction in patients with schizophrenia. The aim of this study was to assess the relationship between JTC bias, neurocognition, and social cognition in patients with schizophrenia. A total of 22 patients with schizophrenia and 21 controls participated in this study. Neurocognition and social cognition were assessed using the Brief Assessment of Cognition in Schizophrenia (BACS) and Social Cognition Screening Questionnaire (SCSQ), respectively. The JTC bias and the decision confidence were assessed using the beads task. The patients were classified into the JTC group (with higher JTC bias; n = 10) and JTC-non group (n = 12). The JTC group scored significantly lower on verbal memory, working memory, and motor speed sub-scores of BACS than the JTC-non group. No difference in social cognition was observed between the two groups. The decision confidence was predicted by metacognition, which is an SCSQ sub-score. Similarly to the patients, the controls were classified into the JTC group (higher JTC bias; n = 9) and the JTC-non group (n = 12). There were no significant differences in neurocognition and social cognition between the control JTC and JTC-non groups. The present results indicated that JTC bias is related to neurocognition and decision confidence is related to social cognition in patients with schizophrenia. These findings may bridge the gaps between psychotic symptom and cognitive dysfunction in schizophrenia.
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Affiliation(s)
- Tomoya Takeda
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, 3-8-15, Kuramoto-cho, Tokushima 770-8503, Japan
| | - Masahito Nakataki
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, 3-8-15, Kuramoto-cho, Tokushima 770-8503, Japan
| | - Masashi Ohta
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, 3-8-15, Kuramoto-cho, Tokushima 770-8503, Japan
| | - Sayo Hamatani
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Kanae Matsuura
- Department of Psychiatry, Tokushima University Hospital, 2-50-1, Kuramoto-cho, Tokushima 770-8503, Japan
| | - Tetsuro Ohmori
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, 3-8-15, Kuramoto-cho, Tokushima 770-8503, Japan
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Clinical relevance of appraisals of persistent psychotic experiences in people with and without a need for care: an experimental study. Lancet Psychiatry 2017; 4:927-936. [PMID: 29179936 PMCID: PMC5714590 DOI: 10.1016/s2215-0366(17)30409-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/27/2017] [Accepted: 09/29/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Cognitive models of psychosis propose that appraisals (ie, the interpretation and meaning attributed to experiences) are central to the transition from anomalous experiences to psychotic symptoms. In the Unusual Experiences Enquiry (UNIQUE) study, we investigated the role of appraisals by comparing individuals with persistent psychotic experiences without a need for care with patients and people without psychotic experiences. METHOD Eligible participants were patients with diagnosed psychotic disorders (clinical group) and adults in the general population with persistent psychotic experiences (non-clinical group) and without psychotic experiences (controls). The appraisals of psychotic experiences among people in the non-clinical and clinical groups were assessed by an in-depth interview, and appraisals of anomalous experiences induced by three experimental tasks were compared between all groups. FINDINGS We recruited 259 participants, 84 in the clinical group, 92 in the non-clinical group, and 83 controls. The clinical group was more likely than the non-clinical group to display paranoid, personalising interpretations of their psychotic experiences (p<0·008; p values are Sidak adjusted to account for multiple testing) and less likely to have normalising (p<0·008) and supernatural (p=0·039) explanations. The clinical group also appraised their psychotic experiences as being more negative, dangerous, and abnormal and less controllable than the non-clinical group (all p<0·005), but groups did not differ for attributions of general externality (p=0·44). For experimentally induced anomalous experiences, the clinical group endorsed more threatening appraisals on all tasks than the non-clinical group (p<0·003), who did not differ from the control group (p=0·07-0·6). The pattern was similar for ratings of salience, distress, personal relevance, global threat, and incorporation of the induced experiences into participants' own psychotic experiences. INTERPRETATION We provide robust evidence that the way psychotic experiences are appraised differs between individuals with and without a need for care, supporting cognitive models of psychosis. Specifically, the absence of paranoid and threatening appraisals might protect against persistent psychotic experiences becoming clinically relevant. FUNDING UK Medical Research Council.
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