Rethinking Social Cognition in Light of Psychosis: Reciprocal Implications for Cognition and Psychopathology

The felt-presence experience: from cognition to the clinic

The felt presence experience is the basic feeling that someone else is present in the immediate environment, without clear sensory evidence. Ranging from benevolent to distressing, personified to ambiguous, felt presence has been observed in neurological case studies and within psychosis and paranoia, associated with sleep paralysis and anxiety, and recorded within endurance sports and spiritualist communities. In this Review, we summarise the philosophical, phenomenological, clinical, and non-clinical correlates of felt presence, as well as current approaches that use psychometric, cognitive, and neurophysiological methods. We present current mechanistic explanations for felt presence, suggest a unifying cognitive framework for the phenomenon, and discuss outstanding questions for the field. Felt presence offers a sublime opportunity to understand the cognitive neuroscience of own-body awareness and social agency detection, as an intuitive, but poorly understood, experience in health and disorder.

Formalising social representation to explain psychiatric symptoms

Recent work in social cognition has moved beyond a focus on how people process social rewards to examine how healthy people represent other agents and how this is altered in psychiatric disorders. However, formal modelling of social representation has not kept pace with these changes, impeding our understanding of how core aspects of social cognition function, and fail, in psychopathology. Here, we suggest that belief-based computational models provide a basis for an integrated sociocognitive approach to psychiatry, with the potential to address important but unexamined pathologies of social representation, such as maladaptive schemas and illusory social agents.

Effectiveness of a Metacognitive Intervention for Schizophrenia (MCI-S) Program for Symptom Relief and Improvement in Social Cognitive Functioning in Patients with Schizophrenia

This study investigated the effectiveness of a metacognitive intervention program for symptom relief and improvement in social cognitive functioning among adults with schizophrenia. The program focused on enhancing metacognition to encourage self-awareness and step-by-step perspective expansion. There were 24 participants in the experimental group and 19 participants in the control group. Delusions decreased, and social cognition and social functioning improved in the experimental group compared to the control group. The program demonstrated utility as a treatment modality, which can be part of an overall program of a mental health promotion institution to improve functioning in patients with schizophrenia.

The effects of developmental trauma on theory of mind and its relationship to psychotic experiences: A behavioural study

BACKGROUND

Developmental psychological trauma induces vulnerability to psychosis. However, the mechanisms underlying this association are poorly understood. Impairments in Theory of Mind (ToM) have been observed in adult survivors of developmental trauma and individuals with psychosis. ToM is therefore a candidate mechanism underlying the association between developmental trauma and psychosis.

METHODS

We used a computerised version of the Director task - where a participant is instructed by a confederate to move an object around a 4 × 4 grid, whilst taking account of whether these objects are visible to a confederate who instructs the participant - to investigate impairments in ToM in 209 participants (age: M = 37.8, SD=13.6; 56% female). Participants were divided into a) developmental trauma-positive (DT+) and control groups (DT-) based on their history of developmental trauma and b) then further into subclinical (S) and healthy groups (H) as based on psychotic experiences indexed by the CAPE-P15. After exclusion, the numbers in each group were: DT+H (47), DT+S (84), DT-H (54), DT-S (12). (Total: 197).

RESULTS

Developmental trauma exposure was associated with psychotic experiences (OR: 7.89, p < .001), which remained significant after controlling for demographic and clinical confounds (adjusted R² = 0.452, R² change = 0.0184, p = .009). Participants with developmental trauma (F_{1, 194}) = 5.46, p = .020, ηp² = 0.027) and participants more prone to psychotic experiences (F_{1, 194}) = 4.71, p = .031, ηp² = 0.024) demonstrated significantly lower accuracy on the Director task relative to their respective control, after controlling for the effects of age.

CONCLUSIONS

ToM deficits are associated with self-reported developmental trauma and psychotic experiences. Further work is needed to explore these relationships further and whether they represent generalised or specific effect effects on developmental trauma and psychopathological domains.

Subclinical psychopathology and affective forecasting: Role of in-the-moment feelings

It is important for positive well-being and social engagement to understand how people predict future emotions, an ability known as affective forecasting. However, mechanisms underpinning the change to affective forecasting are not well understood in people with subclinical psychiatric symptoms. The current study differentiated components that comprise affective forecasting and investigated how non-clinical features relate to these. We recruited 319 participants to complete the social affective forecasting task and respond to questionnaires that captured schizotypal and autistic traits as well as depressive symptoms. Associations between affective forecasting and subclinical features were investigated using correlations, regression, and structure equation modeling. Results showed that interpersonal features of schizotypal traits negatively predicted anticipated emotions in positive social conditions via in-the-moment feelings but not via mental simulation. Findings highlight that in-the-moment feelings may be an intervention target to help people who have difficulties with social interactions to anticipate more pleasure for future social events.

Insight-related beliefs and controllability appraisals contribute little to hallucinated voices: a transdiagnostic network analysis study

Hallucinated voices cause high levels of distress and disability. Current theories suggest that insight-related beliefs, about internal or external origin, perceived source location, and appraisals of controllability are important in mediating the impact of these experiences but previous findings have been mixed. We report two open code and open data network analytic studies of items in the Psychotic Symptoms Ratings Scale for auditory verbal hallucinations (PSYRATS-AH) in a large sample of patients with hallucinated voices to examine the network structure of items at (1) first assessment, and (2) differences over two consecutive assessments during a wait-list period. Networks were generated using least absolute shrinkage and selection operator (LASSO) and extended Bayesian information criterion (EBIC) with node predictability. In Study 1 (N = 386), we report that insight-related items made a negligible contribution to hallucinated voices and the controllability appraisal made at most a modest contribution. Items relating to distress and negative content were the most central and most predicted by the wider network. In Study 2 (N = 204), we tested the longitudinal stability of the structure of hallucinated voices over a period of several months, finding a small change in total hallucination score and global strength but no clear evidence for an alteration in the structural relationship. The insight-related and controllability items remained as least influential over time. Insight-related beliefs and controllability appraisals may contribute less than previously thought to distressing hallucinated voices although we do not discount that other appraisals may remain important.

The roles of coalitional threat and safety in paranoia: A network approach

OBJECTIVE

Paranoia is known to vary with levels of coalitional threat and safety present in the social environment. However, it remains underexplored whether threat and safety are differentially associated with paranoia, if these relationships vary with the source of threat and safety, and whether such effects hold across the continuum of severity of paranoid thoughts.

METHODS

We employed a network analysis approach with community analysis on a large dataset (n = 6,337), the UK Adult Psychiatric Morbidity Survey 2007, to explore these questions. We included one node to capture paranoia typical in the general population, and one pertaining to thought interference common in persecutory delusions in psychosis.

RESULTS

Nodes reflecting paranoia in the general population as well as persecution-related concerns in psychosis shared the strongest positive edges with nodes representing threat stemming from close social relationships. Paranoia common in the general population was negatively associated with both safety stemming from the wider social environment, and safety in close relationships, where the former association was strongest.

CONCLUSIONS

Our results suggest that threat from within one's immediate social group is more closely linked to paranoid thoughts than is safety from either one's social group or the wider social environment. Further, our results imply that coalitional threat may be a particularly associated with concerns common in psychosis, whereas paranoid ideation more common in the general population is also associated with reduced coalitional safety. Overall, this network analysis offers a broad view of how paranoia relates to multiple aspects of our coalitional environment and provides some testable predictions for future research in this area.

PRACTITIONER POINTS

Individuals with paranoia more typical of delusions may find threat in close social relationships most challenging Variation in paranoia in the general population may be attributed to feeling safe in the wider social environment more than in close social relationships.

Illusory social agents within and beyond voices: A computational linguistics analysis of the experience of psychosis

Objectives

Psychosis has a strong social component and often involves the experience of being affected by ‘illusory social agents’. However, this experience remains under‐characterized, particularly for social agents in delusions and non‐vocal hallucinations. One useful approach is a form of computational linguistics called corpus linguistics that studies texts to identify patterns of meaning encoded in both the semantics and linguistic structure of the text.

Methods

Twenty people living with psychosis were recruited from community and inpatient services. They participated in open‐ended interviews on their experiences of social agents in psychosis and completed a measure of psychotic symptoms. Corpus linguistics analysis was used to identify key phenomenological features of vocal and non‐vocal social agents in psychosis.

Results

Social agents i) are represented with varying levels of richness in participants’ experiences, ii) are attributed with different kinds of identities including physical characteristics and names, iii) are perceived to have internal states and motivations that are different from those of the participants, and iv) interact with participants in various ways including through communicative speech acts, affecting participants’ bodies, and moving through space. These representations were equally rich for agents associated with hallucinated voices and those associated with non‐vocal hallucinations and delusions.

Conclusions

We show that the experience of illusory social agents is a rich and complex social experience reflecting many aspects of genuine social interaction and is not solely present in auditory hallucinations, but also in delusions and non‐vocal hallucinations.

Practitioner Points

The experience of being affected by illusory social agents in psychosis extends beyond hallucinated voices.

They are a rich and complex social experience reflecting many aspects of genuine social interaction.

These are also likely to be a source of significant distress and disability.

The Effects of Anhedonia in Social Context

Purpose of Review

Anhedonia is a transdiagnostic symptom comprising reduced subjective reward or pleasure. Anhedonia influences subjective anticipation and in-the-moment experiences. This review draws together affective learning and engagement evidence for anhedonia affecting subjective experiences of social environments.

Recent Findings

While social engagement is diminished consistently, subjective appraisals of social contexts vary across different mental health disorders. Low positive affect during social experiences or stimuli is reported in PTSD, mood, schizophrenia, and anxiety disorders. Diminished neural reward networks underpin the anticipation of social experiences in ADHD, schizophrenia spectrum, and autistic spectrum disorders. Multiple theories exist to explain how anhedonia might interfere with social environments.

Summary

Anhedonia is a barrier to engagement, motivation, and enjoyment of social contexts. While many studies characterize experiences during social contexts, learning theories provide the most promise for developing targeted interventions.

Relating behaviours and therapeutic actions during AVATAR therapy dialogue: An observational study

OBJECTIVES

AVATAR therapy is a novel relational approach to working with distressing voices by engaging individuals in direct dialogue with a digital representation of their persecutory voice (the avatar). Critical to this approach is the avatar transition from abusive to conciliatory during the course of therapy. To date, no observational study has examined the moment-to-moment dialogical exchanges of this innovative therapy. We aim to (1) map relating behaviours between participants and their created avatars and (2) examine therapeutic actions delivered within AVATAR dialogue.

METHOD

Twenty-five of the fifty-three AVATAR therapy completers were randomly selected from a randomized controlled trial (Craig et al. The Lancet Psychiatry, 5, 2018 and 31). Seventy-five audio recordings of active dialogue from sessions 1 and 4 and the last session were transcribed and analysed using a newly developed coding frame. Inter-rater reliability was good to excellent.

RESULTS

Fine-grained analysis of 4,642 observations revealed nuanced communication around relational power and therapeutic activity. Early assertiveness work, reinforced by the therapist, focussed on increasing power and distancing. Participants' submissive behaviours reduced during therapy, but the shift was gradual. Once the transition to a more conciliatory tone took place, the dialogue primarily involved direct communication between participant and avatar, focussing on sense of self and developmental and relational understanding of voices.

CONCLUSIONS

AVATAR therapy supports voice-hearers in becoming more assertive towards a digital representation of their abusive voice. Direct dialogue with carefully characterized avatars aims to build the voice-hearers' positive sense of self, supporting the person to make sense of their experiences.

PRACTITIONER POINTS

AVATAR therapy enables voice-hearers to engage in face-to-face dialogue with a digital representation ('avatar') of their persecutory voice. Fine-grained analyses showed how relating behaviours and therapeutic actions evolve during active AVATAR therapy dialogue. Carefully characterized avatars and direct therapist input help voice-hearers become more assertive over the avatar, enhance positive sense of self, and support individuals to make sense of their experiences.

The Referential Problem Space revisited: An ecological hypothesis of the evolutionary and developmental origins of pointing

Pointing by great apes poses a significant challenge to contemporary theories about the evolutionary and developmental foundations of cognitive development, because pointing has long been viewed by theoreticians as an evolved, human-unique developmental stepping-stone to linguistic reference. Although reports of pointing by great apes have existed in the scientific literature for over a century, only in recent decades has it become clear that ape pointing is definitely an intentionally communicative signal, by the same criteria we adjudge human pointing to be intentionally communicative. Theoretical responses to this changed empirical landscape have generally taken the approach of asserting, without any direct evidence (indeed, in the absence of any possibility of direct evidence), that pointing by humans is psychologically distinct from and more cognitively complex than the pointing of apes. It is commonplace in the contemporary literature to appeal to imaginary, species-unique causal factors to account for human pointing, rendering a large body of contemporary theoretical work untestable with scientific methods: scientific arguments require the public availability of core theoretical entities. In this paper, I will analyze the circumstances of pointing by apes and humans and develop an alternative theoretical model of pointing that does not rely upon non-physical constructs. According to the view espoused, here, pointing develops as a solution to a particular kind of developmental problem, characterized by (a) a developing capacity for tool use, (b) barriers to direct action, and (c) a history of caregiver responsiveness. Pointing by both apes and humans is explicable without invoking imaginary, mental causes. This article is categorized under: Cognitive Biology > Evolutionary Roots of Cognition Cognitive Biology > Cognitive Development Psychology > Comparative Psychology.

The intentionality bias in schizotypy: a social matter

INTRODUCTION

We aimed to investigate the association between schizotypy and intentionality bias, the tendency to interpret ambiguous actions as being intentional, for social and non-social actions separately. This bias contributes to interpersonal difficulties, and has been associated with psychotic symptoms, such as delusions. However, results have been inconsistent for an association between putative psychosis proneness, schizotypy, and intentionality bias. Further, the multidimensional nature of schizotypy has not been considered. Agreeableness was measured to examine the specificity of the relationship, and inhibition to examine its potential role as a mediator.

METHODS

Two online studies are reported (n = 280 and n = 163) in which participants made intentionality judgements about ambiguous actions described in sentences. They also completed questionnaire measures of schizotypy and agreeableness, and inhibitory efficiency (a sentence completion task).

RESULTS

Schizotypy was associated with perceiving ambiguous actions as intentional, particularly in social contexts, after controlling for agreeableness. The association with social intentionality was stronger for schizotypy subscales capturing paranoia and unusual beliefs. Inhibitory efficiency as not a significant predictor of intentionality bias.

CONCLUSION

These finding suggest intentionality biases for social and non-social events are distinguishable. In relation to schizotypy, social situations appear to generate perceptions of intentionality. Intentionality bias represents a phenotypic cognitive risk for psychosis which should be further investigated.

Derationalizing Delusions

Because of the traditional conceptualization of delusion as “irrational belief,” cognitive models of delusions largely focus on impairments to domain-general reasoning. Nevertheless, current rationality-impairment models do not account for the fact that (a) equivalently irrational beliefs can be induced through adaptive social cognitive processes, reflecting social integration rather than impairment; (b) delusions are overwhelmingly socially themed; and (c) delusions show a reduced sensitivity to social context both in terms of how they are shaped and how they are communicated. Consequently, we argue that models of delusions need to include alteration to coalitional cognition—processes involved in affiliation, group perception, and the strategic management of relationships. This approach has the advantage of better accounting for both content (social themes) and form (fixity) of delusion. It is also supported by the established role of mesolimbic dopamine in both delusions and social organization and the ongoing reconceptualization of belief as serving a social organizational function.

Metacognition and Intersubjectivity: Reconsidering Their Relationship Following Advances From the Study of Persons With Psychosis

As research on metacognition has progressed a significant array of definitions, methodologies and therapeutic applications have emerged. Some of this work has primarily framed metacognition as an activity carried out by one person in order to know, monitor, and adjust their beliefs, memories, and behaviors. Accordingly, problems with metacognition have often been characterized as issues related to cognition. This, however, risks neglecting how metacognition is also a fundamentally intersubjective act, one in which human beings know and reflect upon themselves and others primarily with and through connections with other people. In this paper, we review research on metacognition in schizophrenia using the integrative model of metacognition and a research paradigm in which metacognition is assessed within personal narratives. Stimulated by this work, we discuss how disturbances in intersubjective experience and metacognitive capacity mutually influence one another, with disruptions in metacognition perhaps more deeply understood as disruptions in relatedness with others. We then discuss how metacognition and intersubjectivity each affect mental health. We finally focus on the implications of this for treatments that target metacognition as well as future directions for research.

Religiosity and Psychotic Ideation in Stable Schizophrenia: A Role for Empathic Perspective-Taking

The relationship between religiosity and different components of empathy was explored in schizophrenia patients. A total of 81 stable schizophrenia patients and 95 controls from the nearby community completed self-reported questionnaires assessing religiosity and empathy (through the Interpersonal Reactivity Index, IRI). Patients with schizophrenia showed higher religiousness than controls and they presented less perspective-taking and empathic concern but increased personal distress in IRI scores. Regression analyses unveiled an association between religiosity and perspective-taking in schizophrenics after adjusting for age, gender, and psychotic symptoms. In conclusion, religiosity in patients with schizophrenia may be linked to variations in perspective- taking as a component of empathy.

Testing the Interpersonal-Cognitive Model of Auditory Verbal Hallucinations in Youths with Either Early-Stage Borderline Personality Disorder or First-Episode Schizophrenia Spectrum Disorder

This is the first study to explore interpersonal schemata in outpatient youths (age 15-25 years) with early-stage borderline personality disorder (BPD) and auditory verbal hallucinations (AVH). It also aimed to replicate, in a transdiagnostic youth sample, the finding from studies of adults with AVH that negative beliefs about the self and others lead to negative appraisals of voices, which in turn elicits depression. The following 3 groups were compared: youth with BPD+AVH (n = 23), youth with schizophrenia spectrum disorder (SZ) with AVH (SZ+AVH, n = 20), and youths with BPD who did not experience AVH (BPD no AVH, n = 23). The BPD+AVH group reported more negative and fewer positive self schemata than the SZ+AVH group. They also saw themselves as being more socially inferior to others than did the SZ+AVH group, but they did not differ in appraisals of self or others, compared with the BPD no AVH group. In youths with AVH (BPD+AVH, SZ+AVH combined), the indirect effect of beliefs about self or others, via negative appraisals of voices on depression, was not significant. Instead, a significant indirect effect of negative appraisals of voices on depression, via negative beliefs about self, was found. The experience of AVH during adolescence and young adulthood, when the identity is still being formed, might have a more profound effect on the developing self than during later adulthood, when the self is more stable and resilient. Negative self-appraisals might constitute a treatment target for early intervention for youths with distressing voices, including those with BPD.

Fast and slow thinking in distressing delusions: A review of the literature and implications for targeted therapy

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.

Experimentally induced social threat increases paranoid thinking

The ability to attribute intentions to others is a hallmark of human social cognition but is altered in paranoia. Paranoia is the most common positive symptom of psychosis but is also present to varying degrees in the general population. Epidemiological models suggest that psychosis risk is associated with low social rank and minority status, but the causal effects of status and group affiliation on paranoid thinking remain unclear. We examined whether relative social status and perceived group affiliation, respectively, affect live paranoid thinking using two large-N (N = 2030), pre-registered experiments. Interacting with someone from a higher social rank or a political out-group led to an increase in paranoid attributions of harmful intent for ambiguous actions. Pre-existing paranoia predicted a general increase in harmful intent attribution, but there was no interaction with either type of social threat: highly paranoid people showed the same magnitude of increase as non-paranoid people, although from a higher baseline. We conclude social threat in the form of low social status and out-group status affects paranoid attributions, but ongoing paranoia represents a lowered threshold for detecting social threat rather than an impaired reactivity to it.

The network structure of paranoia in the general population

PURPOSE

Bebbington and colleagues' influential study on 'the structure of paranoia in the general population' used data from the British National Psychiatric Morbidity Survey and latent variable analysis methods. Network analysis is a relatively new approach in psychopathology research that considers mental disorders to be emergent phenomena from causal interactions among symptoms. This study re-analysed the British National Psychiatric Morbidity Survey data using network analysis to examine the network structure of paranoia in the general population.

METHODS

We used a Graphical Least Absolute Shrinkage and Selection Operator (glasso) method that estimated an optimal network structure based on the Extended Bayesian Information Criterion. Network sub-communities were identified by spinglass and EGA algorithms and centrality metrics were calculated per item and per sub-community.

RESULTS

We replicated Bebbington's four component structure of paranoia, identifying 'interpersonal sensitivities', 'mistrust', 'ideas of reference' and 'ideas of persecution' as sub-communities in the network. In line with previous experimental findings, worry was the most central item in the network. However, 'mistrust' and 'ideas of reference' were the most central sub-communities.

CONCLUSIONS

Rather than a strict hierarchy, we argue that the structure of paranoia is best thought of as a heterarchy, where the activation of high-centrality nodes and communities is most likely to lead to steady state paranoia. We also highlight the novel methodological approach used by this study: namely, using network analysis to re-examine a population structure of psychopathology previously identified by latent variable approaches.

The tangled roots of inner speech, voices and delusions

The role of inner speech in the experience of auditory verbal hallucinations (AVH) and delusions remains unclear. This exploratory study tested for differences in inner speech (assessed via self-report questionnaire) between 89 participants with psychosis and 37 non-clinical controls. We also tested for associations of inner speech with, i) state/trait AVH, ii) AVH-severity; iii) patients' relations with their voices, and; iv) delusion-severity. Persons with psychosis had greater levels of dialogic inner speech, other people in inner speech, and evaluative/motivational inner speech than non-clinical controls. Those with state, but not trait AVH had greater levels of dialogic and evaluative/motivational inner speech than non-clinical controls. After controlling for delusions, there was a positive relation between AVH-severity and both evaluative/motivational inner speech and other people in inner speech. Participants with greater levels of dialogic inner speech reported better relations both with and between their voices. There was no association between delusion-severity and inner speech. These results highlight the importance of better understanding relations between inner speech and AVH, provide avenues for future research, and underscore the need for research into the interrelatedness of inner speech, voices and delusions, and the complexities involved in disentangling these experiences.

Paranoia and the social representation of others: a large-scale game theory approach

Current definitions of paranoia include two key components: unfounded ideas of harm and the idea that the harm is intended by others. However, attributions of harmful intent have been poorly studied and mainly using artificial scenarios rather than participation in genuine social interactions where genuine resources are at stake. Using a large non-clinical population (N = 3229) recruited online, we asked people to complete a measure of paranoid ideation before playing a modified Dictator Game, where the ‘dictator’ can allocate money to the partner (the ‘receiver’). Participants were allocated to the role of receiver or of an uninvolved observer; and evaluated to what extent they believed dictator decisions were motivated by (i) self-interest or (ii) harmful intent. All participants attributed more harmful intent to unfair as opposed to fair dictators. Paranoia had a positive effect on harmful intent attribution, for both fair and unfair dictators. Paranoia did not interact with attributions of self-interest. Importantly, highly paranoid participants attributed equally strong harmful intent to the dictator in the observer role as in the receiver role. This challenges the assumption that paranoia is mainly due to an exaggerated sense of personalised threat and suggests instead that paranoia involves a negative social representations of others.

The Sensed Presence Questionnaire (SenPQ): initial psychometric validation of a measure of the "Sensed Presence" experience

Background

The experience of ‘sensed presence’—a feeling or sense that another entity, individual or being is present despite no clear sensory or perceptual evidence—is known to occur in the general population, appears more frequently in religious or spiritual contexts, and seems to be prominent in certain psychiatric or neurological conditions and may reflect specific functions of social cognition or body-image representation systems in the brain. Previous research has relied on ad-hoc measures of the experience and no specific psychometric scale to measure the experience exists to date.

Methods

Based on phenomenological description in the literature, we created the 16-item Sensed Presence Questionnaire (SenPQ). We recruited participants from (i) a general population sample, and; (ii) a sample including specific selection for religious affiliation, to complete the SenPQ and additional measures of well-being, schizotypy, social anxiety, social imagery, and spiritual experience. We completed an analysis to test internal reliability, the ability of the SenPQ to distinguish between religious and non-religious participants, and whether the SenPQ was specifically related to positive schizotypical experiences and social imagery. A factor analysis was also conducted to examine underlying latent variables.

Results

The SenPQ was found to be reliable and valid, with religious participants significantly endorsing more items than non-religious participants, and the scale showing a selective relationship with construct relevant measures. Principal components analysis indicates two potential underlying factors interpreted as reflecting ‘benign’ and ‘malign’ sensed presence experiences.

Discussion

The SenPQ appears to be a reliable and valid measure of sensed presence experience although further validation in neurological and psychiatric conditions is warranted.