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Smith KA, Hardy A, Vinnikova A, Blease C, Milligan L, Hidalgo-Mazzei D, Lambe S, Marzano L, Uhlhaas PJ, Ostinelli EG, Anmella G, Zangani C, Aronica R, Dwyer B, Torous J, Cipriani A. Digital Mental Health for Schizophrenia and Other Severe Mental Illnesses: An International Consensus on Current Challenges and Potential Solutions. JMIR Ment Health 2024; 11:e57155. [PMID: 38717799 PMCID: PMC11112473 DOI: 10.2196/57155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/08/2024] [Accepted: 03/21/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Digital approaches may be helpful in augmenting care to address unmet mental health needs, particularly for schizophrenia and severe mental illness (SMI). OBJECTIVE An international multidisciplinary group was convened to reach a consensus on the challenges and potential solutions regarding collecting data, delivering treatment, and the ethical challenges in digital mental health approaches for schizophrenia and SMI. METHODS The consensus development panel method was used, with an in-person meeting of 2 groups: the expert group and the panel. Membership was multidisciplinary including those with lived experience, with equal participation at all stages and coproduction of the consensus outputs and summary. Relevant literature was shared in advance of the meeting, and a systematic search of the recent literature on digital mental health interventions for schizophrenia and psychosis was completed to ensure that the panel was informed before the meeting with the expert group. RESULTS Four broad areas of challenge and proposed solutions were identified: (1) user involvement for real coproduction; (2) new approaches to methodology in digital mental health, including agreed standards, data sharing, measuring harms, prevention strategies, and mechanistic research; (3) regulation and funding issues; and (4) implementation in real-world settings (including multidisciplinary collaboration, training, augmenting existing service provision, and social and population-focused approaches). Examples are provided with more detail on human-centered research design, lived experience perspectives, and biomedical ethics in digital mental health approaches for SMI. CONCLUSIONS The group agreed by consensus on a number of recommendations: (1) a new and improved approach to digital mental health research (with agreed reporting standards, data sharing, and shared protocols), (2) equal emphasis on social and population research as well as biological and psychological approaches, (3) meaningful collaborations across varied disciplines that have previously not worked closely together, (4) increased focus on the business model and product with planning and new funding structures across the whole development pathway, (5) increased focus and reporting on ethical issues and potential harms, and (6) organizational changes to allow for true communication and coproduction with those with lived experience of SMI. This study approach, combining an international expert meeting with patient and public involvement and engagement throughout the process, consensus methodology, discussion, and publication, is a helpful way to identify directions for future research and clinical implementation in rapidly evolving areas and can be combined with measurements of real-world clinical impact over time. Similar initiatives will be helpful in other areas of digital mental health and similarly fast-evolving fields to focus research and organizational change and effect improved real-world clinical implementation.
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Affiliation(s)
- Katharine A Smith
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | | | - Charlotte Blease
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Lea Milligan
- MQ Mental Health Research, London, United Kingdom
| | - Diego Hidalgo-Mazzei
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Sinéad Lambe
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Lisa Marzano
- School of Science and Technology, Middlesex University, London, United Kingdom
| | - Peter J Uhlhaas
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Edoardo G Ostinelli
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - Gerard Anmella
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Caroline Zangani
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - Rosario Aronica
- Psychiatry Unit, Department of Neurosciences and Mental Health, Ospedale Maggiore Policlinico Ca' Granda, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Bridget Dwyer
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
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Raffard S, de Connor A, Freeman D, Bortolon C. [Recent developments in the modeling and psychological management of persecutory ideation]. L'ENCEPHALE 2024; 50:99-107. [PMID: 37748987 DOI: 10.1016/j.encep.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/05/2023] [Accepted: 08/05/2023] [Indexed: 09/27/2023]
Abstract
Persecutory ideas are a major clinical problem and are associated with impaired functioning, reduced compliance with medication and increased risk of hospitalization. Persecutory ideation is defined as the false conviction that others are threatening or conspiring against one. Although persecutory delusions are mainly described and experienced in schizophrenia spectrum disorders, they also occur in other neurological and psychiatric diagnoses including Alzheimer disease, epilepsy, depression, mania, dementia and post-traumatic stress disorder. Moreover, epidemiological data from general and clinical populations indicated that paranoid beliefs occur on a hierarchy of severity and are present to a lesser degree in the general population, with paranoid delusions representing the severe end of a continuum. In this review we focus on the important advances following a decade of research from psychological sciences, and more particularly the work of Daniel Freeman and Philippa Garety in England. Their work has demonstrated that a range of causal factors are involved in the development and maintenance of delusions beyond the traditional cognitive and behavioural models. Indeed, there is now well-validated evidence that sleep disturbances, worry proneness, reasoning biases, such as failure to consider alternative explanations or belief confirmation bias, abnormal experiences such as hallucinations, negative self-beliefs, and safety behaviours, are central factors that contribute to the paranoid phenomenon. In this review, we describe each of these causal factors in detail as well as the clinical interventions developed by Freeman and his collaborators, including the integrative and modular "Feeling Safe" intervention. Broadly speaking, the aim of this psychological intervention is for patients to relearn safety by exposing them to situations they consider as potentially dangerous after reduction of the influence of the maintenance factors described above. A recent publication showed that the Feeling Safe program led to recovery in persecutory delusions for 50% of patients having poor response to antipsychotic medication, making the intervention as the most effective psychological treatment for persecutory delusions. Finally, we will critically discuss the efficacy data from the numerous clinical studies validating its effectiveness. Prospects for the implementation of the Feeling Safe program in France also is discussed.
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Affiliation(s)
- Stéphane Raffard
- Service universitaire de psychiatrie adulte, CHU de Montpellier, 39, avenue Charles-Flahaut, 34295 Montpellier cedex 5, France; Laboratoire Epsylon, EA 4556, université Paul-Valéry-Montpellier, 3, route de Mende, 34199 Montpellier cedex 5, France.
| | - Alexandre de Connor
- Service universitaire de psychiatrie adulte, CHU de Montpellier, 39, avenue Charles-Flahaut, 34295 Montpellier cedex 5, France
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, Royaume-Uni; Oxford Health NHS Foundation Trust, Oxford, Royaume-Uni; NIHR Oxford Health Biomedical Research Centre, Oxford, Royaume-Uni
| | - Catherine Bortolon
- Départment de psychologie, université de Grenoble-Alpes, université Savoie-Mont-Blanc, LIP/PC2S, Grenoble, France; Département de psychologie, institut universitaire de France, Paris, France
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3
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Ulrich S, Lieb R, Zander-Schellenberg T. Rethinking paranoid ideation and reasoning: A pilot study based on the argumentative theory of reasoning. J Behav Ther Exp Psychiatry 2023; 81:101884. [PMID: 37307645 DOI: 10.1016/j.jbtep.2023.101884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 05/17/2023] [Accepted: 05/27/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVES Cognitive theories assume an imbalance of intuitive and analytical reasoning in paranoid ideation. The argumentative theory of reasoning offers an approach on the primary function of reasoning and its flaws. It assumes social exchange as main purpose of reasoning. We applied this theory to delusion research and tested experimentally whether social exchange in the form of production and evaluation of arguments influences subsequent reflective reasoning. Additionally, we examined whether the social network and the frequency/preference for discussions are associated with distorted reflective reasoning and paranoid ideation. METHODS 327 participants completed the Social Network Index (SNI), the Paranoia Checklist (PCL), and the Cognitive Reflection Test-2 (CRT2). Moreover, preference and frequency of discussions were assessed. In the discussion group (N = 165), participants produced arguments and evaluated counterarguments on two socially relevant topics. The control group (N = 162) watched a nature video instead. RESULTS The discussion group showed lower distorted reflective reasoning than the control group. Discussion preference and/or frequency was associated with frequency and disturbance of paranoid thoughts, as well as overall paranoid ideation. LIMITATIONS Due to the online format environmental factors could not be held constant and no intrasubject comparison of the CRT2 could be computed in the trial. Furthermore, the sample mainly consisted of psychology students. CONCLUSION The results contribute to the understanding of distorted reflective reasoning and provides preliminary evidence that the argumentative theory of reasoning may offer a promising perspective for delusion research.
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Affiliation(s)
- Sarah Ulrich
- Division of Clinical Psychology and Epidemiology, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Roselind Lieb
- Division of Clinical Psychology and Epidemiology, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Thea Zander-Schellenberg
- Division of Clinical Psychology and Epidemiology, Faculty of Psychology, University of Basel, Basel, Switzerland.
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4
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Cesur E, Moritz S, Balzan RP, Scheunemann J, Gabbert T, Aleksandrowicz A, Fischer R. Hasty decision making and belief inflexibility in the more delusion prone? A modified disambiguating-scenarios paradigm assessing cognitive biases implicated in delusions. Schizophr Res 2023; 260:41-48. [PMID: 37611329 DOI: 10.1016/j.schres.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/11/2023] [Accepted: 07/05/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION Contemporary models of psychosis imply that cognitive biases such as the jumping to conclusions (JTC), the bias against disconfirmatory evidence (BADE), and the liberal acceptance (LA) bias play a role in the pathogenesis of delusions. Most of the studies investigating the role of cognitive biases, however, have been conducted with socially neutral or abstract stimuli and have assessed patients with established psychoses. For the present study, we aimed to concurrently investigate multiple biases (i.e., the JTC, BADE, and LA biases) in a community sample with a new paradigm using more socially engaging stimuli. METHODS A large sample of participants (N = 874) recruited via Amazon Mechanical Turk was subdivided into two groups based on the frequency of their psychotic-like experiences (PLEs) according to the positive subscale score of the Community Assessment of Psychic Experiences (CAPE) and matched based on major demographics variables, resulting in two equally sized groups called High-PLE (at least 2 SD above the mean) and Low-PLE (maximum 0.5 above the mean; n = 46 for each group). Using a modified version of the written-scenarios BADE task, which emphasized social interactions between agents embedded in the scenario, participants rated the plausibility of response options in the face of new information. RESULTS In line with previous findings, the High-PLE group demonstrated the JTC, BADE, and LA biases. That is, the members of this group made more decisions after the initial piece of information, were less likely to revise their beliefs in light of new information, and provided higher plausibility ratings for implausible response options compared to the Low-PLE group. CONCLUSIONS Results corroborate prior findings suggesting that the JTC, BADE, and LA biases may be contributing factors in delusional ideation and that metacognitive biases extend to social situations.
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Affiliation(s)
- Esra Cesur
- 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.
| | - Ryan P Balzan
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, SA, Australia; Flinders University Institute for Mental Health and Wellbeing, SA, Australia
| | - Jakob Scheunemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tana Gabbert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Adrianna Aleksandrowicz
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Rabea Fischer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Rosenblau G, Frolichs K, Korn CW. A neuro-computational social learning framework to facilitate transdiagnostic classification and treatment across psychiatric disorders. Neurosci Biobehav Rev 2023; 149:105181. [PMID: 37062494 PMCID: PMC10236440 DOI: 10.1016/j.neubiorev.2023.105181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 03/14/2023] [Accepted: 04/13/2023] [Indexed: 04/18/2023]
Abstract
Social deficits are among the core and most striking psychiatric symptoms, present in most psychiatric disorders. Here, we introduce a novel social learning framework, which consists of neuro-computational models that combine reinforcement learning with various types of social knowledge structures. We outline how this social learning framework can help specify and quantify social psychopathology across disorders and provide an overview of the brain regions that may be involved in this type of social learning. We highlight how this framework can specify commonalities and differences in the social psychopathology of individuals with autism spectrum disorder (ASD), personality disorders (PD), and major depressive disorder (MDD) and improve treatments on an individual basis. We conjecture that individuals with psychiatric disorders rely on rigid social knowledge representations when learning about others, albeit the nature of their rigidity and the behavioral consequences can greatly differ. While non-clinical cohorts tend to efficiently adapt social knowledge representations to relevant environmental constraints, psychiatric cohorts may rigidly stick to their preconceived notions or overly coarse knowledge representations during learning.
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Affiliation(s)
- Gabriela Rosenblau
- Department of Psychological and Brain Sciences, George Washington University, Washington DC, USA; Autism and Neurodevelopmental Disorders Institute, George Washington University, Washington DC, USA.
| | - Koen Frolichs
- Section Social Neuroscience, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany; Institute for Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph W Korn
- Section Social Neuroscience, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany; Institute for Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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6
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Na S, Rhoads SA, Yu ANC, Fiore VG, Gu X. Towards a neurocomputational account of social controllability: From models to mental health. Neurosci Biobehav Rev 2023; 148:105139. [PMID: 36940889 PMCID: PMC10106443 DOI: 10.1016/j.neubiorev.2023.105139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 03/22/2023]
Abstract
Controllability, or the influence one has over their surroundings, is crucial for decision-making and mental health. Traditionally, controllability is operationalized in sensorimotor terms as one's ability to exercise their actions to achieve an intended outcome (also termed "agency"). However, recent social neuroscience research suggests that humans also assess if and how they can exert influence over other people (i.e., their actions, outcomes, beliefs) to achieve desired outcomes ("social controllability"). In this review, we will synthesize empirical findings and neurocomputational frameworks related to social controllability. We first introduce the concepts of contextual and perceived controllability and their respective relevance for decision-making. Then, we outline neurocomputational frameworks that can be used to model social controllability, with a focus on behavioral economic paradigms and reinforcement learning approaches. Finally, we discuss the implications of social controllability for computational psychiatry research, using delusion and obsession-compulsion as examples. Taken together, we propose that social controllability could be a key area of investigation in future social neuroscience and computational psychiatry research.
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Affiliation(s)
- Soojung Na
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; Center for Computational Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Shawn A Rhoads
- Center for Computational Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Alessandra N C Yu
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; Center for Computational Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Vincenzo G Fiore
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; Center for Computational Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Xiaosi Gu
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; Center for Computational Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
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7
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Kuhn SAK, Andreou C, Elbel G, Lieb R, Zander-Schellenberg T. Reasoning biases and delusional ideation in the general population: A longitudinal study. Schizophr Res 2023; 255:132-139. [PMID: 36989670 DOI: 10.1016/j.schres.2023.03.009] [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: 08/14/2022] [Revised: 01/13/2023] [Accepted: 03/03/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Reasoning biases have been suggested as risk factors for delusional ideation in both patients and non-clinical individuals. Still, it is unclear how these biases are longitudinally related to delusions in the general population. We hence aimed to investigate longitudinal associations between reasoning biases and delusional ideation in the general population. METHODS We conducted an online cohort study with 1184 adults from the German and Swiss general population. Participants completed measures on reasoning biases (jumping-to-conclusion bias [JTC], liberal acceptance bias [LA], bias against disconfirmatory evidence [BADE], possibility of being mistaken [PM]) and delusional ideation at baseline, and delusional ideation 7 to 8 months later. RESULTS A greater JTC bias was associated with a greater increase in delusional ideation over the following months. This association was better described by a positive quadratic relationship. Neither BADE, LA nor PM were associated with subsequent changes in delusional ideation. CONCLUSIONS This study suggests that jumping-to-conclusions predicts delusional ideation in the general population but that this association may follow a quadratic trajectory. While no other associations turned significant, future studies with shorter temporal distances may shed further light on the role of reasoning biases as risk factors for delusional ideation in non-clinical samples.
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Affiliation(s)
- Sarah Anne Kezia Kuhn
- Division of Clinical Psychology and Epidemiology, Faculty of Psychology, University of Basel, Switzerland.
| | - Christina Andreou
- Department of Psychiatry and Psychotherapy, Translational Psychiatry Unit, University of Luebeck, Luebeck, Germany
| | - Gregory Elbel
- Division of Clinical Psychology and Epidemiology, Faculty of Psychology, University of Basel, Switzerland
| | - Roselind Lieb
- Division of Clinical Psychology and Epidemiology, Faculty of Psychology, University of Basel, Switzerland
| | - Thea Zander-Schellenberg
- Division of Clinical Psychology and Epidemiology, Faculty of Psychology, University of Basel, Switzerland.
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8
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Buck B, Browne J, Gagen EC, Penn DL. Hostile attribution bias in schizophrenia-spectrum disorders: narrative review of the literature and persisting questions. J Ment Health 2023; 32:132-149. [PMID: 32228272 DOI: 10.1080/09638237.2020.1739240] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Social cognition is often aberrant or impaired in psychotic disorders and related to functional outcomes. In particular, one core social cognitive bias - hostile attribution bias - is proposed to be implicated in paranoia, anxiety, mood disturbances and interpersonal conflict outcomes. However, questions remain about this domain's specificity to psychosis and its relationship to general functional outcomes. AIMS The present paper offers a descriptive and critical review of the literature on hostile attribution bias in psychotic disorders, in order to examine (1) its impact on persecutory symptoms in schizophrenia-spectrum disorders, (2) impact on other related psychopathology among those experiencing psychosis and (3) relationship to functioning. METHODS Twenty-eight studies included in this review after parallel literature searches of PsycINFO and PubMed. RESULTS Evidence from these studies highlighted that hostile attribution bias is elevated in schizophrenia, and that it is related to anxiety, depression and interpersonal conflict outcomes. CONCLUSION While results suggest that hostile attributions are elevated in schizophrenia and associated with symptoms and functioning, there exist numerous persisting questions in the study of this area, including identifying which measures are most effective and determining how it presents: as a state or trait-like characteristic, via dual processes, and its situational variation.
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Affiliation(s)
- Benjamin Buck
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Julia Browne
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Emily C Gagen
- Research Service, Providence VA Medical Center, Providence, RI, USA
| | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
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Greenwood KE, Gurnani M, Ward T, Vogel E, Vella C, McGourty A, Robertson S, Sacadura C, Hardy A, Rus‐Calafell M, Collett N, Emsley R, Freeman D, Fowler D, Kuipers E, Bebbington P, Dunn G, Michelson D, Garety P. The service user experience of SlowMo therapy: A co-produced thematic analysis of service users' subjective experience. Psychol Psychother 2022; 95:680-700. [PMID: 35445520 PMCID: PMC9873386 DOI: 10.1111/papt.12393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/18/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES SlowMo is the first blended digital therapy for paranoia, showing significant small-moderate reductions in paranoia in a recent large-scale randomized controlled trial (RCT). This study explored the subjective service-user experience of the SlowMo therapy content and design; the experience of the blended therapy approach, including the triangle of the therapeutic alliance; and the experience of the digital aspects of the intervention. DESIGN Qualitative co-produced sub-study of an RCT. METHODS Participants were 22 adult service users with schizophrenia-spectrum psychosis and persistent distressing paranoia, who completed at least one SlowMo therapy session and a 24-week follow-up, at one of 3 sites in Oxford, London, and Sussex, UK. They were interviewed by peer researchers, using a topic guide co-produced by the Patient and Public Involvement (PPI) team. The transcribed data were analysed thematically. Multiple coding and triangulation, and lay peer researcher validation were used to reach a consensus on the final theme structure. RESULTS Six core themes were identified: (i) starting the SlowMo journey; (ii) the central role of the supportive therapist; (iii) slowing things down; (iv) value and learning from social connections; (v) approaches and challenges of technology; and (vi) improvements in paranoia and well-being. CONCLUSIONS For these service users, slowing down for a moment was helpful, and integrated into thinking over time. Learning from social connections reflected reduced isolation, and enhanced learning through videos, vignettes, and peers. The central role of the supportive therapist and the triangle of alliance between service user, therapist, and digital platform were effective in promoting positive therapeutic outcomes.
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Affiliation(s)
- Kathryn E. Greenwood
- School of PsychologyUniversity of SussexBrightonUK,Sussex Partnership NHS Foundation TrustWorthingUK
| | | | - Tom Ward
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
| | - Evelin Vogel
- Sussex Partnership NHS Foundation TrustWorthingUK
| | - Claire Vella
- Sussex Partnership NHS Foundation TrustWorthingUK
| | | | | | | | - Amy Hardy
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
| | | | | | - Richard Emsley
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Daniel Freeman
- Oxford Health NHS Foundation TrustOxfordUK,Department of PsychiatryOxford UniversityOxfordUK
| | - David Fowler
- School of PsychologyUniversity of SussexBrightonUK,Sussex Partnership NHS Foundation TrustWorthingUK
| | - Elizabeth Kuipers
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
| | | | - Graham Dunn
- Centre for BiostatisticsSchool of Health SciencesManchester Academic Health Science CentreThe University of ManchesterManchesterUK
| | | | - Philippa Garety
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
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10
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Divergent thinking in Italian elementary school children: the key role of probabilistic reasoning style. Cogn Process 2022; 23:637-645. [PMID: 35881317 DOI: 10.1007/s10339-022-01104-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/22/2022] [Indexed: 11/03/2022]
Abstract
Divergent thinking is widely recognised as an individual creative potential and an essential factor in fostering creativity since the early stages of life. Albeit previous research revealed that creativity could be pursued through controlled mental processes (e.g. reasoning), the debate about the impact of children's reasoning on divergent thinking and, ultimately, creativity is still open. The present study sought to deepen the relationships between probabilistic reasoning and divergent thinking in a sample of 106 Italian children (meanage = 8.64, SDage = 1.34; 58 F). The Beads Task was used to evaluate probabilistic reasoning, whereas the Alternative Uses Task was administered to assess divergent thinking. Results revealed that analytical, slow, and effortful forms of thought underpinned by high probabilistic competencies predict children's divergent production. These findings suggest that a higher score for divergence of thinking depends on a high involvement of reasoning style, which in this study relies on the ability to make probabilistic decisions in ambiguous situations. Future research directions were discussed.
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11
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Caddick ZA, Feist GJ. When beliefs and evidence collide: psychological and ideological predictors of motivated reasoning about climate change. THINKING & REASONING 2022. [DOI: 10.1080/13546783.2021.1994009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Gregory J. Feist
- Department of Psychology, San Jose State University, San Jose, CA, USA
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12
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Na S, Blackmore S, Chung D, O’Brien M, Banker S, Heflin M, Fiore VG, Gu X. Computational mechanisms underlying illusion of control in delusional individuals. Schizophr Res 2022; 245:50-58. [PMID: 35177284 PMCID: PMC9232936 DOI: 10.1016/j.schres.2022.01.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
Abstract
Humans navigate complex situations that require the accurate estimation of the controllability of the environment. Aberrant controllability computation might lead to maladaptive behaviors and poor mental health outcomes. Illusion of control, which refers to a heightened sense of control while the environment is uncontrollable, is one such manifestation and has been conceptually associated with delusional ideation. Nevertheless, this association has not yet been formally characterized in a computational framework. To address this, we used a computational psychiatry approach to quantify illusion of control in human participants with high (n = 125) or low (n = 126) trait delusion. Participants played a two-party exchange game in which their choices either did ("Controllable condition") or did not ("Uncontrollable condition") influence the future monetary offers made by simulated partners. We found that the two groups behaved similarly in model-agnostic measures (i.e., offer size, rejection rate). However, computational modeling revealed that compared to the low trait delusion group, the high delusion group overestimated their influence ("expected influence" parameter) over the offers made by their partners under the Uncontrollable condition. Highly delusional individuals also reported a stronger sense of control than those with low trait delusion in the Uncontrollable condition. Furthermore, the expected influence parameter and self-reported beliefs about controllability were significantly correlated in the Controllable condition in individuals with low trait delusion, whereas this relationship was diminished in those with high trait delusion. Collectively, these findings demonstrate that delusional ideation is associated with aberrant computation of and belief about environmental controllability, as well as a belief-behavior disconnect.
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Affiliation(s)
- Soojung Na
- Nash Family Department of Neuroscience, Icahn School of
Medicine at Mount Sinai,Department of Psychiatry, Icahn School of Medicine at
Mount Sinai
| | | | | | - Madeline O’Brien
- Nash Family Department of Neuroscience, Icahn School of
Medicine at Mount Sinai,Department of Psychiatry, Icahn School of Medicine at
Mount Sinai,Center for Computational Psychiatry, Icahn School of
Medicine at Mount Sinai
| | - Sarah Banker
- Nash Family Department of Neuroscience, Icahn School of
Medicine at Mount Sinai,Department of Psychiatry, Icahn School of Medicine at
Mount Sinai,Center for Computational Psychiatry, Icahn School of
Medicine at Mount Sinai
| | - Matthew Heflin
- Department of Psychiatry, Icahn School of Medicine at
Mount Sinai,Center for Computational Psychiatry, Icahn School of
Medicine at Mount Sinai
| | - Vincenzo G. Fiore
- Department of Psychiatry, Icahn School of Medicine at
Mount Sinai,Center for Computational Psychiatry, Icahn School of
Medicine at Mount Sinai
| | - Xiaosi Gu
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, United States of America; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, United States of America; Center for Computational Psychiatry, Icahn School of Medicine at Mount Sinai, United States of America.
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13
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Ward T, Hardy A, Holm R, Collett N, Rus‐Calafell M, Sacadura C, McGourty A, Vella C, East A, Rea M, Harding H, Emsley R, Greenwood K, Freeman D, Fowler D, Kuipers E, Bebbington P, Garety P. SlowMo therapy, a new digital blended therapy for fear of harm from others: An account of therapy personalisation within a targeted intervention. Psychol Psychother 2022; 95:423-446. [PMID: 35019210 PMCID: PMC9306634 DOI: 10.1111/papt.12377] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 12/06/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES SlowMo therapy is a pioneering blended digital therapy for paranoia, augmenting face-to-face therapy with an interactive 'webapp' and a mobile app. A recent large-scale trial demonstrated small-moderate effects on paranoia alongside improvements in self-esteem, worry, well-being and quality of life. This paper provides a comprehensive account of therapy personalisation within this targeted approach. DESIGN Case examples illustrate therapy delivery and descriptive data are presented on personalised thought content. METHOD Thought content was extracted from the webapp (n = 140 participants) and coded using newly devised categories: Worries: (1) Persecutory, (2) Negative social evaluation, (3) Negative self-concept, (4) Loss/life stresses, (5) Sensory-perceptual experiences and (6) Health anxieties. Safer thoughts: (1) Safer alternative (specific alternatives to worries), (2) Second-wave (generalised) coping, (3) Positive self-concept, (4) Positive activities and (5) Third-wave (mindfulness-based) coping. Data on therapy fidelity are also presented. RESULTS Worries: 'Persecutory' (92.9% of people) and 'Negative social evaluation' (74.3%) were most common. 'General worries/ life stresses' (31.4%) and 'Negative self-concept' (22.1%) were present in a significant minority; 'Health anxieties' (10%) and 'Sensory-perceptual' (10%) were less common. Safer thoughts: 'Second-wave (general) coping' (85%), 'Safer alternatives' (76.4%), 'Positive self-concept' (65.7%) and 'Positive activities' (64.3%) were common with 'Third-wave' (mindfulness) coping observed for 30%. Fidelity: Only three therapy withdrawals were therapy related. Session adherence was excellent (mean = 15.2/16; SD = 0.9). Behavioural work was conducted with 71% of people (119/168). CONCLUSION SlowMo therapy delivers a targeted yet personalised approach. Potential mechanisms of action extend beyond reasoning. Implications for cognitive models of paranoia and causal interventionist approaches are discussed.
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Affiliation(s)
- Thomas Ward
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
| | - Amy Hardy
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
| | - Rebecca Holm
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Nicola Collett
- Department of PsychiatryOxford UniversityOxfordUK,Oxford Health NHS Foundation TrustOxfordUK,Oxford Institute of Clinical Psychology Training and ResearchOxford UniversityOxfordUK
| | - Mar Rus‐Calafell
- Department of PsychiatryOxford UniversityOxfordUK,Oxford Health NHS Foundation TrustOxfordUK,Mental Health Research and Treatment CenterFaculty of PsychologyRuhr‐Universität BochumBochumGermany
| | | | | | - Claire Vella
- Sussex Partnership NHS Foundation TrustWorthingUK,School of PsychologyUniversity of SussexBrightonUK
| | - Anna East
- Department of PsychiatryOxford UniversityOxfordUK,Oxford Health NHS Foundation TrustOxfordUK
| | - Michaela Rea
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Helen Harding
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Richard Emsley
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | | | - Daniel Freeman
- Department of PsychiatryOxford UniversityOxfordUK,Oxford Health NHS Foundation TrustOxfordUK
| | - David Fowler
- Sussex Partnership NHS Foundation TrustWorthingUK,School of PsychologyUniversity of SussexBrightonUK
| | - Elizabeth Kuipers
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | | | - Philippa Garety
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
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14
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Lauffenburger JC, DiFrancesco MF, Barlev RA, Robertson T, Kim E, Coll MD, Haff N, Fontanet CP, Hanken K, Oran R, Avorn J, Choudhry NK. Overcoming Decisional Gaps in High-Risk Prescribing by Junior Physicians Using Simulation-Based Training: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e31464. [PMID: 35475982 PMCID: PMC9096643 DOI: 10.2196/31464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 02/03/2022] [Accepted: 02/05/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Gaps between rational thought and actual decisions are increasingly recognized as a reason why people make suboptimal choices in states of heightened emotion, such as stress. These observations may help explain why high-risk medications continue to be prescribed to acutely ill hospitalized older adults despite widely accepted recommendations against these practices. Role playing and other efforts, such as simulation training, have demonstrated benefits to help people avoid decisional gaps but have not been tested to reduce overprescribing of high-risk medications. OBJECTIVE This study aims to evaluate the impact of a simulation-based training program designed to address decisional gaps on prescribing of high-risk medications compared with control. METHODS In this 2-arm pragmatic trial, we are randomizing at least 36 first-year medical resident physicians (ie, interns) who provide care on inpatient general medicine services at a large academic medical center to either intervention (simulation-based training) or control (online educational training). The intervention comprises a 40-minute immersive individual simulation training consisting of a reality-based patient care scenario in a simulated environment at the beginning of their inpatient service rotation. The simulation focuses on 3 types of high-risk medications, including benzodiazepines, antipsychotics, and sedative hypnotics (Z-drugs), in older adults, and is specifically designed to help the physicians identify their reactions and prescribing decisions in stressful situations that are common in the inpatient setting. The simulation scenario is followed by a semistructured debriefing with an expert facilitator. The trial's primary outcome is the number of medication doses for any of the high-risk medications prescribed by the interns to patients aged 65 years or older who were not taking one of the medications upon admission. Secondary outcomes include prescribing by all providers on the care team, being discharged on 1 of the medications, and prescribing of related medications (eg, melatonin, trazodone), or the medications of interest for the control intervention. These outcomes will be measured using electronic health record data. RESULTS Recruitment of interns began on March 29, 2021. Recruitment for the trial ended in Q42021, with follow-up completed by Q12022. CONCLUSIONS This trial will evaluate the impact of a simulation-based training program designed using behavioral science principles on prescribing of high-risk medications by junior physicians. If the intervention is shown to be effective, this approach could potentially be reproducible by others and for a broader set of behaviors. TRIAL REGISTRATION ClinicalTrials.gov NCT04668248; https://clinicaltrials.gov/ct2/show/NCT04668248. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/31464.
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Affiliation(s)
| | | | - Renee A Barlev
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | | | - Erin Kim
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Maxwell D Coll
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Nancy Haff
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | | | - Kaitlin Hanken
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | | | - Jerry Avorn
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Niteesh K Choudhry
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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15
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Bansal S, Bae GY, Robinson BM, Hahn B, Waltz J, Erickson M, Leptourgos P, Corlett P, Luck SJ, Gold JM. Association Between Failures in Perceptual Updating and the Severity of Psychosis in Schizophrenia. JAMA Psychiatry 2022; 79:169-177. [PMID: 34851373 PMCID: PMC8811632 DOI: 10.1001/jamapsychiatry.2021.3482] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Recent accounts suggest that delusions and hallucinations may result from alterations in how prior knowledge is integrated with new information, but experimental evidence supporting this idea has been complex and inconsistent. Evidence from a simpler perceptual task would make clear whether psychotic symptoms are associated with overreliance on prior information and impaired updating. OBJECTIVE To investigate whether individuals with schizophrenia or schizoaffective disorder (PSZ) and healthy control individuals (HCs) differ in the ability to update their beliefs based on evidence in a relatively simple perceptual paradigm. DESIGN, SETTING, AND PARTICIPANTS This case-control study included individuals who met DSM-IV criteria for PSZ and matched HC participants in 2 independent samples. The PSZ group was recruited from the Maryland Psychiatric Research Center, Yale University, and community clinics, and the HC group was recruited from the community. To test perceptual updating, a random dot kinematogram paradigm was implemented in which dots moving coherently in a single direction were mixed with randomly moving dots. On 50% of trials, the direction of coherent motion changed by 90° midway through the trial. Participants were asked to report the direction perceived at the end of the trial. The Peters Delusions Inventory and Brief Psychiatric Rating Scale (BPRS) were used to quantify the severity of positive symptoms. Data were collected from September 2018 to March 2020 and were analyzed from approximately March 2020 to March 2021. MAIN OUTCOMES AND MEASURES Critical measures included the proportion of responses centered around the initial direction vs the subsequent changed direction and the overall precision of motion perception and reaction times. RESULTS A total of 48 participants were included in the PSZ group (31 [65%] male; mean [SD] age, 36.56 [9.76] years) and 36 in the HC group (22 [61%] male; mean [SD] age, 35.67 [10.74] years) in the original sample. An independent replication sample included 42 participants in the PSZ group (29 [69%] male; mean [SD] age, 33.98 [11.03] years) and 34 in the HC group (20 [59%] male; mean [SD] age, 34.29 [10.44] years). In line with previous research, patients with PSZ were less precise and had slower reaction times overall. The key finding was that patients with PSZ were significantly more likely (original sample: mean, 27.88 [95% CI, 24.19-31.57]; replication sample: mean, 26.70 [95% CI, 23.53-29.87]) than HC participants (original sample: mean, 18.86 [95% CI, 16.56-21.16]; replication sample: mean, 15.67 [95% CI, 12.61-18.73]) to report the initial motion direction rather than the final one. Moreover, the tendency to report the direction of initial motion correlated with the degree of conviction on the Peters Delusions Inventory (original sample: r = 0.32 [P = .05]; replication sample: r = 0.30 [P = .05]) and the Brief Psychiatric Rating Scale Reality Distortion score (original sample: r = 0.55 [P = .001]; replication sample: r = 0.35 [P = .03]) and severity of hallucinations (original sample: r = 0.39 [P = .02]; replication sample: r = 0.30 [P = .05]). CONCLUSIONS AND RELEVANCE The findings of this case-control study suggest that the severity of psychotic symptoms is associated with a tendency to overweight initial information over incoming sensory evidence. These results are consistent with predictive coding accounts of the origins of positive symptoms and suggest that deficits in very elementary perceptual updating may be a critical mechanism in psychosis.
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Affiliation(s)
- Sonia Bansal
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore
| | - Gi-Yeul Bae
- Department of Psychology, Arizona State University, Tempe
| | - Benjamin M. Robinson
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore
| | - Britta Hahn
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore
| | - James Waltz
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore
| | - Molly Erickson
- Department of Psychiatry, University of Chicago, Chicago, Illinois
| | - Pantelis Leptourgos
- Department of Psychiatry, Connecticut Mental Health Center, Yale University, New Haven, Connecticut
| | - Phillip Corlett
- Department of Psychiatry, Connecticut Mental Health Center, Yale University, New Haven, Connecticut
| | - Steven J. Luck
- Center for Mind and Brain and Department of Psychology, University of California, Davis
| | - James M. Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore
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16
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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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Garety P, Ward T, Emsley R, Greenwood K, Freeman D, Fowler D, Kuipers E, Bebbington P, Rus-Calafell M, McGourty A, Sacadura C, Collett N, James K, Hardy A. Effects of SlowMo, a Blended Digital Therapy Targeting Reasoning, on Paranoia Among People With Psychosis: A Randomized Clinical Trial. JAMA Psychiatry 2021; 78:714-725. [PMID: 33825827 PMCID: PMC8027943 DOI: 10.1001/jamapsychiatry.2021.0326] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Persistent paranoia is common among patients with psychosis. Cognitive-behavioral therapy for psychosis can be effective. However, challenges in engagement and effectiveness remain. OBJECTIVE To investigate the effects on paranoia and mechanisms of action of SlowMo, a digitally supported reasoning intervention, plus usual care compared with usual care only. DESIGN, SETTING, AND PARTICIPANTS This parallel-arm, assessor-blinded, randomized clinical trial recruited participants at UK community health services from May 1, 2017, to May 14, 2019. Eligible participants consisted of a referral sample with schizophrenia-spectrum psychosis and distressing, persistent (≥3 months) paranoia. INTERVENTIONS Individuals were randomized 1:1 to SlowMo, consisting of 8 digitally supported face-to-face sessions and a mobile app, plus usual care (n = 181) and usual care only (n = 181). MAIN OUTCOMES AND MEASURES The primary outcome was paranoia, measured by the Green et al Paranoid Thoughts Scale (GPTS) total score at 24 weeks. Secondary outcomes included GPTS total score at 12 weeks and GPTS Part A (reference) and Part B (persecutory) scores, the Psychotic Symptom Rating Scales (PSYRATS Delusion subscale), reasoning (belief flexibility, possibility of being mistaken [Maudsley Assessment of Delusions, rated 0%-100%]), and jumping to conclusions (Beads Task). RESULTS A total of 361 participants were included in intention-to-treat analysis, of whom 252 (69.8%) were male and 249 (69.0%) were White; the mean (SD) age was 42.6 (11.6) years. At 24 weeks, 332 participants (92.0%) provided primary outcome data. Of 181 participants in the SlowMo group, 145 (80.1%) completed therapy. SlowMo plus usual care was not associated with greater reductions than usual care in GPTS total score at 24 weeks (Cohen d, 0.20; 95% CI, -0.02 to 0.40; P = .06). There were significant effects on secondary paranoia outcomes at 12 weeks, including GPTS total score (Cohen d, 0.30; 95% CI, 0.09-0.51; P = .005), Part A score (Cohen d, 0.22; 95% CI, 0.06-0.39; P = .009), and Part B score (Cohen d, 0.32; 95% CI, 0.08-0.56; P = .009), and at 24 weeks, including Part B score (Cohen d, 0.25; 95% CI, 0.01-0.49; P = .04) but not Part A score (Cohen d, 0.12; 95% CI, -0.05 to 0.28; P = .18). Improvements were observed in an observer-rated measure of persecutory delusions (PSYRATS delusion) at 12 weeks (Cohen d, 0.47; 95% CI, 0.17-0.78; P = .002) and 24 weeks (Cohen d, 0.50; 95% CI, 0.20-0.80; P = .001) and belief flexibility at 12 weeks (Cohen d, 0.29; 95% CI, 0.09-0.49; P = .004) and 24 weeks (Cohen d, 0.28; 95% CI, 0.08-0.49; P = .005). There were no significant effects on jumping to conclusions. Improved belief flexibility and worry mediated paranoia change (range mediated, 36%-56%). CONCLUSIONS AND RELEVANCE SlowMo did not demonstrate significant improvements in the primary measure of paranoia at 24 weeks; however, a beneficial effect of SlowMo on paranoia was indicated by the results on the primary measure at an earlier point and on observer-rated paranoia and self-reported persecution at 12 and 24 weeks. Further work to optimize SlowMo's effects is warranted. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN 32448671.
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Affiliation(s)
- Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom,South London and Maudsley NHS (National Health Service) Foundation Trust, London, United Kingdom
| | - Thomas Ward
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom,South London and Maudsley NHS (National Health Service) Foundation Trust, London, United Kingdom
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Kathryn Greenwood
- University of Sussex School of Psychology, Brighton, United Kingdom,Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
| | - Daniel Freeman
- Department of Psychiatry, Oxford University, Oxford, United Kingdom,Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - David Fowler
- University of Sussex School of Psychology, Brighton, United Kingdom,Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
| | - Elizabeth Kuipers
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom,South London and Maudsley NHS (National Health Service) Foundation Trust, London, United Kingdom
| | - Paul Bebbington
- Division of Psychiatry, University College London, London, United Kingdom
| | - Mar Rus-Calafell
- Department of Psychiatry, Oxford University, Oxford, United Kingdom,Oxford Health NHS Foundation Trust, Oxford, United Kingdom,Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Alison McGourty
- Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
| | | | - Nicola Collett
- Department of Psychiatry, Oxford University, Oxford, United Kingdom,Oxford Health NHS Foundation Trust, Oxford, United Kingdom,Oxford Institute of Clinical Psychology Training and Research, Oxford University, Oxford, United Kingdom
| | - Kirsty James
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom,South London and Maudsley NHS (National Health Service) Foundation Trust, London, United Kingdom
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18
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Hardy A, Ward T, Emsley R, Greenwood K, Freeman D, Fowler D, Kuipers E, Bebbington P, Garety P. Bridging the ‘digital divide’ in psychological therapies: Engagement with the SlowMo mobile app for paranoia in psychosis (Preprint). JMIR Hum Factors 2021; 9:e29725. [PMID: 35776506 PMCID: PMC9288106 DOI: 10.2196/29725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 10/08/2021] [Accepted: 04/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background Marginalized groups are more likely to experience problems with technology-related access, motivation, and skills. This is known as the “digital divide.” Technology-related exclusion is a potential barrier to the equitable implementation of digital health. SlowMo therapy was developed with an inclusive, human-centered design to optimize accessibility and bridge the “digital divide.” SlowMo is an effective, blended digital psychological therapy for paranoia in psychosis. Objective This study explores the “digital divide” and mobile app engagement in the SlowMo randomized controlled trial. Methods Digital literacy was assessed at baseline, and a multidimensional assessment of engagement (ie, adherence [via system analytics and self-report] and self-reported user experience) was conducted at 12 weeks after therapy. Engagement was investigated in relation to demographics (ie, gender, age, ethnicity, and paranoia severity). Results Digital literacy data demonstrated that technology use and confidence were lower in Black people and older people (n=168). The engagement findings indicated that 80.7% (96/119) of therapy completers met the a priori analytics adherence criteria. However, analytics adherence did not differ by demographics. High rates of user experience were reported overall (overall score: mean 75%, SD 17.1%; n=82). No differences in user experience were found for ethnicity, age, or paranoia severity, although self-reported app use, enjoyment, and usefulness were higher in women than in men. Conclusions This study identified technology-related inequalities related to age and ethnicity, which did not influence engagement with SlowMo, suggesting that the therapy design bridged the “digital divide.” Intervention design may moderate the influence of individual differences on engagement. We recommend the adoption of inclusive, human-centered design to reduce the impact of the “digital divide” on therapy outcomes. Trial Registration ISRCTN Registry ISRCTN32448671; https://www.isrctn.com/ISRCTN32448671
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Affiliation(s)
- Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- South London & Maudsley National Health Services Foundation Trust, London, United Kingdom
| | - Thomas Ward
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- South London & Maudsley National Health Services Foundation Trust, London, United Kingdom
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Kathryn Greenwood
- Department of Psychology, University of Sussex, Brighton, United Kingdom
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - David Fowler
- Department of Psychology, University of Sussex, Brighton, United Kingdom
| | - Elizabeth Kuipers
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Paul Bebbington
- Division of Psychiatry, University College London, London, United Kingdom
| | - Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- South London & Maudsley National Health Services Foundation Trust, London, United Kingdom
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19
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Feyaerts J, Henriksen MG, Vanheule S, Myin-Germeys I, Sass LA. Delusions beyond beliefs: a critical overview of diagnostic, aetiological, and therapeutic schizophrenia research from a clinical-phenomenological perspective. Lancet Psychiatry 2021; 8:237-249. [PMID: 33485408 DOI: 10.1016/s2215-0366(20)30460-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/27/2020] [Accepted: 09/29/2020] [Indexed: 12/13/2022]
Abstract
Delusions are commonly conceived as false beliefs that are held with certainty and which cannot be corrected. This conception of delusion has been influential throughout the history of psychiatry and continues to inform how delusions are approached in clinical practice and in contemporary schizophrenia research. It is reflected in the full psychosis continuum model, guides psychological and neurocognitive accounts of the formation and maintenance of delusions, and it substantially determines how delusions are approached in cognitive-behavioural treatment. In this Review, we draw on a clinical-phenomenological framework to offer an alternative account of delusion that incorporates the experiential dimension of delusion, emphasising how specific alterations to self-consciousness and reality experience underlie delusions that are considered characteristic of schizophrenia. Against that backdrop, we critically reconsider the current research areas, highlighting empirical and conceptual issues in contemporary delusion research, which appear to largely derive from an insufficient consideration of the experiential dimension of delusions. Finally, we suggest how the alternative phenomenological approach towards delusion could offer new ways to advance current research and clinical practice.
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Affiliation(s)
- Jasper Feyaerts
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium; Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium.
| | - Mads G Henriksen
- Center for Subjectivity Research, Faculty of Humanities, University of Copenhagen, Copenhagen, Denmark; Mental Health Center Amager, Copenhagen, Denmark; Mental Health Center Glostrup, Brøndbyvester, Denmark
| | - Stijn Vanheule
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium
| | - Louis A Sass
- Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, NJ, USA
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20
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Moreno-Fernández MM, Blanco F, Matute H. The tendency to stop collecting information is linked to illusions of causality. Sci Rep 2021; 11:3942. [PMID: 33594129 PMCID: PMC7887230 DOI: 10.1038/s41598-021-82075-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/12/2021] [Indexed: 11/18/2022] Open
Abstract
Previous research proposed that cognitive biases contribute to produce and maintain the symptoms exhibited by deluded patients. Specifically, the tendency to jump to conclusions (i.e., to stop collecting evidence soon before making a decision) has been claimed to contribute to delusion formation. Additionally, deluded patients show an abnormal understanding of cause-effect relationships, often leading to causal illusions (i.e., the belief that two events are causally connected, when they are not). Both types of bias appear in psychotic disorders, but also in healthy individuals. In two studies, we test the hypothesis that the two biases (jumping to conclusions and causal illusions) appear in the general population and correlate with each other. The rationale is based on current theories of associative learning that explain causal illusions as the result of a learning bias that tends to wear off as additional information is incorporated. We propose that participants with higher tendency to jump to conclusions will stop collecting information sooner in a causal learning study than those participants with lower tendency to jump to conclusions, which means that the former will not reach the learning asymptote, leading to biased judgments. The studies provide evidence in favour that the two biases are correlated but suggest that the proposed mechanism is not responsible for this association.
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Affiliation(s)
- María Manuela Moreno-Fernández
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Granada, Granada, Spain. .,Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain.
| | - Fernando Blanco
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain.,Department of Social Psychology, Faculty of Psychology, University of Granada, Granada, Spain
| | - Helena Matute
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
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21
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A randomised controlled trial of metacognitive training for psychosis, depression, and belief flexibility. J Affect Disord 2021; 279:388-397. [PMID: 33099054 DOI: 10.1016/j.jad.2020.09.126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/11/2020] [Accepted: 09/27/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Metacognitive training (MCT) has been shown to be effective in reducing psychotic symptoms, including delusions. However, less is known on whether MCT, or its specific modules, are effective in ameliorating reasoning biases e.g. belief flexibility. As inflexibility in appraisal has been associated with psychosis and major depressive disorder (MDD), this study examined the efficacy of a 4-session MCT on delusions, depression, and belief flexibility, in two clinical groups (Psychosis and Depression). METHODS This study adopted a single-blind randomised controlled design, with patients with schizophrenia spectrum disorders (and delusions) and patients with MDD being randomised, respectively, into the MCT condition or a treatment-as-usual (TAU) condition. The MCT intervention consisted of specific modules targeting belief flexibility. Participants were assessed before and after treatment, and at 1- and 6-month follow-ups. RESULTS Among the 113 participants, 27 patients with psychosis and 29 patients with MDD attended MCT. There were significant improvements in psychotic symptoms, especially delusions, for the Psychosis group, and in depressive symptoms for the MDD group. Symptom improvements following MCT were of large effect sizes, were significantly greater than TAU, and persisted at 6-month. Belief flexibility also improved in both groups, although changes were smaller in size and were not significantly greater than TAU. LIMITATIONS An active control condition was not included. CONCLUSIONS This study demonstrated large and stable symptom reductions in delusions and depression, and smaller (yet stable) improvement in belief flexibility across groups, following a 4-session MCT, carrying implications for transdiagnostic process-based interventions and their mechanisms of change.
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22
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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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23
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Martire KA, Growns B, Bali AS, Montgomery-Farrer B, Summersby S, Younan M. Limited not lazy: a quasi-experimental secondary analysis of evidence quality evaluations by those who hold implausible beliefs. COGNITIVE RESEARCH-PRINCIPLES AND IMPLICATIONS 2020; 5:65. [PMID: 33306157 PMCID: PMC7729693 DOI: 10.1186/s41235-020-00264-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022]
Abstract
Past research suggests that an uncritical or ‘lazy’ style of evaluating evidence may play a role in the development and maintenance of implausible beliefs. We examine this possibility by using a quasi-experimental design to compare how low- and high-quality evidence is evaluated by those who do and do not endorse implausible claims. Seven studies conducted during 2019–2020 provided the data for this analysis (N = 746). Each of the seven primary studies presented participants with high- and/or low-quality evidence and measured implausible claim endorsement and evaluations of evidence persuasiveness (via credibility, value, and/or weight). A linear mixed-effect model was used to predict persuasiveness from the interaction between implausible claim endorsement and evidence quality. Our results showed that endorsers were significantly more persuaded by the evidence than non-endorsers, but both groups were significantly more persuaded by high-quality than low-quality evidence. The interaction between endorsement and evidence quality was not significant. These results suggest that the formation and maintenance of implausible beliefs by endorsers may result from less critical evidence evaluations rather than a failure to analyse. This is consistent with a limited rather than a lazy approach and suggests that interventions to develop analytical skill may be useful for minimising the effects of implausible claims.
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Affiliation(s)
- Kristy A Martire
- School of Psychology, The University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Bethany Growns
- School of Social and Behavioral Sciences, Arizona State University, 4701 W Thunderbird Rd, Glendale, AZ, 85069, USA
| | - Agnes S Bali
- School of Psychology, The University of New South Wales, Sydney, NSW, 2052, Australia
| | | | - Stephanie Summersby
- School of Psychology, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Mariam Younan
- School of Psychology, The University of New South Wales, Sydney, NSW, 2052, Australia
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24
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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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25
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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: 25] [Impact Index Per Article: 6.3] [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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26
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Balzan RP, Moritz S. Cognitive biases and psychosis: From bench to bedside. Schizophr Res 2020; 223:368-369. [PMID: 32739344 DOI: 10.1016/j.schres.2020.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Ryan P Balzan
- College of Education, Psychology & Social Work, Flinders University, Australia.
| | - Steffen Moritz
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany
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27
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Abstract
Abstract
Paranoid thoughts are common across the psychosis continuum. It is well established that reasoning biases (conceived as an overreliance on fast thinking and lack of willingness and/or ability to engage in slow thinking) contribute to paranoia. Targeted therapies have shown promise in improving reasoning in order to reduce paranoia. Psychometrically robust and easy-to-use measures of these thinking styles will assist research and clinical practice. Existing assessments include experimental tasks that are complex to administer or self-report measures that have limitations in comprehensively assessing cognitive biases in paranoia. We have developed the first questionnaire to assess fast and slow thinking biases related to paranoid thoughts, and here report on its evaluation. In study 1, we generated, evaluated, and extracted items reflecting reasoning, and assessed their reliability and validity in a non-clinical sample (n = 209). In study 2, we replicated the factor analysis and psychometric evaluation in a clinical sample (n = 265). The resultant Fast and Slow Thinking (FaST) questionnaire consists of two 5-item scales reflecting fast and slow thinking and is therefore brief and suitable for use in both research and clinical practice. The fast thinking scale is reliable and valid. Reliability and criterion validity of the slow scale shows promise. It had limited construct validity with objective reasoning assessments in the clinical group, possibly due to impaired meta-cognitive awareness of slow thinking. We recommend the FaST questionnaire as a new tool for improving understanding of reasoning biases in paranoia and supporting targeted psychological therapies.
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28
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García-Mieres H, Villaplana A, López-Carrilero R, Grasa E, Barajas A, Pousa E, Feixas G, Ochoa S. The Role of Personal Identity on Positive and Negative Symptoms in Psychosis: A Study Using the Repertory Grid Technique. Schizophr Bull 2020; 46:572-580. [PMID: 32275754 PMCID: PMC7147580 DOI: 10.1093/schbul/sbz082] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND People with psychosis experience disruptions in personal identity that affect positive and negative symptoms, but the complexity of these phenomena needs to be addressed in an in-depth manner. Using the Personal Construct Theory, we examined whether distinct dimensions of personal identity, as measured with the Repertory Grid Technique along with other cognitive factors, might influence psychotic symptomatology. METHOD Eighty-five outpatients with schizophrenia-spectrum disorders completed a repertory grid, an observed-rated interview of psychotic symptoms, and measures of cognitive insight, depressive symptoms, neurocognition, and theory of mind. RESULTS Structural equation models revealed that interpersonal dichotomous thinking directly affected positive symptoms. Self-discrepancies influenced positive symptoms by mediation of depressive symptoms. Interpersonal cognitive differentiation and interpersonal cognitive richness mediated the impact of self-reflectivity and neurocognitive deficits in negative symptomatology. CONCLUSIONS This study is the first of its kind to examine the structure of personal identity in relation to positive and negative symptoms of psychosis. Results suggest interventions targeted to improving interpersonal dichotomous thinking, self-discrepancies, interpersonal cognitive differentiation, and interpersonal cognitive richness may be useful in improving psychotic symptoms.
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Affiliation(s)
- Helena García-Mieres
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain,The Institute of Neurosciences, University of Barcelona, Barcelona, Spain,Parc Sanitari Sant Joan de Déu, Sant Joan de Déu Research Institute, Sant Boi de Llobregat, Barcelona, Spain,To whom correspondence should be addressed; Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Passeig de Vall d’Hebrón, 171, 08035, Barcelona, Spain; tel: +34-93-3125123, fax: +34-93-556-96-74, ,
| | - Anna Villaplana
- Parc Sanitari Sant Joan de Déu, Sant Joan de Déu Research Institute, Sant Boi de Llobregat, Barcelona, Spain
| | - Raquel López-Carrilero
- Parc Sanitari Sant Joan de Déu, Sant Joan de Déu Research Institute, Sant Boi de Llobregat, Barcelona, Spain
| | - Eva Grasa
- Department of Psychiatry, Biomedical Research Institute Sant Pau (IIB-SANT PAU), Hospital Santa Creu i Sant Pau; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain,Mental Health Networking Biomedical Research Centre, CIBERSAM, Madrid, Spain
| | - Ana Barajas
- Centro de Higiene Mental Les Corts, Barcelona, Spain
| | - Esther Pousa
- Department of Psychiatry, Biomedical Research Institute Sant Pau (IIB-SANT PAU), Hospital Santa Creu i Sant Pau; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain,Mental Health Networking Biomedical Research Centre, 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, Sant Joan de Déu Research Institute, Sant Boi de Llobregat, Barcelona, Spain,Mental Health Networking Biomedical Research Centre, CIBERSAM, Madrid, Spain
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29
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Riches S, Bird L, Chan N, Garety P, Rus‐Calafell M, Valmaggia L. Subjective experience of paranoid ideation in a virtual reality social environment: A mixed methods cross‐sectional study. Clin Psychol Psychother 2020; 27:337-345. [DOI: 10.1002/cpp.2431] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/14/2020] [Accepted: 01/20/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Simon Riches
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College London London UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital Kent UK
- Social, Genetic and Developmental Psychiatry CentreInstitute of Psychiatry, Psychology & Neuroscience, King's College London London UK
| | - Leanne Bird
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital Kent UK
- Lancashire Care NHS Foundation Trust, Sceptre Point, Sceptre Way, Walton Summit Preston UK
| | - Narelle Chan
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College London London UK
| | - Philippa Garety
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College London London UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital Kent UK
| | - Mar Rus‐Calafell
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College London London UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital Kent UK
| | - Lucia Valmaggia
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College London London UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital Kent UK
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30
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Serrano-Guerrero E, Ruiz-Veguilla M, Martín-Rodríguez A, Rodríguez-Testal JF. Inflexibility of beliefs and jumping to conclusions in active schizophrenia. Psychiatry Res 2020; 284:112776. [PMID: 31981941 DOI: 10.1016/j.psychres.2020.112776] [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: 10/06/2019] [Revised: 01/06/2020] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
Jumping to conclusions (JTC) has been questioned as sufficient cognitive bias for the onset, maintenance, and severity of delusions compared to the bias of inflexibility of beliefs. The WIT (What is this?) test was designed to evaluate JTC and its capacity for classifying participants into a group of patients with active schizophrenia and a comparison group. It was also attempted to determine whether the presence/absence of answer choices, considered a measure of induced inflexibility of beliefs, influences decision-making and is related to the tendency to repeat the first decision, or spontaneous inflexibility of beliefs. The sample was made up of 160 participants, 80 patients with schizophrenia diagnosed at hospital admission and 80 healthy controls. The Beads Task and the WIT test were administered. The WIT classified the participants reasonably well (82.7%) compared to the Beads Task (86.3%). The presence of answer choices favored JTC (d = 0.33), decreasing the number of lines necessary to make a decision (d = 1.78), and influencing keeping to the original answer (d = 1.36), in interaction with the group (d = 0.42). The WIT test overcame some limitations of the Beads Task. The presence/absence of answer choices influenced decision-making and how thinking was flexibilized, more clearly in the case of controls.
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Affiliation(s)
- Estrella Serrano-Guerrero
- U.G.C. Salud Mental, Hospital Universitario Virgen Macarena, C/ Dr. Fedriani, n° 3, CP: 41009, Sevilla, España.
| | - Miguel Ruiz-Veguilla
- U.G.C. Salud Mental, Hospital Universitario Virgen del Rocío/CIBERSAM/IBIS/CSIC/Universidad de Sevilla, Unidad de Hospitalización de Salud Mental, Avenida Manuel Siurot, s/n, CP: 41013, Sevilla, España.
| | - Agustín Martín-Rodríguez
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universidad de Sevilla, C/ Camilo José Cela, s/n, CP: 41018, Sevilla, España.
| | - Juan F Rodríguez-Testal
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universidad de Sevilla, C/ Camilo José Cela, s/n, CP: 41018, Sevilla, España.
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Hua JPY, Karcher NR, Kerns JG. Examining associations between two different jumping to conclusions scores with positive schizotypy and recent distress. Cogn Neuropsychiatry 2020; 25:45-56. [PMID: 31668129 DOI: 10.1080/13546805.2019.1682984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Jumping to conclusions is associated with delusions. It is unclear whether positive schizotypy, which refers to delusion-like and hallucination-like symptoms, is associated with jumping to conclusions. Relatedly, the relative validity of two jumping to conclusions scores, extreme responding and draws to decision, is unclear, particularly whether extreme responding (responding after one or two draws) reflects the same bias as decreased draws to decision on non-extreme responding trials.Methods: Extreme positive schizotypy individuals with increased psychosis risk (n = 69) and controls (n = 95) completed the Probabilistic Reasoning Task and reported on recent distress, which was previously associated with jumping to conclusions. We calculated extreme responding, draws to decision (number of draws), and draws to decision/non-extreme responding (number of draws on trials with three or more draws).Results: Positive schizotypy was associated with extreme responding, but not draws to decision/non-extreme responding. Furthermore, draws to decision and draws to decision/non-extreme responding were associated with recent distress, whereas extreme responding was not.Conclusion: Positive schizotypy was specifically associated with extreme responding and not draws to decision/non-extreme responding, which suggests that the nature of extreme responding and of draws to decision might be different. This could have relevance for assessing and treating jumping to conclusions.
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Affiliation(s)
- Jessica P Y Hua
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Nicole R Karcher
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA.,Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - John G Kerns
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
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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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Penzenstadler L, Chatton A, Huguelet P, Lecardeur L, Bartolomei J, Brazo P, Murys E, Poupart F, Rouvière S, Saoud M, Favrod J, Khazaal Y. Does Change over Time in Delusional Beliefs as Measured with PDI Predict Change over Time in Belief Flexibility Measured with MADS? Psychiatr Q 2019; 90:693-702. [PMID: 31338790 DOI: 10.1007/s11126-019-09659-8] [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: 11/25/2022]
Abstract
Delusional beliefs and their behavioral consequences are predominant symptoms in patients with psychosis and play an important role in the treatment. Delusional beliefs are a multidimensional concept which can be divided into three components: distress, preoccupation and conviction of delusions. These can be measured using Peters delusions inventory (PDI-21). We question, whether changes in delusional beliefs over time during treatment measured with the PDI-21 can predict changes in belief flexibility measured with the Maudsley assessment of delusions schedule (MADS). We used a group of patients from a randomized controlled trial for a cognitive intervention for psychosis or psychotic symptoms. Aside standard treatment for psychosis, half of the patients took part in a group treatment "Michael's game". Patients were assessed at baseline (T1), at 3 months (T2), and at 9 months (T3). We measured delusional beliefs using PDI-21 and belief flexibility with the MADS. One hundred seventy-two patients were included in the analysis. We measured a main effect of PDI-21scores on belief flexibility measured with MADS. PDI-21 Conviction scores predicted outcomes for all measured MADS items. Increasing PDI Distress and Preoccupation scores were predictors for being more likely to dismiss beliefs and change conviction. Time itself was a predictor for changing conviction and being able to plan a behavioral experiment. Overall the changes in PDI scores predicted outcomes for belief flexibility measured with MADS items. The PDI-21 could be a simple and effective way to measure progress in treatment on delusional beliefs.
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Affiliation(s)
- Louise Penzenstadler
- Geneva University Hospitals, Ch, du Petit Bel-Air 2, 1225, Chêne-Bourg, Switzerland.
| | - Anne Chatton
- Geneva University Hospitals, Ch, du Petit Bel-Air 2, 1225, Chêne-Bourg, Switzerland
- Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Philippe Huguelet
- Geneva University Hospitals, Ch, du Petit Bel-Air 2, 1225, Chêne-Bourg, Switzerland
- Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Laurent Lecardeur
- UNICAEN, Imagerie et Strategies Therapeutiques de la schizophrenie (ISTS), Normandie University, EA4766, 14000, Caen, France
| | - Javier Bartolomei
- Geneva University Hospitals, Ch, du Petit Bel-Air 2, 1225, Chêne-Bourg, Switzerland
| | - Perrine Brazo
- UNICAEN, Imagerie et Strategies Therapeutiques de la schizophrenie (ISTS), Normandie University, EA4766, 14000, Caen, France
- UNICAEN, CHU de Caen Normandie, Service de Psychiatrie d'adultes, Centre Esquirol, Normandie University, 14000, Caen, France
| | - Elodie Murys
- Unité Mobile de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Florent Poupart
- Laboratoire Clinique Psychopathologique et Interculturelle, Université de Toulouse, Toulouse, France
- Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | | | - Mohamed Saoud
- PsyR2, INSERM U1028, CNRS UMR5292, PSYR2 Team, Lyon Neuroscience Research Center, Lyon, France Department of Consultation-Liaison Psychiatry, Université Claude Bernard Lyon 1, Lyon, France
| | - Jérôme Favrod
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
| | - Yasser Khazaal
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospitals, Lausanne, Switzerland
- Research Center, Montreal University Institute of Mental Health, Montreal, Canada
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García-Mieres H, Niño-Robles N, Ochoa S, Feixas G. Exploring identity and personal meanings in psychosis using the repertory grid technique: A systematic review. Clin Psychol Psychother 2019; 26:717-733. [PMID: 31412423 DOI: 10.1002/cpp.2394] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/31/2019] [Accepted: 08/06/2019] [Indexed: 01/25/2023]
Abstract
Current research and clinical practice in person-centred approaches highlight the importance of self, identity, and personal meanings in psychosis. Previous research has focused on dimensions of self, but less attention has been paid to the personal meanings involved in identity. The personal construct theory framework and the repertory grid technique (RGT) allow the study of identity and personal meanings within person-centred approaches of psychopathology and treatment in psychosis, as suggested by studies that began more than 40 years ago. However, their contributions have not yet been reviewed. We aimed to systematically review the evidence for the role of identity and personal meanings in psychotic disorders. We performed a systematic search using personal construct and RGT terms in PsycINFO, Web of Science, PubMed, EBSCO, Scopus, and Google Scholar. After identifying 2,574 articles, 15 were included. Nine studies followed an idiographic assessment, and six were nomothetic. Patients reported their subjective experience of isolation in terms of high self-ideal discrepancy and high perceived discrepancy with their significant others, which some studies associated with a lower degree of recovery or with the way in which positive symptoms were construed. Self-fragmentation either decreased with interventions or was associated with recovery. Evidence regarding interpersonal construing was less consistent, but there was a tendency for patients to show a more rigid cognitive structure than controls. To conclude, we found some evidence that self-discrepancies, fragmentation of self, and interpersonal construing are affected in psychosis and potentially modifiable through psychotherapy.
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Affiliation(s)
- Helena García-Mieres
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.,Parc Sanitari Sant Joan de Déu, Barcelona, Spain.,The Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Noelia Niño-Robles
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Barcelona, 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
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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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Reininghaus U, Oorschot M, Moritz S, Gayer-Anderson C, Kempton MJ, Valmaggia L, McGuire P, Murray R, Garety P, Wykes T, Morgan C, Myin-Germeys I. Liberal Acceptance Bias, Momentary Aberrant Salience, and Psychosis: An Experimental Experience Sampling Study. Schizophr Bull 2019; 45:871-882. [PMID: 30189093 PMCID: PMC6581124 DOI: 10.1093/schbul/sby116] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cognitive models of psychosis posit that reasoning biases are an important mechanism contributing to the formation of psychotic symptoms, in part through transforming anomalous experiences of aberrant salience into frank psychotic symptoms. This study aimed to investigate the interplay of liberal acceptance (LA) bias, which is a specific type of reasoning bias, and momentary aberrant salience in the development of paranoid and psychotic experiences in daily life in first-episode psychosis patients (FEP), at-risk mental state participants (ARMS), and controls. We used a novel experimental Experience Sampling Methodology (eESM) task for measuring LA bias (ie, decisions based on low probability estimates) and ESM measures of momentary aberrant salience and paranoid and psychotic experiences in 51 FEP, 46 ARMS, and 53 controls. We found evidence that LA bias was more likely to occur in FEP than in controls. Further, LA bias was associated with psychotic and paranoid experiences (all P < .007) and modified the association between momentary aberrant salience and psychotic experiences (χ2(df) = 7.4(2), P = .025) in ARMS, such that momentary salience was associated with more intense psychotic experiences in the presence of LA bias in ARMS, but not in FEP and controls. Our findings suggest that LA bias may be central for anomalous experiences such as momentary aberrant salience to increase intensity of psychotic experiences in at-risk individuals. Further, LA bias appears to be more likely to be present, but not directly linked to current intensity of psychotic experiences, in treated FEP. Novel eESM tasks open new avenues for targeting psychological processes under real-world conditions.
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Affiliation(s)
- Ulrich Reininghaus
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Margaret Oorschot
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Charlotte Gayer-Anderson
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK
| | - Lucia Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK.,National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK.,National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Robin Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK.,National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK.,National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Til Wykes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK.,National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Craig Morgan
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Psychiatry Research Group, Department of Neurosciences, KU Leuven, Leuven, Belgium
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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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Thinking dispositions and cognitive reflection performance in schizotypy. JUDGMENT AND DECISION MAKING 2019. [DOI: 10.1017/s193029750000293x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AbstractSchizotypy refers to the continuum of normal variability of psychosis-like characteristics and experiences, often classified as positive schizotypy (‘unusual experiences’; UE) and negative schizotypy (‘introvertive anhedonia’; IA). Here, we investigated the link between schizotypy and cognitive processing style and performance. A particular focus was on whether schizotypy is associated more with Type 1 (automatic/heuristic) than Type 2 (reflective/effortful) processes, as may be expected from findings of impaired top-down control in schizophrenia. A large sample (n = 1,512) completed online measures pertaining to schizotypy (Oxford-Liverpool Inventory for Feelings and Experiences; O-LIFE), thinking style (Rational Experiential Inventory-10, Actively Open-Minded Thinking Scale), and reasoning performance (Cognitive Reflection Test). Higher positive (UE) and negative (IA) schizotypy were associated with more pronounced Type 1 processing, i.e. greater self-reported Faith in Intuition (FI), lower Need for Cognition (NFC), lower Actively Open-Minded Thinking (AOT), and lower cognitive reflection test (CRT) scores. Canonical correlation analysis confirmed a significant association between UE and increased FI, lower AOT and lower CRT performance, accounting for 12.38% of the shared variance between schizotypy and thinking dispositions. IA was more highly associated with reduced NFC. These findings suggest that schizotypy may be associated with similar thinking dispositions to those reported in psychosis, with different patterns of associations for positive and negative schizotypy. This result informs research on reasoning processes in psychosis and has clinical implications, including potential treatment targets and refinements for cognitive therapies.
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Hardy A, Wojdecka A, West J, Matthews E, Golby C, Ward T, Lopez ND, Freeman D, Waller H, Kuipers E, Bebbington P, Fowler D, Emsley R, Dunn G, Garety P. How Inclusive, User-Centered Design Research Can Improve Psychological Therapies for Psychosis: Development of SlowMo. JMIR Ment Health 2018; 5:e11222. [PMID: 30518514 PMCID: PMC6300708 DOI: 10.2196/11222] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/27/2018] [Accepted: 08/02/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Real-world implementation of psychological interventions for psychosis is poor. Barriers include therapy being insufficiently usable and useful for a diverse range of people. User-centered, inclusive design approaches could improve the usability of therapy, which may increase uptake, adherence, and effectiveness. OBJECTIVE This study aimed to optimize the usability of an existing psychological intervention, Thinking Well, which targets reasoning processes in paranoia using a basic digital interface. METHODS We conducted inclusive, user-centered design research characterized by purposive sampling of extreme users from the margins of groups, ethnographic investigation of the problem context, and iterative prototyping of solutions. The UK Design Council's double diamond method was used. This consisted of 4 phases: discover, including a case series of Thinking Well, stakeholder interviews, desk research, user profiling, system mapping, and a mood board; define, consisting of workshops to synthesize findings and generate the design brief; develop, involving concept workshops and prototype testing; and deliver, in which the final minimal viable product was storyboarded and iteratively coded. RESULTS Consistent with our previous work, the Thinking Well case series showed medium to large effects on paranoia and well-being and small effects on reasoning. These were maintained at follow-up despite some participants reporting difficulties with the therapy interface. Insights from the discover phase confirmed that usability was challenged by information complexity and poor accessibility. Participants were generally positive about the potential of technology to be enjoyable, help manage paranoia, and provide tailored interpersonal support from therapists and peers, although they reported privacy and security concerns. The define phase highlighted that the therapy redesign should support monitoring, simplify information processing, enhance enjoyment and trust, promote personalization and normalization, and offer flexible interpersonal support. During the develop phase over 60 concepts were created, with 2 key concepts of thoughts visualized as bubbles and therapy as a journey selected for storyboarding. The output of the deliver phase was a minimal viable product of an innovative digital therapy, SlowMo. SlowMo works by helping people to notice their worries and fast thinking habits, and encourages them to slow down for a moment to find ways of feeling safer. A Web app supports the delivery of 8 face-to-face sessions, which are synchronized to a native mobile app. CONCLUSIONS SlowMo makes use of personalization, ambient information, and visual metaphors to tailor the appeal, engagement, and memorability of therapy to a diversity of needs. Feasibility testing has been promising, and the efficacy of SlowMo therapy is now being tested in a multicentered randomized controlled trial. The study demonstrates that developments in psychological theory and techniques can be enhanced by improving the usability of the therapy interface to optimize its impact in daily life.
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Affiliation(s)
- Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Anna Wojdecka
- Helen Hamlyn Centre for Design, Royal College of Art, London, United Kingdom
| | - Jonathan West
- Helen Hamlyn Centre for Design, Royal College of Art, London, United Kingdom
| | - Ed Matthews
- Helen Hamlyn Centre for Design, Royal College of Art, London, United Kingdom
| | | | - Thomas Ward
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Natalie D Lopez
- Department of Psychology, Royal Holloway, Egham, United Kingdom
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Helen Waller
- South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Elizabeth Kuipers
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Paul Bebbington
- Division of Psychiatry, University College London, London, United Kingdom
| | - David Fowler
- Department of Psychology, University of Sussex, Sussex, United Kingdom
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Graham Dunn
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,South London & Maudsley NHS Foundation Trust, London, United Kingdom
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Klein HS, Pinkham AE. Examining reasoning biases in schizophrenia using a modified "Jumping to Conclusions" probabilistic reasoning task. Psychiatry Res 2018; 270:180-186. [PMID: 30261407 DOI: 10.1016/j.psychres.2018.09.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/15/2018] [Accepted: 09/12/2018] [Indexed: 01/05/2023]
Abstract
Although the Jumping To Conclusion (JTC) bias has been extensively studied in relation to schizophrenia and persecutory delusions, the relationship between JTC and other reasoning biases implicated in delusional ideation is not fully understood. We modified the traditional JTC task to assess co-occurrence of reasoning biases in decision making. Forty-six patients with schizophrenia and 46 healthy controls completed two versions [neutral colored beads and salient comments] of the modified task. We replicated previous findings indicating that patients showed a greater JTC bias, and in both groups, the JTC bias was more pronounced for the salient task. However, we observed a significant effect for non-Bayesian judgments, indicating that patients showed greater difficulty in probabilistic reasoning. When controlling for probabilistic reasoning ability, the observed JTC bias effects were diminished. Our findings that faulty probability assessment accounts for the JTC bias indicates that the traditional JTC bias task may not represent an inherent hasty decision-making bias, but rather an inability to fully understand and execute the stated goals of the task. These results call into question the current understanding of the JTC bias and the independence of this bias apart from the cognitive demands of the task.
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Affiliation(s)
- Hans S Klein
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA.
| | - Amy E Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA; Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, USA
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Garety PA, Ward T, Freeman D, Fowler D, Emsley R, Dunn G, Kuipers E, Bebbington P, Waller H, Greenwood K, Rus-Calafell M, McGourty A, Hardy A. SlowMo, a digital therapy targeting reasoning in paranoia, versus treatment as usual in the treatment of people who fear harm from others: study protocol for a randomised controlled trial. Trials 2017; 18:510. [PMID: 29096681 PMCID: PMC5667466 DOI: 10.1186/s13063-017-2242-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 10/04/2017] [Indexed: 02/07/2023] Open
Abstract
Background Paranoia is one of the most common symptoms of schizophrenia-spectrum disorders, and is associated with significant distress and disruption to the person’s life. Developing more effective and accessible psychological interventions for paranoia is a clinical priority. Our research team has approached this challenge in two main ways: firstly, by adopting an interventionist causal approach to increase effectiveness and secondly, by incorporating user-centred inclusive design methods to enhance accessibility and usability. Our resultant new digital intervention, SlowMo, intensively targets a reasoning style associated with paranoia, fast thinking, characterised by jumping to conclusions and belief inflexibility. It consists of an easy-to-use, enjoyable and memorable digital interface. An interactive web-based app facilitates delivery of face-to-face meetings which is then synchronised with an innovative mobile app for use in daily life. Methods/Design We aim to test the clinical efficacy of SlowMo over 24 weeks to determine the mechanisms through which it reduces paranoia, and to identify participant characteristics that moderate its effectiveness. In a parallel-group randomised controlled trial, with 1:1 allocation, 360 participants with distressing persecutory beliefs will be independently randomised to receive either the SlowMo intervention added to treatment as usual (TAU) or TAU, using randomly varying permuted blocks, stratified by paranoia severity and site. Research workers will be blind to therapy allocation. The primary outcome is paranoia severity over 24 weeks; our hypothesised mechanism of change is reasoning; moderators include negative symptoms and working memory; and secondary outcomes include wellbeing, quality of life, and service use. The accessibility, usability and acceptability of the digital platform will be assessed. Discussion SlowMo has been developed as the first blended digital therapy to target fears of harm from others through an inclusive design approach. In addition to testing its efficacy, this trial will add to our understanding of psychological mechanisms in paranoia. The study will examine the usability and adherence of a novel digital therapy, including an app for self-management, in a large sample of people affected by severe mental health difficulties. Trial registration ISRCTN registry, ID: ISRCTN32448671. Registered prospectively on 30 January 2017. Date assigned 2 February 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2242-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Philippa A Garety
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, P077 Henry Wellcome Building, De Crespigny Park, London, SE5 8AF, UK. .,South London and Maudsley NHS Foundation Trust, London, UK.
| | - Thomas Ward
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, P077 Henry Wellcome Building, De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | | | - David Fowler
- School of Psychology, University of Sussex, Brighton, UK.,Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Richard Emsley
- Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Graham Dunn
- Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Elizabeth Kuipers
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, P077 Henry Wellcome Building, De Crespigny Park, London, SE5 8AF, UK
| | - Paul Bebbington
- Division of Psychiatry, University College London, London, UK
| | - Helen Waller
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, P077 Henry Wellcome Building, De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Kathryn Greenwood
- School of Psychology, University of Sussex, Brighton, UK.,Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Mar Rus-Calafell
- Department of Psychiatry, Oxford University, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | | | - Amy Hardy
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, P077 Henry Wellcome Building, De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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