Increased hindsight bias in schizophrenia

Reprint of: Equal egocentric bias in school-aged children with and without autism spectrum disorders

Egocentric bias is a core feature of autism. This phenomenon has been studied using the false belief task. However, typically developing children who pass categorical (pass or fail) false belief tasks may still show subtle egocentric bias. We examined 7- to 13-year-old children with autism spectrum disorder (ASD; n=76) or typical development (n=113) using tasks with a continuous response scale: a modified false belief task and a visual hindsight bias task. All children showed robust egocentric bias on both tasks, but no group effects were found. Our large sample size, coupled with our sensitive tasks and resoundingly null group effects, indicate that children with and without ASD possess more similar egocentric tendencies than previously reported.

Equal egocentric bias in school-aged children with and without autism spectrum disorders

Egocentric bias is a core feature of autism. This phenomenon has been studied using the false belief task. However, typically developing children who pass categorical (pass or fail) false belief tasks may still show subtle egocentric bias. We examined 7- to 13-year-old children with autism spectrum disorder (ASD; n=76) or typical development (n=113) using tasks with a continuous response scale: a modified false belief task and a visual hindsight bias task. All children showed robust egocentric bias on both tasks, but no group effects were found. Our large sample size, coupled with our sensitive tasks and resoundingly null group effects, indicate that children with and without ASD possess more similar egocentric tendencies than previously reported.

Hindsight Bias

Hindsight bias occurs when people feel that they "knew it all along," that is, when they believe that an event is more predictable after it becomes known than it was before it became known. Hindsight bias embodies any combination of three aspects: memory distortion, beliefs about events' objective likelihoods, or subjective beliefs about one's own prediction abilities. Hindsight bias stems from (a) cognitive inputs (people selectively recall information consistent with what they now know to be true and engage in sensemaking to impose meaning on their own knowledge), (b) metacognitive inputs (the ease with which a past outcome is understood may be misattributed to its assumed prior likelihood), and (c) motivational inputs (people have a need to see the world as orderly and predictable and to avoid being blamed for problems). Consequences of hindsight bias include myopic attention to a single causal understanding of the past (to the neglect of other reasonable explanations) as well as general overconfidence in the certainty of one's judgments. New technologies for visualizing and understanding data sets may have the unintended consequence of heightening hindsight bias, but an intervention that encourages people to consider alternative causal explanations for a given outcome can reduce hindsight bias.

Repetition is good? An Internet trial on the illusory truth effect in schizophrenia and nonclinical participants

BACKGROUND AND OBJECTIVES

The investigation of cognitive biases has considerably broadened our understanding of the cognitive underpinnings of schizophrenia. This is the first study to investigate the illusory truth or validity effect in schizophrenia, which denotes the phenomenon that the renewed exposure to difficult knowledge questions shifts responses toward affirmation. We hypothesized an excess of the truth effect in schizophrenia, which may play a role in the maintenance of the disorder, particularly relating to positive symptoms.

METHODS

The study was set up over the Internet. The final analyses considered 36 patients with a probable diagnosis of schizophrenia, and a sample of 40 healthy subjects. Both groups took part on two occasions. In the baseline survey, difficult knowledge questions on neutral (e.g., "On each continent there is a town called Rome." (true)) or emotional (delusion-relevant; e.g., "The German federal police uses approximately 3000 cameras for the purpose of video-based face-detection." (not true)) topics were presented as statements, which were either correct or incorrect. After one week, subjects were requested to take part in the second and final survey. Here, previously presented as well as novel statements had to be appraised according to their truth.

RESULTS

As expected, an overall truth effect was found: statements that were repeated achieved higher subjective truth ratings than novel statements. Patients high on positive symptoms showed an excessive truth effect for emotional (delusion-relevant) items. The positive syndrome was correlated with the emotional truth effect in both healthy and schizophrenia participants.

LIMITATIONS

The sample was recruited via online forums and had probable but not externally validated diagnoses of schizophrenia. No psychiatric control group was tested.

DISCUSSION

The truth effect for emotional items appears to be exaggerated in patients high on positive symptoms, which may play a role in delusion formation and maintenance. Several limitations of the study however render our conclusions preliminary. As patients with schizophrenia often dwell on and ruminate over selective and distorted pieces of information (e.g., conspiracy theories), the subjective authenticity of this information may be further elevated by means of the truth effect.

Healthy people with delusional ideation change their mind with conviction

Emotional distress and reasoning biases are two factors known to contribute to delusions. As a step towards elucidating mechanisms underlying delusions, the main aim of this study was to evaluate a possible "jumping to new conclusions" reasoning bias in healthy people with delusional ideation and its association with emotions. We surveyed 80 healthy participants, measuring levels of depression, anxiety, cognitive error and delusional ideation. Participants completed two versions of the beads task to evaluate their reasoning style. Results showed that people with delusional ideation reached a conclusion after less information, as expected. Interestingly, they also tended to change their conclusions more often than people without delusional ideation and did so with greater conviction. Depression and cognitive errors were strong predictors of delusional ideation but not of reasoning style. We conclude that delusional ideation in non-psychotic individuals is independently predicted by depressive symptoms and by a high conviction in new conclusions.

German validation of the Conners Adult ADHD Rating Scales-self-report (CAARS-S) I: factor structure and normative data

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood. Instruments for diagnosing ADHD in childhood are well validated and reliable, but diagnosis of ADHD in adults remains problematic. Attempts have been made to develop criteria specific for adult ADHD, resulting in the development of self-report and observer-rated questionnaires. To date, the Conners Adult ADHD Rating Scales (CAARS) are the international standard for questionnaire assessment of ADHD. The current study evaluates a German version of the CAARS self-report (CAARS-S).

METHODS

Eight hundred and fifty healthy German control subjects were recruited to fill out the CAARS-S and to answer questions on sociodemographic variables. Explorative and confirmative factor analyses were conducted to obtain the factor structure for the German model and to replicate the factor structure of the original American model. Analyses on gender, age, and education level were calculated for normative data.

RESULTS

The explorative factor analysis of the German sample results in a six-factor solution that explained 52% of the variance. A confirmative analysis that was based on the 42 items of the original American model showed a high model-fit. Analyses of normative data showed significant influences of age, gender, and education level on the emerging subscales.

CONCLUSION

Even though the explorative factor analysis yields a solution different from the American original, the confirmative factor analysis results in such a high model-fit that use of the American version is justified with respect to international multicenter studies, for which this instrument will be highly valuable.

Beauty and belief: William James and the aesthetics of delusions in schizophrenia

INTRODUCTION

This paper proposes the hypothesis that aesthetics plays an important role in the construction and maintenance of delusional ideas in schizophrenia.

METHOD

A selective review of the literature on the cognitive science of aesthetics, beginning with the work of William James on the stream of thought, was undertaken together with a review of some of the cognitive neuroscience literature on delusion formation in schizophrenia.

RESULTS

It is suggested that delusion formation has some similarities to to the creative process, but commences with a proto-psychotic anomalous experience in which an aberrant Jamesian fringe experience is generated. The consequence of such deviation from standard or expected conscious experience is to direct processing resources in a search for meaning, but under conditions of reduced prefrontal cortex monitoring and control mechanisms. Lowering of the usual constraints exercised by prefrontal cortex regulatory mechanisms causes the search for explanation or interpretation to be characterised by low self-reflection, temporal distortion and low volitional control, permitting relatively unfiltered ideas that do not conform to convention to emerge in consciousness. The combination of aberrant Jamesian fringe experience and reduced prefrontal regulatory mechanisms evoke idiosyncratic contextual associations and drive a hypersensitive salience assignment system in the search for meaning, out of which process nascent delusional beliefs emerge. These are accompanied by a 'sense of rightness' in the Jamesian fringe which signals the presence of a 'good fit' between the proto-psychotic anomalous experience in the centre of consciousness and the contextual associations evoked.

CONCLUSION

The 'sense of rightness' or 'good fit' is responsible for the aesthetic qualities of the delusion and, it is proposed, accounts for the incorrigibility of the delusions.

Memory and metamemory in schizophrenia: a liberal acceptance account of psychosis

BACKGROUND

In previous studies we suggested that liberal acceptance (LA) represents a fundamental cognitive bias in schizophrenia and may explain why patients are more willing to accept weak response alternatives and display overconfidence in incorrect responses. The aim of the present study was to test a central assumption of the LA account: false alarms in schizophrenia should be particularly increased when the distractor-target resemblance is weak relative to a control group.

METHOD

Sixty-eight schizophrenia patients were compared to 25 healthy controls on a visual memory task. At encoding, participants studied eight complex displays, each consisting of a unique pairing of four stimulus attributes: symbol, shape, position and colour. At recognition, studied items were presented along with distractors that resembled the targets to varying degrees (i.e. the match between distractors and targets ranged from one to three attributes). Participants were required to make old/new judgements graded for confidence.

RESULTS

The hypotheses were confirmed: false recognition was increased for patients compared to controls for weakly and moderately related distractors only, whereas strong lure items induced similar levels of false recognition for both groups. In accordance with prior research, patients displayed a significantly reduced confidence gap and enhanced knowledge corruption compared to controls. Finally, higher neuroleptic dosage was related to a decreased number of high-confident ratings.

CONCLUSIONS

These data assert that LA is a core mechanism contributing to both enhanced acceptance of weakly supported response alternatives and metamemory deficits, and this may be linked to the emergence of positive symptomatology.

Episodic memory bias and the symptoms of schizophrenia

Much of the research on episodic memory in schizophrenia spectrum disorders has focused on memory deficits and how they relate to clinical measures such as outcome. Memory bias refers to the modulatory influence that state or trait psychopathology may exert on memory performance for specific categories of stimuli, often emotional in nature. For example, subjects suffering from depression frequently have better memory for negative stimuli than for neutral or positive ones. This dimension of memory function has received only scant attention in schizophrenia research but could provide fresh new insights into the relation between symptoms and neurocognition. This paper reviews the studies that have explored memory biases in individuals with schizophrenia. With respect to positive symptoms, we examine studies that have explored the link between persecutory delusions and memory bias for threatening information and between psychosis and a memory bias toward external source memory. Although relatively few studies have examined negative symptoms, we also review preliminary evidence indicating that flat affect and anhedonia may lead to some specific emotional memory biases. Finally, we present recent findings from our group delineating the relation between emotional valence for faces and memory bias toward novelty and familiarity, both in schizophrenia patients and in healthy control subjects. A better understanding of the biasing effects of psychopathology on memory in schizophrenia (but also on other cognitive functions, such as attention, attribution, and so forth) may provide a stronger association between positive and negative symptoms and memory function. Memory measures sensitive to such biases may turn out to be stronger predictors of clinical and functional outcome.