The effect of self-referent material on the reasoning of people with delusions

Examining the influence of self-referential thinking on aberrant salience and jumping to conclusions bias in individuals with schizophrenia-spectrum disorders

BACKGROUND AND OBJECTIVES

Cognitive processes such as aberrant salience and the jumping to conclusions (JTC) bias are implicated in the development of delusions. Self-referential thinking is implicated in this process; however, it is unknown how it may interact with aberrant salience and JTC bias in individuals with schizophrenia-spectrum disorders (SSDs). This study examined associations of self-referential thinking with aberrant salience, JTC bias, and delusion severity, and whether self-referential stimuli led to an increase in aberrant salience and JTC bias in SSDs (n = 20) relative to psychiatrically healthy controls (n = 20).

METHODS

To assess aberrant salience and JTC bias, participants were asked to complete both self-referential and neutral versions of the Salience Attribution Test (SAT) and the Beads Task, as well as self-report measures of aberrant salience and JTC bias.

RESULTS

Self-referential task condition interacted with clinical group to predict JTC beads task scores, such that participants with SSDs exhibited greater levels of JTC bias than psychiatrically healthy controls during the neutral task condition, when controlling for levels of motivation, cognitive insight, and functioning. Self-referential thinking was significantly associated with aberrant salience, JTC bias, and delusion severity.

LIMITATIONS

This experiment examined trait-level relationships between variables, so does not provide information about state-level interrelationships and would benefit from replication using more dynamic methods such as ecological momentary assessment.

CONCLUSIONS

These findings highlight the interrelationships between self-referential thinking, JTC bias, aberrant salience, and delusion severity, in individuals with SSDs, and support the interactive role of self-referential thinking in predicting JTC bias.

Paranoia and Data-Gathering Biases in Autism

Previous research has identified contradictory patterns in autism upon probabilistic reasoning tasks, and high levels of self-report paranoia symptoms have also been reported. To explore this relationship, the present study assessed 64 non-autistic and 39 autistic adults on two variants of a probabilistic reasoning task which examined the amount of evidence required before making a decision and 'jumping to conclusions' (a neutral beads task and an emotionally-salient words variant). The autism group was found to require significantly more evidence before making a decision and to have significantly less jumping to conclusions than the non-autistic group. For those with relatively low levels of paranoia, the emotionally-salient variant impacted on the non-autistic group, but not the autism group.

Thinking biases and their role in persecutory delusions: A systematic review

AIM

Thinking biases are posited to be involved in the genesis and maintenance of delusions. Persecutory delusions are one of the most commonly occurring delusional subtypes and cause substantial distress and disability to the individuals experiencing them. Their clinical relevance confers a rationale for investigating them. Particularly, this review aims to elucidate which cognitive biases are involved in their development and persistence.

METHODS

MEDLINE, Embase, PsycINFO and Global Health were searched from the year 2000 to June 2020. A formal narrative synthesis was employed to report the findings and a quality assessment of included studies was conducted.

RESULTS

Twenty five studies were included. Overall, 18 thinking biases were identified. Hostility and trustworthiness judgement biases appeared to be specific to persecutory delusions while jumping to conclusions, self-serving attributional biases and belief inflexibility were proposed to be more closely related to other delusional subtypes. While the majority of the biases identified were suggested to be involved in delusion maintenance, hostility biases, need for closure and personalizing attributional biases were believed to also have aetiological influences.

CONCLUSIONS

These findings show that some cognitive biases are specific to paranoid psychosis and appear to be involved in the formation and/or persistence of persecutory delusions.

Bayesian reasoning with emotional material in patients with schizophrenia

Delusions are one of the most classical symptoms described in schizophrenia. However, despite delusions are often emotionally charged, they have been investigated using tasks involving non-affective material, such as the Beads task. In this study we compared 30 patients with schizophrenia experiencing delusions with 32 matched controls in their pattern of responses to two versions of the Beads task within a Bayesian framework. The two versions of the Beads task consisted of one emotional and one neutral, both with ratios of beads of 60:40 and 80:20, considered, respectively, as the “difficult” and “easy” variants of the task. Results indicate that patients showed a greater deviation from the normative model, especially in the 60:40 ratio, suggesting that more inaccurate probability estimations are more likely to occur under uncertainty conditions. Additionally, both patients and controls showed a greater deviation in the emotional version of the task, providing evidence of a reasoning bias modulated by the content of the stimuli. Finally, a positive correlation between patients’ deviation and delusional symptomatology was found. Impairments in the 60:40 ratio with emotional content was related to the amount of disruption in life caused by delusions. These results contribute to the understanding of how cognitive mechanisms interact with characteristics of the task (i.e., ambiguity and content) in the context of delusional thinking. These findings might be used to inform improved intervention programs in the domain of inferential reasoning.

Rethinking delusions: A selective review of delusion research through a computational lens

Delusions are rigid beliefs held with high certainty despite contradictory evidence. Notwithstanding decades of research, we still have a limited understanding of the computational and neurobiological alterations giving rise to delusions. In this review, we highlight a selection of recent work in computational psychiatry aimed at developing quantitative models of inference and its alterations, with the goal of providing an explanatory account for the form of delusional beliefs in psychosis. First, we assess and evaluate the experimental paradigms most often used to study inferential alterations in delusions. Based on our review of the literature and theoretical considerations, we contend that classic draws-to-decision paradigms are not well-suited to isolate inferential processes, further arguing that the commonly cited 'jumping-to-conclusion' bias may reflect neither delusion-specific nor inferential alterations. Second, we discuss several enhancements to standard paradigms that show promise in more effectively isolating inferential processes and delusion-related alterations therein. We further draw on our recent work to build an argument for a specific failure mode for delusions consisting of prior overweighting in high-level causal inferences about partially observable hidden states. Finally, we assess plausible neurobiological implementations for this candidate failure mode of delusional beliefs and outline promising future directions in this area.

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

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

People with schizophrenia use less information to interpret ambiguous social situations

BACKGROUND AND OBJECTIVES

The tendency of people with schizophrenia to gather insufficient information before making decisions or jumping to conclusions has been repeatedly reported. However, criticism has also been expressed regarding the ecological validity of this finding. Here we present the results obtained by a group of people with schizophrenia and a control group in a non-probabilistic task that requires obtaining items of information before interpreting an ambiguous social situation.

METHODS

Patients with schizophrenia (n = 48) and controls (n = 44) aged 18-50 years participated in the study. All subjects completed the Beads Task and the modified Social Information Preference Task.

RESULTS

Patients with schizophrenia showed a statistically significant tendency to jump to conclusions, including in the proposed novel social task. Unlike other studies, we were unable to find a relationship between this bias and greater severity of psychotic symptoms.

LIMITATIONS

We did not include patients with high levels of psychotic symptoms or a clinical control group.

CONCLUSIONS

The tendency to jump to conclusions in schizophrenia could be present in everyday interpersonal situations.

People with jumping to conclusions bias tend to make context-independent decisions rather than context-dependent decisions

Beads task (BT) uses a probabilistic reasoning paradigm and reveals jumping to conclusions (JTC) bias, the tendency to make premature judgments based on insufficient information (i.e., making fewer draws to decision-DTD). In this study, healthy participants (N = 207) were tested on the 80:20 and 60:40 color ratio versions of BT. We investigated associations of JTC bias with a set of cognitive bias problems and Cognitive Bias Task (CBT), a non-veridical (agent-centered) decision-making task that determines context-dependent and context-independent decision-making bias.Results showed that the converted CBT scores were negatively, and cognitive bias scores were positively correlated with JTC bias (DTD ≤ 2) on both versions of the BT. The CBT demonstrated to have satisfactory convergent and predictive validity for JTC bias. The findings suggest that people with JTC bias fail to solve cognitive bias problems and are more likely to make context-independent response selections than context-dependent response selections.

Jumping to conclusions and suicidal behavior in depression and psychosis

Suicidal behavior (SB) involves an impairment in decision-making (DM). Jumping to conclusions bias (JTC), described as the tendency to make hasty decisions based on insufficient information, could be considered as analogous of impaired DM. However, the link between JTC and SB in psychosis and other diagnoses (e.g., depression) has never been studied. This study aims to explore the presence of JTC and SB in a sample comprising 121 patients with psychosis and 101 with depression. Sociodemographic and clinical data were collected, including history of SB and symptom-severity scores. JTC was assessed by the beads task, and patients who reached decisions with the second bead or before were considered to exhibit JTC. Age, gender, diagnosis, educational level, symptom severity, substance use, and SB were compared according to JTC presence. Variables found to be significantly different in this comparison were included in a multivariate analysis. JTC was more prevalent in patients with depression than with psychosis: 55.6% in an 85:15 ratio and 64.6% in a 60:40 ratio. When multivariate logistic regression was applied to study the influence of diagnosis (psychosis versus depression), age, and SB, only SB remained statistically significant (OR 2.05; 95% CI 0.99-4.22; p = 0.05). The population studied was assembled by grouping different samples from previous research, and we have not included control variables such as other clinical variables, neurocognitive measurements, or personality traits. JTC may be more closely linked to SB, as a transdiagnostic variable, rather than to a specific diagnosis.

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

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.

Decision-making about intrusive thoughts: Relationships to attitudes towards them

BACKGROUND AND OBJECTIVES

The present study investigated decision-making strategies about and evaluations of intrusive thoughts in OCD presented in hypothetical targets in vignettes in a non-clinical population. It was expected participants would be hastier in their decisions for violent and sexual thoughts than checking and contamination thoughts and find those thoughts more credible. In addition, it was expected that hastier decision-making would be related to poorer evaluation of the targets. It was further expected that higher OC traits would be related to collecting fewer data.

METHODS

Participants (N = 84) read four vignettes, two detailing a target with taboo intrusive thoughts and two detailing a target with non-taboo intrusive thoughts. Participants engaged in decision-making tasks about the targets before making decisions about the validity of the fears and rating their thoughts about the target.

RESULTS

There was a relationship between data gathering and evaluations of the targets, but only for targets with taboo thoughts - requesting fewer data was associated with believing that the violent and sexual thoughts were true and evaluating them more negatively. Participants with higher OC traits gathered fewer data before deciding on three of the four tasks.

LIMITATIONS

The sample was non-clinical and homogenous; stimuli may have been unbalanced across vignettes.

CONCLUSIONS

Reasoning about and attitudes about taboo intrusive thoughts appear to be considerably related.

Standard of proof and intolerance of uncertainty in obsessive-compulsive disorder and social anxiety disorder

BACKGROUND AND OBJECTIVES

Researchers have identified intolerance of uncertainty (IU) as a dysfunctional thought that contributes to OCD. Case examples of OCD suggest that uncertainty and anxiety persist despite low likelihoods of feared outcomes. In this study we examined how people with OCD react to minimal amounts of uncertainty relative to non-anxious individuals and a clinical comparison group of people with social anxiety disorder (SAD).

METHODS

We created a questionnaire to measure the distress people feel when there is only minimal uncertainty regarding a given outcome and if they prefer situations with the certainty of negative outcomes in the present versus living with uncertainty. Part two of our study tested whether IU is related to performance on neutral and idiographic versions of the Beads Task.

RESULTS

OCD and SAD subjects reacted to hypothetical scenarios involving minimal risk with greater negative affect than did non-anxious subjects; however, after repeating analyses to account for comorbid disorders, OCD subjects' scores did not differ from those of non-anxious subjects. Only SAD subjects showed a preference for negative information in the present versus the uncertainty of a future outcome. Part two of our study revealed that self-reported IU was only marginally associated with performance on the neutral Beads Task.

LIMITATIONS

High rates of comorbidity made it difficult to identify the specific relationship of IU with other anxiety disorders.

CONCLUSIONS

IU for general, non-OCD specific scenarios may not figure prominently in all individuals with OCD, but rather may play a larger, more consistent role in anxiety disorders such as SAD. Additionally, the number of beads or words viewed on Beads Task may be an inadequate behavioral measure of IU.

Delusional Ideation, Cognitive Processes and Crime Based Reasoning

Probabilistic reasoning biases have been widely associated with levels of delusional belief ideation (Galbraith, Manktelow, & Morris, 2010; Lincoln, Ziegler, Mehl, & Rief, 2010; Speechley, Whitman, & Woodward, 2010; White & Mansell, 2009), however, little research has focused on biases occurring during every day reasoning (Galbraith, Manktelow, & Morris, 2011), and moral and crime based reasoning (Wilkinson, Caulfield, & Jones, 2014; Wilkinson, Jones, & Caulfield, 2011). 235 participants were recruited across four experiments exploring crime based reasoning through different modalities and dual processing tasks. Study one explored delusional ideation when completing a visually presented crime based reasoning task. Study two explored the same task in an auditory presentation. Study three utilised a dual task paradigm to explore modality and executive functioning. Study four extended this paradigm to the auditory modality. The results indicated that modality and delusional ideation have a significant effect on individuals reasoning about violent and non-violent crime (p < .05), which could have implication for the presentation of evidence in applied setting such as the courtroom.

Association of the Jumping to Conclusions and Evidence Integration Biases With Delusions in Psychosis: A Detailed Meta-analysis

We completed a meta-analysis to investigate the relationship between delusions in psychosis and 4 cognitive biases: "jumping to conclusions" (JTC), the "bias against disconfirmatory evidence" (BADE), the "bias against confirmatory evidence" (BACE), and "liberal acceptance" (LA). Building on recent meta-analyses we compared more narrowly defined groups. We identified 35 JTC, 8 BADE, 7 BACE, and 6 LA studies for inclusion. Groups with schizophrenia who were currently experiencing delusions demonstrated greater JTC, BADE, BACE, and LA than groups with schizophrenia who were not currently experiencing delusions, who in turn demonstrated no more JTC than healthy control groups. Hence JTC, BADE, BACE, and LA co-vary with delusions in cross-sectional samples of people with schizophrenia. Groups who were experiencing delusions due to other psychiatric illnesses also demonstrated greater JTC than healthy controls, and equivalent JTC to groups with schizophrenia currently experiencing delusions. Hence JTC is associated with delusions across a range of diagnoses. Groups with other, non-delusional psychiatric illnesses demonstrated less JTC, BADE, BACE, and LA than groups with schizophrenia currently experiencing delusions, less JTC than groups experiencing delusions due to other diagnoses, and no more JTC, BADE, BACE, or LA than healthy control groups. Hence JTC, BADE, BACE, and LA were not associated with psychiatric illnesses in general. Our results indicate all 4 biases are associated with delusions specifically rather than merely with a diagnosis of schizophrenia or with being psychiatrically ill, consistent with the possibility that they contribute to delusional severity.

Who "jumps to conclusions"? A comprehensive assessment of probabilistic reasoning in psychosis following traumatic brain injury (PFTBI), and comparison with TBI, schizophrenia, and nonclinical controls

INTRODUCTION

The "jumping to conclusions" (JTC) bias has received significant attention in the schizophrenia and delusion literature as an important aspect of cognition characterising psychosis. The JTC bias has not been explored in psychosis following traumatic brain injury (PFTBI).

METHODS

JTC was investigated in 10 patients with PFTBI using the beads task (ratios 85:15 and 60:40). Probabilistic predictions, draws-to-decision, self-rated decision confidence, and JTC bias were recorded. Responses from 10 patients with traumatic brain injury (TBI), 23 patients with schizophrenia, and 23 nonclinical controls were compared. Relationships were explored between draws-to-decision and current intelligence quotient, affective state, executive function, delusions (severity and type), and illness chronicity (duration).

RESULTS

Groups were comparable on JTC measures. Delusion severity and type were not related to draws-to-decision for either trial. In the entire sample, executive function (reduced mental flexibility) was significantly related to more draws-to-decision on the 60:40 ratio trial.

CONCLUSIONS

We found no evidence for an elevated JTC bias in patients with PFTBI or TBI alone. The influence of executive dysfunction should be considered by future studies using the beads tasks in patient populations. These findings need to be replicated in larger PFTBI and TBI samples.

On the Inadequacies of Theory of Mind Explanations of Schizophrenia

An influential theory of schizophrenia proposes that it can be explained by an inability to understand and reason about the mental states of others. In particular, an inability to correctly infer the mental states of others is believed to give rise to delusions and other psychotic symptoms. Our recent research has shown that patients adequately represent their own and others’ mental states and use this competence to communicate successfully in naturalistic social interaction. In talk with delusional content, patients recognize that others do not agree with their delusional claims and are not persuaded by the justification they provide for these claims. Importantly, they recognize their own and others’ discomfort at the disagreement this causes. However, they do not revise their claims. It is the tenacity with which delusional claims are held that is striking. This is all the more interesting given their ability to appreciate and respond appropriately to others’ mental states and their evident discomfort in the face of others’ disagreement. Questions for further research are whether this incorrigibility is specific to delusions, psychotic symptoms or the condition generally, and why patients are so tenacious in disregarding others’ accounts of their problems.

Moderators of noise-induced cognitive change in healthy adults

Environmental noise causes cognitive impairment, particularly in executive function and episodic memory domains, in healthy populations. However, the possible moderating influences on this relationship are less clear. This study assessed 54 healthy participants (24 men) on a cognitive battery (measuring psychomotor speed, attention, executive function, working memory, and verbal learning and memory) under three (quiet, urban, and social) noise conditions. IQ, subjective noise sensitivity, sleep, personality, paranoia, depression, anxiety, stress, and schizotypy were assessed on a single occasion. We found significantly slower psychomotor speed (urban), reduced working memory and episodic memory (urban and social), and more cautious decision-making (executive function, urban) under noise conditions. There was no effect of sex. Variance in urban noise-induced changes in psychomotor speed, attention, Trail Making B-A (executive function), and immediate recall and social noise-induced changes in verbal fluency (executive function) and immediate recall were explained by a combination of baseline cognition and paranoia, noise sensitivity, sleep, or cognitive disorganization. Higher baseline cognition (but not IQ) predicted greater impairment under urban and social noise for most cognitive variables. Paranoia predicted psychomotor speed, attention, and executive function impairment. Subjective noise sensitivity predicted executive function and memory impairment. Poor sleep quality predicted less memory impairment. Finally, lower levels of cognitive disorganization predicted slower psychomotor speed and greater memory impairment. The identified moderators should be considered in studies aiming to reduce the detrimental effects of occupational and residential noise. These results highlight the importance of studying noise effects in clinical populations characterized by high levels of the paranoia, sleep disturbances, noise sensitivity, and cognitive disorganization.

Effects of environmental noise on cognitive (dys)functions in schizophrenia: A pilot within-subjects experimental study

Cognitive impairment, particularly in attention, memory and executive function domains, is commonly present and associated with poor functional outcomes in schizophrenia. In healthy adults, environmental noise adversely affects many cognitive domains, including those known to be compromised in schizophrenia. This pilot study examined whether environmental noise causes further cognitive deterioration in a small sample of people with schizophrenia. Eighteen outpatients with schizophrenia on stable doses of antipsychotics and 18 age and sex-matched healthy participants were assessed on a comprehensive cognitive battery including measures of psychomotor speed, attention, executive functioning, working memory, and verbal learning and memory under three different conditions [quiet: ~30dB(A); urban noise: building site noise, 68-78dB(A); and social noise: background babble and footsteps from a crowded hall without any discernible words, 68-78dB(A)], 7-14days apart, with counter-balanced presentation of noise conditions across participants of both groups. The results showed widespread cognitive impairment in patients under all conditions, and noise-induced impairments of equal magnitude on specific cognitive functions in both groups. Both patient and healthy participant groups showed significant disruption of delayed verbal recall and recognition by urban and social noise, and of working memory by social noise, relative to the quiet condition. Performance under urban and social noise did not differ significantly from each other for any cognitive measure in either group. We conclude that noise has adverse effects on the verbal and working memory domains in schizophrenia patients and healthy participants. This may be particularly problematic for patients as it worsens their pre-existing cognitive deficits.

Psychosis, Delusions and the "Jumping to Conclusions" Reasoning Bias: A Systematic Review and Meta-analysis

We did a systematic review and meta-analysis to investigate the magnitude and specificity of the "jumping to conclusions" (JTC) bias in psychosis and delusions. We examined the extent to which people with psychosis, and people with delusions specifically, required less information before making decisions. We examined (1) the average amount of information required to make a decision and (2) numbers who demonstrated an extreme JTC bias, as assessed by the "beads task." We compared people with psychosis to people with and without nonpsychotic mental health problems, and people with psychosis with and without delusions. We examined whether reduced data-gathering was associated with increased delusion severity. We identified 55 relevant studies, and acquired previously unpublished data from 16 authors. People with psychosis required significantly less information to make decisions than healthy individuals (k= 33,N= 1935,g= -0.53, 95% CI -0.69, -0.36) and those with nonpsychotic mental health problems (k= 13,N= 667,g= -0.58, 95% CI -0.80, -0.35). The odds of extreme responding in psychosis were between 4 and 6 times higher than the odds of extreme responding by healthy participants and participants with nonpsychotic mental health problems. The JTC bias was linked to a greater probability of delusion occurrence in psychosis (k= 14,N= 770, OR 1.52, 95% CI 1.12, 2.05). There was a trend-level inverse association between data-gathering and delusion severity (k= 18;N= 794;r= -.09, 95% CI -0.21, 0.03). Hence, nonaffective psychosis is characterized by a hasty decision-making style, which is linked to an increased probability of delusions.

Observable Social Cognition--A Rating Scale: an interview-based assessment for schizophrenia

INTRODUCTION

Individuals with schizophrenia consistently show impairments in social cognition (SC). SC has become a potential treatment target due to its association with functional outcomes. An alternative method of assessment is to administer an observer-based scale incorporating an informant's "first hand" impressions in ratings.

METHODS

The present study used the Observable Social Cognition: A Rating Scale (OSCARS) in 62 outpatients and 50 non-psychiatric controls (NPCs) to assess performance in domains of SC (e.g. emotion perception, theory of mind).

RESULTS

The OSCARS demonstrated sufficient internal consistency and test-retest reliability. Construct validity was assessed through an exploratory factor analysis. Patient OSCARS indices were not significantly correlated with measures of SC with the exception of aggressive attributional style. Individuals with less impairment in SC reacted more aggressively to ambiguous situations. NPC OSCARS were significantly correlated with measures of theory of mind and attributional style. In a combined sample of patients and controls, six of eight items were significantly correlated with the SC task assessing the same domain, providing modest evidence of convergent validity. In patients, the OSCARS was significantly correlated with measures of functional outcome and neurocognition. Last, the OSCARS was found to be significantly associated with functional outcome after the influence of objective measures of SC was statistically removed.

CONCLUSIONS

The present study provides preliminary evidence that the OSCARS may be useful for clinicians in collecting data about patients' potential real-world SC deficits, in turn increasing the degree to which these impairments may be targeted in treatment.

Delusion proneness and 'jumping to conclusions': relative and absolute effects

BACKGROUND

That delusional and delusion-prone individuals 'jump to conclusions' is one of the most robust and important findings in the literature on delusions. However, although the notion of 'jumping to conclusions' (JTC) implies gathering insufficient evidence and reaching premature decisions, previous studies have not investigated whether the evidence gathering of delusion-prone individuals is, in fact, suboptimal. The standard JTC effect is a relative effect but using relative comparisons to substantiate absolute claims is problematic. In this study we investigated whether delusion-prone participants jump to conclusions in both a relative and an absolute sense.

METHOD

Healthy participants (n = 112) completed an incentivized probabilistic reasoning task in which correct decisions were rewarded and additional information could be requested for a small price. This combination of rewards and costs generated optimal decision points. Participants also completed measures of delusion proneness, intelligence and risk aversion.

RESULTS

Replicating the standard relative finding, we found that delusion proneness significantly predicted task decisions, such that the more delusion prone the participants were, the earlier they decided. This finding was robust when accounting for the effects of risk aversion and intelligence. Importantly, high-delusion-prone participants also decided in advance of an objective rational optimum, gathering fewer data than would have maximized their expected payoff. Surprisingly, we found that even low-delusion-prone participants jumped to conclusions in this absolute sense.

CONCLUSIONS

Our findings support and clarify the claim that delusion formation is associated with a tendency to 'jump to conclusions'. In short, most people jump to conclusions, but more delusion-prone individuals 'jump further'.

Emotional awareness and delusions in schizophrenia and schizoaffective disorder

BACKGROUND AND OBJECTIVES

Emotion plays a significant role in schizophrenia. Emotional awareness (i.e., attention to and clarity of emotions) is associated with a wide range of outcomes. Given that individuals with schizophrenia and schizoaffective disorder differ in the significance of their mood symptoms, the present research examined whether the association between emotional awareness and delusions differs for these two groups of patients.

METHODS

Emotional awareness (i.e., attention to and clarity of emotions) was measured with self-report in a sample of 44 individuals diagnosed with either schizophrenia or schizoaffective disorder. Clinical ratings of delusions were made using the Scale for the Assessment of Positive Symptoms.

RESULTS

For the sample as a whole, individuals with higher levels of attention to emotion tended to have more severe delusions. In addition, diagnostic group significantly moderated the relation between emotional clarity and delusions.

LIMITATIONS

Conclusions regarding causality cannot be drawn due to the cross-sectional design. Replication is particularly important given the small sample sizes.

CONCLUSIONS

The present research indicates that emotional awareness is associated with delusions. The results raise the possibility that the emotional factors that contribute to delusional beliefs among individuals with schizophrenia differ in at least some ways from the emotional factors that contribute to delusional beliefs among individuals with schizoaffective disorder.

An investigation of a novel transdiagnostic model of delusions in a group with positive schizotypal symptoms

INTRODUCTION

Although several theories of delusions have been put forward, most do not offer a comprehensive diagnosis-independent explanation of delusion aetiology. This study used a non-clinical sample to provide empirical support for a novel transdiagnostic model of delusions that implicates aberrant semantic memory and emotion perception processes as key factors in delusion formation and maintenance. It was hypothesised that among a non-clinical sample, people high in schizotypy would demonstrate differences in semantic memory and emotion perception, relative to people low in schizotypy.

METHODS

Using the Cognitive Disorganisation subscale of the Oxford-Liverpool Inventory of Feelings and Experiences, 41 healthy participants were separated into high and low schizotypy groups and completed facial emotion perception and semantic priming tasks.

RESULTS

As expected, participants in the high schizotypy group demonstrated different performance on the semantic priming task and reduced facial affect accuracy for the emotion anger, and reaction time differences to fearful faces.

CONCLUSION

These findings suggest that such processes may be involved in the development of the sorts of unusual beliefs which underlie delusions. Investigation of how emotion perception and semantic memory may interrelate in the aetiology of delusions would be of value in furthering our understanding of their role in delusion formation.

Investigating the 'jumping to conclusions' bias in people with anorexia nervosa

'Jumping to conclusions' (JTC) is an established reasoning bias in people with psychosis and delusion proneness. Research investigating the JTC bias in other clinical populations remains in its infancy. This study investigated whether individuals with anorexia (AN) displayed the JTC bias compared with healthy controls and, if so, whether the bias was greater in relation to emotionally salient information. The study also investigated whether delusionality was correlated with the JTC bias. JTC was measured using the 'beads task'. Three versions were employed: the standard version and two emotionally salient tasks. Results indicated that a majority (55.6%) of people with AN (n=26) displayed poor insight into their eating disorder beliefs but did not display an elevated JTC compared with healthy controls (n=33) on any task. The level of delusionality in the AN group was not correlated with JTC bias. Findings suggest that although a majority of people with AN demonstrated limited insight, they did not display the JTC bias. This may suggest that poor insight in eating disorders has different characteristics to that found in psychotic disorders, which may suggest that differences are needed in relation to how they are treated using psychological means. However, this was a small study, and study replication is required.

Rationale and protocol for a systematic review and meta-analysis on reduced data gathering in people with delusions

BACKGROUND

The tendency to form conclusions based on limited evidence is known as the 'jumping to conclusions' (JTC) bias, and has been a much studied phenomena in individuals with psychosis. Previous reviews have supported the hypothesis that a JTC bias is particularly linked to the formation and maintenance of delusions. A new systematic review is required as a number of studies have since been published, and older reviews are limited by not systematically assessing methodological quality or the role of study design in influencing effect size estimates. This review aimed to investigate if there is an association between psychosis or delusions and JTC bias.

METHODS

The current protocol outlines the background and methodology for this systematic review and meta-analysis. Eligible articles will be identified through searches of the electronic databases PsycInfo, PubMed and Medline using relevant search terms, supplemented by hand-searches of references within eligible articles and key review articles within the field. Eligibility criteria were as follows: studies must recruit individuals with: i) schizophrenia spectrum conditions or ii) experiences of delusions. Case-control, cross-sectional, observational and prospective designs will be included but treatment trials and experimental studies excluded. Studies must use the beads task to assess JTC or a conceptually equivalent task. The outcomes will be the average number of 'draws to a decision' in the beads task (or related variant) and the proportion of the sample judged to demonstrate a JTC bias. Literature searches, study selection, data extraction, risk of bias assessment and outcome quality assessment will be undertaken by two independent reviewers. Meta-analyses will be undertaken for continuous (mean number of 'draws to a decision') and binary outcomes (number of people classified as having JTC bias).

DISCUSSION

Understanding of the size of the JTC effect and the contexts within which it occurs is important both in terms of informing models of delusional thinking and in guiding treatments for those with delusions or psychosis. However, a definitive, up-to-date review and meta-analysis of the JTC bias is currently lacking. The proposed review will fill this gap and resolve key issues regarding the factors which moderate the JTC bias.

PROSPERO REGISTRATION

CRD42014007603 http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014007603.

Changes in delusions in the early phase of antipsychotic treatment - an experience sampling study

It has been suggested that different aspects of delusions (conviction, distress, preoccupation) respond to treatment at different rates, and that the cognitive bias of 'Jumping to Conclusions' (JTC) may predict treatment outcome. This study investigates changes in delusion dimensions using Experience Sampling Methodology (ESM) and the role of JTC as a predictor of change during the initial 2 weeks of antipsychotic treatment on admission to hospital. Sixteen acute patients with delusions were assessed seven times per day for 14 days using computerised ESM. ESM assessed moment-by-moment experiences of affect, psychotic symptoms, and delusion dimensions. Clinical ratings were completed at baseline, 1 week and 2 weeks later. The 'beads' task was used to measure JTC at baseline. Delusion dimensions improved over the two weeks of antipsychotic treatment and admission to hospital. Different delusional dimensions changed at different rates, with distress and disruption being more responsive than conviction and preoccupation on both PSYRATS and ESM ratings. Eight out of 16 participants showed a JTC bias on the beads task at baseline. Exploratory analyses showed that JTC predicted changes in the ESM ratings of delusion conviction and distress, suggesting that reasoning biases may predict treatment response.

Jumping to conclusions and delusions: the impact of discussion of the bias on the bias

The present study was an investigation of the impact a brief intervention designed to raise awareness of a cognitive bias known to be robust for individuals with delusions has on the reasoning strategies of individuals with delusions. Individuals with delusions (n=57) were randomly assigned either to receive or not to receive a discussion of the jumping to conclusions bias and its pitfalls. Participants' performance on 3 reasoning trials - 1 emotionally neutral (beads) and 2 emotionally salient (self-referred survey words) - was then assessed; the number of stimuli participants requested before making a decision was evaluated to determine if the Jumping to Conclusions Discussion resulted in increased data gathering. There was no difference between groups (those who received and those who did not receive the Jumping to Conclusions Discussion) in terms of how many beads they gathered (p=.36), but there were significant differences on both reasoning trials of emotionally salient stimuli (p's<.05), such that participants who received the Jumping to Conclusions Discussion requested more stimuli on those tasks than individuals who did not receive the discussion. Thus, results suggest that discussion of the jumping to conclusions bias may impact the bias directly, at least for material that is emotional in nature. Results are discussed in terms of their relevance to cognitive behavioral therapies for psychosis and existing research on reasoning and delusions.

How do people with persecutory delusions evaluate threat in a controlled social environment? A qualitative study using virtual reality

BACKGROUND

Environmental factors have been associated with psychosis but there is little qualitative research looking at how the ongoing interaction between individual and environment maintains psychotic symptoms.

AIMS

The current study investigates how people with persecutory delusions interpret events in a virtual neutral social environment using qualitative methodology.

METHOD

20 participants with persecutory delusions and 20 controls entered a virtual underground train containing neutral characters. Under these circumstances, people with persecutory delusions reported similar levels of paranoia as non-clinical participants. The transcripts of a post-virtual reality interview of the first 10 participants in each group were analysed.

RESULTS

Thematic analyses of interviews focusing on the decision making process associated with attributing intentions of computer-generated characters revealed 11 themes grouped in 3 main categories (evidence in favour of paranoid appraisals, evidence against paranoid appraisals, other behaviour).

CONCLUSIONS

People with current persecutory delusions are able to use a range of similar strategies to healthy volunteers when making judgements about potential threat in a neutral environment that does not elicit anxiety, but they are less likely than controls to engage in active hypothesis-testing and instead favour experiencing "affect" as evidence of persecutory intention.

Increased reflection impulsivity in patients with ephedrone-induced Parkinsonism

AIMS

To examine a syndrome of chronic manganism that occurs in drug addicts in eastern Europe who use intravenous methcathinone (ephedrone) contaminated with potassium permanganate. In many cases the basal ganglia, especially the globus pallidus and the putamen, are damaged irreversibly. Routine neuropsychological assessment has revealed no cognitive deficits, despite widespread abnormalities on brain imaging studies and severe extrapyramidal motor handicap on clinical examination.

DESIGN

Case-control study.

SETTING

Ephedrone patients and patients with opioid dependence were recruited from Lviv, Ukraine.

PARTICIPANTS

We tested 15 patients with ephedrone-induced toxicity, 13 opiate-dependent patients who were receiving opioid replacement therapy and 18 matched healthy volunteers.

MEASUREMENTS

The 'beads task', an information-gathering task to assess reflection impulsivity, was used and feedback learning, working memory and risk-taking were also assessed.

FINDINGS

Opiate-dependent patients differed from controls on three of four tasks, whereas ephedrone patients differed from controls on only one task. More specifically, both patient groups were more impulsive and made more irrational choices on the beads task than controls (P < 0.001). However, ephedrone patients had no deficits in working memory (P > 0.1) or risk-taking (P > 0.1) compared with controls. Opioid-dependent patients had significantly worse working memory (P < 0.001) and were significantly more risk-prone than controls (P = 0.002).

CONCLUSIONS

Ephedrone patients may have similar deficits in information-gathering and decision-making to opiate-dependent patients, with preservation of working memory and risk-taking. This may reflect specific damage to anterior cingulate- basal ganglia loops.

The jumping-to-conclusions bias in new religious movements

The jumping-to-conclusions bias has not been examined in a new religious movement (NRM) group. Twenty-seven delusion-prone NRM individuals were compared with 25 individuals with psychotic disorders and 63 non-delusion-prone individuals on four probabilistic inference tasks, together with measures of psychotic symptoms and delusion proneness. The NRM individuals requested significantly less evidence when compared with the control individuals on both meaningful and nonmeaningful tasks. The NRM individuals requested significantly more evidence on a difficult meaningful task when compared with the individuals with psychotic disorders. A specific reasoning style but not a general reasoning style differentiates the NRM individuals from the individuals with psychotic disorders. These findings may be specific to NRM individuals and may not be generalized to other delusion-prone groups.

Delusions and metacognition in patients with schizophrenia

INTRODUCTION

The aim of the present study was to explore the basis of the strong feeling of conviction and the high resistance to change characteristic of delusions and to test whether patients with schizophrenia suffering from delusions have specific metacognitive impairments when compared to both patients without delusions and healthy controls.

METHODS

14 actively delusional patients with schizophrenia, 14 nondelusional patients, and 14 healthy subjects were administered two measures assessing different aspects of metacognition: an emotional metacognitive version of the WCST adapted from Koren et al. (2004) and the Beck Cognitive Insight Scale.

RESULTS

Relative to both healthy controls and nondelusional patients, delusional participants were specifically impaired on metacognitive measures of free choice improvement and global monitoring. This was correlated with high self-certainty on the BCIS relative to nondelusional patients.

CONCLUSIONS

Our results suggest that metacognitive impairments play an important role in the maintenance of delusional beliefs. It may therefore be important to adapt remediation strategies to the metacognitive profiles of patients.

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.

Jumping to conclusions, a lack of belief flexibility and delusional conviction in psychosis: a longitudinal investigation of the structure, frequency, and relatedness of reasoning biases

Two reasoning biases, jumping to conclusions (JTC) and belief inflexibility, have been found to be associated with delusions. We examined these biases and their relationship with delusional conviction in a longitudinal cohort of people with schizophrenia-spectrum psychosis. We hypothesized that JTC, lack of belief flexibility, and delusional conviction would form distinct factors, and that JTC and lack of belief flexibility would predict less change in delusional conviction over time. Two hundred seventy-three patients with delusions were assessed over twelve months of a treatment trial (Garety et al., 2008). Forty-one percent of the sample had 100% conviction in their delusions, 50% showed a JTC bias, and 50%–75% showed a lack of belief flexibility. Delusional conviction, JTC, and belief flexibility formed distinct factors although conviction was negatively correlated with belief flexibility. Conviction declined slightly over the year in this established psychosis group, whereas the reasoning biases were stable. There was little evidence that reasoning predicted the slight decline in conviction. The degree to which people believe their delusions, their ability to think that they may be mistaken and to consider alternative explanations, and their hastiness in decision making are three distinct processes although belief flexibility and conviction are related. In this established psychosis sample, reasoning biases changed little in response to medication or psychological therapy. Required now is examination of these processes in psychosis groups where there is greater change in delusion conviction, as well as tests of the effects on delusions when these reasoning biases are specifically targeted.

Probabilistic reasoning in patients with body dysmorphic disorder

BACKGROUND AND OBJECTIVES

Many patients with body dysmorphic disorder (BDD) have poor insight into their condition. Indeed, their conviction in their ugliness is often delusional. Perhaps the most robust information-processing abnormality associated with delusions is a jumping to conclusions (JTC) reasoning bias such that delusional individuals request significantly less information before making a decision relative to healthy controls. We investigated whether patients with BDD (n = 20) demonstrate a JTC reasoning style relative to patients with OCD (n = 20) and healthy controls (n = 20).

METHODS

Participants completed a clinician-rated measure of delusionality and two tests of probabilistic reasoning: the beads task and the survey task.

RESULTS

Patients with BDD did exhibit higher delusionality than the patients with OCD. They did not, however, exhibit a JTC reasoning bias relative to the patients with OCD or the healthy controls. Patients with poor insight BDD requested significantly less information before making a decision than did patients with fair insight BDD.

LIMITATIONS

The clinical groups were characterized by multiple comorbidities and concomitant medications. The BDD group had relatively good insight as compared to other studies examining delusionality in BDD.

CONCLUSIONS

Taken together, our results suggest that although a JTC reasoning bias was not present in all patients with BDD, a modest JTC reasoning bias may be present among patients with poor insight BDD. Future studies could provide additional information on this hypothesis.

Bayesian modelling of Jumping-to-Conclusions bias in delusional patients

INTRODUCTION. When deciding about the cause underlying serially presented events, patients with delusions utilise fewer events than controls, showing a "Jumping-to-Conclusions" bias. This has been widely hypothesised to be because patients expect to incur higher costs if they sample more information. This hypothesis is, however, unconfirmed. METHODS. The hypothesis was tested by analysing patient and control data using two models. The models provided explicit, quantitative variables characterising decision making. One model was based on calculating the potential costs of making a decision; the other compared a measure of certainty to a fixed threshold. RESULTS. Differences between paranoid participants and controls were found, but not in the way that was previously hypothesised. A greater "noise" in decision making (relative to the effective motivation to get the task right), rather than greater perceived costs, best accounted for group differences. Paranoid participants also deviated from ideal Bayesian reasoning more than healthy controls. CONCLUSIONS. The Jumping-to-Conclusions Bias is unlikely to be due to an overestimation of the cost of gathering more information. The analytic approach we used, involving a Bayesian model to estimate the parameters characterising different participant populations, is well suited to testing hypotheses regarding "hidden" variables underpinning observed behaviours.

Examining Cognitive Biases in Patients With Delusions of Reference

Cognitive biases may not be seen in all subtypes of delusions, and might be more involved in the etiology of some delusional subtypes than others. A sample of patients with delusions of reference did not show the jumping to conclusions (JTC) bias. JTC appears to be more closely related to paranoia than referential delusions.

When does jumping-to-conclusions reach its peak? The interaction of vulnerability and situation-characteristics in social reasoning

BACKGROUND AND OBJECTIVES

Persons with delusions tend to display a jumping-to-conclusions (JTC) bias which is considered relevant to delusion formation. However, its contribution in real life social scenarios is unknown. This study investigates whether JTC increases when decisions have to be made in delusion-relevant situations and whether the increase is uniquely moderated by delusion-proneness.

METHODS

JTC was assessed by a social reasoning paradigm in 92 healthy participants that were classified as high, medium or low in paranoid ideation and social anxiety. Decisions had to be made for emotionally salient scenarios without direct self-relevance, self-relevant scenarios and delusion-relevant scenarios, by successively drawing pieces of information.

RESULTS

All participants drew less information in the scenarios that were self-relevant and delusion-relevant compared to non-self-relevant scenarios. Participants with higher paranoid ideation generally drew less information than persons with medium or low levels of paranoid ideation. However, the hypothesized interaction of delusion-proneness and type of scenario was not significant. Social anxiety had no effect on draws to decision in any of the task types.

LIMITATIONS

The description of social encounters in the task does still not capture the full perceptual experience in real life encounters.

CONCLUSIONS

The data support the assumption that the formation of persecutory delusions might arise as a function of a delusion-specific JTC-bias in combination with a normal and functional tendency to collect less information in self-relevant situations.

Reasoning bias and belief conviction in obsessive-compulsive disorder and delusions: jumping to conclusions across disorders?

OBJECTIVES

This study investigated whether a reasoning bias ('jumping to conclusions'; JTC) found to be associated with higher levels of conviction in delusions is also associated with high-conviction beliefs in obsessive-compulsive disorder (OCD).

DESIGN

The experimental design was mixed-effects, with one between-subjects factor of group and one within-subjects factor of task.

METHODS

Participants were 16 people with high-conviction OCD (≥ 50%), 16 people with low-conviction OCD (< 50%), 16 people with delusions (≥ 50% conviction), and 16 non-clinical controls. JTC was assessed using a neutral probabilistic reasoning task (beads task) and a version involving words of differing emotional salience (words task).

RESULTS

There was no statistically significant difference in draws to decision on the beads task between the high-conviction OCD group, the low-conviction OCD group, and the non-clinical controls. The delusions group made significantly fewer draws to decision compared to the non-clinical controls on the words task but not the beads task and significantly fewer draws on both tasks compared with the combined OCD group. Emotionally salient material (words task) did not affect draws to decision in any group.

CONCLUSIONS

JTC is associated with delusions but not high-conviction beliefs in OCD. The cognitive processes associated with high-conviction beliefs in OCD and psychosis may not be trans-diagnostic. This is consistent with the view that high-conviction OCD should not be classified as a psychotic disorder.

Prefrontal cortex dysfunction and 'Jumping to Conclusions': bias or deficit?

The 'beads task' is used to measure the cognitive basis of delusions, namely the 'Jumping to Conclusions' (JTC) reasoning bias. However, it is not clear whether the task merely taps executive dysfunction - known to be impaired in patients with schizophrenia - such as planning and resistance to impulse. To study this, 19 individuals with neurosurgical excisions to the prefrontal cortex, 21 unmedicated adults with Attention Deficit Hyperactivity Disorder (ADHD), and 25 healthy controls completed two conditions of the beads task, in addition to tests of memory and executive function as well as control tests of probabilistic reasoning ability. The results indicated that the prefrontal lobe group (in particular, those with left-sided lesions) demonstrated a JTC bias relative to the ADHD and control groups. Further exploratory analyses indicated that JTC on the beads task was associated with poorer performance in certain executive domains. The results are discussed in terms of the executive demands of the beads task and possible implications for the model of psychotic delusions based on the JTC bias.

'Jumping to conclusions' in first-episode psychosis

AIM

People with psychotic symptoms are reported to have a characteristic reasoning style in which they jump to conclusions (JTC). The aims of this research were threefold. The first was to establish how prevalent this style is in people with first-episode psychosis. The second was to examine the specificity of JTC to delusions. The third was to examine explanatory factors that may account for the JTC style. This was investigated by attempting to replicate, with a large sample, previous studies indicating that JTC is associated with specific psychotic and non-psychotic symptoms and processes.

METHODS

Seventy-seven service users were recruited from a first-episode service and completed measures of reasoning and psychotic and non-psychotic symptomatologies. A well-established criterion was used to compare the JTC performance of those people with and without JTC.

RESULTS

JTC was present in over 40% of the sample, which is consistent with previous studies of people with long-standing psychotic symptoms. Unlike previous research, no strong associations were found in relation to symptoms and other processes.

CONCLUSIONS

JTC is a phenomenon common in many people in first-episode services. In this large cohort sample, no clear associations with symptoms or other psychological processes were evident. Hence, the reason people JTC is still unclear.

Subclinical delusional ideation and a self-reference bias in everyday reasoning

Previous studies (e.g. Moller & Husby, 2000; Blackwood et al., 2004) have revealed that delusional thinking is accompanied by an exaggerated focus upon the self and upon stimuli that are perceived to be related to the self. The objective was to examine whether those high in subclinical delusional ideation exhibit a heightened tendency for self-reference. Using a mixed design, healthy individuals, classified into high- and low-scoring groups on the Peters et al. Delusions Inventory (Peters, Day, & Garety, 1996), were compared on everyday reasoning tasks across three experiments. High-PDI scorers, in contrast to the low-PDI group, rated self-referent objections to everyday arguments as stronger than other-referent objections and formulated more self-referent assertion-based objections to everyday arguments. The findings support the notion that subclinical delusional ideation is linked to a self-reference bias, which is evident in the sort of everyday thinking that people engage in when forming or evaluating their beliefs and which may contribute to delusion formation.

Paranoia and emotion perception across the continuum

OBJECTIVES

Persons with high levels of paranoid ideation may be more sensitive to emotional stimuli, particularly negative emotions, reflecting the operation of a paranoid schema. However, this finding has not been consistently supported and needs further study. This study examined the effect of paranoia, as measured on a continuum, on emotion perception. It was predicted that higher levels of paranoia would be associated with improved emotion perception scores with better recognition for negative emotions than positive.

DESIGN

A four-group ANOVA design was used to compare participants with clinical and sub-clinical paranoia to reflect the continuum view of paranoia.

METHODS

A group with persecutory delusions (N=30) was compared with three sub-clinical groups (N=88) on two posed emotion perception tasks. The sub-clinical participants were divided into high, moderate, and low groups based on scores from the Paranoia Scale, a widely used measure of sub-clinical paranoia.

RESULTS

Persons with persecutory delusions had lower overall emotion perception scores than all of the sub-clinical groups. For negative emotions, persons with persecutory delusions had lower identification scores than the moderate and low sub-clinical groups, but were no different than the high sub-clinical group. Anger was especially problematic for clinical participants. There were no differences for positive emotions.

CONCLUSIONS

Instead of an enhanced sensitivity for the recognition of emotional states, higher levels of paranoia were linked to a performance deficit on emotion perception tasks. The deficits in emotion perception may reflect the increased skepticism and scrutiny associated with posed emotion tasks (Davis & Gibson, 2000). Research should begin to focus on the underlying mechanisms of emotion perception deficits in paranoia.

Do antipsychotics improve reasoning biases? A review

OBJECTIVE

To explore how reasoning biases in schizophrenic patients respond to treatment. Patients with schizophrenia, especially those with delusions, show not only cognitive deficits but also "reasoning biases," namely, "jumping to conclusions," reduced belief flexibility, an externalizing attributional style, and an impaired "theory of mind."

METHODS

This is a systematic review of 17 longitudinal and cross-sectional studies.

RESULTS

"Jumping to conclusions" and reduced "belief flexibility" are most closely related to the severity of delusions, whereas "theory of mind" is better related to negative symptoms and "attributional style" to overall psychopathology. Antipsychotic treatment leads to an improvement in belief flexibility and theory of mind, with the suggestion that "belief flexibility" may be mediating the treatment response. On the other hand, the "jumping to conclusions" bias is likely a stable "trait" factor, which does not change with treatment, although it may moderate the outcome of response. The findings above are offered with the caveat that most of the available studies are small, often uncontrolled, few are longitudinal, that the measurement of some of the reasoning measures varies across studies, and that their relationship to the more established "cognitive" deficits remains unclear.

CONCLUSIONS

The fact that these reasoning biases could be moderators and mediators of treatment outcome provides a greater impetus to study them systematically.

Jumping to conclusions and perceptions in early psychosis: relationship with delusional beliefs

INTRODUCTION

Previous research has suggested that biases in cognitive processes involved in everyday reasoning may contribute to the development of delusional beliefs. The aim of this study was to explore jumping to conclusions (JTC), a data-gathering bias, and jumping to perceptions (JTP), a bias towards believing ambiguous perceptual events are real and external.

METHODS

Individuals with current delusions (n=17), remitted delusions (n=17), both recruited from an early psychosis service, and nonclinical participants (n=35) were compared on a probabilistic reasoning task, an auditory perceptual bias task, and the Barely Visible Words task.

RESULTS

The deluded participants did not demonstrate the expected JTC bias; therefore the relationship between JTC and JTP could not be examined. However, both clinical groups exhibited a JTP bias on the auditory perceptual bias task. In contrast, the lowered perceptual threshold for threat displayed by the control group was absent in the clinical groups.

CONCLUSIONS

These results suggest that the JTP bias may be a trait characteristic in those with a propensity to delusions, and that these individuals may also show a bias away from threat.

Correspondences between theory of mind, jumping to conclusions, neuropsychological measures and the symptoms of schizophrenia

Tasks measuring reasoning biases and social cognition were originally applied to the study of schizophrenia in order to shed light on the cognitive underpinnings of positive symptoms. However, the empirical evidence for overlap between these tasks, and their association with positive symptoms, remains preliminary. In the current study we explore these associations using multivariate methodology, with primary interest in two commonly studied paradigms: jumping to conclusions (JTC) and theory of mind (ToM). We also included measures of memory, executive function and fluency performance, in order to relate the cognitive constructs to more traditional neuropsychological constructs. Forty-six schizophrenia inpatients were administered JTC, ToM, verbal fluency, executive functioning, and verbal memory tasks. A principal component analysis resulted in three components interpreted as Memory, Elaboration and Flexibility. ToM loaded with verbal fluency on the Elaboration component, whereas JTC loaded with executive functioning on the Flexibility component. The negative susbscale of the Positive and Negative Syndrome Scale (PANSS) correlated with the Elaboration component, but no other component-subscale correlations reached significance. Implications of these results are that impairments in elaboration may underlie the commonly observed correlation between ToM and negative symptoms, but argue against a common neurocognitive system for JTC, ToM and positive symptoms.