Paranoid thinking, cognitive bias and dangerous neighbourhoods: Implications for perception of threat and expectations of victimisation

Reasoning and interpretation cognitive biases related to psychotic characteristics: An umbrella-review

Cognitive biases have been studied in relation to schizophrenia and psychosis for over 50 years. Yet, the quality of the evidence linking cognitive biases and psychosis is not entirely clear. This umbrella-review examines the quality of the evidence and summarizes the effect sizes of the reasoning and interpretation cognitive biases studied in relation to psychotic characteristics (psychotic disorders, psychotic symptoms, psychotic-like experiences or psychosis risk). It also examines the evidence and the effects of psychological interventions for psychosis on cognitive biases. A systematic review of the literature was performed using the PRISMA guidelines and the GRADE system for 128 analyses extracted from 16 meta-analyses. Moderate to high-quality evidence with medium to large effect sizes were found for the following interpretation biases: externalization of cognitive events and self-serving bias, when people with psychotic symptoms were compared to control conditions. Regarding reasoning biases, moderate to high quality evidence with medium to large effect sizes were found for belief inflexibility when linked to delusion conviction and global severity in people with active delusions, although measures from the MADS, overlapping with symptoms, may have inflated effect sizes. Moderate quality evidence with medium to large effect sizes were found for jumping to conclusion biases when clinical samples with psychosis were compared to controls, when using data-gathering tasks. Other cognitive biases are not supported by quality evidence (e.g., personalizing bias, belief about disconfirmatory evidence), and certain measures (i.e., IPSAQ and ASQ) systematically found no effect or small effects. Psychological interventions (e.g., MCT) showed small effect sizes on cognitive biases, with moderate-high-quality evidence. This umbrella review brings a critical regard on the reasoning and interpretation biases and psychotic symptoms literature-although most biases linked to psychotic symptoms are supported by meta-analyses in some way, some have only demonstrated support with a specific population group (e.g., aberrant salience and hostility attribution in healthy individuals with psychotic-like experiences), whereas other biases are currently insufficiently supported by quality evidence. Future quality studies, particularly with clinical populations with psychotic symptoms, are still warranted to ascertain the psychosis-cognitive bias link for specific biases.

Sense of Freedom in the Golden Years: Disentangling the Complex Ties Between Community Safety Concerns and Depressive Symptoms in Later Life

This study investigates the "Negative Spillover Effect"-a conceptual framework that highlights the correlation between older adults' community safety concerns and depressive symptoms. It explores the moderating influence of the sense of freedom in this relationship. Through the analysis of data from 3408 participants in the China Labor-force Dynamics Survey, employing a two-stage least squares regression approach, the study uncovers the intricate role of the sense of freedom in influencing the depressive symptoms of older adults based on their community safety concerns. The sense of freedom serves as a protective factor against the adverse psychological effects of community safety concerns when they are strong. However, this protective role diminishes when coupled with a low perception of the fair match between labor input and living condition rewards. The study underscores the importance of addressing and mitigating the negative spillover effect to foster sustainable and equitable community development. Reducing these adverse effects is essential for enhancing the mental health and well-being of the older demographic.

Paranoid thinking and perceived competitive intention

Paranoid thinking, that others are hostile, can be seen even in the general population. Paranoia is considered the expectation that others are competitors who aim to maximize the differences in payoffs rather than maximize their own payoffs. This study examined whether paranoia reflects the irrational belief that others have a competitive intention and is associated with avoiding perceived competition. We recruited 884 US residents via the Internet and conducted a modified Dictator Game, in which monetary allocation was carried out between the Dictator and the Recipient. The Dictator chooses either fair or competitive allocation while selecting the competitive allocation is irrelevant to increasing the Dictator's payoffs. The Recipient decides whether to accept the Dictator's decision or receive sure but low rewards. We found that Recipients with high-level paranoid thinking expected their opponent to select competitive allocation more than those with low levels, even when selecting it was costly for Dictators. Paranoid thinking was not associated with selecting sure rewards or competitive allocations. The results suggest that paranoia reflects the belief that others have a competitive intention but is not related to avoidance behavior against perceived threats and unilateral attacks.

Peer Victimization Influences Attention Processing Beyond the Effects of Childhood Maltreatment by Caregivers

Background

Different types of maltreatment (emotional, physical, and sexual) lead to distortions in emotion and attention processing. The present study investigated whether the experience of peer victimization in childhood and adolescence has an additional influence on attention processing in adulthood.

Methods

Two non-clinical samples consisting of individuals with different levels of experiences of maltreatment were recruited. In an evaluative conditioning task, images of faces with neutral emotional expression were either associated with short videos of intense negative statements, or associated with neutral videos. Subsequently, these faces were used as stimuli in an emotional Stroop task as well as a dot-probe task.

Results

In both tasks, hierarchical regression analyses revealed that retrospective reports of relational peer victimization made an incremental contribution to the prediction of attentional biases beyond child maltreatment. In the emotional Stroop task, emotional abuse was the strongest predictor for an attentional bias showing delayed responses to negatively associated faces, while peer victimization was associated with faster responses to negatively associated faces. In the dot-probe task, relational peer victimization was the strongest predictor for an attentional bias. When the attentional bias was examined in more detail, though, peer victimization did not show incremental contributions although emotional abuse remained the strongest predictor for facilitated attention toward negatively associated neutral faces.

Conclusion

Experiences of peer victimization leave additional cognitive scars beyond effects of childhood maltreatment by caregivers. It is likely that attentional biases in the aftermath of victimization put individuals at risk for the development of psychopathology.

Patient’s Experiences of Violence as Perpetrator: A Qualitative Study from Patients with Schizophrenia in Indonesia

BACKGROUND: Individuals with schizophrenia are at an increased risk for violence – limited study on exploring the experience of violence in patients with schizophrenia as a perpetrator. AIM: This research aimed to investigate the perception of violence as a perpetrator in Indonesia in patients with schizophrenia. METHODS: This study used phenomenology using a purposive sampling technique. A total of 40 patients were from the psychiatric ward of significant mental hospitals in West Java, Indonesia. The inclusion criteria for patients were the following: Age over 18 years old confirmed diagnosis with schizophrenia. Focus group discussion of patients comprised four groups. Each group consisted of tens of patients. RESULTS: The patient’s experiences as a perpetrator were categorized into six subthemes: Committing physical violence to family, quarreling with family, verbal abuse to family, a perpetrator of verbal violence to neighbors, expression of anger to object, and physical violence to nurse. CONCLUSION: The patient’s experiences of violence were not linear, but rather it was a complex experience of being a perpetrator, yet at the same time as of perpetrator violence. A staff training program to reduce patient violence is needed.

How is paranoia experienced in a student population? A qualitative study of students scoring highly on a paranoia measure

OBJECTIVES

Recent studies have suggested that students may experience high levels of paranoia. This study aimed to explore both experiences of paranoia and coping strategies in students scoring at high levels on a measure of paranoia.

DESIGN

This was a qualitative study which utilized a quantitative measure to identify potential participants.

METHODS

From an overall sample of 174 London-based university students in the United Kingdom, a sub-sample of 31 students with the highest total scores on the Green et al. Paranoid Thoughts Scale were invited to interview resulting in interviews with seven students (six female and one male) aged between 20 and 36 (M = 28.14). A thematic analysis of the interview transcripts was conducted from a critical realist standpoint.

RESULTS

Two key foci structured the analysis: perceived causal influences on paranoia (comprised of 'historical contexts fostering mistrust'; 'finding a social situation strange'; 'anticipating threat'; and 'evaluating the concern') and living with paranoia (comprised of 'effects on everyday life' and 'trying to minimize the effects of paranoia and regaining control').

CONCLUSIONS

Key aspects of the findings discussed in the context of the literature include paranoia as a threat heuristic; the role of internal and external dialogues; the influence of gender on content; and the importance of meaning in life as a coping resource.

PRACTITIONER POINTS

Paranoia may be a significant issue for some students. Paranoia needs to be seen in the context of past aversive experiences. Dialogical approaches may be useful in developing new therapeutic narratives. Valued social roles, activities, and responsibilities may be an important coping resource.

Risk perception in paranoia and anxiety: Two investigations across clinical and non-clinical populations

Objectives

It is common, among clinical and non-clinical populations alike, for paranoia and anxiety to co-occur. It has been suggested that anxiety and its related appraisal styles may contribute to development of paranoia. We aimed to evaluate different aspects of risk perception in relation to paranoia and anxiety and to identify specific aspects that may differentiate paranoia from anxiety. This paper consists of two inter-related studies.

Methods

Study 1 compared 30 patients with persecutory delusions, 21 patients with generalized anxiety disorder and 52 healthy controls. Study 2 compared 30 non-clinical individuals with high levels of paranoia and anxiety, 28 individuals with high anxiety only and 36 healthy controls. Within each study, the two symptomatic groups were matched on level of anxiety. Four dimensions of risk perception (i.e. likelihood, harm, controllability, and intentionality) were compared across groups, as measured by the locally validated Risk Perception Questionnaire.

Results

In both studies, the paranoia and the anxiety groups reported an elevated perceived likelihood of negative events than controls respectively. Only the paranoia groups reported an elevated perceived harm of neutral events than controls. In Study 2, the two at-risk groups attributed more harm and intentionality to negative events than controls.

Conclusion

Although perception of negative events was characteristic in anxiety (with or without paranoia), a biased perception of neutral events as risky was unique to the addition of paranoia. Implications to the transdiagnostic and continual view of psychopathology, and mechanism-based interventions were discussed.

Paranoia and conspiracy: group cohesion increases harmful intent attribution in the Trust Game

Current theories argue that hyper-sensitisation of social threat perception is central to paranoia. Affected people often also report misperceptions of group cohesion (conspiracy) but little is known about the cognitive mechanisms underpinning this conspiracy thinking in live interactions. In a pre-registered experimental study, we used a large-scale game theory approach (N > 1,000) to test whether the social cohesion of an opposing group affects paranoid attributions in a mixed online and lab-based sample. Participants spanning the full population distribution of paranoia played as proposers in a modified Trust Game: they were allocated a bonus and chose how much money to send to a pair of responders which was quadrupled before reaching these responders. Responders decided how much to return to the proposers through the same process. Participants played in one of two conditions: against a cohesive group who communicated and arrived at a joint decision, or a non-cohesive group who made independent decisions. After the exchange, proposers rated the extent to which the responders’ decisions were driven by (i) self-interest and (ii) intent to harm. Although the true motives are ambiguous, cohesive responders were reliably rated by participants as being more strongly motivated by intent to harm, indicating that group cohesion affects social threat perception. Highly paranoid participants attributed harmful intent more strongly overall but were equally reactive to social cohesion as other participants. This suggests that paranoia involves a generally lowered threshold for social threat detection but with an intact sensitivity for cohesion-related group characteristics.

Paranoia and conspiracy: group cohesion increases harmful intent attribution in the Trust Game

Current theories argue that hyper-sensitisation of social threat perception is central to paranoia. Affected people often also report misperceptions of group cohesion (conspiracy) but little is known about the cognitive mechanisms underpinning this conspiracy thinking in live interactions. In a pre-registered experimental study, we used a large-scale game theory approach (N > 1,000) to test whether the social cohesion of an opposing group affects paranoid attributions in a mixed online and lab-based sample. Participants spanning the full population distribution of paranoia played as proposers in a modified Trust Game: they were allocated a bonus and chose how much money to send to a pair of responders which was quadrupled before reaching these responders. Responders decided how much to return to the proposers through the same process. Participants played in one of two conditions: against a cohesive group who communicated and arrived at a joint decision, or a non-cohesive group who made independent decisions. After the exchange, proposers rated the extent to which the responders' decisions were driven by (i) self-interest and (ii) intent to harm. Although the true motives are ambiguous, cohesive responders were reliably rated by participants as being more strongly motivated by intent to harm, indicating that group cohesion affects social threat perception. Highly paranoid participants attributed harmful intent more strongly overall but were equally reactive to social cohesion as other participants. This suggests that paranoia involves a generally lowered threshold for social threat detection but with an intact sensitivity for cohesion-related group characteristics.

Reading characters in voices: Ratings of personality characteristics from voices predict proneness to auditory verbal hallucinations

People rapidly make first impressions of others, often based on very little information–minimal exposure to faces or voices is sufficient for humans to make up their mind about personality of others. While there has been considerable research on voice personality perception, much less is known about its relevance to hallucination-proneness, despite auditory hallucinations being frequently perceived as personified social agents. The present paper reports two studies investigating the relation between voice personality perception and hallucination-proneness in non-clinical samples. A voice personality perception task was created, in which participants rated short voice recordings on four personality characteristics, relating to dimensions of the voice’s perceived Valence and Dominance. Hierarchical regression was used to assess contributions of Valence and Dominance voice personality ratings to hallucination-proneness scores, controlling for paranoia-proneness and vividness of mental imagery. Results from Study 1 suggested that high ratings of voices as dominant might be related to high hallucination-proneness; however, this relation seemed to be dependent on reported levels of paranoid thinking. In Study 2, we show that hallucination-proneness was associated with high ratings of voice dominance, and this was independent of paranoia and imagery abilities scores, both of which were found to be significant predictors of hallucination-proneness. Results from Study 2 suggest an interaction between gender of participants and the gender of the voice actor, where only ratings of own gender voices on Dominance characteristics are related to hallucination-proneness scores. These results are important for understanding the perception of characterful features of voices and its significance for psychopathology.

In and out of schizophrenia: Activation and deactivation of the negative and positive schemas

Theorists, clinicians, and investigators have attempted to find a common source for the negative and positive symptoms of schizophrenia. We propose that a unified theory, based on a common cognitive structure not only has explanatory value, but can serve as a framework for a psychotherapeutic intervention. Specifically, we propose that the cognitive triad - the negative view of the self, others, and the future - is the source of the content for the negative and positive symptoms. We report literature supporting the relationship between each facet of the negative triad and each of the key symptoms: expressive negative symptoms, delusions, and verbal hallucinations. We conclude that the literature supports the validity of the cognitive model of negative and positive symptoms. The cognitive model furthers the understanding of the positive and negative symptoms of schizophrenia, and we describe how this provides a framework for a psychotherapeutic intervention.

Paranoid beliefs and realistic expectations of victimization: Data from the survey of police-public encounters

BACKGROUND

The anticipation of threat or victimization is a core feature of paranoia. Cognitive theories of paranoia suggest that paranoid thoughts may arise as a psychological response to trauma exposure, which likewise may lead to greater anticipation of subsequent victimization. Little is known, however, about the relation between paranoid beliefs and anticipated victimization when accounting for past victimization experience. The present study aimed to address whether the experiences of past victimization contribute to the link between paranoid beliefs and the anticipation of threat or victimization, with a particular focus on exposure to police violence.

METHODS

Data were collected through the Survey of Police-Public Encounters (N=1615), a cross-sectional, general population survey study conducted in four Eastern U.S. cities. Associations between paranoia and anticipated victimization were assessed using linear regression models, with and without adjustment for past victimization exposure.

RESULTS

Paranoid beliefs were positively associated with police victimization expectations (β=0.19, p<0.001), but these associations were statistically better explained by past exposures to similar victimization such that paranoia was no longer associated with anticipated victimization in adjusted models (β=0.02, p=0.451). To assess for the specificity of past exposures to victimization, adjusting for past exposure to intimate partner violence (as a control condition) did not eliminate the association between paranoia and expected police victimization.

CONCLUSIONS

The overall findings are consistent with cognitive theories of paranoia in which paranoid beliefs may be a severe but normative reaction to past victimization exposures in some cases.

Childhood Bullying, Paranoid Thinking and the Misappraisal of Social Threat: Trouble at School

Experiences of bullying predict the development of paranoia in school-age adolescents. While many instances of psychotic phenomena are transitory, maintained victimization can lead to increasingly distressing paranoid thinking. Furthermore, paranoid thinkers perceive threat in neutral social stimuli and are vigilant for environmental risk. The present paper investigated the association between different forms of bullying and paranoid thinking, and the extent to which school-age paranoid thinkers overestimate threat in interpersonal situations. Two hundred and thirty participants, aged between eleven and fourteen, were recruited from one secondary school in the UK. Participants completed a series of questionnaires hosted on the Bristol Online Survey tool. All data were collected in a classroom setting in quiet and standardized conditions. A significant and positive relationship was found between experiences of bullying and paranoid thinking: greater severity of bullying predicted more distressing paranoid thinking. Further, paranoid thinking mediated the relationship between bullying and overestimation of threat in neutral social stimuli. Exposure to bullying is associated with distressing paranoid thinking and subsequent misappraisal of threat. As paranoid thinkers experience real and overestimated threat, the phenomena may persist.