1
|
Zhao W, Cannon TD. Moral learning and positive schizotypy: Social cognitive mechanisms in psychosis- proneness. Schizophr Res 2024; 266:156-164. [PMID: 38402656 DOI: 10.1016/j.schres.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 11/06/2023] [Accepted: 02/17/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Delusional thoughts such as paranoia and conspiratorial thinking reflect beliefs in others' intentions to do harm. Given the integral role of harm evaluation in moral cognition, a better understanding of how psychosis-prone individuals process others' moral characters may provide insights into social cognitive mechanisms of these types of delusions. METHODS An online sample of 293 participants was drawn from the general population, using Amazon Mechanical Turk. Participants performed a moral inference task, where they predicted and judged the binary choices of two fictitious agents ("good" or "bad") to impose harm under different levels of financial incentives. An investment game involving the same agents then examined participants' trust behavior. Psychosis-proneness was measured with the Multidimensional Schizotypy Scale Brief Edition. RESULTS A set of multiple regressions showed that positive schizotypy was associated with a lower yet more confident pre-experimental expectation of the agent's moral character, lower prediction accuracy of the agent's harm preferences, less belief revision, and undifferentiated perception of the good and bad agents' characters. Positive schizotypy was also related to higher expectations for reciprocity in the investment game, regardless of agent characters. CONCLUSION Our findings suggest that inflexible beliefs associated with psychosis-proneness extend beyond negative prior expectations, also reflecting difficulties in moral learning. The resulting undifferentiated moral impressions might contribute to undue suspicion of benevolent individuals and increased gullibility to malicious ones, potentially further strengthening conspiratorial beliefs.
Collapse
Affiliation(s)
- Wanchen Zhao
- Department of Psychology, Yale University, United States of America.
| | - Tyrone D Cannon
- Department of Psychology, Yale University, United States of America
| |
Collapse
|
2
|
Penzenstadler L, Chatton A, Huguelet P, Lecardeur L, Bartolomei J, Brazo P, Murys E, Poupart F, Rouvière S, Saoud M, Favrod J, Khazaal Y. Does Change over Time in Delusional Beliefs as Measured with PDI Predict Change over Time in Belief Flexibility Measured with MADS? Psychiatr Q 2019; 90:693-702. [PMID: 31338790 DOI: 10.1007/s11126-019-09659-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Delusional beliefs and their behavioral consequences are predominant symptoms in patients with psychosis and play an important role in the treatment. Delusional beliefs are a multidimensional concept which can be divided into three components: distress, preoccupation and conviction of delusions. These can be measured using Peters delusions inventory (PDI-21). We question, whether changes in delusional beliefs over time during treatment measured with the PDI-21 can predict changes in belief flexibility measured with the Maudsley assessment of delusions schedule (MADS). We used a group of patients from a randomized controlled trial for a cognitive intervention for psychosis or psychotic symptoms. Aside standard treatment for psychosis, half of the patients took part in a group treatment "Michael's game". Patients were assessed at baseline (T1), at 3 months (T2), and at 9 months (T3). We measured delusional beliefs using PDI-21 and belief flexibility with the MADS. One hundred seventy-two patients were included in the analysis. We measured a main effect of PDI-21scores on belief flexibility measured with MADS. PDI-21 Conviction scores predicted outcomes for all measured MADS items. Increasing PDI Distress and Preoccupation scores were predictors for being more likely to dismiss beliefs and change conviction. Time itself was a predictor for changing conviction and being able to plan a behavioral experiment. Overall the changes in PDI scores predicted outcomes for belief flexibility measured with MADS items. The PDI-21 could be a simple and effective way to measure progress in treatment on delusional beliefs.
Collapse
Affiliation(s)
- Louise Penzenstadler
- Geneva University Hospitals, Ch, du Petit Bel-Air 2, 1225, Chêne-Bourg, Switzerland.
| | - Anne Chatton
- Geneva University Hospitals, Ch, du Petit Bel-Air 2, 1225, Chêne-Bourg, Switzerland
- Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Philippe Huguelet
- Geneva University Hospitals, Ch, du Petit Bel-Air 2, 1225, Chêne-Bourg, Switzerland
- Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Laurent Lecardeur
- UNICAEN, Imagerie et Strategies Therapeutiques de la schizophrenie (ISTS), Normandie University, EA4766, 14000, Caen, France
| | - Javier Bartolomei
- Geneva University Hospitals, Ch, du Petit Bel-Air 2, 1225, Chêne-Bourg, Switzerland
| | - Perrine Brazo
- UNICAEN, Imagerie et Strategies Therapeutiques de la schizophrenie (ISTS), Normandie University, EA4766, 14000, Caen, France
- UNICAEN, CHU de Caen Normandie, Service de Psychiatrie d'adultes, Centre Esquirol, Normandie University, 14000, Caen, France
| | - Elodie Murys
- Unité Mobile de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Florent Poupart
- Laboratoire Clinique Psychopathologique et Interculturelle, Université de Toulouse, Toulouse, France
- Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | | | - Mohamed Saoud
- PsyR2, INSERM U1028, CNRS UMR5292, PSYR2 Team, Lyon Neuroscience Research Center, Lyon, France Department of Consultation-Liaison Psychiatry, Université Claude Bernard Lyon 1, Lyon, France
| | - Jérôme Favrod
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
| | - Yasser Khazaal
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospitals, Lausanne, Switzerland
- Research Center, Montreal University Institute of Mental Health, Montreal, Canada
| |
Collapse
|
3
|
Ward T, Garety PA. Fast and slow thinking in distressing delusions: A review of the literature and implications for targeted therapy. Schizophr Res 2019; 203:80-87. [PMID: 28927863 PMCID: PMC6336980 DOI: 10.1016/j.schres.2017.08.045] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/16/2017] [Accepted: 08/21/2017] [Indexed: 12/21/2022]
Abstract
The recent literature on reasoning biases in psychosis and delusions is reviewed. The state-of-the-art knowledge from systematic reviews and meta-analyses on the evidence for jumping to conclusions is briefly summarised, before a fuller discussion of the more recent empirical literature on belief flexibility as applied to delusions. The methodology and evidence in relation to studies of belief flexibility and the Bias Against Disconfirmatory Evidence (BADE) across the delusional continuum will be critically appraised, and implications drawn for improving cognitive therapy. It will be proposed that dual process models of reasoning, which Kahneman (Kahneman, 2011) popularised as 'fast and slow thinking', provide a useful theoretical framework for integrating further research and informing clinical practice. The emergence of therapies which specifically target fast and slow thinking in people with distressing delusions will be described.
Collapse
Affiliation(s)
- Thomas Ward
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, United Kingdom; South London and Maudsley NHS Foundation Trust, United Kingdom
| | - Philippa A Garety
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, United Kingdom; South London and Maudsley NHS Foundation Trust, United Kingdom.
| |
Collapse
|
4
|
Andreou C, Veckenstedt R, Lüdtke T, Bozikas VP, Moritz S. Differential relationship of jumping-to-conclusions and incorrigibility with delusion severity. Psychiatry Res 2018; 264:297-301. [PMID: 29660572 DOI: 10.1016/j.psychres.2018.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 02/05/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
Abstract
Reasoning biases such as jumping-to-conclusions (JTC) and incorrigibility have been suggested to contribute to the generation and maintenance of delusions. However, it is still debated whether these biases represent stable traits of patients with delusions, or are related to state fluctuations of delusion severity. The present study aimed to elucidate this question by combining a cross-sectional with a longitudinal approach. JTC, incorrigibility and delusion severity were assessed in 79 patients with a history of delusions over a 6-month period. To allow for a differentiated look into effects of time vs. symptom changes, patients were divided into patients with (D+) and without (D-) current delusions at baseline. Significant improvement of delusions was noted in D+ at follow-up. JTC did not differ between the two patient groups either at baseline or over time. In contrast, incorrigibility was significantly higher in D+ than D- at baseline; this difference remained stable throughout the 6-month follow-up period. The two biases did not significantly co-vary over time. Our results suggest a dissociation between incorrigibility and JTC as regards their relation to current presence of delusions, and tentatively support theoretical accounts attributing different roles to the two biases in the generation (JTC) and maintenance (incorrigibility) of delusions.
Collapse
Affiliation(s)
- Christina Andreou
- Center for Psychotic Disorders, University of Basel Psychiatric Clinics, Basel, Switzerland; Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Ruth Veckenstedt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thies Lüdtke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vasilis P Bozikas
- 1st Department of Psychiatry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
5
|
Garety PA, Ward T, Freeman D, Fowler D, Emsley R, Dunn G, Kuipers E, Bebbington P, Waller H, Greenwood K, Rus-Calafell M, McGourty A, Hardy A. SlowMo, a digital therapy targeting reasoning in paranoia, versus treatment as usual in the treatment of people who fear harm from others: study protocol for a randomised controlled trial. Trials 2017; 18:510. [PMID: 29096681 PMCID: PMC5667466 DOI: 10.1186/s13063-017-2242-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 10/04/2017] [Indexed: 02/07/2023] Open
Abstract
Background Paranoia is one of the most common symptoms of schizophrenia-spectrum disorders, and is associated with significant distress and disruption to the person’s life. Developing more effective and accessible psychological interventions for paranoia is a clinical priority. Our research team has approached this challenge in two main ways: firstly, by adopting an interventionist causal approach to increase effectiveness and secondly, by incorporating user-centred inclusive design methods to enhance accessibility and usability. Our resultant new digital intervention, SlowMo, intensively targets a reasoning style associated with paranoia, fast thinking, characterised by jumping to conclusions and belief inflexibility. It consists of an easy-to-use, enjoyable and memorable digital interface. An interactive web-based app facilitates delivery of face-to-face meetings which is then synchronised with an innovative mobile app for use in daily life. Methods/Design We aim to test the clinical efficacy of SlowMo over 24 weeks to determine the mechanisms through which it reduces paranoia, and to identify participant characteristics that moderate its effectiveness. In a parallel-group randomised controlled trial, with 1:1 allocation, 360 participants with distressing persecutory beliefs will be independently randomised to receive either the SlowMo intervention added to treatment as usual (TAU) or TAU, using randomly varying permuted blocks, stratified by paranoia severity and site. Research workers will be blind to therapy allocation. The primary outcome is paranoia severity over 24 weeks; our hypothesised mechanism of change is reasoning; moderators include negative symptoms and working memory; and secondary outcomes include wellbeing, quality of life, and service use. The accessibility, usability and acceptability of the digital platform will be assessed. Discussion SlowMo has been developed as the first blended digital therapy to target fears of harm from others through an inclusive design approach. In addition to testing its efficacy, this trial will add to our understanding of psychological mechanisms in paranoia. The study will examine the usability and adherence of a novel digital therapy, including an app for self-management, in a large sample of people affected by severe mental health difficulties. Trial registration ISRCTN registry, ID: ISRCTN32448671. Registered prospectively on 30 January 2017. Date assigned 2 February 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2242-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Philippa A Garety
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, P077 Henry Wellcome Building, De Crespigny Park, London, SE5 8AF, UK. .,South London and Maudsley NHS Foundation Trust, London, UK.
| | - Thomas Ward
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, P077 Henry Wellcome Building, De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | | | - David Fowler
- School of Psychology, University of Sussex, Brighton, UK.,Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Richard Emsley
- Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Graham Dunn
- Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Elizabeth Kuipers
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, P077 Henry Wellcome Building, De Crespigny Park, London, SE5 8AF, UK
| | - Paul Bebbington
- Division of Psychiatry, University College London, London, UK
| | - Helen Waller
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, P077 Henry Wellcome Building, De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Kathryn Greenwood
- School of Psychology, University of Sussex, Brighton, UK.,Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Mar Rus-Calafell
- Department of Psychiatry, Oxford University, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | | | - Amy Hardy
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, P077 Henry Wellcome Building, De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
6
|
Eisenacher S, Zink M. Holding on to false beliefs: The bias against disconfirmatory evidence over the course of psychosis. J Behav Ther Exp Psychiatry 2017; 56:79-89. [PMID: 27608522 DOI: 10.1016/j.jbtep.2016.08.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/29/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES The ability to integrate evidence into a reasoning process is crucial in order to react to changing information, e.g. to adapt one's beliefs according to new evidence or to generate new beliefs when facing better alternatives. Evidence integration ability is thus associated with belief flexibility. A specific bias of evidence integration, a bias against disconfirmatory evidence (BADE), can be found in patients with schizophrenia and has been linked to delusion development and maintenance. Knowledge about whether the BADE occurs already in risk constellations of psychosis can clarify its role in the pathogenesis of psychosis. METHODS This article reviews the current literature on BADE. Many studies demonstrate BADE over the course of illness, ranging from healthy controls with subclinical properties of schizotypy, over patients with at-risk mental states (ARMS) and patients with a first episode of psychosis to patients with chronic schizophrenia. These data allow a comparison of competences and deficits over the course of illness. Underlying mechanisms of BADE are discussed, including interrelations with neurocognitive performance and dopaminergic processes. RESULTS The BADE could be found in different phases of psychosis development and can be regarded as a cognitive marker of the beginning psychotic state. LIMITATIONS The presented findings are derived from independent cross-sectional studies. So far, no comprehensive longitudinal assessment has been published. CONCLUSIONS Treatments of metacognitive deficits in general and as early as in the ARMS might interfere with the cognitive pathogenesis of psychosis, and thereby ameliorate, postpone or even prevent the transition to psychosis.
Collapse
Affiliation(s)
- Sarah Eisenacher
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany.
| | - Mathias Zink
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany
| |
Collapse
|
7
|
Waller H, Emsley R, Freeman D, Bebbington P, Dunn G, Fowler D, Hardy A, Kuipers E, Garety P. Thinking Well: A randomised controlled feasibility study of a new CBT therapy targeting reasoning biases in people with distressing persecutory delusional beliefs. J Behav Ther Exp Psychiatry 2015; 48:82-9. [PMID: 25770671 PMCID: PMC4429971 DOI: 10.1016/j.jbtep.2015.02.007] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 02/11/2015] [Accepted: 02/15/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Delusional beliefs with persecutory content are common in psychosis, but difficult to treat. Interventions targeting hypothesised causal and maintaining factors have been proposed as a way of improving therapy. The current study is a feasibility randomised controlled trial of the 'Thinking Well (TW)' intervention: This novel approach combines the recently developed Maudsley Review Training Programme (MRTP), with additional, focussed cognitive-behavioural therapy sessions. METHODS 31 participants with distressing persecutory delusions and schizophrenia spectrum disorders were randomised to TW or to treatment as usual in a 2:1 ratio. Participants completed outcome assessments at 0 (baseline), 1 (post-MRTP), 6 (post-TW) and 8 (follow-up) weeks. Key outcomes included belief flexibility, paranoia, and delusional conviction and distress. Participants allocated to TW completed the MRTP package and four CBT sessions with a clinical psychologist. RESULTS Recruitment proved feasible. Participants reported the intervention was relevant and had resulted in positive changes in thinking and mood, which they could use in everyday life. Treatment effects were moderate-large for key outcomes including belief flexibility, paranoia conviction and distress. The additional TW sessions appeared to confer benefits over MRTP alone. LIMITATIONS Assessments were not carried out blind to treatment condition. Recruitment was opportunistic, from an identified pool of research participants. Finally, a few participants had already completed the MRTP as part of a previous study. CONCLUSIONS The TW intervention appears to be feasible and acceptable to participants, and the effects of treatment are promising. A fully powered randomised controlled trial of the intervention is warranted.
Collapse
Affiliation(s)
- Helen Waller
- King's College London, The Institute of Psychiatry, Psychology & Neuroscience, UK.
| | - Richard Emsley
- Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester Academic Health Science Centre, UK
| | | | - Paul Bebbington
- Mental Health Sciences Unit, Faculty of Brain Sciences, University College London, UK
| | - Graham Dunn
- Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester Academic Health Science Centre, UK
| | - David Fowler
- Department of Psychology, University of Sussex, Brighton, UK
| | - Amy Hardy
- King's College London, The Institute of Psychiatry, Psychology & Neuroscience, UK
| | - Elizabeth Kuipers
- King's College London, The Institute of Psychiatry, Psychology & Neuroscience, UK
| | - Philippa Garety
- King's College London, The Institute of Psychiatry, Psychology & Neuroscience, UK
| |
Collapse
|