Suzanne So - Academia.edu (original) (raw)

Papers by Suzanne So

Journal of Sex Research, 2005

Psychiatry Research, 2015

Delusional experiences can be considered on a range of dimensions including conviction, distress,... more Delusional experiences can be considered on a range of dimensions including conviction, distress, preoccupation, and disruption, which have been shown to be related to depression and anxiety. This study aimed to test the hypotheses that delusional conviction is less responsive to antipsychotic treatment than delusional distress and preoccupation, and that depression and anxiety reduce alongside improvements in delusional dimensions. Forty acutely ill inpatients with delusions were assessed during their early stage of antipsychotic treatment. Interview data were analysed using mixed models for repeated measures. There was a significant reduction in psychotic symptoms over eight weeks, after controlling for baseline dosage of antipsychotics. We found no differential rate of improvement across delusional dimensions, and all dimensions improved over time. However, conviction ratings remained relatively high throughout the eight weeks. There was no significant improvement in anxiety and depression, and delusional preoccupation covaried with anxiety and depression throughout eight weeks, suggesting a relationship between emotional and delusional processes during the early recovery phase of psychosis.

PLOS ONE, 2015

Literature comparing 'jumping to conclusions' (JTC) between patients and healthy controls has dem... more Literature comparing 'jumping to conclusions' (JTC) between patients and healthy controls has demonstrated the importance of the reasoning bias in the development of delusions. When groups that vary along the entire delusional continuum are included, the relationship between JTC and delusionality is less clear. This study compared JTC and delusional dimensions between 28 patients with delusions, 35 delusion-prone individuals and 32 nondelusion-prone individuals. Delusion proneness was defined by an established threshold based on the Peters et al. Delusions Inventory. Two versions of the beads task (85:15 and 60:40) were used to measure JTC. As hypothesized, patients manifested hastier data gathering than the two non-clinical groups on both beads tasks. However, delusion-prone individuals did not manifest a hastier decision making style than non-delusion prone individuals. Instead, non-delusion-prone participants showed more JTC bias than delusionprone individuals on the easier beads task. There was no evidence for a dose-response relationship between JTC and delusional dimensions, with correlations between JTC and PDI scores found in the non-delusion-prone group only. The present finding confirms the link between an extreme JTC bias and the presence of clinical delusions, and argues against a linear relationship between JTC and delusionality along the symptomatic continuum.

Psychosomatic Medicine, 2010

Objective: To explore how reasoning biases in schizophrenic patients respond to treatment. Patien... more 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.

Psychiatry Research, 2014

It has been suggested that different aspects of delusions (conviction, distress, preoccupation) r... more 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 0 beads 0 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.

Psychiatry Research, 2013

This study aimed to explore the feasibility and validity of using experience sampling methodology... more This study aimed to explore the feasibility and validity of using experience sampling methodology (ESM, or ecological momentary assessment or mobile device signaling) to measure temporal changes and fluctuations in psychotic symptoms in patients with acute psychosis at the start of antipsychotic treatment.

Journal of Abnormal Psychology, 2012

Two reasoning biases, jumping to conclusions (JTC) and belief inflexibility, have been found to b... more 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 . 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.

Australian and New Zealand Journal of Psychiatry, 2008

Objective: This is the first study to investigate the relationship between the level of state anx... more Objective: This is the first study to investigate the relationship between the level of state anxiety and the jumping to conclusions (JTC) reasoning bias in patients with first-episode psychosis using an experimental manipulation procedure. Method: Thirty patients with psychotic delusions and 30 non-clinical controls, from Hong Kong, were randomized into an anxiety induction or an anxiety reduction imagery condition. Questionnaires were used to measure trait emotions, psychotic symptoms and delusional thinking at baseline. After the anxiety manipulation, participants completed two versions of an assessment of the JTC reasoning bias, the beads task. Results: Both the patients and the non-clinical controls were responsive to the anxiety reduction imagery, but only the non-clinical controls responded to the anxiety induction imagery. The JTC reasoning bias was, as hypothesized, more common in patients than in controls, but was not significantly different between the anxiety manipulation conditions. Both patients and controls had higher rates of JTC than in previous studies. Conclusions: Patients with psychotic delusions have a marked JTC cognitive bias. This is the first JTC study in a Chinese sample, and the results suggest that the bias applies cross-culturally. The results indicate that state anxiety does not influence JTC. Limitations of the study include an inadequate anxiety state manipulation effect in psychotic patients using brief imagery, and unusually high rates of JTC in both patients and controls.

Frontiers in Psychology, 2015

Metacognitive training (MCT) was developed to promote awareness of reasoning biases among patient... more Metacognitive training (MCT) was developed to promote awareness of reasoning biases among patients with schizophrenia. While MCT has been translated into 31 languages, most MCT studies were conducted in Europe, including newer evidence recommending an individualized approach of delivery. As reasoning biases covered in MCT are separable processes and are associated with different symptoms, testing the effect of selected MCT modules would help to develop a targeted and cost-effective intervention for specific symptoms and associated mechanisms. This study tested the efficacy of a four-session metacognitive training for delusions, MCTd (in Traditional Chinese with cultural adaptations, provided individually), as an adjunct to antipsychotics in reducing severity and conviction of delusions, jumping to conclusions (JTC) bias and belief inflexibility. Forty-four patients with delusions were randomized into the MCTd or the wait-list control condition. Patients on wait-list received the same MCTd after 4 weeks of treatment as usual (TAU). Assessment interviews took place before and after the treatment, and at 4-week follow-up. There was an additional baseline assessment for the controls. JTC and belief flexibility were measured by the beads tasks and the Maudsley Assessment of Delusions Scale. Attendance rate of the MCTd was satisfactory (84.5%). Compared to TAU, there was a greater reduction in psychotic symptoms, delusional severity and conviction following MCTd. There was a large treatment effect size in improvement in belief flexibility. Improvement in reaction to hypothetical contradiction predicted treatment effect in positive symptoms and delusions. JTC bias was reduced following MCTd, although the treatment effect was not significantly larger than TAU. Our results support the use of process-based interventions that target psychological mechanisms underlying specific psychotic symptoms as adjuncts to more conventional approaches.