Pathways to paranoia: Analytic thinking and belief flexibility (original) (raw)
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Schizophrenia bulletin, 2015
Given the evidence that reasoning biases contribute to delusional persistence and change, several research groups have made systematic efforts to modify them. The current experiment tested the hypothesis that targeting reasoning biases would result in change in delusions. One hundred and one participants with current delusions and schizophrenia spectrum psychosis were randomly allocated to a brief computerized reasoning training intervention or to a control condition involving computer-based activities of similar duration. The primary hypotheses tested were that the reasoning training intervention, would improve (1) data gathering and belief flexibility and (2) delusional thinking, specifically paranoia. We then tested whether the changes in paranoia were mediated by changes in data gathering and flexibility, and whether working memory and negative symptoms moderated any intervention effects. On an intention-to-treat analysis, there were significant improvements in state paranoia an...
The Cognitive and Affective Structure of Paranoid Delusions
Archives of General Psychiatry, 2009
Context: Paranoid delusions are a common symptom of a range of psychotic disorders. A variety of psychological mechanisms have been implicated in their cause, including a tendency to jump to conclusions, an impairment in the ability to understand the mental states of other people (theory of mind), an abnormal anticipation of threat, and an abnormal explanatory style coupled with low self-esteem.
Delusions and belief flexibility in psychosis
Psychology and Psychotherapy: Theory, Research and Practice, 2010
A defining characteristic of delusions is inflexibility. However, it is not known if this is specific to the deluded individual's thinking about delusional beliefs, or whether this might apply more generally to the thinking style of people with delusions.
Journal of Abnormal Psychology, 2012
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.
Jumping to conclusions and paranoid ideation in the general population
Schizophrenia Research, 2008
An association of a 'jumping to conclusions' (JTC) reasoning style and delusions has been repeatedly found. The data-gathering bias has been particularly implicated with higher levels of delusional conviction in schizophrenia. For the first time the symptom, psychological and social correlates of jumping to conclusions are examined in a large general population sample. This is based upon the recognition that delusional ideation in non-clinical populations is on a continuum of severity with delusions in psychosis. Two hundred individuals completed a probabilistic reasoning task and assessments of paranoid ideation, intellectual functioning, affective symptoms, anomalies of experience, cognitive flexibility, illicit drug use, social support, and trauma. The jumping to conclusions reasoning bias was found in 20% of the non-clinical sample. JTC was strongly associated with higher levels of conviction in paranoid thoughts and the occurrence of perceptual anomalies, but not with the presence of affective symptoms. The results indicate that jumping to conclusions is a reasoning bias specifically associated with levels of delusional conviction, and is not a product of generally high levels of distress and affect. The association of jumping to conclusions with the types of anomalies of experience seen in psychotic disorders is intriguing, and consistent with recent dopamine dysregulation theories and the importance of reasoning to perception. The study is a further illustration of the need to consider the dimensions of delusional experience separately.
The jumping to conclusions bias in delusions: Specificity and changeability
Journal of Abnormal Psychology, 2010
There are indications that a jumping to conclusions bias (JTC) plays a role in the formation and maintenance of delusions and should be targeted in therapy. However, it is unclear whether (a) JTC is uniquely associated with delusions or simply an epiphenomenon of schizophrenia or impaired intellectual functioning and (b) it can be changed by varying task demands, motivational factors, or feedback. Seventy-one patients with schizophrenia spectrum disorders and either acute or remitted delusions and 68 healthy controls were included. Patients were assessed with self-and observer-rated symptom measures. All participants were assessed for intellectual ability and performed the classic beads task with a ratio of 80:20. They were then presented with task variations that involved increasing the difficulty of the ratio to 60:40, introducing a rule for which correct decisions were rewarded by monetary gains and false decisions led to financial losses, and providing feedback on the accuracy of the previous decisions. Participants with current delusional symptoms took fewer draws to decision (DTD) than did those in remission and healthy controls. DTD were associated with observer-rated delusions, but controlling for negative symptoms or intelligence rendered this association insignificant. DTD increased after the difficulty of the task increased and after feedback. The study demonstrated that JTC is linked to delusions but that this association is not unique. Patients with delusions are principally able to adapt their decisions to altered conditions but still decide relatively quickly even when decisions have negative consequences. These difficulties might stem in part from impaired intellectual functioning.
Current Paranoid Thinking in Patients With Delusions: The Presence of Cognitive-Affective Biases
Schizophrenia Bulletin, 2013
Background: There has been renewed interest in the influence of affect on psychosis. Psychological research on persecutory delusions ascribes a prominent role to cognitive processes related to negative affect: anxiety leads to the anticipation of threat within paranoia; depressive negative ideas about the self create a sense of vulnerability in which paranoid thoughts flourish; and selfconsciousness enhances feelings of the self as a target. The objective of this study was to examine such affective processes in relation to state paranoia in patients with delusions. Methods: 130 patients with delusions in the context of a nonaffective psychosis diagnosis (predominately schizophrenia) were assessed for contemporaneous levels of persecutory ideation on 5 visual analog scales. Measures were taken of anxiety, depression, threat anticipation, interpretation of ambiguity, self-focus, and negative ideas about the self. Results: Of the patients, 85% report paranoid thinking at testing. Symptoms of anxiety and depression were highly prevalent. Current paranoid thinking was associated with anxiety, depression, greater anticipation of threat events, negative interpretations of ambiguous events, a self-focused cognitive style, and negative ideas about the self. Conclusions: The study provides a clear demonstration that a range of emotionrelated cognitive biases, each of which could plausibly maintain delusions, are associated with current paranoid thinking in patients with psychosis. We identified biases both in the contents of cognition and in the processing of information. Links between affect and psychosis are central to the understanding of schizophrenia. We conclude that treatment of emotional dysfunction should lead to reductions in current psychotic experiences.