Individualized metacognitive therapy for delusions: A randomized controlled rater-blind study

Theory-driven interventions targeting specific factors that contribute to delusions are receiving increased interest. The present study aimed to assess the efficacy of individualized metacognitive therapy (MCT+), a short manualized intervention that addresses delusion-associated cognitive biases.; 92 patients with current or past delusions were randomized to receive 12 twice-weekly sessions of either MCT+ or a control intervention within a randomized controlled rater-blind design. Psychopathology and cognitive biases were assessed at baseline, 6 weeks and 6 months. ANCOVAs adjusted for baseline scores were used to assess differences between groups regarding outcome variables. Both per-protocol and intention-to-treat analyses were conducted.; At 6 weeks, there was a significant difference in favor of MCT+ regarding decrease in delusion severity and improvement of self-reflectiveness (medium effect size), and a trend-wise difference regarding probability thresholds to decision. These effects increased, when only patients attending a minimum of 4 therapy sessions were considered. Control group patients subsequently showed further improvement while patients in the MCT+ group remained stable, such that there were no differences between groups at the 6-month follow-up.; Lower attendance rates in the control group possibly leading to unequal therapeutic effort; lower baseline delusion severity in the MCT+ group.; The result pattern suggests that MCT+ led to earlier improvement in delusions and cognitive biases compared to the control intervention. The absence of a long-term effect might reflect floor effects in the MCT+ group, but may also indicate the need for further measures to promote sustainability of MCT+ effects

Differential relationship of jumping-to-conclusions and incorrigibility with delusion severity

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

Seeing minds – a signal detection study of agency attribution along the autism-psychosis continuum

Introduction - Diametrically aberrant mentalising biases, namely hypermentalising in psychosis and hypomentalising in autism, are postulated by some theoretical models. To test this hypothesis, we measured psychotic-like experiences, autistic traits and mentalising biases in a visual chasing paradigm. Methods - Participants from the general population (N = 300) and psychotic patients (N=26) judged the absence or presence of a chase during five-second long displays of seemingly randomly moving dots. Hypermentalising is seeing a chase where there is none, whereas hypomentalising is missing to see a chase. Results - Psychotic-like experiences were associated with hypermentalising. Autistic traits were not associated with hypomentalising, but with a reduced ability to discriminate chasing from non-chasing trials. Given the high correlation (τ = .41) between autistic traits and psychotic-like experiences, we controlled for concomitant symptom severity on agency detection. We found that all but those with many autistic and psychotic traits showed hypomentalising, suggesting an additive effect of traits on mentalising. In the second study, we found no hypermentalising in patients with psychosis, who performed also similarly to a matched control group. Conclusions - The results suggest that hypermentalising is a cognitive bias restricted to subclinical psychotic-like experiences. There was no support for a diametrically opposite mentalising bias along the autism-psychosis continuum

Seeing minds – a signal detection study of agency attribution along the autism-psychosis continuum

Introduction Diametrically aberrant mentalising biases, namely hypermentalising in psychosis and hypomentalising in autism, are postulated by some theoretical models. To test this hypothesis, we measured psychotic-like experiences, autistic traits and mentalising biases in a visual chasing paradigm. Methods Participants from the general population (N = 300) and psychotic patients (N=26) judged the absence or presence of a chase during five-second long displays of seemingly randomly moving dots. Hypermentalising is seeing a chase where there is none, whereas hypomentalising is missing to see a chase. Results Psychotic-like experiences were associated with hypermentalising. Autistic traits were not associated with hypomentalising, but with a reduced ability to discriminate chasing from non-chasing trials. Given the high correlation (τ = .41) between autistic traits and psychotic-like experiences, we controlled for concomitant symptom severity on agency detection. We found that all but those with many autistic and psychotic traits showed hypomentalising, suggesting an additive effect of traits on mentalising. In the second study, we found no hypermentalising in patients with psychosis, who performed also similarly to a matched control group. Conclusions The results suggest that hypermentalising is a cognitive bias restricted to subclinical psychotic-like experiences. There was no support for a diametrically opposite mentalising bias along the autism-psychosis continuum

Repetition is good? An Internet trial on the illusory truth effect in schizophrenia and nonclinical participants

Background and objectives: The investigation of cognitive biases has considerably broadened our understanding of the cognitive underpinnings of schizophrenia. This is the first study to investigate the illusory truth or validity effect in schizophrenia, which denotes the phenomenon that the renewed exposure to difficult knowledge questions shifts responses toward affirmation. We hypothesized an excess of the truth effect in schizophrenia, which may play a role in the maintenance of the disorder, particularly relating to positive symptoms. Methods: The study was set up over the Internet. The final analyses considered 36 patients with a probable diagnosis of schizophrenia, and a sample of 40 healthy subjects. Both groups took part on two occasions. In the baseline survey, difficult knowledge questions on neutral (e.g., On each continent there is a town called Rome. (true)) or emotional (delusion-relevant; e.g., The German federal police uses approximately 3000 cameras for the purpose of video-based face-detection. (not true)) topics were. presented as statements, which were either correct or incorrect. After one week, subjects were requested to take part in the second and final survey. Here, previously presented as well as novel statements had to be appraised according to their truth. Results: As expected, an overall truth effect was found: statements that were repeated achieved higher subjective truth ratings than novel statements. Patients high on positive symptoms showed an excessive truth effect for emotional (delusion-relevant) items. The positive syndrome was correlated with the emotional truth effect in both healthy and schizophrenia participants. Limitations: The sample was recruited via online forums and had probable but not externally validated diagnoses of schizophrenia. No psychiatric control group was tested. Discussion: The truth effect for emotional items appears to be exaggerated in patients high on positive symptoms, which may play a role in delusion formation and maintenance. Several limitations of the study however render our conclusions preliminary. As Patients with schizophrenia often dwell on and ruminate over selective and distorted pieces of information (e.g.. conspiracy theories), the subjective authenticity of this information may be further elevated by means of the truth effect. (c) 2012 Elsevier Ltd. All rights reserved

Neurocognitive capabilities modulate the integration of evidence in schizophrenia

Previous studies have demonstrated a cognitive bias in the integration of disconfirmatory evidence (BADE) in patients with schizophrenia. This bias has been associated with delusions. So far, it is unclear how the integration of evidence is associated with neurocognitive capabilities. In the current study, 31 patients with schizophrenia and 29 healthy controls, matched on age, gender, education and premorbid verbal intelligence, underwent a BADE task. Written scenarios of three consecutive sentences each were presented, which progressively reduced the ambiguity of situations. Participants were asked to rate the plausibility of four possible interpretations and adjust their ratings in response to the provided sentences. Psychometric rating scales and a neuropsychological test battery were applied. Patients displayed a bias in the integration of confirmatory, but not disconfirmatory evidence and a liberal acceptance of belief formation. Correlation analyses revealed no associations of evidence integration with the severity of positive symptoms, but with neurocognitive domains, especially with processing speed, executive functioning, vigilance and working memory. In conclusion, patients with schizophrenia show a bias in evidence integration. Neurocognitive functioning emerged as a modulatory factor that should be considered in further research. Studies investigating BADE in earlier stages of psychosis will be necessary to reveal causal relationship

Metamemory in schizophrenia: retrospective confidence ratings interact with neurocognitive deficits

Prior studies with schizophrenia patients described a reduced ability to discriminate between correct and false memories in terms of confidence compared to control groups. This metamemory bias has been associated with the emergence and maintenance of delusions. The relation to neuropsychological performance and other clinical dimensions is incompletely understood. In a cross-sectional study, metamemory functioning was explored in 32 schizophrenia patients and 25 healthy controls. Metamemory was assessed using a verbal recognition task combined with retrospective confidence level ratings. Associations of metamemory performance with six neuropsychological domains (executive functioning/problem solving, speed of processing, working memory, verbal and visual learning, and attention/vigilance) and psychopathological measures were analyzed. Results revealed a significantly smaller discrepancy between confidence ratings for correct and incorrect recognitions in the patient group. Furthermore, patients showed significantly lower recognition accuracy in the metamemory task and marked deficits in all neuropsychological domains. Across all participants, metamemory performance significantly correlated with executive functioning and working memory. No associations with delusions were found. This data confirms prior findings of metamemory biases in schizophrenia. Selective neuropsychological abilities seem to be modulating factors of metamemory functioning. Longitudinal studies in at risk mental state and first-episode patients are needed to reveal causal interrelation

Bias against disconfirmatory evidence in the 'at-risk mental state' and during psychosis

Prior studies have confirmed a bias against disconfirmatory evidence (BADE) in schizophrenia which has been associated with delusions. However, its role in the pathogenesis of psychosis is yet unclear. The objective was to investigate BADE for the first time in subjects with an at-risk-mental-state for psychosis (ARMS), patients with a first episode of psychosis without antipsychotic treatment (FEP) and healthy controls (HC). A standard BADE test presenting written scenarios was employed. In addition, psychometric rating scales and a neuropsychological test battery were applied. A three-staged image was revealed. FEP-patients showed a significant BADE compared to the other groups. The performance of ARMS-patients lay in between HC and FEP-patients. A trend towards significance became evident for a bias against confirmatory evidence (BACE) in FEP-patients. Results were not attributable to antipsychotic or other medication or depressive symptoms. Correlations with delusions reached medium effect sizes but failed significance after Bonferroni-corrections. These results provide evidence for aberrations in evidence integration in the pathogenesis of psychosis and contribute to our knowledge of metacognitive functioning which can be used for (meta-)cognitive intervention in psychosis

Cognitive Biases Questionnaire for psychosis

OBJECTIVE: The Cognitive Biases Questionnaire for psychosis (CBQp) was developed to capture 5 cognitive distortions (jumping to conclusions, intentionalising, catastrophising, emotional reasoning, and dichotomous thinking), which are considered important for the pathogenesis of psychosis. Vignettes were adapted from the Cognitive Style Test (CST),(1) relating to “Anomalous Perceptions” and “Threatening Events” themes. METHOD: Scale structure, reliability, and validity were investigated in a psychosis group, and CBQp scores were compared with those of depressed and healthy control samples. RESULTS: The CBQp showed good internal consistency and test-retest reliability. The 5 biases were not independent, with a 2-related factor scale providing the best fit. This structure suggests that the CBQp assesses a general thinking bias rather than distinct cognitive errors, while Anomalous Perception and Threatening Events theme scores can be used separately. Total CBQp scores showed good convergent validity with the CST, but individual biases were not related to existing tasks purporting to assess similar reasoning biases. Psychotic and depressed populations scored higher than healthy controls, and symptomatic psychosis patients scored higher than their nonsymptomatic counterparts, with modest relationships between CBQp scores and symptom severity once emotional disorders were partialled out. Anomalous Perception theme and Intentionalising bias scores showed some specificity to psychosis. CONCLUSIONS: Overall, the CBQp has good psychometric properties, although it is likely that it measures a different construct to existing tasks, tentatively suggested to represent a bias of interpretation rather than reasoning, judgment or decision-making processes. It is a potentially useful tool in both research and clinical arenas