A Randomized Experimental Investigation of Reasoning Training for People With Delusions

The present study aimed to investigate whether a brief reasoning training module changes the “jumping to conclusions” data gathering bias in people with delusions. A secondary aim was to examine whether improvements in reasoning would lead to greater flexibility in thinking about delusions. It was found that people with delusions and a diagnosis of schizophrenia (n = 34) requested less information on a reasoning task compared with a nonclinical control group (n = 34). The clinical group was then randomly allocated to a session of reasoning training or to an attention control condition. Following training, participants showed a significant increase in data gathering, and a small number reported more flexibility and less conviction in their delusions, although this finding was not significant. The presence at baseline of an extreme reasoning bias moderated the effect of training. The study provides further confirmation of the jumping to conclusions bias and shows that data gathering can be improved, though the severest form of the bias is resistant to change. It is recommended that lengthier, delusion-related reasoning packages be developed and evaluated

Jumping to the wrong conclusions? An investigation of the mechanisms of reasoning errors in delusions

Understanding how people with delusions arrive at false conclusions is central to the refinement of cognitive behavioural interventions. Making hasty decisions based on limited data ('jumping to conclusions', JTC) is one potential causal mechanism, but reasoning errors may also result from other processes. In this study, we investigated the correlates of reasoning errors under differing task conditions in 204 participants with schizophrenia spectrum psychosis who completed three probabilistic reasoning tasks. Psychotic symptoms, affect, and IQ were also evaluated. We found that hasty decision makers were more likely to draw false conclusions, but only 37% of their reasoning errors were consistent with the limited data they had gathered. The remainder directly contradicted all the presented evidence. Reasoning errors showed task-dependent associations with IQ affect, and psychotic symptoms. We conclude that limited data-gathering contributes to false conclusions but is not the only mechanism involved. Delusions may also be maintained by a tendency to disregard evidence. Low IQ and emotional biases may contribute to reasoning errors in more complex situations. Cognitive strategies to reduce reasoning errors should therefore extend beyond encouragement to gather more data, and incorporate interventions focused directly on these difficulties

Emotional dysfunction in schizophrenia spectrum psychosis: the role of illness perceptions

Background. Assessing illness perceptions has been useful in a range of medical disorders. This study of people with a recent relapse of their psychosis examines the relationship between illness perception, their emotional responses and their attitudes to medication.Method. One hundred patients diagnosed with a non-affective psychotic disorder were assessed within 3 months of relapse. Measures included insight, self-reported. illness perceptions, medication adherence, depression, self-esteem and anxiety.Results. Illness perceptions about psychosis explained 46, 36 and 34% of the variance in depression, anxiety and self-esteem respectively. However, self-reported medication adherence was more strongly associated with a measure of insight.Conclusions. Negative illness perceptions in psychosis are clearly related to depression, anxiety and self-esteem. These in turn have been linked to symptom maintenance and recurrence. Clinical interventions that foster appraisals of recovery rather than of chronicity and severity may therefore improve emotional well-being in people with psychosis. It might be better to address adherence to medication through direct attempts at helping them understand their need for treatment

Thérapie cognitive béhaviorale des psychoses

Bien que la médication neuroleptique ait démontré son efficacité pour le traitement des psychoses, les interventions psychologiques auprès des personnes qui en souffrent ont encore un rôle important à jouer. Les chiffres varient mais on estime qu'entre le quart et la moitié des personnes avec un diagnostic de schizophrénie souffrent de symptômes persistants, comme les délires et les hallucinations, qui provoquent de la détresse et interfèrent dans leur fonctionnement malgré la prise de médicaments (Fowler et al., 1995). Les rechutes se produisent souvent même chez les patients qui se conforment au régime de médication et plusieurs personnes sont réticentes à une médication suivie sur une longue période à cause de ses effets secondaires déplaisants et même débilitants. Ces dernières années, le développement de la thérapie cognitive béhaviorale (TCB) a connu un intérêt croissant pour les personnes atteintes de psychoses qui continuent d'éprouver des symptômes psychotiques malgré un traitement continu de médication anti-psychotique. La TCB des psychoses tente d'aborder directement ces structures de comportements, de pensées et de réactions émotionnelles qui sous-tendent et maintiennent les délires et les hallucinations graves et persistants.Although neuroleptic medication is clearly effective, there is still an important role for psychological interventions for people with psychosis. Figures vary, but it can be estimated that between one quarter and one half of people with a diagnosis of schizophrenia experience persistent symptoms such as delusions and hallucinations, which cause distress and interference with functioning, despite taking medication (Fowler et al. 1995). Relapse occurs commonly even amongst patients who do adhere to medication regimes, and many people are reluctant to take long-term medication, because of its unpleasant and even disabling side-effects. In recent years, there has been a growing interest in developing cognitive behavioural therapy for those people with psychosis who continue to experience psychotic symptoms despite ongoing treatment with anti-psychotic medication. Cognitive behaviour therapy for psychosis seeks to address directly those patterns of behaviour, thinking and emotional response which underpin and maintain severe and chronic delusions and hallucinations.Aunque los medicamentos neurolépticos hayan demostrado su efi-cacia en el tratamiento de las psicosis, las intervenciones psicologicas con las personas que los sufren, juegan todavia un papel importante. Las estadisticas varian, pero se estima que entre el cuarto y la mitad de las personas con un diagnôstico de esquizofrenia, sufren de sintomas per-sistentes como los delirios y las alucinaciones que provocan angustia e interfieren en su funcionamiento diario, a pesar de la toma de medicamentos (Fowler y al., 1995). Frecuentemente, las recaidas se producen en los mismos pacientes que se conforman al régimen de la medicacion y varias personas son réticentes a la medicacion tomada sobre un largo perîodo, a causa de sus efectos secundarios desagradables y hasta débilitantes. Estos ûltimos anos, el desarrollo de la terapia cognoscitiva be-haviorala (TCB) ha conocido un interés creciente para las personas afectadas por psicosis y que siguen padeciendo los sintomas psicôticos a pesar de un tratamiento continuo de medicamentos anti-psicoticos. La TCB de la psicosis intenta abordar directamente esos patterns (es-quemas) de comportamientos, de pensamientos y de reacciones emocio-nales qu apuntalan y mantien los delirios y las alucinaciones graves y persitentes

Measuring reasoning in paranoia: development of the Fast and Slow Thinking questionnaire

Paranoid thoughts are common across the psychosis continuum. It is well established that reasoning biases (conceived as an overreliance on fast thinking and lack of willingness and/or ability to engage in slow thinking) contribute to paranoia. Targeted therapies have shown promise in improving reasoning in order to reduce paranoia. Psychometrically robust and easy-to-use measures of these thinking styles will assist research and clinical practice. Existing assessments include experimental tasks that are complex to administer or self-report measures that have limitations in comprehensively assessing cognitive biases in paranoia. We have developed the first questionnaire to assess fast and slow thinking biases related to paranoid thoughts, and here report on its evaluation. In study 1, we generated, evaluated, and extracted items reflecting reasoning, and assessed their reliability and validity in a non-clinical sample (n = 209). In study 2, we replicated the factor analysis and psychometric evaluation in a clinical sample (n = 265). The resultant Fast and Slow Thinking (FaST) questionnaire consists of two 5-item scales reflecting fast and slow thinking and is therefore brief and suitable for use in both research and clinical practice. The fast thinking scale is reliable and valid. Reliability and criterion validity of the slow scale shows promise. It had limited construct validity with objective reasoning assessments in the clinical group, possibly due to impaired meta-cognitive awareness of slow thinking. We recommend the FaST questionnaire as a new tool for improving understanding of reasoning biases in paranoia and supporting targeted psychological therapies

Orbitofrontal cortex, emotional decision-making and response to cognitive behavioural therapy for psychosis

Grey matter volume (GMV) in the orbitofrontal cortex (OFC) may relate to better response to cognitive behavioural therapy for psychosis (CBTp) because of the region's role in emotional decision-making and cognitive flexibility. This study aimed to determine the relation between pre-therapy OFC GMV or asymmetry and CBTp responsiveness and emotional decision-making as measured by the Iowa Gambling Task (IGT). Thirty patients received CBTp + standard care (CBTp+SC; 25 completers) for 6-8 months. All patients (before receiving CBTp) and 25 healthy participants underwent structural magnetic resonance imaging and performed the IGT. Patients' symptoms were assessed before and after therapy. Pre-therapy OFC GMV, measured using a region-of-interest approach, and IGT performance, measured as overall learning, attention to reward, memory for past outcomes and choice consistency, were comparable between patient and healthy groups. In the CBTp+SC group, greater OFC GMV was correlated with positive symptom improvement, specifically hallucinations and persecution. Greater rightward OFC asymmetry correlated with improvement in several negative and general psychopathology symptoms. Greater left OFC GMV was associated with lower IGT attention to reward. The findings suggest that greater OFC volume and rightward asymmetry, which maintain the OFC's function in emotional decision-making and cognitive flexibility, are beneficial for CBTp responsiveness

Effective elements of cognitive behaviour therapy for psychosis: results of a novel type of subgroup analysis based on principal stratification

Background. Meta-analyses show that cognitive behaviour therapy for psychosis (CBT-P) improves distressing positive symptoms. However, it is a complex intervention involving a range of techniques. No previous study has assessed the delivery of the different elements of treatment and their effect on outcome. Our aim was to assess the differential effect of type of treatment delivered on the effectiveness of CBT-P, using novel statistical methodology. Method. The Psychological Prevention of Relapse in Psychosis (PRP) trial was a multi-centre randomized controlled trial (RCT) that compared CBT-P with treatment as usual (TAU). Therapy was manualized, and detailed evaluations of therapy delivery and client engagement were made. Follow-up assessments were made at 12 and 24 months. In a planned analysis, we applied principal stratification (involving structural equation modelling with finite mixtures) to estimate intention-to-treat (ITT) effects for subgroups of participants, defined by qualitative and quantitative differences in receipt of therapy, while maintaining the constraints of randomization. Results. Consistent delivery of full therapy, including specific cognitive and behavioural techniques, was associated with clinically and statistically significant increases in months in remission, and decreases in psychotic and affective symptoms. Delivery of partial therapy involving engagement and assessment was not effective. Conclusions. Our analyses suggest that CBT-P is of significant benefit on multiple outcomes to patients able to engage in the full range of therapy procedures. The novel statistical methods illustrated in this report have general application to the evaluation of heterogeneity in the effects of treatment