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The Benefits of Doubt: Cognitive Bias Correction Reduces Hasty Decision-Making in Schizophrenia

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Abstract

Many patients with schizophrenia display neuropsychological deficits in concert with cognitive biases, particularly the tendency to jump to conclusions (JTC). The present study examined the effects of a generic psychoeducational cognitive bias correction (CBC) program. We hypothesized that demonstrating the fallibility of human cognition to patients would diminish their susceptibility to the JTC bias. A total of 70 participants with schizophrenia were recruited online. At baseline, patients were asked to fill out a JTC task (primary outcome) and the Paranoia Checklist before being randomized to either the CBC or a waitlist control condition. The CBC group received six successive pdf-converted PowerPoint presentations teaching them about cognitive biases; we neither placed any emphasis on psychosis-related cognitive distortions nor addressed psychosis. Six weeks after inclusion, subjects were re-administered the JTC task and the Paranoia Checklist. At a medium-to-large effect size the JTC bias was significantly improved under the CBC condition in comparison to controls for both the per protocol and the intention to treat analysis. The Paranoia Checklist remained essentially unchanged over time. No effects were observed for depression. Psychoeducational and cognitive programs are urgently needed as many patients are still deprived of any psychological treatment despite recommendations of most guidelines. Self-help may bridge the large treatment gap in schizophrenia and motivate patients to seek help. The study asserts both the feasibility and effectiveness of self-help programs in schizophrenia.

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References

  • Alvarez-Jimenez, M., Alcazar-Corcoles, M. A., Gonzalez-Blanch, C., Bendall, S., McGorry, P. D., & Gleeson, J. F. (2014). Online, social media and mobile technologies for psychosis treatment: A systematic review on novel user-led interventions. Schizophrenia Research, 156, 96–106.

    Article  CAS  PubMed  Google Scholar 

  • Andreou, C., Treszl, A., Roesch-Ely, D., Kother, U., Veckenstedt, R., & Moritz, S. (2014). Investigation of the role of the jumping-to-conclusions bias for short-term functional outcome in schizophrenia. Psychiatry Research, 218, 341–347.

    Article  PubMed  Google Scholar 

  • Balzan, R. P., Delfabbro, P. H., Galletly, C. A., & Woodward, T. S. (2012a). Over-adjustment or miscomprehension? A re-examination of the jumping to conclusions bias. Australian and New Zealand Journal of Psychiatry, 46, 532–540.

    Article  PubMed  Google Scholar 

  • Balzan, R. P., Delfabbro, P. H., Galletly, C. A., & Woodward, T. S. (2012b). Reasoning heuristics across the psychosis continuum: The contribution of hypersalient evidence-hypothesis matches. Cognitive Neuropsychiatry, 17, 431–450.

    Article  PubMed  Google Scholar 

  • Balzan, R. P., Delfabbro, P. H., Galletly, C. A., & Woodward, T. S. (2013). Confirmation biases across the psychosis continuum: The contribution of hypersalient evidence-hypothesis matches. British Journal of Clinical Psychology, 52, 53–69.

    Article  PubMed  Google Scholar 

  • Balzan, R. P., Delfabbro, P. H., Galletly, C. A., & Woodward, T. S. (2014). Metacognitive training for patients with schizophrenia: Preliminary evidence for a targeted, single-module programme. Australian and New Zealand Journal of Psychiatry, 48, 1126-1136.

    Article  PubMed  Google Scholar 

  • Bentall, R. P. (1992). A proposal to classify happiness as a psychiatric disorder. Journal of Medical Ethics, 18, 94–98.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Bentall, R. P., Kinderman, P., & Kaney, S. (1994). The self, attributional processes and abnormal beliefs: towards a model of persecutory delusions. Behaviour Research and Therapy, 32, 331–341.

    Article  CAS  PubMed  Google Scholar 

  • Broadbent, D. (1958). Perception and communication. London: Pergamon Press.

    Book  Google Scholar 

  • Chun, M. M., & Marois, R. (2002). The dark side of visual attention. Current Opinion in Neurobiology, 12, 184–189.

    Article  CAS  PubMed  Google Scholar 

  • Combs, D. R., Adams, S. D., Penn, D. L., Roberts, D., Tiegreen, J., & Stem, P. (2007). Social cognition and interaction training (SCIT) for schizophrenia. Schizophrenia Bulletin, 33, 585.

    Google Scholar 

  • Fioravanti, M., Bianchi, V., & Cinti, M. E. (2012). Cognitive deficits in schizophrenia: an updated metanalysis of the scientific evidence. BMC Psychiatry, 12, 64.

    Article  PubMed Central  PubMed  Google Scholar 

  • Fortune, E. E., & Goodie, A. S. (2012). Cognitive distortions as a component and treatment focus of pathological gambling: A review. Psychology of Addictive Behaviors, 26, 298–310.

    Article  PubMed  Google Scholar 

  • Freeman, D. (2007). Suspicious minds: The psychology of persecutory delusions. Clinical Psychology Review, 27, 425–457.

    Article  PubMed  Google Scholar 

  • Freeman, D., Garety, P. A., Bebbington, P. E., Smith, B., Rollinson, R., Fowler, D., & Dunn, G. (2005). Psychological investigation of the structure of paranoia in a non-clinical population. British Journal of Psychiatry, 186, 427–435.

    Article  PubMed  Google Scholar 

  • Garety, P. A., & Freeman, D. (2013). The past and future of delusions research: from the inexplicable to the treatable. British Journal of Psychiatry, 203, 327–333.

    Article  CAS  PubMed  Google Scholar 

  • Garety, P. A., Freeman, D., Jolley, S., Dunn, G., Bebbington, P. E., Fowler, D. G., & Dudley, R. (2005). Reasoning, emotions, and delusional conviction in psychosis. Journal of Abnormal Psycholology, 114, 373–384.

    Article  Google Scholar 

  • Garety, P. A., Hemsley, D. R., & Wessely, S. (1991). Reasoning in deluded schizophrenic and paranoid patients. Biases in performance on a probabilistic inference task. Journal of Nervous and Mental Disease, 179, 194–201.

    Article  CAS  PubMed  Google Scholar 

  • Hanssen, M. S. S., Bijl, R. V., Vollebergh, W., & Van Os, J. (2003). Self-reported psychotic experiences in the general population: A valid screening tool for DSM-III-R psychotic disorders? Acta Psychiatrica Scandinavica, 107, 369–377.

    Article  CAS  PubMed  Google Scholar 

  • Hautzinger, M., & Brähler, M. (1993). Allgemeine Depressionsskala (ADS) [General Depression Scale]. Göttingen: Hogrefe.

    Google Scholar 

  • Heinrichs, R. W., & Zakzanis, K. K. (1998). Neurocognitive deficit in schizophrenia: A quantitative review of the evidence. Neuropsychology, 12, 426–445.

    Article  CAS  PubMed  Google Scholar 

  • Huq, S. F., Garety, P. A., & Hemsley, D. R. (1988). Probabilistic judgements in deluded and non-deluded subjects. Quarterly Journal of Experimental Psychology, 40A, 801–812.

    Article  Google Scholar 

  • Kahneman, D. (2012). Thinking, fast and slow. London: Penguin Books.

    Google Scholar 

  • Konings, M., Bak, M., Hanssen, M., van Os, J., & Krabbendam, L. (2006). Validity and reliability of the CAPE: A self-report instrument for the measurement of psychotic experiences in the general population. Acta Psychiatrica Scandinavica, 114, 55–61.

    Article  CAS  PubMed  Google Scholar 

  • Lincoln, T. M., Mehl, S., Exner, C., Lindenmeyer, J., & Rief, W. (2010a). Attributional style and persecutory delusions. Evidence for an event independent and state specific external-personal attribution bias for social situations. Cognitive Therapy and Research, 34, 297–302.

    Article  Google Scholar 

  • Lincoln, T. M., Ziegler, M., Lullmann, E., Muller, M. J., & Rief, W. (2010b). Can delusions be self-assessed? Concordance between self- and observer-rated delusions in schizophrenia. Psychiatry Research, 178, 249–254.

    Article  PubMed  Google Scholar 

  • Lincoln, T. M., Ziegler, M., Mehl, S., & Rief, W. (2010c). The jumping to conclusions bias in delusions: Specificity and changeability. Journal of Abnormal Psychology, 119, 40–49.

    Article  PubMed  Google Scholar 

  • Mehl, S., Landsberg, M. W., Schmidt, A. C., Cabanis, M., Bechdolf, A., Herrlich, J., Wagner, M. (2014). Why do bad things happen to me? Attributional style, depressed mood, and persecutory delusions in patients with schizophrenia. Schizophrenia Bulletin, 40, 1338–1346.

    Article  PubMed  Google Scholar 

  • Miller, E. A. (2013). The “working” of working memory. Dialogues in Clinical Neuroscience, 15, 411–418.

    PubMed Central  PubMed  Google Scholar 

  • Moritz, S., Andreou, C., Schneider, B. C., Wittekind, C. E., Menon, M., Balzan, R. P., & Woodward, T. S. (2014a). Sowing the seeds of doubt: A narrative review on metacognitive training in schizophrenia. Clinical Psychology Review, 34, 358–366.

    Article  PubMed  Google Scholar 

  • Moritz, S., Göritz, A. S., Van Quaquebeke, N., Andreou, C., Jungclaussen, D., & Peters, M. J. (2014b). Knowledge corruption for visual perception in individuals high on paranoia. Psychiatry Research, 30, 700–705.

    Article  Google Scholar 

  • Moritz, S., & Jelinek, L. (2009). Inversion of the “unrealistic optimism” bias contributes to overestimation of threat in obsessive-compulsive disorder. Behavioural and Cognitive Psychotherapy, 37, 179–193.

    Article  PubMed  Google Scholar 

  • Moritz, S., & Laroi, F. (2008). Differences and similarities in the sensory and cognitive signatures of voice-hearing, intrusions and thoughts: Voice-hearing is more than a disorder of input. Schizophrenia Research, 102, 96–107.

    Article  PubMed  Google Scholar 

  • Moritz, S., & Pohl, R. F. (2009). Biased processing of threat-related information rather than knowledge deficits contributes to overestimation of threat in obsessive-compulsive disorder. Behavior Modification, 33, 763–777.

    Article  PubMed  Google Scholar 

  • Moritz, S., Van Quaquebeke, N., & Lincoln, T. M. (2012a). Jumping to conclusions is associated with paranoia but not general suspiciousness: A comparison of two versions of the probabilistic reasoning paradigm. Schizophrenia Research and Treatment, 2012, 384039.

    Article  PubMed Central  PubMed  Google Scholar 

  • Moritz, S., Van Quaquebeke, N., Lincoln, T. M., Kother, U., & Andreou, C. (2013). Can we trust the internet to measure psychotic symptoms? Schizophrenia Research and Treatment, 2013, 457010.

    Article  PubMed Central  PubMed  Google Scholar 

  • Moritz, S., Veckenstedt, R., Andreou, C., Bohn, F., Hottenrott, B., Leighton, L., et al. (2014c). Sustained and “sleeper” effects of group metacognitive training for schizophrenia: a randomized clinical trial. JAMA Psychiatry, 71, 1103–1111.

    Article  PubMed  Google Scholar 

  • Moritz, S., & Woodward, T. S. (2005). Jumping to conclusions in delusional and non-delusional schizophrenic patients. British Journal of Clinical Psychology, 44, 193–207.

    Article  PubMed  Google Scholar 

  • Moritz, S., & Woodward, T. S. (2006). The contribution of metamemory deficits to schizophrenia. Journal of Abnormal Psychology, 115, 15–25.

    Article  PubMed  Google Scholar 

  • Moritz, S., Woodward, T. S., & Ruff, C. C. (2003). Source monitoring and memory confidence in schizophrenia. Psychological Medicine, 33, 131–139.

    Article  CAS  PubMed  Google Scholar 

  • Moritz, S., Woznica, A., Andreou, C., & Kother, U. (2012b). Response confidence for emotion perception in schizophrenia using a Continuous Facial Sequence Task. Psychiatry Research, 200, 202–207.

    Article  PubMed  Google Scholar 

  • Peters, M. J., Cima, M. J., Smeets, T., de Vos, M., Jelicic, M., & Merckelbach, H. (2007). Did I say that word or did you? Executive dysfunctions in schizophrenic patients affect memory efficiency, but not source attributions. Cognitive Neuropsychiatry, 12, 391–411.

    Article  PubMed  Google Scholar 

  • Pohl, P. F. (2004). Cognitive illusions: A handbook on fallacies and biases in thinking, judgement and memory. Hove: Psychology Press.

    Google Scholar 

  • Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.

    Article  Google Scholar 

  • Roberts, D. L., & Penn, D. L. (2009). Social cognition and interaction training (SCIT) for outpatients with schizophrenia: A preliminary study. Psychiatry Research, 166, 141–147.

    Article  PubMed  Google Scholar 

  • Roiser, J. P., & Sahakian, B. J. (2013). Hot and cold cognition in depression. CNS Spectrums, 18, 139–149.

    Article  PubMed  Google Scholar 

  • Ross, K., Freeman, D., Dunn, G., & Garety, P. (2011). A randomized experimental investigation of reasoning training for people with delusions. Schizophrenia Bulletin, 37, 324–333.

    Article  PubMed Central  PubMed  Google Scholar 

  • Savulich, G., Shergill, S., & Yiend, J. (2012). Biased cognition in psychosis. Journal of Experimental Psychopathology, 3, 514–536.

    Google Scholar 

  • Schacter, D. L. (1999). The seven sins of memory. Insights from psychology and cognitive neuroscience. American Psychologist, 54, 182–203.

    Article  CAS  PubMed  Google Scholar 

  • Schaefer, J., Giangrande, E., Weinberger, D. R., & Dickinson, D. (2013). The global cognitive impairment in schizophrenia: Consistent over decades and around the world. Schizophrenia Research, 150, 42–50.

    Article  PubMed Central  PubMed  Google Scholar 

  • Speechley, W., Moritz, S., Ngan, E., & Woodward, T. S. (2012). Impaired integration of disconfirmatory evidence and delusions in schizophrenia. Journal of Experimental Psychopathology, 3, 688–701.

    Article  Google Scholar 

  • Steel, C., Wykes, T., Ruddle, A., Smith, G., Shah, D. M., & Holmes, E. A. (2010). Can we harness computerised cognitive bias modification to treat anxiety in schizophrenia? A first step highlighting the role of mental imagery. Psychiatry Research, 178, 451–455.

    Article  PubMed  Google Scholar 

  • Stefanis, N. C., Hanssen, M., Smirnis, N. K., Avramopoulos, D. A., Evdokimidis, I., & Stefanis, C. N. (2002). Evidence that three dimensions of psychosis have a distribution in the general population. Psychological Medicine, 32, 347–358.

    Article  CAS  PubMed  Google Scholar 

  • Turner, R., Hoppitt, L., Hodgekins, J., Wilkinson, J., Mackintosh, B., & Fowler, D. (2011). Cognitive bias modification in the treatment of social anxiety in early psychosis: A single case series. Behavioural and Cognitive Psychotherapy, 39, 341–347.

    Article  PubMed  Google Scholar 

  • van der Gaag, M. (2006). A neuropsychiatric model of biological and psychological processes in the remission of delusions and auditory hallucinations. Schizophrenia Bulletin, 32(Suppl. 1), 113–122.

    Article  Google Scholar 

  • Waller, H., Freeman, D., Jolley, S., Dunn, G., & Garety, P. (2011). Targeting reasoning biases in delusions: A pilot study of the Maudsley Review Training Programme for individuals with persistent, high conviction delusions. Journal of Behavior Therapy and Experimental Psychiatry, 42, 414–421.

    Article  PubMed Central  PubMed  Google Scholar 

  • Wittekind, C. E., Terfehr, K., Otte, C., Jelinek, L., Hinkelmann, K., & Moritz, S. (2014). Mood-congruent memory in depression—the influence of personal relevance and emotional context. Psychiatry Research, 215, 606–613.

    Article  PubMed  Google Scholar 

  • Woodward, T. S., Balzan, R. P., Menon, M., & Moritz, S. (2014). Metacognitive training and therapy: an individualized and group intervention for psychosis. In P. H. Lysaker, G. Dimaggio & M. Brüne (Eds.), Social cognition and metacognition in schizophrenia. Psychopathology and treatment approaches (pp. 179–195). Oxford, UK: Academic Press Inc.

    Google Scholar 

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Conflict of Interest

Steffen Moritz, Lisa Endlich, Helena Mayer-Stassfurth, Christina Andreou, Nora Ramdani, Franz Petermann and Ryan P. Balzan declare that they have no conflict of interest. The study was not externally funded and results neither published nor presented elsewhere.

Informed Consent

All procedures were in accordance with the ethical standards of the Ethical Board of the German Psychological Society (DGPs). We obtained informed consent from all individual participants taking part in our study. Study aims were fully disclosed.

Animal Rights

No animal studies were carried out by the authors for this article.

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Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    Steffen Moritz, Helena Mayer-Stassfurth, Lisa Endlich, Christina Andreou & Nora Ramdani

  2. Center of Clinical Psychology and Rehabilitation, University of Bremen, Grazer Straße 6, 28359, Bremen, Germany

    Franz Petermann

  3. School of Psychology, Flinders University, Adelaide, SA, Australia

    Ryan P. Balzan

Authors
  1. Steffen Moritz
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  2. Helena Mayer-Stassfurth
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  3. Lisa Endlich
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  4. Christina Andreou
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  5. Nora Ramdani
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  6. Franz Petermann
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  7. Ryan P. Balzan
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Correspondence to Steffen Moritz.

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Franz Petermann shares senior authorship.

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Moritz, S., Mayer-Stassfurth, H., Endlich, L. et al. The Benefits of Doubt: Cognitive Bias Correction Reduces Hasty Decision-Making in Schizophrenia. Cogn Ther Res 39, 627–635 (2015). https://doi.org/10.1007/s10608-015-9690-8

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