The relationship between cognitive biases and psychological dimensions of delusions: The importance of jumping to conclusions

https://doi.org/10.1016/j.jbtep.2016.08.003Get rights and content

Highlights

  • The linkage between delusions’ dimensions and cognitive biases was investigated controlling for hallucinations.

  • Jumping to conclusions was related to emotional and cognitive dimensions of delusions controlling for hallucinations.

  • Dichotomous thinking and intentionalizing were related to emotional dimensions of hallucinations controlling for delusions.

  • Jumping to conclusions seem to be a specific cognitive bias for both emotional and cognitive dimensions of delusions.

Abstract

Background and objectives

Cognitive biases play a role in the development and maintenance of delusions. However, delusions are multidimensional (i.e., emotional and cognitive facets) and often co-occur with auditory hallucinations. Therefore, further refinement of the precise relationship between cognitive biases, delusions, and hallucinatory experiences is warranted.

Methods

A total sample of 167 patients with schizophrenia spectrum disorders was split into two groups consisting of patients with active delusions (n = 127) and active hallucinations (n = 92). All patients were assessed for delusions and hallucinations using the semi-structured psychotic symptom rating scales (PSYRATS), which assesses the emotional (i.e., distress) and cognitive (i.e., conviction, preoccupation) dimensions of these symptoms. Cognitive biases were assessed with the Cognitive Biases Questionnaire for Psychosis (CBQp) self-report questionnaire (assessing jumping to conclusions, intentionalising, catastrophising, emotional reasoning, and dichotomous thinking biases). Multiple stepwise regressions were performed to investigate the relationship between delusions and cognitive biases, while controlling for auditory hallucinations (and vice-versa).

Results

The only cognitive bias to significantly predict delusions after controlling for the severity of auditory hallucinations was the jumping to conclusions (JTC) bias (predicted both emotional and cognitive dimensions). Only the emotional dimension of auditory hallucinations was predicted by the intentionalising and dichotomous thinking biases, after delusional severity was controlled for.

Limitations

The cross-sectional design precludes causal inferences. Only positive psychotic symptoms were assessed and no wider psychopathology assessment was utilised (e.g., negative symptoms, anxiety, depression).

Conclusions

The jumping to conclusions bias is associated with both delusional conviction and emotional distress.

Introduction

Delusions are a characteristic and frequent clinical symptom of schizophrenia spectrum disorders. More recently, cognitive models have provided an empirically-based theoretical framework to explain mechanisms that may lead to psychotic symptoms (Garety, Kuipers, Fowler, Freeman, & Bebbington, 2001). One of the core assumptions of these cognitive models is that delusions are a consequence of dysfunctional information processing, typically referred to as ‘cognitive biases’ (Freeman and Garety, 2014, Freeman et al., 2002). Indeed, growing evidence suggests that cognitive biases both precede (An et al., 2010, Gawęda and Prochwicz, 2015, McKay et al., 2006) and actively contribute to the formation and maintenance of delusions (Falcone et al., 2015, Moritz and Woodward, 2005, Woodward et al., 2006). Furthermore, cognitive models have been supported by clinical studies showing that ameliorating cognitive biases during psychological interventions improves psychotic symptoms (for review see: Eichner and Berna, 2016, Garety et al., 2015, Moritz et al., 2014a, Moritz et al., 2014b).

A wide range of cognitive biases have been recognised as contributing to the development and maintenance of delusions, however the most extensively studied is the ‘jumping to conclusions’ (JTC) bias (for reviews and meta-analyses see: Dudley et al., 2016, Fine et al., 2007, Garety and Freeman, 2013, Ross et al., 2015). A very recent meta-analysis of the existing cross-sectional and longitudinal JTC data concluded that the bias is associated with delusions specifically, rather than merely with a diagnosis of schizophrenia or with being psychiatrically ill, consistent with the possibility that it contributes to delusional severity (McLean, Mattiske, & Balzan, 2016).

Although these results highlight the role that cognitive biases play in the development and maintenance of delusions, it is less clear which specific aspects or dimensions of delusions are influenced by these biases. One of the most frequently used measures for assessing the psychological dimensions of psychotic symptoms, such as delusions and hallucinations, is the PSYRATS (Haddock, McCarron, Tarrier, & Faragher, 1999). This measure assesses the total severity of delusions and hallucinations by incorporating the cognitive (e.g., conviction, preoccupation) and emotional (e.g., distress) dimensions of these symptoms. Preliminary findings suggest that jumping to conclusions may be linked to the cognitive dimension of delusions (Garety et al., 2005), but these results need to be replicated with a wider range of cognitive biases. The recently developed self-report Cognitive Biases Questionnaire for psychosis (CBQp) questionnaire captures five cognitive biases or distortions (jumping to conclusions, intentionalising, catastrophising, emotional reasoning, and dichotomous thinking), which are considered important for the pathogenesis of psychosis (Peters et al., 2014). The CBQp is a valid and reliable tool for distinguishing patients with schizophrenia, and also clinical voices-hearers, from healthy controls in terms of self-reported cognitive distortions (Peters et al., 2014). A recent study using the CBQp revealed that catastrophising and JTC predicted delusion-like experiences among healthy individuals and patients with schizophrenia (Gawęda & Prochwicz, 2015). With regard to the clinical sample exclusively, it was found that the total severity of active clinical delusions (as measured with the PSYRATS) was best predicted by catastrophising, and the cognitive dimension of delusions was specifically related to JTC (Gawęda & Prochwicz, 2015).

Despite refining the relationship between cognitive biases and delusions, previous studies (e.g. Gawęda & Prochwicz, 2015) did not take into the account the potential confounding influence of hallucinations. Therefore, it is difficult to determine whether these cognitive biases are specific to delusional thinking or whether they may also be caused by, and/or lead to, distressing hallucinatory experiences. Hence, the aim of this study was to investigate whether there are cognitive biases that predict psychological dimensions of delusions specifically, after controlling for hallucinations. For this purpose, we assessed psychological dimensions of both delusions and hallucinations to see whether these two psychotic symptoms share similar cognitive biases. To investigate this, regression analyses were conducted for delusions and hallucinations separately, while controlling for the other symptom. We hypothesized that delusions (particularly the cognitive dimension of delusions), but not hallucinations, would be related to the jumping to conclusions bias.

Section snippets

Participants

A total sample of 167 patients diagnosed with schizophrenia spectrum disorders (i.e., schizophrenia: 149; schizoaffective: 13; other psychosis: 5) took part in the study after written informed consent was obtained. Participants were recruited if they had a diagnosis of a schizophrenia spectrum disorder according to ICD-10 (diagnosis was based on clinical records, but not verified using structured clinical interviews), and active delusions and/or hallucinations. Exclusion criteria included a

Characteristics of the group

Table 1 presents detailed characteristics of the two group (i.e., active delusions and active hallucinations) split sample.

Relationship between cognitive biases and dimensions of delusions

There were no differences between male and females with regard to cognitive biases and delusions in the subsample of patients with active delusions. Pearson's correlation coefficients performed among patients with active delusions (n = 127) revealed that among the five different factors of cognitive biases only jumping to conclusions (JTC) was significantly related to

Discussion

The main aim of the study was to investigate the relationship between cognitive biases and the cognitive and emotional dimensions of delusions in patients with schizophrenia spectrum disorders, while controlling for the potentially confounding influence of hallucinations. In general, our results suggest that delusions are associated with different cognitive biases than hallucinations, which is consistent with the cognitive model of psychotic symptoms (Garety et al., 2001). Delusions (total

Role of funding

ŁG is supported by the Polish Foundation for Science (“START” program for young scientists) and the Polish Ministry of Higher Education and Science (0295/E-393/STY/10/2015 and MOBILITY PLUS programme 1258/MOB/IV/2015/0).

Contributions

ŁG designed the study; ŁG, MS, RB collected the data for the study; ŁG and RB interpreted the results; ŁG and RB wrote the manuscript and all authors have approved its final version.

Conflict of interest

The authors declare no conflicts of interest.

Acknowledgments

The authors thank Todd S. Woodward for his help in preliminary data analysis. The authors express their gratitude to all patients to take part in our study.

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