Prospects of a cognitive-developmental account of psychotic experiences
ABSTRACT It has recently been recognized that psychosis represents the end-point of abnormal developmental pathways. The neurodevelopmental framework, within which this observation has typically been interpreted, has a number of limitations, particularly its failure to take account of recent advances in our understanding of the psychology of unusual experiences, such as hallucinations and delusions. The purpose of the present review is to highlight the advantages of considering psychosis within the framework of mainstream developmental psychology. The approach we advocate integrates findings from neurodevelopmental research with research on typical cognitive and sociocognitive development and the psychology of psychotic symptoms.
We review selected research on the developmental precursors of psychosis and on the role of cognitive processes in psychotic symptoms, together with relevant literature addressing the development of these processes in healthy children.
Developmental psychology provides clues about the cognitive and sociocognitive abnormalities that may be involved in hallucinations and delusions. An integration of these findings with existing knowledge on the neurodevelopment of psychosis suggests new avenues of research for investigators working at both biological and psychological levels of explanation.
The literature on typical cognitive and sociocognitive development provides a rich source of hypotheses about the ontogenetic pathways leading to psychosis.
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- "Appraisal theory proposes that the emotional response and physiological activation that occur in a situation are dependent on the appraisal, or meaning, given to what just occurred and on whether we think we will be able to cope with what just happened (Lazarus, 1991). In line with this theoretical framework, cognitive models of psychosis propose that early stressful events may result in a cognitive vulnerability which influences the interpretation and appraisal of daily stressors, and increases the likelihood that anomalous experiences develop into a psychotic disorder (Bentall et al., 2007; Freeman et al., 2002; Garety et al., 2001, 2007; Morrison and Wells, 2003). It is difficult to assess real time appraisals in social situations in life. "
ABSTRACT: The experience of social defeat may increase the risk of developing psychotic symptoms and psychotic disorders. We studied the relationship between social defeat and paranoid appraisal in people at high risk for psychosis in an experimental social environment created using Virtual Reality (VR). We recruited UHR (N=64) participants and healthy volunteers (N=43). Regression analysis was used to investigate which baseline measures predicted paranoid appraisals during the VR experience. At baseline, UHR subjects reported significantly higher levels of social defeat than controls (OR=.957, (CI) .941-.973, p<.000). Following exposure to the VR social environment, the UHR group reported significantly more paranoid appraisals than the controls (p<.000). Within the UHR sample, paranoid appraisals were predicted by the level of social defeat at baseline, as well as by the severity of positive psychotic and disorganised symptoms. In people who are at high risk of psychosis, a history of social defeat is associated with an increased likelihood of making paranoid appraisals of social interactions. This is consistent with the notion that social defeat increases the risk of developing psychosis. Copyright © 2015 Elsevier B.V. All rights reserved.Schizophrenia Research 08/2015; DOI:10.1016/j.schres.2015.07.050 · 4.43 Impact Factor
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- "Cognitive models of psychosis describe a dynamic, multi-factorial pathway from anomalous experiences to positive symptoms involving social factors, pre-existing beliefs, maladaptive appraisals and affective and cognitive disturbances (Bentall et al., 2001; Garety et al., 2001; Morrison, 2001; Bentall et al., 2007; Garety et al., 2007). Cognitive and perceptual biases are viewed as causal in the development and maintenance of delusions in particular (Freeman, 2007). "
ABSTRACT: Background There is evidence that people with psychosis display a “jump-to-conclusions” (JTC) reasoning style, and that this bias may be specific to delusions. A “jump-to-perceptions” (JTP) cognitive bias has also been found and is typically linked to hallucinations. However, there is some evidence for an association between JTP and delusions, and its specificity to hallucinations remains unclear. It has been suggested that these biases are related and products of shared cognitive processes. Methods This study examined the symptom specificity of JTC and JTP, and the relationship between them, in a sample of 98 individuals with delusions divided into ‘hallucinators’ (n = 51) and ‘non-hallucinators’ (n = 47). Biases were assessed using the beads task and visual and auditory perceptual tasks. Results As predicted, both groups demonstrated a JTC bias, but the ‘hallucinators’ showed a more pronounced JTP style in both modalities. The presence of JTC and JTP biases did not co-occur: making a decision on the beads task after two or fewer draws was not related to visual JTP, and was associated with a less marked JTP bias in the auditory perceptual task. No differences were found in JTP or JTC between participants with and without a schizophrenia diagnosis. JTP, but not JTC, was associated with the presence of hallucinations. Conclusions These findings suggest that the JTC and JTP biases show specificity to delusions and hallucinations, respectively, and not to diagnosis. There was no evidence that they are the product of shared cognitive processes, further supporting their specificity.Schizophrenia Research 04/2014; 154(1-3). DOI:10.1016/j.schres.2014.02.004 · 4.43 Impact Factor
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- "Auditory hallucinations (AHs) have been conceptualized as a neurodevelopmental phenomenon (Bentall et al., 2007) with a prevalence varying from 6 to 33% in adolescence (see review Larøi et al., 2006). A number of cognitive processes are thought to sustain the expression of AH, such as attention shift/enhancement, executive and inhibitory deficits, and source monitoring (SM) (Hugdahl, 2009; Jones, 2010; Badcock and Hugdahl, 2012; Waters et al., 2012). "
ABSTRACT: Theoretical and empirical accounts suggest that impairments in self-other discrimination processes are likely to promote the expression of hallucinations. However, our understanding of such processes during adolescence is still at an early stage. The present study thus aims 1) to delineate the neural correlates sustaining mental simulation of actions involving self-performed actions (first-person perspective; 1PP) and other-performed actions (third-person perspective; 3PP) during adolescence 2) to identify atypical activation patterns during 1PP/3PP mental simulation of actions in hallucination-prone adolescents 3) to examine whether differential risk for schizophrenia (clinical vs genetic) is also associated with differential impairments in the 1PP/3PP mental simulation of actions during adolescence. Twenty-two typically developing controls (Control group; 6 females), twelve hallucination-prone adolescents (AH group; 7 females) and thirteen adolescents with 22q11.2 Deletion Syndrome (22q11.2DS group; 4 females) were included in the study. During the fMRI task, subjects were presented with a cue (self-other priming cues) indicating to perform the task using either a first person perspective (“you”-1PP) or a third person perspective (“friend”-3PP) and then they were asked to mentally simulate actions based on the type of cue. Our results indicated that atypical patterns of cerebral activation, particularly in the key areas of self-other distinction, were found in both groups at risk for auditory hallucinations (AH and 22q11.2DS). More precisely, adolescents in the AH and 22q11.2DS groups presented decreased activations in the parieto-occipital region BA19 during 3PP. This study characterizes the neural correlates of mental imagery for actions during adolescence, and suggests that a differential risk for hallucination-proneness (clinical vs. genetic) is associated to similar patterns of atypical activations in key areas sustaining self-other discrimination processes.Frontiers in Human Neuroscience 07/2013; 7:329. DOI:10.3389/fnhum.2013.00329 · 2.90 Impact Factor