Prospects of a cognitive-developmental account of psychotic experiences

Durham University, Durham, England, United Kingdom
British Journal of Clinical Psychology (Impact Factor: 1.9). 07/2007; 46(Pt 2):155-73. DOI: 10.1348/014466506X123011
Source: PubMed


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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Available from: Rhiannon Corcoran, Sep 25, 2015
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    • "Cognitive models state that a key factor in the transition to psychotic symptoms is the negative interpretation or 'appraisal' of anomalous perceptual experiences [26] [25] [55] [3] [4]. Maladaptive appraisals endorsed by patients typically represent perceptions of externalised, personalised threat [8] [48] [78]. "
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    ABSTRACT: A key factor in the transition to psychosis is the appraisal of anomalous experiences as threatening. Cognitive models of psychosis have identified attentional and interpretative biases underlying threat-based appraisals. While much research has been conducted into these biases within the clinical and cognitive literature, little examination has occurred at the neural level. However, neurobiological research in social cognition employing threatening stimuli mirror cognitive accounts of maladaptive appraisal in psychosis. This review attempted to integrate neuroimaging data regarding social cognition in psychosis with the concepts of attentional and interpretative threat biases. Systematic review methodology was used to identify relevant articles from Medline, PsycINFO and EMBASE, and PubMed databases. The selective review showed that attentional and interpretative threat biases relate to abnormal activation of a range of subcortical and prefrontal structures, including the amygdala, insula, hippocampus, anterior cingulate, and prefrontal cortex, as well as disrupted connectivity between these regions, when processing threatening and neutral or ambiguous stimuli. Notably, neural findings regarding the misattribution of threat to neutral or ambiguous stimuli presented a more consistent picture. Overall, however, the findings for any specific emotion were mixed, both in terms of the specific brain areas involved and the direction of effects (increased/decreased activity), possibly owing to confounds including small sample sizes, varying experimental paradigms, medication, and heterogeneous, in some cases poorly characterised, patient groups. Further neuroimaging research examining these biases by employing experimentally induced anomalous perceptual experiences and well-characterised large samples is needed for greater aetiological specificity.
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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. "
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    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; 168(1). DOI:10.1016/j.schres.2015.07.050 · 3.92 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). "
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    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 · 3.92 Impact Factor
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