[Show abstract][Hide abstract] ABSTRACT: Cognitive insight is implicated in the formation and maintenance of hallucinations and delusions. However, it is not yet known whether cognitive insight relates to broader outcome measures like quality of life. In the current study, we investigated whether the component elements of cognitive insight—self-certainty and self-reflectiveness—were related to quality of life for 43 outpatients with schizophrenia or schizoaffective disorder. Cognitive insight was assessed using the Beck Cognitive Insight Scale (BCIS) while quality of life was assessed with Quality of Life Scale (QLS). We tested whether this relationship was moderated by clinical insight and symptom severity using the Scale to Assess Unawareness of Mental Disorder (SUMD) and the Positive and Negative Syndrome Scale (PANSS). We found that self- reflectiveness had an unmoderated positive relationship with quality of life. Self-certainty was associated with better quality of life for people with more severe symptoms. Theoretical and clinical implications of these findings are discussed and areas of future research are proposed.
Psychiatry Research 11/2015; DOI:10.1016/j.psychres.2015.10.014 · 2.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Obsessive–compulsive disorder (OCD) has been largely ignored in the stigma literature. The present study examined perceptions of violent thoughts that varied in terms of the diagnostic label – OCD, Schizophrenia, or no diagnostic label – assigned to a target experiencing such thoughts. Participants were randomly assigned to read a vignette about a target with one of the three diagnostic labels. Participants then completed measures of social distance and reported how dangerous and unpredictable they found the target, in addition to providing the diagnosis they believed the target had. They were then given a brief education about OCD and Schizophrenia and asked to complete assessments again. Results indicated that while an OCD diagnosis was not credible before education, it became the most credible diagnosis following education. Results indicated that education resulted in significantly decreased negative attitudes toward the target, which was accounted for by the shift to determining that the target had OCD.
Journal of Obsessive-Compulsive and Related Disorders 01/2015; 5:16-23. DOI:10.1016/j.jocrd.2015.01.003 · 1.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Following research on reasoning and the continuum of delusional ideation, the present study attempted to investigate the impact of different experimentally-induced states (stress, paranoia, and neutral) on the jumping-to-conclusions reasoning bias in individuals with varying levels of subclinical delusional ideation (SDI). Participants (N=117) completed a measure of subclinical delusional ideation (the Peters et al. Delusions Inventory or PDI; Peters et al., 1999); and were randomly assigned to receive one of two experimental inductions (stress or paranoia), or no experimental induction; their performance on two probabilistic reasoning tasks - one easy and one challenging - was assessed. Although no differences were found between individuals with high vs. low subclinical delusional ideation in the no induction condition or following the paranoia induction, in the stress-induction condition, individuals with high levels of subclinical delusional ideation were significantly less likely to jump to conclusions on the easy reasoning task. No significant effects emerged on the more challenging task. Assessment of post-test paranoid thinking indicated our paranoia induction did not have its intended effect. Importantly, because there was no pre-test of anxiety, paranoid thinking, or reasoning to determine if they shifted after the inductions, results need to be interpreted with caution.
Psychiatry Research 07/2014; 220(1-2). DOI:10.1016/j.psychres.2014.07.014 · 2.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: While alexithymia, or difficulties identifying and describing affect, has been commonly observed in schizophrenia, little is known about its causes and correlates. To test the hypothesis that deficits in emotion identification and expression result from, or are at least related to, deficits in neurocognition and affective symptoms, we assessed alexithymia using the Toronto Alexithymia Scale (TAS-20), symptoms using the Positive and Negative Syndrome Scale (PANSS), and neurocognition using the MATRICS battery among 65 adults with schizophrenia spectrum disorders in a non-acute phase of illness. Partial correlations controlling for the effects of social desirability revealed that difficulty identifying feelings and externally oriented thinking were linked with greater levels of neurocognitive deficits, while difficulty describing feelings was related to heightened levels of emotional distress. To explore whether neurocognition and affective symptoms were uniquely related to alexithymia, a multiple regression was conducted in which neurocognitive scores and affective symptoms were allowed to enter to predict overall levels of alexithymia after controlling for social desirability. Results revealed both processing speed and anxiety uniquely contributed to the prediction of the total score on the TAS-20. Results suggest that dysfunctions in both cognitive and affective processes may be related to alexithymia in schizophrenia independently of one another.
[Show abstract][Hide abstract] ABSTRACT: The present study was an investigation of the impact a brief intervention designed to raise awareness of a cognitive bias known to be robust for individuals with delusions has on the reasoning strategies of individuals with delusions. Individuals with delusions (n=57) were randomly assigned either to receive or not to receive a discussion of the jumping to conclusions bias and its pitfalls. Participants' performance on 3 reasoning trials - 1 emotionally neutral (beads) and 2 emotionally salient (self-referred survey words) - was then assessed; the number of stimuli participants requested before making a decision was evaluated to determine if the Jumping to Conclusions Discussion resulted in increased data gathering. There was no difference between groups (those who received and those who did not receive the Jumping to Conclusions Discussion) in terms of how many beads they gathered (p=.36), but there were significant differences on both reasoning trials of emotionally salient stimuli (p's<.05), such that participants who received the Jumping to Conclusions Discussion requested more stimuli on those tasks than individuals who did not receive the discussion. Thus, results suggest that discussion of the jumping to conclusions bias may impact the bias directly, at least for material that is emotional in nature. Results are discussed in terms of their relevance to cognitive behavioral therapies for psychosis and existing research on reasoning and delusions.
Schizophrenia Research 09/2013; 150(2-3). DOI:10.1016/j.schres.2013.09.003 · 3.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Jumping to conclusions (JTC) is a reasoning bias in which persons arrive at conclusions with relatively little data. It is prevalent in schizophrenia and tied to outcomes. To understand the correlates and the roots of this phenomenon, this study explored whether deficits in mastery, a domain of metacognition which reflects the ability to use knowledge about oneself and others to cope with psychological problems, was linked to a heightened tendency to jump to conclusions.
Participants were 40 adults with a schizophrenia spectrum disorder in a nonacute phase being treated in an outpatient setting. JTC was assessed using the Beads Test, and mastery was measured as an element of metacognition using the Metacognition Assessment Scale. To rule out the possibility that results were the effect of impairments in memory or executive function, the Wisconsin Card Sorting Test and Hopkins Verbal Learning Test were included.
Partial correlations controlling for memory and executive function revealed that lower levels of mastery were correlated with a lower average number of beads requested before reaching a conclusion, or a greater tendency to jump to conclusions (r = 0.39, p < 0.05).
Results are consistent with the possibility that deficits in metacognition influence or are influenced by reasoning biases.
[Show abstract][Hide abstract] ABSTRACT: Research suggests that many with schizophrenia experience a range of deficits in metacognition including difficulties recognizing the emotions and intentions of others as well as reflecting upon and questioning their own thinking. Unclear, however, is the extent to which these deficits are stable over time, how closely related they are to one another and whether their associations with core aspects of the disorder such as disorganization symptoms are stable over time. To explore this issue, we administered three assessments of Theory of Mind (ToM), the Beck Cognitive Insight Scale (BCIS), and the Positive and Negative Syndrome Scale at baseline and 6 months to 36 participants with schizophrenia. Correlations revealed the ToM and BCIS scores were stable across the two test administrations and that the ToM tests were closely linked to each other but not to the BCIS. Poorer baseline performance on the ToM tests and the Self-Certainty scale of the BCIS were linked to greater cognitive symptoms at baseline and follow-up, while greater Self-Reflectivity on the BCIS was linked to greater levels of emotional distress at both baseline and 6-month follow-up. Results are consistent with assertions that deficits in metacognition are a stable feature of schizophrenia.
Psychiatry Research 11/2011; 190(1):18-22. DOI:10.1016/j.psychres.2010.07.016 · 2.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Previous studies have been inconsistent in demonstrating a relationship between delusion proneness and induced stress on reasoning biases. The present study was an experimental investigation of the role of stress in the form of feeling rushed, which has previously been shown to be related to the jumping-to-conclusions reasoning bias for delusion-prone individuals, on the reasoning of delusion-prone individuals. University students (n = 133) completed a measure of delusion proneness and were randomly assigned to either receive or not receive a stress induction in the form of a speeded subtraction task. All participants engaged in four trials of a probabilistic reasoning task. Delusion-prone and not delusion-prone participants performed similarly when there was no stress induction, but delusion-prone individuals demonstrated reasoning biases relative to not delusion-prone individuals when stress was induced. The reasoning of delusion-prone individuals may be particularly vulnerable when they feel rushed and in stressful conditions.
[Show abstract][Hide abstract] ABSTRACT: The present study is an examination of the association of self-esteem with various themes of delusional thinking for individuals with psychotic disorders. Individuals with psychotic disorders (N = 30) completed a measure of delusional ideation and a measure of severity of delusions and also a measure of self-esteem. Results indicated individuals with higher levels of delusional thinking in the domains of persecution, thought disturbances, catastrophic ideation/thought broadcast, and negative self had lower self-esteem (p < 0.05). The 2 measures of delusional ideation or severity were not related to one another, yet they yielded similar relationships in terms of self-esteem, indicating both assessments may be useful and unique. Results are discussed in relation to previous research investigating self-esteem and delusions and delusional ideation.
The Journal of nervous and mental disease 01/2011; 199(1):58-61. DOI:10.1097/NMD.0b013e3182044b43 · 1.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Research investigating the relationships between executive functioning impairments and the positive, negative, and cognitive schizophrenia symptoms has produced inconsistent results. This inconsistency may be due to the tendency to view executive functioning as a unified process as opposed to multiple fractionated processes. A fractionated model of executive functioning has been supported in several studies of various populations, but few schizophrenia studies have used the factor analytic methods of these studies to empirically determine separate executive functioning components, causing conclusions regarding the relationships between these components and schizophrenia symptoms to be unreliable. The purposes of the present study were to (1) identify separate components of executive functioning by conducting a factor analysis of the performance of individuals with schizophrenia on the Delis Kaplan Executive Function System (D-KEFS) and (2) investigate the relationships between executive functioning components and the three schizophrenia symptom dimensions by correlating the derived factor scores with the scale scores of the Positive and Negative Symptom Scale (PANSS). An exploratory factor analysis revealed two separate components: inhibition/set shifting and mental flexibility. The results showed that the symptom dimensions were differentially related to impairments in executive functioning, with both negative and cognitive symptoms associated with the inhibition/set shifting component, cognitive symptoms alone associated with the mental flexibility component, and positive symptoms unrelated to either component.
Schizophrenia Research 12/2010; 124(1-3):169-75. DOI:10.1016/j.schres.2010.08.004 · 3.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: An increasing number of studies have used the Beck Cognitive Insight Scale (BCIS) to understand the reasoning of individuals with psychotic disorders. Less is known, however, about "normal" levels of insight and how non-psychiatric individuals compare to those with psychosis. The present study examined the structure of the BCIS in a non-psychiatric population and made comparisons between the scores of non-psychiatric individuals and those with psychosis. Participants were 418 students at American universities and 93 outpatients at a VA Medical Center with SCID-confirmed diagnoses of schizophrenia or schizoaffective disorder. Confirmatory factor analysis supports the 2-factor, 15-item structure previously reported for the BCIS, with one factor called self reflectiveness and the other called self certainty. Reliability analyses suggest strong internal consistency and test-retest results. Further, the BCIS subscales and composite index reliably distinguished between non-psychiatric and patient groups, though receiver operating characteristic (ROC) analysis did not suggest a particular cutoff score for predicting patient status. These results suggest that the BCIS is a valid measure to use in a non-psychiatric population, and that it reliably distinguishes between non-psychiatric individuals and those with psychotic disorders.
Schizophrenia Research 08/2010; 121(1-3):39-45. DOI:10.1016/j.schres.2010.03.028 · 3.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The present study was an examination of global self-esteem and various types of unusual beliefs in a nonclinical population. Individuals with no history of psychotic disorder (N = 121) completed a measure of delusion-proneness and also a measure of self-esteem. Results indicated high delusion prone individuals had lower self-esteem than low delusion prone individuals (p = 0.044). In addition, higher levels of paranoid ideation and suspiciousness were associated with lower self-esteem (p < 0.001). Significant, yet smaller relationships also emerged between low self-esteem and higher levels of beliefs related to thought disturbances, catastrophic ideation/thought broadcasting, and ideation of reference/influence. The significance of these findings as they relate to theories of delusion formation is discussed.
The Journal of nervous and mental disease 06/2010; 198(6):455-7. DOI:10.1097/NMD.0b013e3181e086c5 · 1.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The present study investigated the reasoning of high and low-delusion-prone individuals on probability estimation tasks using emotionally neutral and delusional narratives. Undergraduate students (N = 33) who were classified as high-delusion-prone or low-delusion-prone based on their scores on a widely used measure of delusion-proneness in reasoning research (the Peters et al. Delusions Inventory) were asked to rate the probability that five neutral and eight unusual situations, presented in narratives that ranged in terms of degree of likelihood, could be true. Results indicated that compared to low-delusion-prone participants, high-delusion-prone participants assigned equivalent probability estimations to neutral narratives, but considered delusional narratives to be more likely (p < .001). Differences emerged between groups at all probability levels for delusional narratives except the least likely. Findings support the presence of a reasoning bias among high-delusion-prone individuals for delusional material similar to that previously found among actively delusional individuals. Results are discussed as they relate to reasoning, psychosis and delusion-proneness.
[Show abstract][Hide abstract] ABSTRACT: Deficits in metacognitive capacity, or the abilities to think about thinking, are thought to be a key barrier to functioning in schizophrenia. Although metacognitive function may be linked to executive function, it is unclear how the different domains of each phenomenon are related to one another. Accordingly, we assessed 4 domains of metacognition on the basis of a self-generated narrative using the Metacognition Assessment Scale. These were correlated with subtests of the Delis Kaplan Executive Function System which assessed 2 domains of executive function: mental flexibility and inhibition. Participants were 49 men with schizophrenia spectrum disorders in a postacute phase of illness. Spearman Rho correlations revealed awareness of one's thoughts and feelings were more closely linked to performance on tests which required mental flexibility while recognizing others' needs, and independent relationships were more closely linked to performance on tasks which required inhibitory control. Results suggest different domains of metacognition may be influenced by and influence different neurocognitive processes.
The Journal of nervous and mental disease 06/2008; 196(5):384-9. DOI:10.1097/NMD.0b013e3181710916 · 1.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The present study was an investigation into the reasoning of delusion prone individuals. Seventy healthy individuals in the general population completed a measure of delusion proneness and engaged in 8 trials of difficult probabilistic reasoning tasks, 4 emotionally neutral and 4 emotionally salient, and were asked to report their level of confidence in their decisions. While delusion prone individuals did not request any fewer stimuli on reasoning tasks than did individuals who were not delusion prone, delusion prone individuals were more confident in their decisions on the neutral task than individuals who were not delusion prone and were more confident in their decision on the first trial, regardless of the type of stimuli presented. Further, despite requesting less information on neutral than salient tasks, delusion prone individuals reported equivalent confidence on both tasks. Delusion proneness and delusion onset may be related to overconfidence in decisions, particularly overconfidence in initial judgment.
The Journal of nervous and mental disease 02/2008; 196(1):9-15. DOI:10.1097/NMD.0b013e3181601141 · 1.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The present study examined the jumping to conclusions reasoning bias across the continuum of delusional ideation by investigating individuals with active delusions, delusion prone individuals, and non-delusion prone individuals. Neutral and highly self-referent probabilistic reasoning tasks were employed. Results indicated that individuals with delusions gathered significantly less information than delusion prone and non-delusion prone participants on both the neutral and self-referent tasks, (p<.001). Individuals with delusions made less accurate decisions than the delusion prone and non-delusion prone participants on both tasks (p<.001), yet were more confident about their decisions than were delusion prone and non-delusion prone participants on the self-referent task (p=.002). Those with delusions and those who were delusion prone reported higher confidence in their performance on the self-referent task than they did the neutral task (p=.02), indicating that high self-reference impacted information processing for individuals in both of these groups. The results are discussed in relation to previous research in the area of probabilistic reasoning and delusions.
Behaviour Research and Therapy 07/2007; 45(6):1255-69. DOI:10.1016/j.brat.2006.09.002 · 3.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: While several studies have determined the Beck Cognitive Insight Scale (BCIS; [Beck, A.T., Baruch, E., Balter, J.M., Steer, R.A., Warman, D.M., 2004. A new instrument for measuring insight: The Beck Cognitive Insight Scale. Schizophr. Res. 68, 319-329] is a useful measure of cognitive insight, a number of questions have remained unanswered. While individuals with psychotic disorders have been shown to have impaired cognitive insight compared to a psychiatric comparison group, it has remained unclear how the cognitive insight of individuals with psychotic disorders compares to healthy individuals. Further, as previous studies have classified participants based on diagnostic classification, it has remained unknown if individuals with delusions and individuals with psychotic disorders without active delusions score differently on this measure. To examine these questions, we assessed the cognitive insight of healthy individuals and individuals with psychotic disorders, both with and without active delusions. Results indicated that individuals with psychotic disorders had impaired cognitive insight relative to healthy controls (p=.005), though individuals with active delusions and individuals with psychotic disorders without delusions had impairments in different domains. Individuals with delusions were overly confident in their own judgment relative to healthy controls and those without delusions (p=.011), though their self-reflectiveness was the same as normal controls. Individuals without delusions reported low self-reflectiveness relative to healthy controls and individuals with delusions (p=.004), though they were not overconfident in their judgment. These results are discussed in terms of existing research on cognitive insight, decision making, and psychosis.
Schizophrenia Research 03/2007; 90(1-3):325-33. DOI:10.1016/j.schres.2006.09.011 · 3.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Research suggests stigma is a barrier to self-esteem and the attainment of resources in schizophrenia. Less clear is the association of stigma experiences with symptoms and social function both concurrently and prospectively. To assess this, symptoms were measured using the Positive and Negative Syndrome Scale, social function was measured using the Quality of Life Scale and stigma experience was assessed using the Internalized Stigma of Mental Illness Scale among 36 persons with schizophrenia at two points, 6 months apart. Correlations found stigma was associated with concurrent levels of positive and emotional discomfort symptoms and degree of social contact. When initial stigma levels were controlled for, stigma at 6 months was predicted by baseline levels of positive symptoms. Greater initial stigma predicted greater emotional discomfort at follow-up. Results suggest internalized stigma is linked with social function and symptoms. Positive symptoms may make some persons with schizophrenia more vulnerable to ongoing stigma experience.
Psychiatry Research 02/2007; 149(1-3):89-95. DOI:10.1016/j.psychres.2006.03.007 · 2.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The present study investigated whether those who are delusion-prone demonstrate a jumping to conclusions reasoning bias similar to that demonstrated by those with active delusions in previous studies. Two hundred individuals, none of whom had a psychotic disorder, were assessed for delusion-proneness and engaged in two probabilistic reasoning tasks, one emotionally neutral and the other emotionally salient. The emotionally salient task consisted of both positively and negatively valenced personally referent stimuli. Level of delusion-proneness was positively related to jumping to conclusions when stimuli were emotionally salient, though the bias was present only when the first personally referent stimulus was negatively valenced (p < 0.01). Thus, the jumping to conclusions reasoning bias previously demonstrated by individuals who have active delusions appears to be demonstrated under certain conditions by those who are not actively delusional but score high on a measure of delusion-proneness.
[Show abstract][Hide abstract] ABSTRACT: The present study investigated the relationship between delusion proneness, as assessed using the Peters et al. Delusions Inventory [Peters, E.R., Joseph, S.A., Garety, P.A., 1999. The measurement of delusional ideation in the normal population: Introducing the PDI (Peters et al. Delusions Inventory). Schizophr. Bull. 25 553-576], and cognitive insight, as assessed using the Beck Cognitive Insight Scale (BCIS; [Beck, A.T., Baruch, E., Balter, J.M., Steer, R.A., Warman, D.M., 2004. A new instrument for measuring insight: The Beck Cognitive Insight Scale. Schizophr. Res. 68, 319-329]. Two hundred undergraduate students with no history of psychotic disorder participated. Results indicated that, consistent with hypotheses, those higher in delusion proneness endorsed more certainty in their beliefs and judgment than those who were lower in delusion proneness (Self-Certainty subscale of the BCIS; p = .007). Contrary to hypotheses, however, those who were higher in delusion proneness were more open to external feedback and were more willing to acknowledge fallibility than those who were lower in delusion proneness (Self-Reflectiveness subscale of the BCIS; p = .002). The results are discussed in relation to theories of delusion formation.
Schizophrenia Research 07/2006; 84(2-3):297-304. DOI:10.1016/j.schres.2006.02.004 · 3.92 Impact Factor