Debbie M Warman

Publications (19)48.75 Total impact

• Source

  Available from: Kelly D Buck

  Article: The relationship of metacognition with jumping to conclusions among persons with schizophrenia spectrum disorders.

  Kelly D Buck, Debbie M Warman, Vyv Huddy, Paul H Lysaker
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  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.
  Psychopathology 07/2012; 45(5):271-5. · 1.82 Impact Factor
• Article: Metacognition in schizophrenia: correlates and stability of deficits in theory of mind and self-reflectivity.

  Paul H Lysaker, Kyle L Olesek, Debbie M Warman, Joel M Martin, Anlize K Salzman, Giuseppe Nicolò, Giampaolo Salvatore, Giancarlo Dimaggio
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  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. · 2.52 Impact Factor
• Article: Delusional ideation and self-esteem in individuals with psychotic disorders.

  Debbie M Warman, Paul H Lysaker
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  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. · 1.77 Impact Factor
• Article: Cognitive insight in non-psychiatric individuals and individuals with psychosis: an examination using the Beck Cognitive Insight Scale.

  Joel M Martin, Debbie M Warman, Paul H Lysaker
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  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.
  Biological Psychiatry 08/2010; 121(1-3):39-45. · 8.28 Impact Factor
• Article: Self-esteem and delusion proneness.

  Debbie M Warman, Paul H Lysaker, Brandi Luedtke, Joel M Martin
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  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. · 1.77 Impact Factor
• Article: Reasoning, delusion proneness and stress: an experimental investigation.

  Kristy M Keefe, Debbie M Warman
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  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.
  Clinical Psychology & Psychotherapy 02/2010; 18(2):138-47. · 1.66 Impact Factor
• Article: Metacognition in schizophrenia: associations with multiple assessments of executive function.

  Paul H Lysaker, Debbie M Warman, Giancarlo Dimaggio, Michele Procacci, Valerie A Larocco, Laura K Clark, Craig A Dike, Giuseppe Nicolò
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  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. · 1.77 Impact Factor
• Article: Reasoning and delusion proneness: confidence in decisions.

  Debbie M Warman
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  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. · 1.77 Impact Factor
• Article: Jumping to conclusions and the continuum of delusional beliefs.

  Debbie M Warman, Paul H Lysaker, Joel M Martin, Louanne Davis, Samantha L Haudenschield
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  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. · 3.30 Impact Factor
• Source

  Available from: Paul H Lysaker

  Article: Cognitive insight and psychotic disorder: the impact of active delusions.

  Debbie M Warman, Paul H Lysaker, Joel M Martin
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  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. · 4.75 Impact Factor
• Article: Stigma, social function and symptoms in schizophrenia and schizoaffective disorder: associations across 6 months.

  Paul H Lysaker, Louanne W Davis, Debbie M Warman, Amy Strasburger, Nicole Beattie
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  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. · 2.52 Impact Factor
• Article: Jumping to conclusions and delusion proneness: the impact of emotionally salient stimuli.

  Debbie M Warman, Joel M Martin
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  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.
  Journal of Nervous & Mental Disease 11/2006; 194(10):760-5. · 1.68 Impact Factor
• Article: Cognitive insight and delusion proneness: An investigation using the Beck Cognitive Insight Scale.

  Debbie M Warman, Joel M Martin
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  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. · 4.75 Impact Factor
• Article: Individual and group cognitive-behavioral therapy for psychotic disorders: a pilot investigation.

  Debbie M Warman, Paul Grant, Kenneth Sullivan, Stanley Caroff, Aaron T Beck
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  ABSTRACT: The present study is an uncontrolled pilot investigation of individual and group cognitive-behavioral therapy (CBT) for patients with positive symptoms of psychosis (n = 6). While previous studies have utilized either individual or group CBT for schizophrenia, the present investigation is the first to include both components for patients in the chronic phase of a psychotic illness. The results of this pilot study suggest that this approach may be useful for both positive and negative symptoms of psychosis. In addition, depression, anxiety, and hopelessness scores all decreased dramatically. The majority of the gains made during treatment were maintained over an 11-month follow-up period. A combined CBT treatment program may offer benefits in terms of delusional thinking, depression, and anxiety when used as an adjunctive treatment to medication. While the present study demonstrated positive effects from treatment, results are limited by the small sample size.
  Journal of Psychiatric Practice 02/2005; 11(1):27-34. · 2.16 Impact Factor
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  Available from: senyfundacio.org

  Article: A new instrument for measuring insight: the Beck Cognitive Insight Scale.

  Aaron T Beck, Edward Baruch, Jordan M Balter, Robert A Steer, Debbie M Warman
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  ABSTRACT: The clinical measurements of insight have focused primarily on patients' unawareness of their having a mental disorder and of their need for treatment ([Acta Psychiatr. Scand. 89 (1994) 62; Am. J. Psychiatry 150 (1993) 873]; etc.). A complementary approach focuses on some of the cognitive processes involved in patients' re-evaluation of their anomalous experiences and of their specific misinterpretations: distancing, objectivity, perspective, and self-correction. The Beck Cognitive Insight Scale (BCIS) was developed to evaluate patients' self-reflectiveness and their overconfidence in their interpretations of their experiences. A 15-item self-report questionnaire was subjected to a principle components analysis, yielding a 9-item self-reflectiveness subscale and a 6-item self-certainty subscale. A composite index of the BCIS reflecting cognitive insight was calculated by subtracting the score for the self-certainty scale from that of the self-reflectiveness scale. The scale demonstrated good convergent, discriminant, and construct validity: (a) the BCIS composite index showed a significant correlation with being aware of having a mental disorder on the Scale to Assess Unawareness of Mental Disorder (SUMD; Arch. Gen. Psychiatry 51 (1994) 826) and the self-reflectiveness subscale was significantly correlated with being aware of delusions on the SUMD, (b) the composite index score of the BCIS differentiated inpatients with psychotic diagnoses from inpatients without psychotic diagnoses, and (c) in a separate study, change scores on the BCIS were significantly correlated with change scores on positive and negative symptoms. The results provided tentative support for the validity of the BCIS. Suggestions were made for further investigation of the cognitive processes involved in identifying and correcting erroneous beliefs and misinterpretations.
  Schizophrenia Research 07/2004; 68(2-3):319-29. · 4.75 Impact Factor
• Source

  Available from: Evan M Forman

  Article: Suicidality and psychosis: beyond depression and hopelessness.

  Debbie M Warman, Evan M Forman, Gregg R Henriques, Gregory K Brown, Aaron T Beck
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  ABSTRACT: The present study examined recent suicide attempters with and without psychotic disorders in order to understand factors that contribute to suicide ideation during and following the suicide attempt. Patients with psychotic disorders endorsed higher levels of suicide ideation than patients without psychotic disorders. Even when depression, hopelessness, substance abuse, and social problem solving were controlled for, there was a significant association between psychotic disorder and suicide ideation. During the follow-up period, patients with psychotic disorders subsequently attempted suicide at a significantly higher rate than patients without psychotic disorders. The clinical relevance of these findings is discussed.
  Suicide and Life-Threatening Behavior 02/2004; 34(1):77-86. · 1.33 Impact Factor
• Article: Cognitive-behavioral therapy for schizophrenia: a review.

  Douglas Turkington, Robert Dudley, Debbie M Warman, Aaron T Beck
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  ABSTRACT: Cognitive-behavioral therapy (CBT) has a proven role as an adjunct to antipsychotic medication and remediative approaches such as social skills training in the management of residual symptoms of chronic schizophrenia. Positive symptoms, depression, and overall symptoms appear to be viable treatment targets for CBT with a less pronounced effect on negative symptoms. The effect size at end of therapy is strong, with durability at short-term follow up. CBT can be used safely in patients with schizophrenia, and caregivers can help with homework exercises. There is also evidence that psychiatric nurses in the community can use CBT effectively with this patient group under supervision. CBT can be combined with family therapy and assertive community treatment programs targeted to reduce relapse. CBT improves the coping of patients with schizophrenia through improved adherence and symptom management. CBT techniques include development of trust, normalizing, coping strategy enhancement, reality testing, and work with dysfunctional affective and behavioral reactions to psychotic symptoms. An enhanced response to CBT would be expected when given with low dose cognitively enhancing atypical antipsychotic medication.
  Journal of Psychiatric Practice 02/2004; 10(1):5-16. · 2.16 Impact Factor
• Article: A cognitive therapy intervention for suicide attempters: An overview of the treatment and case examples

  Michele S. Berk, Gregg R. Henriques, Debbie M. Warman, Gregory K. Brown, Aaron T. Beck
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  ABSTRACT: Although suicidal behavior is a serious public health problem, few effective treatments exist to treat this population. This article describes a new cognitive therapy intervention that has been developed for treating recent suicide attempters. The intervention is based on general principles of cognitive therapy and targets the automatic thoughts and core beliefs that were activated just prior to the individual's suicide attempt. Specific cognitive and behavioral techniques are taught to the patient with the goal of decreasing suicidal thoughts and preventing future suicide attempts. The treatment is unique in targeting suicidal behavior as the primary problem, apart from psychiatric diagnosis. Three detailed case examples are provided that illustrate the use of the treatment with different types of patients.
  Cognitive and Behavioral Practice.
• Article: Probability estimations and delusion-proneness

  Valerie A. LaRocco, Debbie M. Warman
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  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.
  Personality and Individual Differences.