Prospects of a cognitive-developmental account of psychotic experiences

Durham University, Durham, England, United Kingdom
British Journal of Clinical Psychology (Impact Factor: 2.28). 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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    • "In cognitive models of psychosis (Bentall et al. 2001Bentall et al. , 2007Garety et al. 2001Garety et al. , 2007Morrison, 2001;Howes & Murray, 2014), threatening appraisals are not considered specific to psychosis, but rather a transdiagnostic risk factor representing cognitive biases and disturbed affect that develop independently of PEs, and are thus trait-dependent (Freeman & Garety, 2003). Although causality cannot be inferred, the findings in the remitted group indicate a potential dampening of threatening appraisals as symptoms remit in clinical individuals , implying that threatening appraisals may be, in part, secondary to the presence of PEs, and thus statedependent . "
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    ABSTRACT: Background: Appraisals are suggested to play a determining role in the clinical outcome of psychotic experiences (PEs). We used experimental tasks that mimic PEs to investigate appraisals in individuals with PEs with and without a 'need-for-clinical-care', and psychosis patients whose symptoms have remitted. We predicted that patients would appraise the tasks as threatening regardless of current symptom level, while non-clinical and control groups would appraise them as non-threatening. Method: Appraisals following three anomalous experiences-inducing tasks [Telepath, Cards task, Virtual acoustic space paradigm (VASP)] were examined in 71 individuals: symptomatic (n = 18) and remitted (n = 16) psychosis patients; non-clinical group with PEs (n = 16); controls without PEs (n = 21). Results: As predicted, symptomatic patients endorsed more threatening appraisals for all tasks than non-clinical and control groups, who did not differ from each other. However, remitted patients were less likely to endorse threatening appraisals of the Cards and Telepath than their symptomatic counterparts, although they did not differ in global ratings of how striking, threatening and distressing they found the tasks. Moreover, remitted participants endorsed more threatening appraisals of the Telepath and VASP than non-clinical participants, and of the VASP than controls. Remitted participants also rated all three tasks as globally more threatening than the non-clinical group and controls. Conclusions: Clinical outcome may not necessarily be driven by the presence of symptoms, with threatening appraisals of PEs representing a key factor. The remitted group's intermediate appraisal scores imply that the relationship between appraisal and clinical outcome is not straightforward, and potential mediating factors need to be determined.
    Full-text · Article · Jan 2016 · Psychological Medicine
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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.
    Full-text · Article · Oct 2015 · European Psychiatry
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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.
    Full-text · Article · Aug 2015 · Schizophrenia Research
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