Birgit Hottenrott

Different sides of the same coin? Intercorrelations of cognitive biases in schizophrenia

Introduction. A number of cognitive biases have been associated with delusions in schizophrenia. It is yet unresolved whether these biases are independent or represent different sides of the same coin. Methods. A total of 56 patients with schizophrenia underwent a comprehensive cognitive battery encompassing paradigms tapping cognitive biases with special relevance to schizophrenia (e.g., jumping to conclusions, bias against disconfirmatory evidence), motivational factors (self-esteem and need for closure), and neuropsychological parameters. Psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS). Results. Core parameters of the cognitive bias instruments were submitted to a principal component analysis which yielded four independent components: jumping to conclusions, personalising attributional style, inflexibility, and low self-esteem. Conclusions. The study lends tentative support for the claim that candidate cognitive mechanisms for delusions only partially overlap, and thus encourage current approaches to target these biases independently via (meta)cognitive training.

Decision making under uncertainty and mood induction: further evidence for liberal acceptance in schizophrenia

BACKGROUND Cognitive biases, especially jumping to conclusions (JTC), are ascribed a vital role in the pathogenesis of schizophrenia. This study set out to explore motivational factors for JTC using a newly developed paradigm. METHOD Twenty-seven schizophrenia patients and 32 healthy controls were shown 15 classical paintings, divided into three blocks. Four alternative titles (one correct and three lure titles) had to be appraised according to plausibility (0-10). Optionally, participants could decide for one option and reject one or more alternatives. In random order across blocks, anxiety-evoking music, happy music or no music was played in the background. RESULTS Patients with schizophrenia, particularly those with delusions, made more decisions than healthy subjects. In line with the liberal acceptance (LA) account of schizophrenia, the decision threshold was significantly lowered in patients relative to controls. Patients were also more prone than healthy controls to making a decision when the distance between the first and second best alternative was close. Furthermore, implausible alternatives were judged as significantly more plausible by patients. Anxiety-evoking music resulted in more decisions in currently deluded patients relative to non-deluded patients and healthy controls. CONCLUSIONS The results confirm predictions derived from the LA account and assert that schizophrenia patients decide hastily under conditions of continued uncertainty. The fact that mood induction did not exert an overall effect could be due to the explicit nature of the manipulation, which might have evoked strategies to counteract their influence.

Attributional biases in paranoid schizophrenia: Further evidence for a decreased sense of self‐causation in paranoia

Attributional biases are assumed to be part of the pathogenesis of persecutory delusions. The aim of the present study was to explore whether such biases are confined to current paranoid delusions or related to other positive symptoms as well. Another goal was to investigate whether current paranoid schizophrenia patients only show an exaggerated personalizing bias for negative events (i.e. personalizing blame) or also tend to externalize responsibility for positive events (i.e. decreased sense of self‐causation). The Internal, Personal and Situational Attributions Questionnaire (IPSAQ) was administered to 29 schizophrenia patients (10 with current paranoia), 26 psychiatric patients (OCD) and 33 healthy controls. Acutely paranoid patients made fewer internal attributions for positive and negative events, thus replicating a previously reported decreased sense of self‐causation. This kind of attributional style was related to acute positive symptomatology, but not to persecutory beliefs in particular. No evidence was found for a relationship between personalizing blame and the severity of current persecutory beliefs. An analysis of the narrative causal statements of the IPSAQ revealed that paranoid patients more often made external‐situational attributions particularly for positive events. Both psychiatric groups gave significantly more mono‐causal explanations for events than healthy controls.

Incorrigibility, jumping to conclusions, and decision threshold in schizophrenia

Introduction. Previous studies confirmed a bias against disconfirmatory evidence (BADE) for both delusional and delusion-neutral events in paranoid schizophrenia. In the present study, we examined a potential relationship between the BADE and delusional ideation. Methods. Fifty-five patients with schizophrenia (32 with current delusions), 20 patients with obsessive-compulsive disorder and 30 healthy participants were presented written scenarios composed of three successive sentences which increasingly disambiguated the situation. Participants were asked to rate interpretations presented along with the sentences. After each new sentence, participants could adjust their judgements in view of the new information. One interpretation (“true”) did not seem to fit the first statement but became increasingly plausible, whereas “lure” interpretations appeared very likely initially but were eventually incorrect. Patients were given the option to decide for one of the statements. Results. Patients with schizophrenia, irrespective of delusion severity, attenuated their ratings significantly less for lure interpretations in face of disconfirmatory evidence (BADE) compared to both control groups. We found no impairment regarding the integration of confirmatory evidence. Patients with schizophrenia made more incorrect decisions after the first sentence indicating jumping to conclusions relative to healthy controls. Participants with schizophrenia showed a lowered decision threshold compared to the controls. Conclusions. The findings lend further evidence to the claim that patients with schizophrenia are hastier and rather inflexible in their decision making. This response pattern may represent a trait-like vulnerability factor for the emergence of delusional incorrigibility, a hallmark symptom of schizophrenia.

Effects of obsessive-compulsive symptoms on neuropsychological test performance: complicating an already complicated story.

Theoretical models of obsessive-compulsive disorder (OCD) implicate neurocognitive dysfunction, particularly deficits in nonverbal memory and executive functioning, in the pathogenesis of the disorder. The opposite hypothesis (poor performance in neuropsychological test as an epiphenomenon of OCD symptoms) has rarely been contemplated although checking behavior, obsessional doubt, lack of motivation, and slowness as well as preoccupation with touching objects may result in secondary test impairment and mimic manifestations of neural dysfunction. A total of 60 patients with OCD and 30 healthy controls were tested with a multi-functional neuropsychological battery. At the end of the testing participants were asked about their effort and the severity of OCD symptoms during task execution. Up to one fourth of the OCD patients affirmed OCD-related worries and motivational problems during task execution. Poor motivation and checking were significantly associated with enhanced objective performance deficits. Whereas the present study does not negate a role of neurocognitive deficits in the formation of OCD, in our view the reverse relationship should be contemplated as well. We advise researchers to pay closer attention to possible confounds that may mediate the relationship between OCD and neurocognition. Limitations of the study are discussed.

When cancer is associated with illness but no longer with animal or zodiac sign: investigation of biased semantic networks in obsessive-compulsive disorder (OCD).

Building upon semantic network models, it is proposed that individuals with obsessive-compulsive disorder (OCD) process ambiguous words (e.g., homographs such as cancer) preferably in the context of the OC meaning (i.e., illness) and connect them to a lesser degree to other (neutral) cognitions (e.g., animal). To investigate this assumption, a new task was designed requiring participants to generate up to five associations for different cue words. Cue words were either emotionally neutral, negative or OC-relevant. Two thirds of the items were homographs, while the rest was unambiguous. Twenty-five OCD and 21 healthy participants were recruited via internet. Analyses reveal that OCD participants produced significantly more negative and OC-relevant associations than controls, supporting the assumption of biased associative networks in OCD. The findings support the use of psychological interventions such as Association Splitting that aim at restructuring associative networks in OCD by broadening the semantic scope of OC cognitions.

Visual false memories in post-traumatic stress disorder (PTSD)

There is an ongoing debate whether or not patients with post-traumatic stress disorder (PTSD) are more prone to produce false memories. The present study investigated this question using a visual variant of the Deese-Roediger-McDermott (DRM) paradigm, additionally addressing underlying mechanisms of false memory production (e.g., depression, dissociation, emotional valence, arousal). The visual paradigm was administered to 48 traumatized individuals with (n=20) and without PTSD (n=28) and 28 non-traumatized controls. Groups did not differ with regard to memory performance and memory confidence. False memories were correlated with depression. We recommend that future studies employ trauma-related material to further explore memory aberrations in PTSD.

Mindfulness and relaxation treatment reduce depressive symptoms in individuals with psychosis

INTRODUCTION Self-help is increasingly accepted for the treatment of mental disorders, including psychosis, as both a provisional first step and a way to bridge the large treatment gap. Though mindfulness-based interventions do not belong to first line treatment strategies in psychosis and randomized controlled trials are lacking, encouraging preliminary findings speak for the usefulness of this approach. For the present study, we examined whether patients with psychosis benefit from mindfulness bibliotherapy. METHODS A sample of 90 patients with psychosis (including a subsample with a verified diagnosis of schizophrenia) took part in the study via the Internet. Following baseline assessment, participants were randomized to either a mindfulness group or a Progressive Muscle Relaxation (PMR) control group and received the respective self-help manual including accompanying audio files. Symptom change was measured six weeks after the baseline assessment with self-rating scales including the Paranoia Checklist. The retention rate was 71%. The quality of the online dataset was confirmed by various strategies (e.g., psychosis lie scale; examination of response biases). The trial was registered at the ISRCTN registry (ISRCTN86762253). RESULTS No changes across time or between groups were noted for the Paranoia Checklist. Both conditions showed a decline in depressive and obsessive-compulsive symptoms at a medium effect size (per protocol and intention to treat analyses). DISCUSSION/CONCLUSION The study provided partial support for the effectiveness of self-help mindfulness and PMR for depression in psychosis. Whether mindfulness delivered by a licensed therapist might lead to improved treatment adherence and a superior outcome relative to PMR remains to be established. The results underscore that bibliotherapy is a worthwhile approach to narrow the large treatment gap seen in psychosis.

Perseveration and not strategic deficits underlie delayed alternation impairment in obsessive–compulsive disorder (OCD)

The claim that the prefrontal cortex, particularly its orbito-frontal part, is involved in obsessive-compulsive disorder (OCD) is based upon evidence from neuroimaging as well as behavioral studies. Studies have repeatedly suggested problems with delayed alternation learning in OCD, an executive dysfunction that presumably involves the orbito-frontal cortex. However, it is unclear whether such impairment stems from perseveration or strategic deficits as these aspects are intertwined in the original task. In the present study, 36 OCD and 16 healthy controls underwent a variant of the delayed alternation task involving three response options instead of two as in the original task. This modification enabled us to separate perseveration errors (i.e., the participant incorrectly chooses the same response option as before) from shift errors (i.e., the decision is switched to an incorrect response alternative). We found that patients with OCD committed significantly more perseveration errors following previously valid response options, whereas perseveration for previously invalid responses and shift errors did not distinguish groups. Group differences were not accounted for by comorbid depression and may be linked to the pathogenesis of OCD.

No evidence for object alternation impairment in obsessive-compulsive disorder (OCD)

Recent neuroimaging studies have consistently ascribed the orbito-frontal cortex (OFC) a pivotal role in the pathogenesis of obsessive-compulsive disorder (OCD). Cognitive tests presumed sensitive to this region, such as the Object Alternation Task (OAT), are considered important tools to verify this assumption and to investigate the impact of cortical dysfunction on behavior. The aim of the present study was to assess if patients with OCD show enhanced perseveration errors on the OAT relative to healthy controls taking into account several potential moderators, especially comorbid depression and OCD subtype. Thirty-five OCD patients and 18 healthy controls underwent the OAT as well as the Trail-Making Tests (TMT) A and B. In line with prior studies, OCD patients were slowed on both TMT tasks. In contrast, samples performed similarly on the OAT. While the latter finding does not invalidate the assumption that the OFC is affected in OCD, dysfunctions involving this region may be more subtle than often claimed and likely encompass only a small subset of functional domains hosted in the OFC.