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Personalizing and externalizing biases in deluded and depressed patients: Are attributional biases a stable and specific characteristic of delusions?

OBJECTIVES The purpose of this study was to explore whether explicit and implicit attributional styles of delusional patients were associated to their clinical state, and whether attributions biases are specific to delusional psychopathology or also appear in other disorders (i.e. depression). DESIGN AND METHODS A cross-sectional design was used. The sample consisted of 136 participants (40 acute deluded participants, 25 remitted deluded participants, 35 depressed patients and 36 normal controls). The Internal, Personal and Situational Attributions Questionnaire (IPSAQ) and the Pragmatic Inferential Test (PIT) were used to assess explicit and implicit attributional style, respectively. RESULTS All participants, with the exception of the depressed patients group, showed an externalizing bias (EB) for negative events. Although both acute and remitted deluded patients showed a similar overall pattern of explicit attributions, the personalizing bias (PB) was significantly greater in the acute group. The magnitude of this bias, which was also found in the depressed patients, was significantly related to the patients degree of severity, as assessed by the total BPRS score (r=.45, p<.001). The results on the implicit attributions were more equivocal, perhaps due the low reliability of the PIT. CONCLUSIONS Attributional biases seem to be a stable characteristic of delusions. Yet, the PB might be a rather unspecific characteristic that varies with the degree of the severity of psychopathology. The implications of these findings for understanding the role of attributional biases in depression and delusion formation are discussed.

Implicit and Explicit Self-Esteem Discrepancies in Paranoia and Depression

The main purpose of the present study was to examine implicit and explicit self-esteem (SE) in patients with persecutory delusions. In samples of paranoid patients, depressed patients, and healthy controls, implicit SE was assessed using the experimental go/no-go association task, whereas explicit SE was measured using 2 self-reporting questionnaires: the self-worth subscale of the World Assumption Scale (Janoff-Bulman, 1989) and the self-acceptance subscale of the Scales of Psychological Well-Being (Ryff & Keyes, 1995). Our analysis revealed that depressed patients showed lower explicit SE than did paranoid and healthy control participants. However, participants with persecutory delusions had significantly lower implicit SE scores than did healthy controls. We interpret the discrepancies observed between overt and covert measures in the paranoid group as psychological defense mechanisms. The present study stresses the clinical and theoretical importance of the use of implicit measures in psychopathology.

Predictors of subjective well-being in patients with paranoid symptoms: Is insight necessarily advantageous?

In schizophrenia, poor insight has been associated with negative outcome. In fact, some studies have found insight to be associated with greater treatment adherence and lower levels of symptomatology, as well as better psychosocial functioning. However, others have found that insight into illness is associated with an increase in depression, low self-esteem, and possibly higher risk of suicide. We investigated the relationship between insight and well-being in a sample of 40 people presenting paranoid symptoms and diagnosed with schizophrenia or other psychotic disorder. Independent-samples t-tests revealed that compared to a paranoid group with high insight, paranoid participants with low insight had more self-acceptance, higher sense of autonomy and personal growth, and greater orientation towards gratification. Moderation analyses showed that when experiential avoidance was high, insight into paranoia had a detrimental effect on self-acceptance. Overall, our results support the need to explore which psychological variables moderate insight in patients with persecutory beliefs. We discuss the implications of these results for the research of paranoia.

Metacognitive beliefs and psychological well-being in paranoia and depression

Introduction. Despite the growing interest in the effects of metacognitive beliefs and psychological well-being on psychiatric conditions, little is known about how these two variables interact in clinical samples. The central aim of this study was to investigate the role of some metacognitive beliefs in the relationship between psychological well-being dimensions and psychopathology. Methods. Fifty-five participants with persecutory delusions diagnosed with schizophrenia or other psychotic disorders, 38 participants with a major depressive episode, and 44 healthy controls completed the 30-item short form of the Metacognitions Questionnaire (MCQ-30) and the 54-item form of the Ryff Scales of Psychological Well-Being (PWB). Results. MANCOVA analyses revealed group differences on four subscales of PWB (self-acceptance, autonomy, personal growth, and environmental mastery), as well as on three subscales of MCQ-30 (uncontrollability of worry, need to control thoughts, and lack of memory confidence). Moderation analyses showed the interaction between persecutory thinking and cognitive self-consciousness to be a predictor of psychological well-being. Conclusions. These findings suggest that psychological well-being is particularly compromised in participants with a high level of persecutory thinking when they have low levels of cognitive self-consciousness.

World assumptions in psychosis: do paranoid patients believe in a just world?

The aim of this study was to examine the contents of world views held by patients with current persecutory beliefs. We examined whether these beliefs in a just world (BJW) were associated with the severity of psychopathology of participants. Our results showed that, compared with a healthy control group, the current persecutory beliefs group had weaker beliefs in a just world related to themselves (BJW-P), but there were no differences between both groups in their beliefs in general justice in the world (BJW-G). Regression analyses showed that BJW, particularly weaker beliefs in personal justice, significantly associated with more severe symptoms of depression and paranoia as well as with lower scores of psychological well-being. Our results support the relevance of the BJW framework in exploring world views in patients with persecutory beliefs. We discuss the implications of these results for the research and treatment of paranoid ideation.

Insight in paranoia: The role of experiential avoidance and internalized stigma.

Evidence suggests that insight in psychosis has been related to treatment adherence, recovery and good prognosis, but also to depression, low self-esteem, and diminished quality of life. Thus, insight might not be advantageous under all circumstances. Internalized-stigma (i.e. self-acceptance of stigmatizing images of illness) and experiential avoidance (i.e. unwillingness to experience negative private events) have been proposed as moderating variables between insight, and psychological health variables and/or distress. We investigated the patterns of association of insight with satisfaction with life, self-esteem, depression, anxiety and psychotic psychopathology as moderated by self-stigmatizing beliefs and experiential avoidance, in a sample of 47 participants with persecutory beliefs and diagnosed with schizophrenia or other psychotic disorder. Moderation analyses confirm the importance of internalized-stigma and experiential avoidance. The presence of insight was associated with more depression when there were high levels of self-stigma. Whereas, the absence of insight was associated with a greater life satisfaction when there were high levels of experiential avoidance. To summarize, our results help understand the complex relationship between insight, psychological health variables and emotional distress, pointing to a differential pattern of moderation for negative and positive outcomes. We discuss the implications of these results for research and treatment of paranoia.

Evaluative beliefs as mediators of the relationship between parental bonding and symptoms of paranoia and depression

This study was aimed to explore the distinct pathways that lead to depression and paranoia. We first examined the association of dysfunctional parenting experiences and negative self-evaluations in depression and paranoia. Furthermore, we also examined whether different self-evaluative beliefs could mediate the relationships between dysfunctional parenting experiences (i.e. parental overprotection or lack of care) and the development of depression and paranoia. A sample composed of 55 paranoid patients, 38 depressed patients and 44 healthy controls completed the Parental Bonding Instrument (PBI), the Evaluative Beliefs Scale (EBS) and some clinical scales. Our analyses revealed that lack of parental care and negative self-self evaluations were associated with depression symptoms. Analyses also revealed that parental overprotection and negative other-self evaluations were associated with paranoid symptoms. Furthermore, negative self-self and other-self evaluations fully mediated the relationship of parental overprotection and paranoia, whereas negative self-self evaluations partially mediated the relationship between lack of parental care and depression. These findings suggest that distinct patterns of parental practices may contribute to the development of different dysfunctional schemas which in turn may lead to either depression or paranoia.

Explicit self-esteem mediates the relationship between implicit self-esteem and memory biases in major depression

This study examines the relationships between explicit and implicit self-esteem and self-referent memory biases in depression. We specifically tested the hypothesis that implicit self-esteem would influence depression-related memory biases via its association with explicit self-esteem. Self-esteem was assessed in patients with a current Major Depressive Disorder (MDD; n=38) and in a control group of participants who had never experienced depression (ND; n=40) by using explicit (Rosenberg Self-esteem Questionnaire) and implicit (Go/No-go Association Task) measures. A self-referent processing task of negative and positive adjectives was used to assess memory bias. Our analyses revealed that participants diagnosed with MDD showed lower levels of both explicit and implicit self-esteem in comparison to ND participants. MDD compared to ND participants also recalled a greater number of depressed self-referent adjectives and lower recall of positive self-referent information. Mediation analyses showed an indirect effect of explicit self-esteem on the relationship between implicit self-esteem and depression-related memory biases in the MDD group. These findings suggest an association between implicit and explicit self-esteem in depression that may result in negative cognitive processing, as reflected by self-referent memory biases.

Recovery style and stigma in psychosis: the healing power of integrating

ABSTRACT Introduction. Persecutory delusions are a very common symptom in psychotic disorders and represent a considerable cost for both patients and for society. The way in which a person faces their psychotic disorder (i.e., recovery style) has impact on their recovery. The impact of coping style as a moderator in the course of their illness has not been studied sufficiently in persecutory delusions. In addition, internalised stigma is a common process in psychosis that not only might affect emotional distress, but might also shape recovery style. The goal of this study was to examine the moderator role of recovery style between internalised stigma and emotional distress in people with persecutory delusions. Methods. All 50 people with persecutory beliefs were assessed by the Recovery Style Questionnaire, the Beck Anxiety Inventory, Beck Depression Inventory, Second Edition, and Internalised Stigma of Mental Illness. Results. Moderation analysis showed that participants with a sealing-over recovery style had high levels of depression when they experienced internalised stigma and low levels of depression only when internalised stigma was low. However, participants with an integration recovery style presented similar levels of depression regardless of the level of their internalised stigma. Conclusions. Findings suggest the moderator role of recovery style between internalised stigma and depression in people with persecutory delusions.

Trauma and posttraumatic stress disorder in Spanish public mental health system clients with severe psychiatric conditions: Clinical and demographic correlates.

Objective: Compared with the general population, those with severe psychiatric conditions have a substantially higher likelihood of trauma exposure, increased probability of developing posttraumatic stress disorder (PTSD), and more severe consequences if trauma is left untreated. Nevertheless, identification of trauma/PTSD continues to be a neglected mental health system priority. In Spain, few investigations have examined the prevalence of trauma, particularly in persons with severe psychiatric conditions. Method: This study reports findings from a trauma/PTSD screening within a large Madrid public mental health agency serving clients with severe psychiatric conditions. Results: Of the 323 participants, 272 (84.2%) reported at least 1 traumatic event; and 124 (38.4%) met criteria for “probable” PTSD, although none had a medical record diagnosis of PTSD. Those with probable PTSD were predominantly male, were in their mid-40s, had received mental health services for 16 years on average, and endorsed 5.64 types of lifetime traumatic events. The most frequent and distressing traumatic event was the sudden, unexpected death of a loved one. The number of traumatic event types reported was positively correlated with PTSD symptom severity. Conclusions and Implications for Practice: Despite lower Spanish general population prevalence of trauma/probable PTSD (compared with the United States and other Western countries), rates within those with co-occurring severe psychiatric conditions are high. These findings reinforce the importance of conducting system-wide screening in public mental health clinics serving persons with severe psychiatric conditions in Spain (and beyond), in order to address this ongoing but neglected issue, and begin to offer much-needed recovery services.