Joel M. Martin

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

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.

Metacognition in schizophrenia: Correlates and stability of deficits in theory of mind and self-reflectivity

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.

Cognitive insight and delusion proneness: An investigation using the Beck Cognitive Insight Scale

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.

Jumping to conclusions and delusion proneness: the impact of emotionally salient stimuli.

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.

Self-Esteem and Delusion Proneness

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 Stigma of Voice-Hearing Experiences: Religiousness and Voice-Hearing Contents Matter.

Extensive research confirms that people with psychotic disorders suffer high levels of social stigma on average. However, psychotic-like experiences show incredible diversity and cannot reasonably be understood as a monolithic category. It is plausible that voice-hearing experiences with benign content might elicit less stigma than those with negative content, and researchers have hypothesized that culturally or theologically consistent voice-hearing experiences might elicit no stigma at all. The present study evaluated these hypotheses by testing how voice-hearing experiences that varied in terms of valence and the presence or absence of religious content affected stigma responses (i.e., perceived dangerousness and desired social distance) among people who were high or low in religiousness. Participants read vignettes describing two people who hear voices: one with positive content (complimentary, supportive) and the other negative (insulting, homicidal). Via random assignment, half read vignettes that attributed the voice to Abraham Lincoln whereas the other half read vignettes that replaced the words Abraham Lincoln with the word God. Results suggested that different voice-hearing contents elicited different levels of stigma. More religious participants perceived God-hearers to be less dangerous and desired particularly low levels of social distance from people who were described as hearing the voice of God saying positive things. Religiousness was associated with decreased stigma only in the context of specific voice-hearing experiences, lending support to the hypothesis that the stigma of voice-hearing experiences is determined as a simultaneous function of the contents of the experiences and the cultural context within which they are embedded.