Katharina Kolbeck

Monocausal attribution and its relationship with reasoning biases in schizophrenia

BACKGROUND Aberrant attributional styles are counted to a set of circumscribed cognitive biases that are implicated in the pathogenesis of (paranoid) psychosis. However, evidence for a specific profile (e.g., an exaggerated self-serving bias, other-blaming bias) has become equivocal over the years. More recently, one-sided (monocausal) attributions have been reported in patients with psychosis. METHODS We compared a large sample of patients with diagnosed schizophrenia (n=145) to nonclinical controls (n=30) on a revised version of the Internal, Personal and Situational Attributions Questionnaire (IPSAQ-R). In this task, participants have to assign probability estimates to each of three potential causes (i.e., myself, others, circumstances) for a specific (negative or positive) event. RESULTS Participants with schizophrenia displayed an abolished self-serving bias and showed a significant preference for one-sided/monocausal attributions, which was neither correlated with jumping to conclusions nor overconfidence in errors. School education correlated with less monocausal attributions. We did not find any congruence between attributional styles with core delusional ideas. CONCLUSIONS Our study corroborates earlier investigations showing that monocausal attributions may play a role in the pathogenesis of psychosis; this bias unlikely represents an epiphenomenon of established biases. Unexpectedly, attributional styles (e.g., external-blaming) did not shape delusional contents. The true prevalence of monocausal attributions in psychosis is perhaps underestimated in the study, as groups were equated on school education, which was correlated with monocausal attributions.

The role of effective connectivity between the task-positive and task-negative network for evidence gathering [Evidence gathering and connectivity]

&NA; Reports linking a ‘jumping‐to‐conclusions’ bias to delusions have led to growing interest in the neurobiological correlates of probabilistic reasoning. Several brain areas have been implicated in probabilistic reasoning; however, findings are difficult to integrate into a coherent account. The present study aimed to provide additional evidence by investigating, for the first time, effective connectivity among brain areas involved in different stages of evidence gathering. We investigated evidence gathering in 25 healthy individuals using fMRI and a new paradigm (Box Task) designed such as to minimize the effects of cognitive effort and reward processing. Decisions to collect more evidence (‘draws’) were contrasted to decisions to reach a final choice (‘conclusions’) with respect to BOLD activity. Psychophysiological interaction analysis was used to investigate effective connectivity. Conclusion events were associated with extensive brain activations in widely distributed brain areas associated with the task‐positive network. In contrast, draw events were characterized by higher activation in areas assumed to be part of the task‐negative network. Effective connectivity between the two networks decreased during draws and increased during conclusion events. Our findings indicate that probabilistic reasoning may depend on the balance between the task‐positive and task‐negative network, and that shifts in connectivity between the two may be crucial for evidence gathering. Thus, abnormal connectivity between the two systems may significantly contribute to the jumping‐to‐conclusions bias. HighlightsWe examined fMRI activity and connectivity patterns during evidence gathering.Activations in the task‐negative network (TNN) characterized evidence collection.Activations in the task‐positive network (TPN) marked the time‐point of conclusion.Effective connectivity between TNN and TPN increased during conclusion events.Probabilistic reasoning may depend on the balance between TPN and TNN.

Antipsychotics decrease response confidence

Antipsychotics represent the first-choice treatment for schizophrenia. However, the cognitive and emotional pathways through which symptom reduction is achieved have remained unclear. We recently proposed that the induction of doubt is a core mechanism of action of antipsychotics. In the framework of a randomized, double-blind, placebo-controlled, crossover design, 39 nonclinical participants filled out a questionnaire tapping into cognitive and emotional changes (Effect of Antipsychotic Medication on Emotion and Cognition-revised (EAMEC-r)) each time they had received one of three substances (haloperidol, placebo, L-dopa). Participants reported more doubt under haloperidol than under L-dopa lending support to the theory that antipsychotics decrease delusional conviction via the reduction of confidence. Key points from this study are: (a) antipsychotics induce doubt, and (b) doubt may represent a core mechanism of action for the reduction of delusional ideas

Metacognitive Training for Patients with Borderline Personality Disorder (B-MCT): Modification of Cognitive Biases

Abstract. Metacognitive Training for borderline personality disorder (B-MCT) is a low-threshold group intervention program, which targets borderline-specific cognitive biases and aims to ameliorate...

fMRI correlates of jumping-to-conclusions in patients with delusions: Connectivity patterns and effects of metacognitive training

Background Reasoning biases such as the jumping-to-conclusions bias (JTC) are thought to contribute to delusions. Interventions targeting these biases such as metacognitive training (MCT) may improve delusions. So far, it is not clear whether JTC depends on dopaminergic reward areas that constitute the main action locus of antipsychotic drugs, or on additional cortical areas. The present study aimed to investigate fMRI activation and functional connectivity patterns underlying JTC, and their changes following MCT, in patients with delusions. Methods Participants were 25 healthy individuals and 26 patients with current delusions who were either medication-free or on stable medication without sufficient response. We assessed (1) BOLD activity in the task-positive (TPN), task-negative (TNN), and subcortical reward network (RN); (2) Psychophysiological interactions (PPI) of peak activation areas. Results Presence of JTC (irrespective of group) was associated with lower RN activity during conclusion events, and with increased effective connectivity between TPN and TNN during draw events. Following MCT, changes were observed in TPN activity and in effective connectivity of inferior parietal cortex (part of the TPN) with all three target networks. Conclusion JTC is associated not only with reward system areas that constitute the main target of antipsychotic drugs, but also with cortical areas, particularly of the TPN.

Borderline Personality Disorder: Associations Between Dimensional Personality Profiles and Self-Destructive Behaviors

Ongoing research is shifting towards a dimensional understanding of borderline personality disorder (BPD). Aim of this study was to identify personality profiles in BPD that are predictive of self-destructive behaviors. Personality traits were assessed (n = 130) according to the five-factor model of personality (i.e., Neuroticism, Extraversion, Openness to Experience, Agreeableness, Conscientiousness) and an additional factor called Risk Preference. Self-destructive behavior parameters such as non-suicidal self-injury (NSSI) and other borderline typical dyscontrolled behaviors (e.g., drug abuse) were assessed by self-report measures. Canonical correlation analyses demonstrated that Neuroticism, Extraversion, and Conscientiousness are predictors of NSSI. Further, Neuroticism, Agreeableness, and Risk Preference were associated with dyscontrolled behaviors. Our results add further support on personality-relevant self-destructive behaviors in BPD. A combined diagnostic assessment could offer clinically meaningful insights about the causes of self-destruction in BPD to expand current therapeutic repertoires.

Behandlungen kognitiver Verzerrungen bei Psychose: Ein Überblick der aktuellen Befunde

Wahnideen sind definiert als feste Überzeugungen, die trotz gegenteiliger Evidenz beibehalten werden. Eine Vielzahl von Studien belegt, dass Verzerrungen in der Informationsverarbeitung (z.B. voreiliges Schlussfolgern) bei der Entstehung und Aufrechterhaltung der (schizophrenen) Psychose beteiligt sind. Das Metakognitive Training (MKT) bei Psychose sowie die individualisierte Metakognitive Therapie (MKT+) sind niedrigschwellige Therapieangebote, die Betroffene für verzerrte Denkstile sensibilisieren und diese korrigieren sollen, um so die psychotische Symptomatik zu reduzieren. Die bisherige Studienlage spricht für die Wirksamkeit des MKT, wenngleich bei akuten Patienten die individualisierte Version, das MKT+, vorzuziehen ist. Neben dem MKT werden 2 Therapieprogramme mit ähnlicher Zielsetzung vorgestellt, das «Reasoning Training» und das «Social Cognition and Interaction Training», ebenso wie neue Techniken, die kognitive Verzerrungen mittels virtueller Realität (VR) reduzieren. VR-basierte Interventionen können dysfunktionale kognitive Verzerrungen realitätsnah erfahrbar machen und dadurch korrektive Prozesse erleichtern. Die vorgestellten niedrigschwelligen Therapieprogramme stellen eine leicht implementierbare Möglichkeit dar, um die Versorgungslücke von Menschen mit Psychosen zu verringern. Durch den normalisierenden Ansatz können auch Patienten mit geringer Krankheitseinsicht von den Interventionen profitieren.

Metakognitives Training bei Psychose und Depression

Das „Metakognitive Training“ (MKT) ist eine leicht anzuwendende und wirksame Intervention für unterschiedliche Störungsbereiche wie Psychosen, Depressionen oder Borderline-Persönlichkeitsstörung. Das MKT kann im Einzel- sowie Gruppensetting genutzt werden, ist mit einer hohen Akzeptanz der Patienten assoziiert und scheint langfristig das Wohlbefinden zu fördern.