Sarah Randjbar

Further evidence for the efficacy of a metacognitive group training in schizophrenia.

Metacognitive training (MCT) for patients with schizophrenia is a novel psychological group treatment targeting cognitive biases putatively involved in the pathogenesis of schizophrenia (e.g. jumping to conclusions, overconfidence in errors). Its eight modules are available cost-free online in many languages. In the present study, 36 subacute or remitted patients were randomly allocated to either the MCT or a wait-list group who received treatment-as-usual (TAU). Baseline and post assessments were 8 weeks apart and were performed blind to group status. MCT showed significantly greater improvement on the following parameters relative to the TAU group: delusion distress (PSYRATS), memory and social quality of life. In the MCT group, the rate of jumping to conclusions bias was reduced after training. No differences occurred on the PANSS. The present study confirms prior reports that MCT exerts beneficial effects on some cognitive and symptomatic parameters.

Antipsychotic treatment beyond antipsychotics: metacognitive intervention for schizophrenia patients improves delusional symptoms.

BACKGROUND Although antipsychotic medication still represents the treatment of choice for schizophrenia, its objective impact on symptoms is only in the medium-effect size range and at least 50% of patients discontinue medication in the course of treatment. Hence, clinical researchers are intensively looking for complementary therapeutic options. Metacognitive training for schizophrenia patients (MCT) is a group intervention that seeks to sharpen the awareness of schizophrenia patients on cognitive biases (e.g. jumping to conclusions) that seem to underlie delusion formation and maintenance. The present trial combined group MCT with an individualized cognitive-behavioural therapy-oriented approach entitled individualized metacognitive therapy for psychosis (MCT+) and compared it against an active control. METHOD A total of 48 patients fulfilling criteria of schizophrenia were randomly allocated to either MCT+ or cognitive remediation (clinical trial NCT01029067). Blind to intervention, both groups were assessed at baseline and 4 weeks later. Psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS) and the Psychotic Symptom Rating Scales (PSYRATS). Jumping to conclusions was measured using a variant of the beads task. RESULTS PANSS delusion severity declined significantly in the combined MCT treatment compared with the control condition. PSYRATS delusion conviction as well as jumping to conclusions showed significantly greater improvement in the MCT group. In line with prior studies, treatment adherence and subjective efficacy was excellent for the MCT. CONCLUSIONS The results suggest that the combination of a cognition-oriented and a symptom-oriented approach ameliorate psychotic symptoms and cognitive biases and represents a promising complementary treatment for schizophrenia.

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.

The organization of autobiographical and nonautobiographical memory in posttraumatic stress disorder (PTSD).

Disorganized trauma memory seems to play an important role in the pathogenesis of posttraumatic stress disorder (PTSD). However, it is unclear whether memory organization of nonautobiographical material (i.e., sequence memory) is also impaired in PTSD. A novel task designed to assess nonautobiographical memory for content and order information was administered to trauma survivors with (n = 26) and without PTSD (n = 55) as well as to nontraumatized healthy adults (n = 30). In addition, traumatized participants were asked to give a detailed narrative of the traumatic event and an unpleasant autobiographical event. Transcripts of both types of narratives were analyzed with regard to disorganization. Results indicated that trauma memories were more disorganized than memories of an unpleasant event in the PTSD group in comparison with the non-PTSD group. However, no differences were found for memory organization of nonautobiographical material among trauma survivors with and without PTSD and nontraumatized controls. With regard to memory accuracy of nonautobiographical material, group differences were more strongly associated with trauma exposure than with PTSD.

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.

Was Freud partly right on obsessive-compulsive disorder (OCD)? Investigation of latent aggression in OCD.

Inflated responsibility is increasingly regarded a pathogenetic mechanism in obsessive-compulsive disorder (OCD). In seeming contrast, there is mounting evidence that latent aggression is also elevated in OCD. Building upon psychodynamic theories that an altruistic façade including exaggerated concerns for others is partly a defense against latent aggression, evidence was recently obtained for high interpersonal ambivalence in OCD patients relative to psychiatric and healthy controls using a newly developed instrument entitled the Responsibility and Interpersonal Behaviors and Attitudes Questionnaire (RIBAQ). A total of 46 OCD patients and 23 healthy participants took part in the present study. OCD patients displayed a higher social responsibility than controls. At the same time, patients also disclosed more latent aggression/calculating behavior and interpersonal distrust. While the pathogenic role of latent aggression is still not fully uncovered, it may deserve more consideration in treatment in view of frequent tensions in the families of OCD patients. Longitudinal studies with at-risk sample are needed to assess the relationship between problems with anger expression as well as (exaggerated) moral standards in OCD.

Evidence for an attentional bias for washing- and checking-relevant stimuli in obsessive–compulsive disorder

There is equivocal evidence whether or not patients with obsessive-compulsive disorder (OCD) share an attentional bias for concern-related material and if so, whether this reflects hypervigilance towards or problems to disengage from disorder-related material. In a recent study, we failed to detect an attentional bias in OCD patients using an emotional variant of the inhibition of return (IOR) paradigm containing OCD-relevant and neutral words. We reinvestigated the research question with a more stringent design that addressed potential moderators. A new IOR paradigm was set up using visual stimuli. Forty-two OCD patients and 31 healthy controls were presented with neutral (e.g., cup), anxiety-relevant (e.g., shark), checking-relevant (e.g., broken door), and washing-relevant (e.g., dirty toilet) cue pictures at one of two possible locations. Following a short or long interval sensitive to automatic versus controlled processes, a simple target stimulus appeared at either the cued or the uncued location. OCD patients responded significantly slower to targets that were preceded by an OCD-relevant cue. Results lend support to the claim that OCD patients share a processing abnormality for concern-related visual material.

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.

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.