The contributions of risk-taking and impulsivity to jumping to conclusions in the psychosis spectrum.

The jumping to conclusions (JTC) bias has been linked to the formation and maintenance of delusions across the psychosis spectrum. However, it remains unclear whether this bias reflects a primary cognitive deviation or is secondary to other cognitive processes. To this end, we investigated the relationship between JTC, risk-taking, impulsivity, and sensation seeking in individuals with psychotic-like experiences (PLEs) and controls. A large online community sample (N = 1151) completed the Fish Task as a measure for the JTC bias, as well as the Balloon Analogue Risk Task (BART) and the Brief Risk-Taking Propensity Scale (R-1) as measures of the propensity to take risks. Measures assessing impulsivity (Impulsive Behavior Scale-8, I-8), sensation seeking (Brief Sensation Seeking Scale, BSSS-4), and verbal intelligence (12-item Wordsum test) were also administered. We dichotomized the sample into extreme groups based on the positive subscale of the Community Assessment of Psychotic Experiences (CAPE). The present study confirms the existence of a JTC bias in psychosis-prone individuals. Of note, PLE-high individuals self-reported higher risk-taking propensity in the R-1 while at the same time displaying higher objective risk aversion in the BART relative to controls, speaking for a dissociation of subjective versus objective risk-taking behavior. PLE-high individuals showed deviances in other psychological traits (impulsivity, sensation seeking), but these were not associated with hasty decision-making as measured by JTC or risk-taking propensity. The results speak against impulsivity, sensation seeking, or verbal intelligence as driving mechanisms of JTC and risky decision-making.

A randomized controlled trial on COGITO, a free self-help smartphone app to enhance mental well-being.

BACKGROUND: Smartphone apps may help to prevent the transition from minor to severe mental health problems. We compared a free self-help smartphone app (COGITO; www.uke.de/cogito_app) against a wait-list condition for the improvement of self-esteem and depression. METHODS: The Rosenberg Self-Esteem Scale represented the primary outcome in this controlled trial. The final sample (n = 213) was randomly assigned to either the app or to the control condition. RESULTS: The app condition significantly improved the primary outcome relative to controls for all analyses. Satisfaction of completers was high. The present results warrant independent replication; the retention rate needs to be increased to allow solid inferences about acceptance. CONCLUSIONS: The present study demonstrates that the COGITO app may represent an effective self-help tool for psychological problems.

Toll-Like Receptor mRNA Levels in Schizophrenia: Association With Complement Factors and Cingulate Gyrus Cortical Thinning.

BACKGROUND AND HYPOTHESES: Previous studies revealed innate immune system activation in people with schizophrenia (SZ), potentially mediated by endogenous pathogen recognition receptors, notably Toll-like receptors (TLR). TLRs are activated by pathogenic molecules like bacterial lipopolysaccharides (TLR1 and TLR4), viral RNA (TLR3), or both (TLR8). Furthermore, the complement system, another key component of innate immunity, has previously been linked to SZ. STUDY DESIGN: Peripheral mRNA levels of TLR1, TLR3, TLR4, and TLR8 were compared between SZ and healthy controls (HC). We investigated their relationship with immune activation through complement expression and cortical thickness of the cingulate gyrus, a region susceptible to immunological hits. TLR mRNA levels and peripheral complement receptor mRNA were extracted from 86 SZ and 77 HC white blood cells; structural MRI scans were conducted on a subset. STUDY RESULTS: We found significantly higher TLR4 and TLR8 mRNA levels and lower TLR3 mRNA levels in SZ compared to HC. TLRs and complemental factors were significantly associated in SZ and HC, with the strongest deviations of TLR mRNA levels in the SZ subgroup having elevated complement expression. Cortical thickness of the cingulate gyrus was inversely associated with TLR8 mRNA levels in SZ, and with TLR4 and TLR8 levels in HC. CONCLUSIONS: The study underscores the role of innate immune activation in schizophrenia, indicating a coordinated immune response of TLRs and the complement system. Our results suggest there could be more bacterial influence (based on TLR 4 levels) as opposed to viral influence (based on TLR3 levels) in schizophrenia. Specific TLRs were associated with brain cortical thickness reductions of limbic brain structures.

Dimensions of beliefs without strong supporting evidence and reasons for holding them.

Beliefs without strong supporting evidence (BWSSE) are commonplace, such as religious beliefs and conspiracy theories. The goals of the current study were to identify dimensions of BWSSE in the general public and study how reasons for holding each dimension depend on the strength of the belief. Participants completed a BWSSE questionnaire online, and principal component analysis suggested that the questionnaire captured 6 dimensions of beliefs that range in strength: New Age Spiritual, Traditional Spiritual, Nonconformist, Science, Mythical, and Conspiracy Theory. Mixed-model analyses of variance showed that while high-strength believers in both New Age and Traditional Spiritual shifted their reasons-for-belief away from 'just believe' and towards personal experience, only Traditional Spiritual shifted away from 'just believe' to culture. In contrast, for Conspiracy Theory and Mythical, the dominant reason for belief was media, but for Conspiracy Theory only, there was a shift from media to education/personal research for high-strength believers. This demonstrates that although spiritual beliefs are strengthened by personal experience, conspiracy theory beliefs are strengthened by information gathering. Understanding the source of an existing belief is important for debiasing attempts to move people towards beliefs with strong supporting evidence, including greater acceptance of evidence provided by experts, a likely requirement for negotiating global humanitarian emergencies in the not-so-distant future. Statement of Relevance. Beliefs without strong supporting evidence (BWSSE) have been gaining attention in mainstream society; particularly, the sources of information that may contribute to their formation and resistance to correction. Understanding the source of an existing belief is important for debiasing attempts to move people towards beliefs with strong supporting evidence, including greater acceptance of evidence provided by experts, a likely requirement for negotiating global humanitarian emergencies in the not-so-distant future.

Hasty decision making and belief inflexibility in the more delusion prone? A modified disambiguating-scenarios paradigm assessing cognitive biases implicated in delusions.

INTRODUCTION: Contemporary models of psychosis imply that cognitive biases such as the jumping to conclusions (JTC), the bias against disconfirmatory evidence (BADE), and the liberal acceptance (LA) bias play a role in the pathogenesis of delusions. Most of the studies investigating the role of cognitive biases, however, have been conducted with socially neutral or abstract stimuli and have assessed patients with established psychoses. For the present study, we aimed to concurrently investigate multiple biases (i.e., the JTC, BADE, and LA biases) in a community sample with a new paradigm using more socially engaging stimuli. METHODS: A large sample of participants (N = 874) recruited via Amazon Mechanical Turk was subdivided into two groups based on the frequency of their psychotic-like experiences (PLEs) according to the positive subscale score of the Community Assessment of Psychic Experiences (CAPE) and matched based on major demographics variables, resulting in two equally sized groups called High-PLE (at least 2 SD above the mean) and Low-PLE (maximum 0.5 above the mean; n = 46 for each group). Using a modified version of the written-scenarios BADE task, which emphasized social interactions between agents embedded in the scenario, participants rated the plausibility of response options in the face of new information. RESULTS: In line with previous findings, the High-PLE group demonstrated the JTC, BADE, and LA biases. That is, the members of this group made more decisions after the initial piece of information, were less likely to revise their beliefs in light of new information, and provided higher plausibility ratings for implausible response options compared to the Low-PLE group. CONCLUSIONS: Results corroborate prior findings suggesting that the JTC, BADE, and LA biases may be contributing factors in delusional ideation and that metacognitive biases extend to social situations.

A randomized controlled feasibility trial of metacognitive training with adolescents receiving treatment for anorexia nervosa.

OBJECTIVE: This pilot study investigated the feasibility and preliminary efficacy of the metacognitive training for eating disorders (MCT-ED) program in adolescents with anorexia nervosa (AN). We report attrition and subjective evaluation as well as changes to cognitive flexibility, perfectionism and eating disorder pathology relative to waitlist controls. METHOD: Female (n = 35, aged 13-17 years) outpatients with a diagnosis of AN (n = 20) or atypical AN (n = 15) completed baseline measures of cognitive flexibility, perfectionism, and eating disorder pathology (May 2020-May 2022). Participants were randomly allocated to either treatment-as-usual (TAU) plus MCT-ED or TAU waitlist condition. All participants completed post-intervention and 3-month follow-up questionnaires. RESULTS: The MCT-ED condition had a treatment attrition rate <15%. Participants provided positive evaluation of the program. There were large between groups differences favoring MCT-ED at post-intervention and 3-month follow-up for concern over mistakes perfectionism (respective ds = -1.25, 95% CI [-2.06, -.45]; -.83, 95% CI [-1.60, .06]) with a significant group difference post-intervention but not 3-month follow-up. DISCUSSION: Findings provide tentative support for the feasibility of MCT-ED as an adjunct intervention for young people with AN, however replication is needed with a larger sample size to further explore its efficacy. PUBLIC SIGNIFICANCE: Metacognitive training for eating disorders (MCT-ED) is a feasible adjunct intervention for adolescents with anorexia nervosa. The intervention, which targets thinking styles and is delivered online by a therapist, received positive feedback, had high treatment retention, and led to reductions in perfectionism by the end of treatment compared to wait-list controls. Although these gains were not sustained long-term, the program is suitable adjunct intervention for young people with eating disorders.

Delusion-like beliefs and data quality: Are classic cognitive biases artifacts of carelessness?

There is widespread agreement that delusions in clinical populations and delusion-like beliefs in the general population are, in part, caused by cognitive biases. Much of the evidence comes from two influential tasks: the Beads Task and the Bias Against Disconfirmatory Evidence Task. However, research using these tasks has been hampered by conceptual and empirical inconsistencies. In an online study, we examined relationships between delusion-like beliefs in the general population and cognitive biases associated with these tasks. Our study had four key strengths: A new animated Beads Task designed to reduce task miscomprehension, several data-quality checks to identify careless responders, a large sample (n = 1,002), and a preregistered analysis plan. When analyzing the full sample, our results replicated classic relationships between cognitive biases and delusion-like beliefs. However, when we removed 82 careless participants from the analyses (8.2% of the sample) we found that many of these relationships were severely diminished and, in some cases, eliminated outright. These results suggest that some (but not all) seemingly well-established relationships between cognitive biases and delusion-like beliefs might be artifacts of careless responding. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Interventions for perinatal borderline personality disorder and complex trauma: a systematic review.

Perinatal borderline personality disorder (BPD) and complex post-traumatic stress disorder (cPTSD) are associated with significant impairment to interpersonal functioning, and risk of intergenerational transmission of psychopathology. Evaluation of interventions, however, is scarce. To date, no systematic review has addressed interventions for perinatal BPD, cPTSD, and associated symptomatology. Given the modest evidence to support informed clinical guidelines, the objective of this systematic review is to synthesise the literature on interventions for perinatal BPD and cPTSD, and to generate future directions for research. A comprehensive literature search following PRISMA guidelines was conducted in PsycInfo, MEDLINE, Emcare, Scopus, and ProQuest Dissertations and Theses Global databases. Seven original studies were included, of which only two were randomised controlled trials, using less intensive comparison conditions. Results suggest an association between Dialectical Behavioural Therapy (DBT) group skills training, a multimodal therapeutic approach at a Mother-Baby Unit (MBU), and Child-Parent Psychotherapy with improved perinatal mental health outcomes and remission of symptoms. MBU admission and home-visiting programs were associated with healthy postpartum attachment relationships. Home-visiting programs and DBT group skills were additionally associated with improved maternal parenting capabilities. Conclusions to inform clinical guidelines are limited by a lack of credible comparison conditions, and low quantity and quality of evidence. The feasibility of implementing intensive interventions in real-world settings is dubious. Hence, it is suggested that future research considers utilising antenatal screening to identify at-risk mothers, and the implementation of early intervention, using robust designs that can inform robust conclusions.

Disrupted auditory N1, theta power and coherence suppression to willed speech in people with schizophrenia.

The phenomenon of sensory self-suppression - also known as sensory attenuation - occurs when a person generates a perceptible stimulus (such as a sound) by performing an action (such as speaking). The sensorimotor control system is thought to actively predict and then suppress the vocal sound in the course of speaking, resulting in lowered cortical responsiveness when speaking than when passively listening to an identical sound. It has been hypothesized that auditory hallucinations in schizophrenia result from a reduction in self-suppression due to a disruption of predictive mechanisms required to anticipate and suppress a specific, self-generated sound. It has further been hypothesized that this suppression is evident primarily in theta band activity. Fifty-one people, half of whom had a diagnosis of schizophrenia, were asked to repeatedly utter a single syllable, which was played back to them concurrently over headphones while EEG was continuously recorded. In other conditions, recordings of the same spoken syllables were played back to participants while they passively listened, or were played back with their onsets preceded by a visual cue. All participants experienced these conditions with their voice artificially shifted in pitch and also with their unaltered voice. Suppression was measured using event-related potentials (N1 component), theta phase coherence and power. We found that suppression was generally reduced on all metrics in the patient sample, and when voice alteration was applied. We additionally observed reduced theta coherence and power in the patient sample across all conditions. Visual cueing affected theta coherence only. In aggregate, the results suggest that sensory self-suppression of theta power and coherence is disrupted in schizophrenia.

Metacognitive training for psychosis (MCT): past, present, and future.

This article provides an overview and retrospective on metacognitive training for psychosis (MCT), which first appeared approximately 2 decades ago. We recount how our empirical understanding of psychosis at that time led to the first preliminary version of the program. We describe setbacks and challenges that led to major changes, including revisions to existing modules (e.g., more focus on metacognitive variables, particularly on decision confidence as one of the primary targets of treatment) and the creation of new modules addressing mood, as well as attempts to improve sustainability of effects via homework exercises and a smartphone app ( www.uke.de/mct_app ). We have also enhanced dissemination efforts by creating new culturally sensitive language versions and facilitating low-threshold training through e-learning courses ( www.uke.de/e-mct ). Finally, we discuss several meta-analyses on the efficacy of MCT that have been published over the last decade. While reviews were initially inconsistent, possibly reflecting the insufficient statistical power and lower design quality of the first MCT studies, more recent meta-analyses have confirmed the efficacy of MCT on positive symptoms, insight, and cognitive biases, which has led to the inclusion of MCT in some national treatment guidelines for schizophrenia.

Whodunit - A novel video-based task for the measurement of jumping to conclusions in the schizophrenia spectrum.

Jumping to conclusions (JTC) is implicated in the formation and maintenance of the positive symptoms of psychosis and over the years has become a prominent treatment target. Yet, measures designed to detect JTC are compromised by a number of limitations. We aimed to address some of these shortcomings with a new video-based "Whodunit task" among participants scoring high and low on the Community Assessment of Psychic Experiences (CAPE). We recruited a large sample (N = 979) from the general population who were divided into subgroups high vs. low on psychotic-like experiences (PLE), matched for depression and background characteristics. In the Whodunit task, participants were asked to rate the likelihood that one out of six suspects was the perpetrator of a crime (deliberately ambiguous with no clear clues until the end). The primary measure was the number of sequences-to-decision (STD). In line with the hypothesis, participants scoring high on the CAPE positive subscale displayed significantly lower STD and a higher rate of JTC. Response confidence in the assessments was elevated in the PLE-High group. The number of overall decisions was also significantly elevated for the PLE-High group. No group differences were found when comparing those scoring high versus low on depression. The STD index correlated significantly with a corresponding index from another JTC task. The study presents a new paradigm for the measurement of data gathering in the schizophrenia spectrum. Speaking to its validity, the Whodunit task was correlated with another JTC measure. Future research should test abbreviated versions of the paradigm, preferably using multiple trials with differing topics/emotional themes.

Functional brain networks underlying probabilistic reasoning and delusions in schizophrenia.

Delusions in schizophrenia are false beliefs that are assigned certainty and not afforded the scrutiny that normally gives rise to doubt, even under conditions of weak evidence. The goal of the current functional magnetic resonance imaging (fMRI) study is to identify the brain network(s) involved in gathering information under conditions of weak evidence, in people with schizophrenia experiencing delusions. fMRI activity during probabilistic reasoning in people with schizophrenia experiencing delusions (n = 29) compared to people with schizophrenia not experiencing delusions (n = 41) and healthy controls (n = 41) was observed when participants made judgments based on evidence that weakly or strongly matched (or mismatched) with the focal hypothesis. A brain network involved in visual attention was strongly elicited for conditions of weak evidence for healthy controls and patients not experiencing delusions, but this increase was absent for patients experiencing delusions. This suggests that the state associated with delusions manifests in fMRI as reduced activity in an early visual attentional process whereby weak evidence is incorrectly stamped as conclusive, manifestating as a feeling of fluency and misplaced certainty, short-circuiting the search for evidence, and providing a candidate neural process for 'seeding' delusions.

Hasty decision-making in individuals at higher risk of developing an eating disorder.

BACKGROUND AND OBJECTIVES: The Jumping to Conclusions (JTC) bias is the tendency to make hasty decisions based on limited evidence and may contribute to the formation of over-valued beliefs about the importance of weight, shape and eating. Previous research investigating the JTC bias in clinical eating disorder samples, as assessed by the beads task, is inconclusive. The current study investigated the JTC bias in a non-clinical sample of undergraduate students identified as being lower or higher risk of developing an eating disorder. The study used a more reliable 'distractor' beads task that also incentivised hastier decisions by elevating the pressure of the task. METHODS: Female undergraduate students (N = 156, 48%, classified as higher risk) completed a pressure and non-pressure distractor beads task, along with measures of weight concern and body-image flexibility. RESULTS: Higher risk participants displayed a hastier decision-making style than lower risk participants. Task pressure elicited a hastier decision-making style across the whole sample, however, was unable to distinguish between higher and lower eating disorder risk status. LIMITATIONS: Interpretation of findings are limited to non-clinical samples and may not generalise to clinical eating disorder populations. CONCLUSIONS: Findings suggest the need for replication in a clinical eating disorder sample using the distractor beads task. Future research should investigate whether eating disorder salient stimuli elicits a stronger bias.

Autistic traits as a potential confounding factor in the relationship between schizotypy and conspiracy beliefs.

BACKGROUND: Conspiracy Theories (CT) are complex belief systems that view the world as being manipulated by multiple actors collaborating in the pursuit of malevolent goals. Although culture, education and sociological factors have been implicated in their development, psychological factors are recognized as important. Certain individual differences, including schizotypy and cognitive processing style, have been shown to make some individuals susceptible to CTs. However, the finding that schizotypy often co-occurs with autism spectrum disorder raises a question as to the relative and potentially confounding role of autistic traits in increasing vulnerability to CT beliefs. METHOD: A total of 508 adults were recruited from an international online panel. The study included measures of conspiracy beliefs, schizotypy and autistic traits as well as measures of information searching and cognitive style. RESULTS: The results confirmed that both autistic and schizotypy traits were positively associated with CT beliefs, but that schizotypy traits were the strongest predictor. Exploratory analyses of cognitive style measures indicated potential avenues for further investigation in relation in differences in cognitive processes that might underlie the development of CTs for in people with autistic traits as opposed to schizotypal traits. LIMITATIONS: The study was based on a self-report methodology and did not utilise a clinical sample. CONCLUSION: Both schizotypal and autistic traits are reliable predictors of conspiracy beliefs, but schizotypy appears to be the stronger predictor and that autistic traits are not a strong confounding factor in this relationship. However, autistic traits may pose an additional risk factor for CT beliefs.

Schizotypy is associated with difficulty maintaining multiple hypotheses.

Among neurocognitive accounts of delusions, there is a growing consensus that it is the certainty with which delusions are held, rather than their content that defines some beliefs as delusional. On a continuum model of psychosis, this inappropriate certainty ought to be present (albeit in an attenuated form) in healthy adults who score highly in schizotypy. It was hypothesised that this might be most evident in circumstances where the environment provides incomplete or probabilistic information, which thereby forces the participant to hold two imperfectly supported, concurrent hypotheses in mind. A cued visual search task was used to measure people's capacity to use partially predictive information (i.e., a cue that predicted the target may occur in one of the two locations) to facilitate speeded responding. As hypothesised, people's performance on the trials that required holding two hypotheses in mind concurrently was significantly and specifically associated with the positive components of schizotypy. This finding is consistent with a hyperfocusing of attention in schizophrenia, and may help explain why delusion-prone individuals have a tendency to "jump to conclusions" or be resistant to disconfirming information when faced with multiple, partially supported hypotheses.

COVID-19-related conspiracy beliefs and their relationship with perceived stress and pre-existing conspiracy beliefs.

Previous studies have down that erroneous Conspiracy Theory (CT) beliefs develop more strongly in people who have underlying conspiratorial reasoning styles and psychopathological traits and particularly when they are faced with stressful external events (Swami et al., 2013; van Prooijen, 2018). In this study, we test this proposition by examining the individual differences associated with the development of COVID-19-related CT beliefs during the pandemic. A total of 660 adults completed a survey that captured COVID-related CT beliefs and broader conspiracy beliefs, education, perceived stress and attitudes towards government responses. The results showed that COVID-19 related CT beliefs were: strongly related to broader CT beliefs, higher in those with lower levels of education; and, positively (although weakly) correlated with more negative attitudes towards government responses. However, no relationship was found between COVID-19 beliefs and self-reported stress. These findings hold implications for why some people are more likely to be resistant to public health interventions relating to COVID-19. The findings encourage more detailed exploration of the causes and sources of CTs and, in particular, the role of social media use and other information sources in the development and perpetuation of health-related CT beliefs.

Altered levels of immune cell adhesion molecules are associated with memory impairment in schizophrenia and healthy controls.

Increased cytokines and increased intercellular adhesion molecule-1 (ICAM1) found in the schizophrenia prefrontal cortex and in the blood may relate to cognitive deficits. Endothelial ICAM1 regulates immune cell trafficking into the brain by binding to integrins located on the surface of leukocytes. Whether the circulating levels of the main ICAM1 adhesion partners, lymphocyte-function associated antigen-1 (LFA1) and complement receptor 3 (CR3), both integrins, are altered in schizophrenia is unknown. Gene expressions of ICAM1, LFA1 and CR3 were measured in leukocytes from 86 schizophrenia patients and 77 controls. Participants were also administered cognitive testing to determine the extent to which cognitive ability was related to molecular measures of leukocyte adhesion. This cohort was previously stratified into inflammatory subgroups based on circulating cytokine mRNAs; thus, gene expressions were analysed by diagnosis and by inflammatory subgroups. Previously measured plasma ICAM1 protein was elevated in "high inflammation" schizophrenia compared to both "high" and "low inflammation" controls while ICAM1 mRNA was unchanged in leukocytes. LFA1 mRNA was decreased and CR3 mRNA was increased in leukocytes from people with schizophrenia compared to controls. LFA1 mRNA levels were positively correlated with working memory and elevated soluble ICAM1 was negatively correlated with verbal memory in schizophrenia. Altogether, some of the cognitive deficits in schizophrenia may be associated with altered expression of molecules that regulate immune cell trafficking.

Jumping to conclusions in the less-delusion-prone? Further evidence from a more reliable beads task.

BACKGROUND: A single meta-analysis has found that healthy people with higher delusion-proneness tend to gather less information (i.e., make fewer draws to decision, or DTD) on the beads task, although the findings of contributing studies were mixed, and the pooled effect size was small. However, using a new and more reliable "distractor sequences" beads task, we recently found a positive relationship between delusion-proneness and DTD in a healthy sample. In the current study, we re-tested this relationship in a new sample, and tested the possibility that the relationship is driven by participant's ability to understand and use odds or likelihood information ("odds literacy"). METHODS: Healthy participants (N = 167) completed the distractor sequences beads task, the Peters Delusions Inventory (PDI) which measures delusion-proneness, a measure of odds literacy, and the Depression, Anxiety, and Stress scale. RESULTS: PDI and DTD were positively correlated, and comparing PDI quartiles on DTD confirmed a statistically significant trend of increasing DTD with PDI quartile. Odds literacy was positively rather than negatively associated with both DTD and PDI. Anxiety was positively correlated with PDI and DTD. CONCLUSIONS: We replicated our earlier finding that DTD and delusion-proneness were positively related in a non-clinical sample, but found that increased odds-literacy did not drive lower PDI and DTD, and hence did not explain their covariance. It is possible however that anxiety and co-occurring risk aversion drive increased delusion-proneness and information-gathering, potentially accounting for the positive relationship between PDI and DTD.

Prolonged rather than hasty decision-making in schizophrenia using the box task. Must we rethink the jumping to conclusions account of paranoia?

Jumping to conclusions (JTC) is the best established cognitive bias in schizophrenia and is increasingly targeted in interventions aimed to improve positive symptoms. To address shortcomings of the standard measure to capture JTC, the beads task, we developed a new variant-the box task-which was subsequently validated in people with elevated psychotic-like experiences. For the first time, the box task was administered in a sample of individuals with manifest schizophrenia. We hypothesized that patients with schizophrenia would display an elevated JTC bias relative to controls. METHOD: We recruited a large sample of 101 patients with schizophrenia and matched them to an online sample recruited from the general population. In the box task, participants must decide which of two kinds of colored balls are presented more often. Participants are told that the task may end prematurely, and that task performance will be counted as an error if no decision had been made before that point. The primary measure was the number of draws to decision (DTD), where fewer DTD corresponds to greater JTC. RESULTS: In contrast to expectations, participants with schizophrenia showed significantly higher DTD (i.e., reduced JTC). Consistent with our previous findings, patients also displayed a lowered decision threshold compared to controls. Response confidence for the final decision was lower in patients and correlated with self-esteem and positive symptoms. While there was evidence that previous knowledge of the box task lowered DTD, exclusion of participants with experience on the box task did not substantially change results. DISCUSSION: The study fits a growing body of experiments casting doubt on the generalizability of the JTC effect in schizophrenia across different tasks. While the study tentatively supports a liberal acceptance account of psychosis, caution is warranted and we recommend that research should explore and control for potentially important mediators (e.g., task difficulty, stress, test-taking attitudes).