Examining the effects of diagnostic awareness, positive symptoms, and negative symptoms on stigmatizing attitudes and social exclusion towards schizophrenia.

BACKGROUND: Social exclusion towards schizophrenia can occur as a response to symptom presentations and/or diagnostic knowledge. The present study examined stigma towards schizophrenia as a function of diagnostic awareness, positive symptoms, and negative symptoms. METHODS: 559 participants were presented with one of eight vignettes depicting an individual in a social situation based on a 2 (label: present, absent) x 2 (positive symptoms: present, absent) x 2 (negative symptoms: present, absent) design. Participants then completed various measures of social exclusion and stigmatizing attitudes. RESULTS: A significant three-way interaction between positive symptoms, negative symptoms, and a diagnostic label was found for stigmatizing attitudes such that knowledge of diagnosis was associated with less stigma when symptoms were present but resulted in more stigma when symptoms were absent. A significant interaction between diagnostic label and negative symptoms was found on social distance such that knowledge of diagnosis increased desire for social distance when negative symptoms were present. CONCLUSION: Diagnostic awareness increases stigmatizing attitudes and social distance when symptoms are not present. However, when contextualized with the presence of symptoms, diagnostic awareness may reduce exclusion by providing an explanation for those symptoms. Determining when and to whom to disclose one's diagnosis may be helpful to improve social functioning in schizophrenia.

Examining the influence of self-referential thinking on aberrant salience and jumping to conclusions bias in individuals with schizophrenia-spectrum disorders.

BACKGROUND AND OBJECTIVES: Cognitive processes such as aberrant salience and the jumping to conclusions (JTC) bias are implicated in the development of delusions. Self-referential thinking is implicated in this process; however, it is unknown how it may interact with aberrant salience and JTC bias in individuals with schizophrenia-spectrum disorders (SSDs). This study examined associations of self-referential thinking with aberrant salience, JTC bias, and delusion severity, and whether self-referential stimuli led to an increase in aberrant salience and JTC bias in SSDs (n = 20) relative to psychiatrically healthy controls (n = 20). METHODS: To assess aberrant salience and JTC bias, participants were asked to complete both self-referential and neutral versions of the Salience Attribution Test (SAT) and the Beads Task, as well as self-report measures of aberrant salience and JTC bias. RESULTS: Self-referential task condition interacted with clinical group to predict JTC beads task scores, such that participants with SSDs exhibited greater levels of JTC bias than psychiatrically healthy controls during the neutral task condition, when controlling for levels of motivation, cognitive insight, and functioning. Self-referential thinking was significantly associated with aberrant salience, JTC bias, and delusion severity. LIMITATIONS: This experiment examined trait-level relationships between variables, so does not provide information about state-level interrelationships and would benefit from replication using more dynamic methods such as ecological momentary assessment. CONCLUSIONS: These findings highlight the interrelationships between self-referential thinking, JTC bias, aberrant salience, and delusion severity, in individuals with SSDs, and support the interactive role of self-referential thinking in predicting JTC bias.

Examining the Role of Failure and Success Experiences on Task Persistence and Neurocognition in Schizophrenia-Spectrum Disorders.

BACKGROUND: Recent theoretical models suggest that a variety of psychological and contextual factors account for a significant proportion of the observed neurocognitive impairment in schizophrenia-spectrum disorders (SSD). Numerous non-neurocognitive mechanisms of neurocognitive functioning have been proposed that warrant investigation; however, few studies have empirically examined these factors. This cross-over study examined whether the experience of failure or success affects task persistence and neurocognition differentially between individuals with SSD and healthy controls. METHODS: Twenty-nine participants with SSD and 30 healthy controls (Mage = 29.33, SD = 10.72) completed success and failure inductions, psychological questionnaires, an anagram persistence task, and brief neurocognitive testing remotely at two time-points. RESULTS: Both groups demonstrated significantly lower persistence and worse decision-making skills in the failure condition relative to the success condition. Individuals with SSD demonstrated slower processing speed, but this was not affected by prior failure or success. CONCLUSIONS: This study demonstrates that the experience of failure is similarly detrimental to persistence and decision-making in healthy controls and individuals with SSD but does not contribute to processing speed performance. This suggests that higher-order executive functions are more susceptible to manipulation by contextual factors compared to lower-order cognitive functions.

Examining Cognitive Biases Uniquely Associated with Schizotypy.

INTRODUCTION: Individuals with schizotypy can experience a number of cognitive biases that may increase their risk in developing schizophrenia-spectrum psychopathology. However, cognitive biases are also present in mood and anxiety disorders, and it is currently unclear which biases are specific to schizotypy and which may be a result of comorbid depression and/or anxiety. METHODS: 462 participants completed measures of depression, anxiety, cognitive biases, cognitive schemas, and schizotypy. Correlation analyses were conducted to examine the relationship between these constructs. Three hierarchical regression analyses were conducted to examine if schizotypy, depression, and anxiety explained a statistically significant amount of variance in cognitive biases after controlling for depression and anxiety, schizotypy and anxiety, and schizotypy and depression, respectively. Moderated regression analyses were also conducted to investigate the moderating role of biological sex and ethnicity in the association between cognitive biases and schizotypy. RESULTS: Self-referential processing, belief inflexibility, and attention for threat were associated with schizotypy. The belief inflexibility bias and social cognition problems were specifically associated with schizotypy after controlling for depression and anxiety and were not directly associated with either depression or anxiety. These associations were not moderated by biological sex or ethnicity. CONCLUSION: The belief inflexibility bias may be an important cognitive bias underlying schizotypal personality, and further research will be important to determine whether this bias is also associated with an increased likelihood of transitioning to psychosis.

Efficacy of Remotely Delivered Evidence-Based Psychosocial Treatments for Schizophrenia-Spectrum Disorders: A Series of Systematic Reviews and Meta-Analyses.

BACKGROUND: Schizophrenia is among the most persistent and debilitating mental health conditions worldwide. The American Psychological Association (APA) has identified 10 psychosocial treatments with evidence for treating schizophrenia and these treatments are typically provided in person. However, in-person services can be challenging to access for people living in remote geographic locations. Remote treatment delivery is an important option to increase access to services; however, it is unclear whether evidence-based treatments for schizophrenia are similarly effective when delivered remotely. STUDY DESIGN: The current study consists of a series of systematic reviews and meta-analyses examining the evidence-base for remote-delivery of each of the 10 APA evidence-based treatments for schizophrenia. RESULTS: Of the 10 treatments examined, only cognitive remediation (CR), cognitive-behavioral therapy (CBT), and family psychoeducation had more than 2 studies examining their efficacy for remote delivery. Remote delivery of CBT produced moderate effects on symptoms (g = 0.43) and small effects on functioning (g = 0.26). Remote delivery of CR produced small-moderate effects on neurocognition (g = 0.35) and small effects on functioning (g = 0.21). There were insufficient studies of family psychoeducation with equivalent outcome measures to assess quantitatively, however, studies of remotely delivered family psychoeducation suggested that it is feasible, acceptable, and potentially effective. CONCLUSIONS: Overall, the evidence-base for remotely delivered treatment for schizophrenia is limited. Studies to date suggest that remote adaptations may be effective; however, more rigorous trials are needed to assess efficacy and methods of remote delivery that are most effective.

Examining the association of life course neurocognitive ability with real-world functioning in schizophrenia-spectrum disorders.

There is considerable variability in neurocognitive functioning within schizophrenia-spectrum disorders, and neurocognitive performance ranges from severe global impairment to normative performance. Few investigations of neurocognitive clusters have considered the degree to which deterioration relative to premorbid neurocognitive abilities is related to key illness characteristics. Moreover, while neurocognition and community functioning are strongly related, understanding of the sources of variability in the association between these two domains is also limited; it is unknown what proportion of participants would over-perform or under-perform the level of functioning expected based on current neurocognitive performance vs. lifelong attainment. This study examined data from 954 outpatients with schizophrenia-spectrum disorders across three previous studies. Neurocognition, community functioning, and symptoms were assessed. Neurocognitive subgroups were created based on current neurocognition, estimated premorbid IQ, and degree of deterioration from premorbid using z-score cut-offs; functional subgroups were created with cluster analysis based on the Specific Level of Functioning Scale and current neurocognition. The sample was neurocognitively heterogeneous; 65% displayed current neurocognitive impairment and 84% experienced some level of deterioration. Thirty percent of our sample was relatively higher functioning despite significant neurocognitive impairment. Individuals with better community functioning, regardless of neurocognitive performance, had lower symptom severity compared to those with worse functioning. These results highlight the variability in neurocognition and its role in functioning. Understanding individual differences in neurocognitive and functional profiles and the interaction between prior and current cognitive functioning can guide individualized treatment and selection of participants for clinical treatment studies.

Social exclusion in psychotic disorders: An interactional processing model.

Psychotic disorders are among the most highly stigmatized mental disorders, and individuals with psychosis experience significant exclusion from the community. Stigma reduction programs have done little to reduce social exclusion of individuals with psychosis, and there are significant limitations to the traditional stigma model as it applies to social exclusion. Herein, we present the Interactional Processing Model (IPM) of social exclusion towards individuals with psychosis. The IPM considers social exclusion to be the result of two interacting pathways with additional consideration for a feedback loop through which social exclusion sets in motion natural behavioural responses of individuals with psychosis that inadvertently perpetuates exclusion. The IPM considers initial social exclusion to be the result of an interaction between these two pathways. The first path aligns with the traditional stigma model and consists of the community becoming aware that an individual is diagnosed with a psychotic disorder and then excluding the individual based on pre-existing, generalized knowledge about the disorder. The second path to exclusion involves the observation of atypical behaviours from the individual, and generation of an individualized exclusion response. We provide initial empirical support for the IPM of social exclusion, outline testable hypotheses stemming from the model, and discuss implications for novel ways to consider both societal stigma reduction and personalized intervention.

Can cognitive remediation therapy be delivered remotely? A review examining feasibility and acceptability of remote interventions.

Cognitive remediation (CR) is an effective treatment for schizophrenia. However, issues such as motivational impairments, geographic limitations, and limited availability of specialized clinicians to deliver CR, can impede dissemination. Remote delivery of CR provides an opportunity to implement CR on a broader scale. While empirical support for the efficacy of in-person CR is robust, the evidence-base for virtual delivery of CR is limited. Thus, in this review we aimed to evaluate the feasibility and acceptability of remote CR interventions. Nine (n = 847) fully remote and one hybrid CR intervention were included in this review. Attrition rates for remote CR were generally high compared to control groups. Acceptability rates for remote CR interventions were high and responses from caregivers were positive. Further research using more methodologically rigorous designs is required to evaluate appropriate adaptations for remote treatment and determine which populations may benefit more from remote CR.

Information seeking and health anxiety during the COVID-19 pandemic: The mediating role of catastrophic cognitions.

Cognitive-behavioural models of health anxiety propose a positive association between information seeking and health anxiety; however, it is unclear the extent to which cognitive mechanisms may mediate this relationship. Catastrophic cognitions are one type of cognition that may mediate this relationship, and the COVID-19 pandemic has presented an opportunity to examine these relationships within the context of a global health catastrophe. The current study investigated both cross-sectional (N = 797) and longitudinal (n = 395) relationships between information seeking, health anxiety and catastrophizing during the pandemic. Data were collected using Amazon Mechanical Turk during April and May 2020. Information seeking and health anxiety were positively associated both cross-sectionally and longitudinally (rs = .25-.29). Catastrophic cognitions significantly mediated the relationship between information seeking and health anxiety both cross-sectionally and longitudinally. Developing effective methods of reducing information seeking and catastrophizing may serve to reduce health anxiety during global health crises such as the current pandemic.

Predictors and consequences of loneliness during the COVID-19 Pandemic.

The COVID-19 pandemic has created a global context in which social isolation has become normative in order to reduce the risk of COVID-19 transmission. As a result of social distancing policies, the risk for loneliness and associated decline in quality of life has increased. The current study examined factors associated with loneliness and quality of life during the COVID-19 pandemic cross-sectionally (n = 797) and longitudinally (n = 395). Older age and larger social network size were associated with less loneliness, whereas having multiple physical or mental health diagnoses was associated with greater loneliness. Greater virtual social contact was also associated with increased loneliness. Greater loneliness was associated with all domains of quality of life both cross-sectionally and longitudinally. Understanding factors associated with loneliness is critical to developing effective strategies at reducing loneliness and improving quality of life during the pandemic. Contrary to popular perceptions, older age was associated with less loneliness and more virtual social contact was associated with more loneliness. Thus, it may be prudent to deemphasize virtual social contact in public campaigns and to emphasize safe methods of interacting in person.

COVID-19 conspiracy beliefs: Relations with anxiety, quality of life, and schemas.

BACKGROUND: The COVID-19 pandemic has produced a worldwide mental health crisis. Conspiracy beliefs regarding the origin of COVID-19 are prevalent, however, mental health consequences and factors associated with the likelihood of endorsing COVID-19 conspiracy theories have not yet been examined. The current study examined predictors and mental health consequences of conspiracy beliefs. METHODS: Participants in Canada and the United States were surveyed via Amazon Mechanical Turk in April 2020 (N = 797), approximately one month after the WHO declared COVID-19 a pandemic, and again in May 2020 (N = 395). RESULTS: Approximately half of the sample (49.7%) believed at least one conspiracy theory. Greater Covid-19 conspiracy beliefs were associated with more anxiety at follow up but not quality of life. Religiosity/spirituality, not knowing someone at high-risk for COVID-19, and non-white ethnicity were associated with greater conspiracy beliefs. Lower positive other-schemas were associated with greater conspiracy beliefs, only at low and moderate levels of positive self-schemas. CONCLUSIONS: There is substantial conspiracy belief endorsement during the COVID-19 pandemic and conspiracy beliefs are associated with anxiety, but not quality of life. Positive self-schemas protect against believing conspiracy theories and interventions to increase positive self-schemas may be effective to reduce the negative effects of conspiracy beliefs.

Stigma towards individuals with schizophrenia: Examining the effects of negative symptoms and diagnosis awareness on preference for social distance.

Social exclusion towards individuals with schizophrenia can occur as a result of stigmatizing attitudes towards the diagnosis or as a response to observing atypical behaviours resulting from symptoms. The present study examined social exclusion towards schizophrenia as a function of diagnosis awareness and presence of negative symptoms. 64 healthy participants watched four different videos of confederates who were either labelled / not labelled with schizophrenia and displayed / did not display negative symptoms. Participants ranked their preference for social interaction with individuals in ten different activities and were told that they would complete the activities based on their rankings. A significant interaction between label and symptoms was found as knowledge of diagnosis increased desire for social distance if symptoms were absent and decreased desire for social distance if symptoms were present. A main effect of symptom presence was also found as participants displayed greater desire to complete activities with individuals not displaying symptoms than participants displaying symptoms but there was no effect of diagnostic label. Social exclusion appears to be dependent on both presence of negative symptoms and knowledge of diagnosis. It may be useful to focus on increasing public acceptance of specific symptom presentations in public mental health campaigns.

Attention bias modification in depression: A randomized trial using a novel, reward-based, eye-tracking approach.

BACKGROUND AND OBJECTIVES: Biased attention to negative information is a mechanism for risk and relapse in depression. Attentional bias modification (ABM) paradigms manipulate attention away from negative information to reduce this bias. ABM results have been mixed due to inconsistent methodologies and stimuli design. This randomized controlled trial used a novel approach to modifying attentional bias. METHODS: An eye tracker manipulated stimuli in response to participants' fixations to preferentially reward attention to positive stimuli by obscuring or enhancing image quality of negative and positive stimuli, respectively. Participants with major depressive disorder completed three 35-min sessions of active (n = 20) or sham (n = 20) ABM training. Attentional bias, memory for emotional words, and mood were assessed pre- and post-training. RESULTS: Training reduced negative attentional bias; relative to sham, active training participants focused significantly more on positive compared to negative stimuli in a free-viewing eye-tracker task (p = .038, ηp2 = 0.109) and, at trend, disengaged from sad information more quickly in a computerized task (p = .052, ηp2 = 0.096). Active training participants remembered more happy than sad words in an emotional word learning task, indicating a distal transfer of training to emotional memory (p = .036, ηp2 = 0.11). Training did not significantly affect mood in the one-week trial. LIMITATIONS: Future studies should build on this proof-of-principle study with larger sample sizes and more intensive treatment to explore which mechanisms of training may lead to improvements in mood. CONCLUSIONS: Attention biases in depression are modifiable through reward-based, eye-tracking training. These data suggest generalizability of training to other cognitive faculties - recall for affective information.

Relationships between psychiatric symptoms, functioning and personal recovery in psychosis.

BACKGROUND: Recovery from psychosis is increasingly being viewed as a combination of symptomatic, functional, and personal recovery. Negative and depressive symptoms have been linked to community functioning, and negative affect has been linked to personal recovery. The current study examines differential associations of symptoms with functional and personal recovery, and the interaction of cognitive and emotional components of psychotic experiences in predicting recovery. METHODS: Baseline data from four studies of individuals with schizophrenia-spectrum disorders were amalgamated for the current analyses. All studies utilized the Positive and Negative Syndrome Scale, Psychotic Symptom Rating Scale, Personal and Social Performance Scale, and the Questionnaire about the Process of Recovery. RESULTS: 971 individuals participated across the four studies. Affective symptoms were most strongly associated with personal recovery, accounting for 30% of the variance in personal recovery and only 2% of the variance in objective functioning. Negative and disorganized symptoms were related to both functional and personal recovery, excitement symptoms were only related to personal recovery, and broad measures of positive symptoms were not associated with either functional or personal recovery. Cognitive interpretations of psychotic experiences were more strongly related to objective functioning, and emotional components of psychotic experiences were more strongly related to personal recovery; cognitive interpretations moderated the relationship between emotional characteristics and recovery measures. CONCLUSIONS: Functional and personal recovery are distinct domains of recovery with differential relationships to symptomatology. Interventions that target cognitive interpretations of psychotic experiences and negative affect may be more likely to affect multiple domains of recovery.

An examination of the moderating effects of neurophysiology on treatment outcomes from cognitive training in schizophrenia-spectrum disorders.

BACKGROUND: Impairments in neurocognition and community functioning are core features of schizophrenia and cognitive training techniques have been developed with the aim of improving these impairments. While cognitive training has produced reliable improvements in neurocognition and functioning, little is known about factors that moderate treatment response. Electroencephalographic (EEG) measures provide a neurophysiological indicator of cognitive functions that may moderate treatment outcomes from cognitive training. METHODS: Data from a clinical trial comparing two cognitive training approaches in schizophrenia-spectrum disorders were utilized in the current report. Cluster analysis was conducted to identify participant clusters based on baseline P300, mismatch negativity (MMN), and theta power during an n-back task, and the EEG measures were also examined as continuous predictors of treatment response. RESULTS: Three clusters were identified based on the baseline EEG variables; however, there were no significant differences in treatment response across the three clusters. Higher P300 amplitude and theta power during the n-back at baseline were significantly associated with greater improvements in a cognitive composite score post-treatment. None of the EEG measures were significantly associated with treatment outcomes in specific cognitive domains or community functioning. Change in EEG measures from baseline to post-treatment was not significantly associated with durability of cognitive or functional change at 12-week follow-up. CONCLUSIONS: Clusters derived from the EEG measures were not significantly associated with either neurocognitive or functional outcomes. P300 and n-back theta power may be associated with learning-related processes, which are important for acquisition and retention of skills during cognitive training programs. Future research should aim to identify at an individual level who is likely to respond to specific forms of cognitive enhancement.

Motivation and engagement during cognitive training for schizophrenia spectrum disorders.

BACKGROUND: Motivation and engagement are important factors associated with therapeutic outcomes in cognitive training for schizophrenia. The goals of the present report were to examine relations between objective treatment engagement (number of sessions attended, amount of homework completed) and self-reported motivation (intrinsic motivation and perceived competence to complete cognitive training) with neurocognitive and functional outcomes from cognitive training. METHODS: Data from a clinical trial comparing two cognitive training approaches in schizophrenia-spectrum disorders were utilized in the current report (n = 38). Relations were examined between baseline intrinsic motivation, perceived competence, homework completion, and session attendance with improvements in neurocognition, functional competence, and community functioning. RESULTS: Number of sessions attended (r = 0.38) and time doing homework (r = 0.51) were significantly associated with improvements in neurocognition. Homework completion was associated with change in community functioning at a trend-level (r = 0.30). Older age was associated with greater treatment engagement (ß = 0.37) and male biological sex was associated with greater self-reported motivation (ß = 0.43). Homework completion significantly mediated the relationship between session attendance and neurocognitive treatment outcomes. CONCLUSIONS: Objective measures of treatment engagement were better predictors of treatment outcomes than subjective measures of motivation. Homework completion was most strongly related to treatment outcomes and mediated the relationship between session attendance and treatment outcomes, suggesting continued engagement with cognitive stimulation may be an especially important component of cognitive remediation programs. Future research should examine methods to improve homework completion and session attendance to maximize therapeutic outcomes.

Global Processing Makes People Happier Than Local Processing.

Past research demonstrates that mood can influence level of perceptual processing (global vs. local). The present research shows that level of perceptual processing can influence mood as well. In four studies, we manipulated people's level of perceptual processing using a Navon letter task (Study 1), landscape scenery (Study 2), and Google Maps Street View images (Studies 3 and 4). Results from these studies and a meta-analysis support the conclusion that global processing results in higher happiness than local processing. In conjunction with previous findings that mood affects level of cognitive processing, these results suggest that the link between level of processing and mood may be reciprocal and bidirectional.

A Randomized Controlled Trial of Executive Functioning Training Compared With Perceptual Training for Schizophrenia Spectrum Disorders: Effects on Neurophysiology, Neurocognition, and Functioning.

OBJECTIVE: Cognitive remediation is an efficacious treatment for schizophrenia. However, different theoretical approaches have developed without any studies to directly compare them. This is the first study to compare the two dominant approaches to cognitive remediation (training of executive skills and training of perceptual skills) and employed the broadest assessment battery in the literature to date. METHODS: Outpatients with schizophrenia spectrum disorders were randomly assigned to receive either executive training or perceptual training. Electrophysiological activity, neurocognition, functional competence, case manager-rated community functioning, clinical symptoms, and self-report measures were assessed at baseline, immediately after treatment, and at a 12-week posttreatment follow-up assessment. RESULTS: Perceptual training improved the EEG mismatch negativity significantly more than executive training immediately after treatment, although the effect did not persist at the 12-week follow-up. At the follow-up, executive training improved theta power during an n-back task, neurocognition, functional competence, and case manager-rated community functioning to a greater extent than perceptual training. These effects were not observed immediately after treatment. CONCLUSIONS: Both perceptual training and executive training improved neurophysiological mechanisms specific to their domains of intervention, although only executive training resulted in improvement in neurocognition and functioning. Improvements in favor of executive training did not appear immediately after treatment but emerged 12 weeks after the end of active treatment. Thus, short-term intervention targeting higher-order cognitive functions may prime further cognitive and functional improvement.

Brief executive function training for individuals with severe mental illness: Effects on EEG synchronization and executive functioning.

BACKGROUND: Executive Functioning (EF) is an important factor for community functioning for people with severe mental illness. Cognitive remediation programs often improve EF, but do so by using multiple therapeutic techniques. Little is known regarding how individual treatment elements promote cognitive improvement. Oscillatory brain activity is a potential neurophysiological mechanism that may change as a result of targeted training on computerized exercises. The current study aimed to examine the effects of a brief EF training program on EEG and neurocognitive measures. METHODS: 25 people with severe mental illness were randomized to either 2weeks of computerized EF training or control training. Training consisted of 1h training sessions 3 times per week and 40min of daily home training. Assessments examined EEG theta and alpha band oscillatory power during EF tasks and neurocognitive measures of EF. RESULTS: EF training resulted in greater frontal theta power and reduced posterior alpha power during computerized EF tasks than control training. Power in the alpha frequency band over frontal electrode sites did not significantly differ between the two groups as a result of training. Additionally, participants in the EF training experienced significantly greater improvement in EF ability as measured by neurocognitive tests than the control condition. CONCLUSIONS: Two weeks of EF training is sufficient to produce neurophysiological and neurocognitive change. Frontal theta power and posterior alpha power may be important neurophysiological markers to consider in cognitive remediation studies, and the addition of a brief executive function training procedure to other psychosocial interventions is worth examining.