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.

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.

Public understanding of different kinds of voice-hearing experiences: Causal beliefs, perceptions of mental illness, and stigma.

OBJECTIVE: Voice-hearers tend to face a high degree of stigma that can impact subjective well-being and social functioning. However, researchers have hypothesized that the content of the voice-hearing experience and its cultural context are relevant to stigma responses. This study experimentally tested how perceptions of voice-hearing experiences change as a function of the voice's content and the perceiver's characteristics. METHOD: In total, 143 nonclinical participants were presented with vignettes describing people who heard voices that were attributed to either "God" or "Abraham Lincoln" and were described as either complimentary/encouraging or insulting/threatening. For each vignette, participants were asked about the likelihood that the voice-hearer had schizophrenia or mental illness. The Causal Beliefs Questionnaire was also delivered, with two new subscales added to test for belief in positive and negative religious causes for the voices. Stigma was measured by perceived dangerousness and desire for social distance. RESULTS: Voice-hearing experiences elicited greater stigma from participants who endorsed greater likelihood that the voice-hearer was mentally ill, greater belief in biological causes of the voice-hearing, negative religious causes, psychosocial causes, socialization causes, and causes related to personal responsibility. Endorsing positive religious causes was associated with lower stigma. Participants who were more religious were more likely to attribute voice-hearing experiences to negative religious causes (possession, lack of/misguided faith), except when the target was described as hearing the voice of God saying positive things. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The stigma of voice-hearing experiences depends upon what the voice is saying and perceptions about the cause of the voice. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Initial reliability and validity studies of the revised Treatment Services Review (TSR-6).

OBJECTIVE: Report the results of initial reliability and validity analyses for a revised Treatment Services Review (TSR-6) instrument which measures a broader range of services than the original TSR. METHOD: First, the number of services for a 28-day period was compared for three versions of the instrument varying in their reporting timeframes. Accordingly, four successive 7-day TSR-6s, two 14-day TSR-6s, or one 28-day TSR-6 were administered to more than 300 clients (30% women) in substance abuse treatment (SAT). Second, short-term (2-5 days) test-retest reliabilities were compared for an initial 7-, 14-, or 28-day version of the TSR-6. Third, test-retest reliabilities were compared when an initial in-person (IP) administration was followed by either IP or telephone (TEL) TSR-6 administration. Finally, preliminary discriminative validity analyses were conducted. RESULTS: Few differences in the quantity of services reported for a 4-week period were found with versions of the TSR-6 that used different timeframes. Also, comparisons of test-retest reliabilities for the different version of the TSR-6 revealed few differences. Test-retest reliabilities were generally comparable for the IP-TEL and IP-IP conditions. Finally, analyses demonstrated preliminary discriminative validity for the instrument when services for three distinctive forms of treatment: intensive outpatient, methadone and residential were compared. CONCLUSIONS: The findings of this study support the reliability and validity of the TSR-6 and suggest that a version with a 28-day reporting period can provide information comparable to that obtained with versions using shorter reporting periods.

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.

Jumping to conclusions and the continuum of delusional beliefs.

The present study examined the jumping to conclusions reasoning bias across the continuum of delusional ideation by investigating individuals with active delusions, delusion prone individuals, and non-delusion prone individuals. Neutral and highly self-referent probabilistic reasoning tasks were employed. Results indicated that individuals with delusions gathered significantly less information than delusion prone and non-delusion prone participants on both the neutral and self-referent tasks, (p<.001). Individuals with delusions made less accurate decisions than the delusion prone and non-delusion prone participants on both tasks (p<.001), yet were more confident about their decisions than were delusion prone and non-delusion prone participants on the self-referent task (p=.002). Those with delusions and those who were delusion prone reported higher confidence in their performance on the self-referent task than they did the neutral task (p=.02), indicating that high self-reference impacted information processing for individuals in both of these groups. The results are discussed in relation to previous research in the area of probabilistic reasoning and delusions.

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 delusions: the impact of discussion of the bias on the bias.

The present study was an investigation of the impact a brief intervention designed to raise awareness of a cognitive bias known to be robust for individuals with delusions has on the reasoning strategies of individuals with delusions. Individuals with delusions (n=57) were randomly assigned either to receive or not to receive a discussion of the jumping to conclusions bias and its pitfalls. Participants' performance on 3 reasoning trials - 1 emotionally neutral (beads) and 2 emotionally salient (self-referred survey words) - was then assessed; the number of stimuli participants requested before making a decision was evaluated to determine if the Jumping to Conclusions Discussion resulted in increased data gathering. There was no difference between groups (those who received and those who did not receive the Jumping to Conclusions Discussion) in terms of how many beads they gathered (p=.36), but there were significant differences on both reasoning trials of emotionally salient stimuli (p's<.05), such that participants who received the Jumping to Conclusions Discussion requested more stimuli on those tasks than individuals who did not receive the discussion. Thus, results suggest that discussion of the jumping to conclusions bias may impact the bias directly, at least for material that is emotional in nature. Results are discussed in terms of their relevance to cognitive behavioral therapies for psychosis and existing research on reasoning and delusions.

Cognitive insight in non-psychiatric individuals and individuals with psychosis: an examination using the Beck Cognitive Insight Scale.

An increasing number of studies have used the Beck Cognitive Insight Scale (BCIS) to understand the reasoning of individuals with psychotic disorders. Less is known, however, about "normal" levels of insight and how non-psychiatric individuals compare to those with psychosis. The present study examined the structure of the BCIS in a non-psychiatric population and made comparisons between the scores of non-psychiatric individuals and those with psychosis. Participants were 418 students at American universities and 93 outpatients at a VA Medical Center with SCID-confirmed diagnoses of schizophrenia or schizoaffective disorder. Confirmatory factor analysis supports the 2-factor, 15-item structure previously reported for the BCIS, with one factor called self reflectiveness and the other called self certainty. Reliability analyses suggest strong internal consistency and test-retest results. Further, the BCIS subscales and composite index reliably distinguished between non-psychiatric and patient groups, though receiver operating characteristic (ROC) analysis did not suggest a particular cutoff score for predicting patient status. These results suggest that the BCIS is a valid measure to use in a non-psychiatric population, and that it reliably distinguishes between non-psychiatric individuals and those with psychotic disorders.

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.