Hostname: page-component-6587cd75c8-67gbf Total loading time: 0 Render date: 2025-04-24T01:38:20.964Z Has data issue: false hasContentIssue false
  • English
  • Français

Impaired integration of disambiguating evidence in delusional schizophrenia patients

Published online by Cambridge University Press:  27 February 2014

N. Sanford ,
R. Veckenstedt ,
S. Moritz ,
R. P. Balzan  and
T. S. Woodward
N. Sanford
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada BC Mental Health and Addiction Research Institute, Vancouver, BC, Canada
R. Veckenstedt
Affiliation:
Department of Psychiatry and Psychotherapy, Clinical Neuropsychology, University Medical Centre Hamburg-Eppendorf, Germany
S. Moritz
Affiliation:
Department of Psychiatry and Psychotherapy, Clinical Neuropsychology, University Medical Centre Hamburg-Eppendorf, Germany
R. P. Balzan
Affiliation:
School of Psychology, Flinders University, Australia
T. S. Woodward*
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada BC Mental Health and Addiction Research Institute, Vancouver, BC, Canada
*
* Address for correspondence: T. S. Woodward, Ph.D., Room A3-A116, BC Mental Health and Addiction Research Institute, Translational Research Building, 3rd Floor, 938 W. 28th Avenue, Vancouver, BC, CanadaV5Z 4H4. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

It has been previously demonstrated that a cognitive bias against disconfirmatory evidence (BADE) is associated with delusions. However, small samples of delusional patients, reliance on difference scores and choice of comparison groups may have hampered the reliability of these results. In the present study we aimed to improve on this methodology with a recent version of the BADE task, and compare larger groups of schizophrenia patients with/without delusions to obsessive–compulsive disorder (OCD) patients, a population with persistent and possibly bizarre beliefs without psychosis.

Method

A component analysis was used to identify cognitive operations underlying the BADE task, and how they differ across four groups of participants: (1) high-delusional schizophrenia, (2) low-delusional schizophrenia, (3) OCD patients and (4) non-psychiatric controls.

Results

As in past studies, two components emerged and were labelled ‘evidence integration’ (the degree to which disambiguating information has been integrated) and ‘conservatism’ (reduced willingness to provide high plausibility ratings when justified), and only evidence integration differed between severely delusional patients and the other groups, reflecting delusional subjects giving higher ratings for disconfirmed interpretations and lower ratings for confirmed interpretations.

Conclusions

These data support the finding that a reduced willingness to adjust beliefs when confronted with disconfirming evidence may be a cognitive underpinning of delusions specifically, rather than obsessive beliefs or other aspects of psychosis such as hallucinations, and illustrates a cognitive process that may underlie maintenance of delusions in the face of counter-evidence. This supports the possibility of the BADE operation being a useful target in cognitive-based therapies for delusions.

Keywords

Bias against disconfirmatory evidence (BADE)delusionsobsessive-compulsive disorder (OCD)reasoningschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 13 , October 2014 , pp. 2729 - 2738
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Anastasi, A, Urbina, S (1997). Psychological Testing. Prentice Hall: Upper Saddle River, NJ.Google Scholar
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. DSM-IV-TR. American Psychiatric Association: Washington, DC.Google Scholar
Balzan, RP, Delfabbro, PH, Galletly, C, Woodward, TS (2012). Reasoning heuristics across the psychosis continuum: the contribution of hypersalient evidence-hypothesis matches. Cognitive Neuropsychiatry 17, 431–450.Google Scholar
Balzan, RP, Delfabbro, PH, Galletly, CA, Woodward, TS (2013). Confirmation biases across the psychosis continuum: the contribution of hypersalient evidence-hypothesis matches. British Journal of Clinical Psychology 52, 53–69.Google Scholar
Bandalos, D, Boehm-Kaufman, M (2008). Four common misconceptions in exploratory factor analysis. In Statistical and Methodological Myths and Urban Legends: Doctrine, Verity and Fable in the Organizational and Social Sciences (ed. Lance, C. E. and Vandenberg, R. J.), pp. 61–87. Taylor & Francis Group: New York, NY.Google Scholar
Barlow, DH (2002). Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic. Guilford Press: New York.Google Scholar
Barrett, SL, Mulholland, CC, Cooper, SJ, Rushe, TM (2009). Patterns of neurocognitive impairment in first-episode bipolar disorder and schizophrenia. British Journal of Psychiatry 195, 67–72.Google Scholar
Buchy, L, Woodward, TS, Liotti, M (2007). A cognitive bias against disconfirmatory evidence (BADE) is associated with schizotypal traits. Schizophrenia Research 90, 334–337.Google Scholar
Byerly, MJ, Nakonezny, PA, Lescouflair, E (2007). Antipsychotic medication adherence in schizophrenia. Psychiatric Clinics of North America 30, 437–452.Google Scholar
Cliff, N (1988). The eigenvalues-greater-than-one rule and the reliability of components. Psychological Bulletin 103, 276–279.CrossRefGoogle Scholar
Colbert, S, Peters, ER, Garety, PA (2010). Delusions and belief flexibility in psychosis. Psychology and Psychotherapy 83, 45–57.Google Scholar
Elkis, H (2007). Treatment-resistant schizophrenia. Psychiatric Clinics of North America 30, 511–533.CrossRefGoogle ScholarPubMed
Fine, C, Gardner, M, Craigie, J, Gold, I (2007). Hopping, skipping or jumping to conclusions? Clarifying the role of the JTC bias in delusions. Cognitive Neuropsychiatry 12, 46–77.Google Scholar
Freeman, D, Garety, PA, Kuipers, E, Fowler, D, Bebbington, PE (2002). A cognitive model of persecutory delusions. British Journal of Clinical Psychology 41, 331–347.Google Scholar
Freeman, D, Pugh, K, Garety, PA (2008). Jumping to conclusions and paranoid ideation in the general population. Schizophrenia Research 102, 254–260.Google Scholar
Garety, PA, Hemsley, DR, Wessely, S (1991). Reasoning in deluded schizophrenic and paranoid patients: biases in performance on a probabilistic inference task. Journal of Nervous and Mental Disease 179, 194–201.CrossRefGoogle ScholarPubMed
Garety, PA, Kuipers, E, Fowler, D, Freeman, D, Bebbington, PE (2001). A cognitive model of the positive symptoms of psychosis. Psychological Medicine 31, 189–195.Google Scholar
Hayton, JC, Allen, DG, Scarpello, V (2004). Factor retention decisions in exploratory factor analysis: a tutorial on parallel analysis. Organizational Research Methods 7, 191–205.Google Scholar
Jackson, DA (1993). Stopping rules in principal components analysis: a comparison of heuristical and statistical approaches. Ecology 74, 2204–2214.Google Scholar
Kay, SR, Opler, LA, Lindenmayer, JP (1989). The Positive and Negative Syndrome Scale (PANSS): rationale and standardisation. British Journal of Psychiatry 155, 59–67.Google Scholar
Leucht, S, Arbter, D, Engel, RR, Kissling, W, Davis, JM (2009). How effective are second-generation antipsychotic drugs? A meta-analysis of placebo-controlled trials. Molecular Psychiatry 14, 429–447.CrossRefGoogle ScholarPubMed
Liddle, PF (1987). The symptoms of chronic schizophrenia: a re-examination of the positive-negative dichotomy. British Journal of Psychiatry 151, 145–151.Google Scholar
Loong, J (1991). Wisconsin Card Sorting Test – IBM Version. Wang Neuropsychological Laboratories: San Luis Obispo, CA.Google Scholar
Menon, M, Quilty, LC, Zawadzki, JA, Woodward, TS, Sokolowski, HM, Boon, HS, Wong, AH (2013). The role of cognitive biases and personality variables in subclinical delusional ideation. Cognitive Neuropsychiatry 18, 208–218.Google Scholar
Moritz, S, Veckenstedt, R, Randjbar, S, Vitzthum, F, Woodward, TS (2011). Antipsychotic treatment beyond antipsychotics: metacognitive intervention for schizophrenia patients improves delusional symptoms. Psychological Medicine 41, 1823–1832.Google Scholar
Moritz, S, Woodward, TS (2004). Plausibility judgment in schizophrenic patients: evidence for a liberal acceptance bias. German Journal of Psychiatry 7, 66–74.Google Scholar
Moritz, S, Woodward, TS (2006 a). A generalized bias against disconfirmatory evidence in schizophrenia. Psychiatry Research 142, 157–165.Google Scholar
Moritz, S, Woodward, TS (2006 b). Metacognitive control over false memories: a key determinant of delusional thinking. Current Psychiatry Reports 8, 184–190.Google Scholar
Moritz, S, Woodward, TS, Jelinek, L, Klinge, R (2008). Memory and metamemory in schizophrenia: a liberal acceptance account of psychosis. Psychological Medicine 38, 825–832.Google Scholar
Moritz, S, Woodward, TS, Lambert, M (2007). Under what circumstances do patients with schizophrenia jump to conclusions? A liberal acceptance account. British Journal of Clinical Psychology 46, 127–137.Google Scholar
Reitan, RM, Wolfson, D (1985). The Halstead-Reitan Neuropsychological Test Battery. Neuropsychological Press: Tucson, AZ.Google Scholar
Riccaboni, R, Fresi, F, Bosia, M, Buonocore, M, Leiba, N, Smeraldi, E, Cavallaro, R (2012). Patterns of evidence integration in schizophrenia and delusion. Psychiatry Research 200, 108–114.Google Scholar
Sanford, N, Lecomte, T, Leclerc, C, Wykes, T, Woodward, TS (2013). Change in jumping to conclusions linked to change in delusions in early psychosis. Schizophrenia Research 147, 207–208.Google Scholar
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R, Dunbar, GC (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59, 22–33.Google ScholarPubMed
So, S, Garety, PA, Peters, ER, Kapur, S (2010). Do antipsychotics improve reasoning biases? A review. Psychosomatic Medicine 72, 681–693.Google Scholar
Speechley, WJ, Ngan, ET-C, Moritz, S, Woodward, TS (2012). Impaired evidence integration and delusions in schizophrenia. Journal of Experimental Psychopathology 3, 688–701.Google Scholar
Speechley, WJ, Whitman, JC, Woodward, TS (2010). The contribution of hypersalience to the ‘jumping to conclusions’ bias associated with delusions in schizophrenia. Journal of Psychiatry and Neuroscience 35, 7–17.CrossRefGoogle Scholar
van der Gaag, M, Hoffman, T, Remijsen, M, Hijman, R, de Haan, L, van Meijel, B, van Harten, PN, Valmaggia, L, de Hert, M, Cuijpers, A, Wiersma, D (2006). The five-factor model of the Positive and Negative Syndrome Scale II: a ten-fold cross-validation of a revised model. Schizophrenia Research 85, 280–287.Google Scholar
Veckenstedt, R, Randjbar, S, Vitzthum, F, Hottenrott, B, Woodward, TS, Moritz, S (2011). Incorrigibility, jumping to conclusions, and decision threshold in schizophrenia. Cognitive Neuropsychiatry 16, 174–192.Google Scholar
Woodward, TS, Buchy, L, Moritz, S, Liotti, M (2007). A bias against disconfirmatory evidence is associated with delusion proneness in a nonclinical sample. Schizophrenia Bulletin 33, 1023–1028.Google Scholar
Woodward, TS, Jung, K, Hwang, H, Yin, J, Taylor, L, Menon, M, Peters, E, Kuipers, E, Waters, F, Lecomte, T, Sommer, I, Daalman, K, van Lutterveld, R, Hubl, D, Kindler, J, Homan, P, Badcock, JC, Chhabra, S, Cella, M, Keedy, S, Allen, P, Mechelli, A, Preti, A, Siddi, S, Erickson, D (in press). Symptom dimensions of the Psychotic Symptom Rating Scales (PSYRATS) in psychosis: a multi-site study. Schizophrenia Bulletin.Google Scholar
Woodward, TS, Jung, K, Smith, G, Hwang, H, Barr, AM, Procyshyn, RM, Flynn, S, van der Gaag, M, Honer, WG (2013). Symptom changes in five dimensions of the Positive and Negative Syndrome Scales in refractory psychosis. European Archives of Psychiatry and Clinical Neuroscience. Published online: 15 10 2013 . doi:10.1007/s00406-13-460-x.Google Scholar
Woodward, TS, Moritz, S, Cuttler, C, Whitman, J (2006). The contribution of a cognitive bias against disconfirmatory evidence (BADE) to delusions in schizophrenia. Journal of Clinical and Experimental Neuropsychology 28, 605–617.Google Scholar
Woodward, TS, Moritz, S, Menon, M, Klinge, R (2008). Belief inflexibility in schizophrenia. Cognitive Neuropsychiatry 13, 267–277.Google Scholar
Woodward, TS, Munz, M, Leclerc, C, Lecomte, T (2009). Change in delusions is associated with change in ‘jumping to conclusions’. Psychiatry Research 170, 124–127.Google Scholar
Woodward, TS, Ruff, CC, Thornton, AE, Moritz, S, Liddle, P (2003). Methodological considerations regarding the association of Stroop and verbal fluency performance with the symptoms of schizophrenia. Schizophrenia Research 61, 207–214.Google Scholar
Woodward, TS, Thornton, AE, Ruff, CC, Moritz, S, Liddle, PF (2004). Material-specific episodic memory associates of the psychomotor poverty syndrome in schizophrenia. Cognitive Neuropsychiatry 9, 213–227.Google Scholar