Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-19T10:53:11.078Z Has data issue: false hasContentIssue false
  • English
  • Français

Decision making under uncertainty and mood induction: further evidence for liberal acceptance in schizophrenia

Published online by Cambridge University Press:  11 May 2009

S. Moritz ,
R. Veckenstedt ,
S. Randjbar ,
B. Hottenrott ,
T. S. Woodward ,
F. V. v. Eckstaedt ,
C. Schmidt ,
L. Jelinek  and
T. M. Lincoln
S. Moritz*
Affiliation:
University Medical Center Hamburg-Eppendorf, Hospital for Psychiatry and Psychotherapy, Hamburg, Germany
R. Veckenstedt
Affiliation:
University Medical Center Hamburg-Eppendorf, Hospital for Psychiatry and Psychotherapy, Hamburg, Germany
S. Randjbar
Affiliation:
University Medical Center Hamburg-Eppendorf, Hospital for Psychiatry and Psychotherapy, Hamburg, Germany
B. Hottenrott
Affiliation:
University Medical Center Hamburg-Eppendorf, Hospital for Psychiatry and Psychotherapy, Hamburg, Germany
T. S. Woodward
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada Department of Research, BC Mental Health and Addictions Research Institute, Vancouver, Canada
F. V. v. Eckstaedt
Affiliation:
University Medical Center Hamburg-Eppendorf, Hospital for Psychiatry and Psychotherapy, Hamburg, Germany
C. Schmidt
Affiliation:
University Medical Center Hamburg-Eppendorf, Hospital for Psychiatry and Psychotherapy, Hamburg, Germany
L. Jelinek
Affiliation:
University Medical Center Hamburg-Eppendorf, Hospital for Psychiatry and Psychotherapy, Hamburg, Germany
T. M. Lincoln
Affiliation:
Department of Psychology, Philipps-University Marburg, AG Clinical Psychology and Psychotherapy, Marburg, Germany
*
*Address for correspondence: Professor S. Moritz, University Medical Center Hamburg-Eppendorf, Hospital for Psychiatry and Psychotherapy, Hamburg, Germany. (Email: moritz@uke.uni-hamburg.de)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Cognitive biases, especially jumping to conclusions (JTC), are ascribed a vital role in the pathogenesis of schizophrenia. This study set out to explore motivational factors for JTC using a newly developed paradigm.

Method

Twenty-seven schizophrenia patients and 32 healthy controls were shown 15 classical paintings, divided into three blocks. Four alternative titles (one correct and three lure titles) had to be appraised according to plausibility (0–10). Optionally, participants could decide for one option and reject one or more alternatives. In random order across blocks, anxiety-evoking music, happy music or no music was played in the background.

Results

Patients with schizophrenia, particularly those with delusions, made more decisions than healthy subjects. In line with the liberal acceptance (LA) account of schizophrenia, the decision threshold was significantly lowered in patients relative to controls. Patients were also more prone than healthy controls to making a decision when the distance between the first and second best alternative was close. Furthermore, implausible alternatives were judged as significantly more plausible by patients. Anxiety-evoking music resulted in more decisions in currently deluded patients relative to non-deluded patients and healthy controls.

Conclusions

The results confirm predictions derived from the LA account and assert that schizophrenia patients decide hastily under conditions of continued uncertainty. The fact that mood induction did not exert an overall effect could be due to the explicit nature of the manipulation, which might have evoked strategies to counteract their influence.

Keywords

Cognitiondecision makingjumping to conclusionsmoodmood inductionschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 11 , November 2009 , pp. 1821 - 1829
Copyright
Copyright © Cambridge University Press 2009

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.)

References

Aronson, E, Wilson, TD, Akert, RM, Fehr, B (2004). Social Psychology: Second Canadian Edition. Pearson Prentice Hall: Toronto.Google Scholar
Bechdolf, A, Phillips, LJ, Francey, SM, Leicester, S, Morrison, AP, Veith, V, Klosterkotter, J, McGorry, PD (2006). Recent approaches to psychological interventions for people at risk of psychosis. European Archives of Psychiatry and Clinical Neuroscience 256, 159–173.CrossRefGoogle ScholarPubMed
Bell, V, Halligan, PW, Ellis, HD (2006). Explaining delusions: a cognitive perspective. Trends in Cognitive Sciences 10, 219–226.CrossRefGoogle ScholarPubMed
Bentall, RP, Corcoran, R, Howard, R, Blackwood, N, Kinderman, P (2001). Persecutory delusions: a review and theoretical integration. Clinical Psychology Review 21, 1143–1192.CrossRefGoogle ScholarPubMed
Bentall, RP, Kaney, S (2005). Attributional lability in depression and paranoia. British Journal of Clinical Psychology 44, 475–488.CrossRefGoogle Scholar
Bentall, RP, Kinderman, P, Kaney, S (1994). The self, attributional processes and abnormal beliefs: towards a model of persecutory delusions. Behaviour Research and Therapy 32, 331–341.CrossRefGoogle Scholar
Bentall, RP, Swarbrick, R (2003). The best laid schemas of paranoid patients: autonomy, sociotropy and need for closure. Psychology and Psychotherapy 76, 163–171.CrossRefGoogle ScholarPubMed
Bouhuys, AL, Bloem, GM, Groothuis, TG (1995). Induction of depressed and elated mood by music influences the perception of facial emotional expressions in healthy subjects. Journal of Affective Disorders 33, 215–226.CrossRefGoogle ScholarPubMed
Broome, MR, Johns, LC, Valli, I, Woolley, JB, Tabraham, P, Brett, C, Valmaggia, L, Peters, E, Garety, PA, McGuire, PK (2007). Delusion formation and reasoning biases in those at clinical high risk for psychosis. British Journal of Psychiatry 51 (Suppl.), s38–42.CrossRefGoogle ScholarPubMed
Colbert, SM, Peters, ER (2002). Need for closure and jumping-to-conclusions in delusion-prone individuals. Journal of Nervous and Mental Disease 190, 27–31.CrossRefGoogle ScholarPubMed
Colbert, SM, Peters, ER, Garety, PA (2006). Need for closure and anxiety in delusions: a longitudinal investigation in early psychosis. Behaviour Research and Therapy 44, 1385–1396.CrossRefGoogle ScholarPubMed
Combs, DR, Adams, SD, Penn, DL, Roberts, D, Tiegreen, J, Stem, P (2007). Social Cognition and Interaction Training (SCIT) for inpatients with schizophrenia spectrum disorders: preliminary findings. Schizophrenia Research 91, 112–116.CrossRefGoogle ScholarPubMed
Dudley, RE, John, CH, Young, AW, Over, DE (1997). Normal and abnormal reasoning in people with delusions. British Journal of Clinical Psychology 36, 243–258.CrossRefGoogle ScholarPubMed
Dutton, DG, Aron, AP (1974). Some evidence for heightened sexual attraction under conditions of high anxiety. Journal of Personality and Social Psychology 30, 510–517.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.CrossRefGoogle ScholarPubMed
Freeman, D, Garety, P, Kuipers, E, Colbert, S, Jolley, S, Fowler, D, Dunn, G, Bebbington, P (2006). Delusions and decision-making style: use of the Need for Closure Scale. Behaviour Research and Therapy 44, 1147–1158.CrossRefGoogle ScholarPubMed
Garety, PA, Freeman, D (1999). Cognitive approaches to delusions: a critical review of theories and evidence. British Journal of Clinical Psychology 38, 113–154.CrossRefGoogle ScholarPubMed
Garety, PA, Freeman, D, Jolley, S, Dunn, G, Bebbington, PE, Fowler, DG, Kuipers, E, Dudley, R (2005). Reasoning, emotions, and delusional conviction in psychosis. Journal of Abnormal Psychology 114, 373–384.CrossRefGoogle ScholarPubMed
Huq, SF, Garety, PA, Hemsley, DR (1988). Probabilistic judgements in deluded and non-deluded subjects. Quarterly Journal of Experimental Psychology A 40, 801–812.CrossRefGoogle ScholarPubMed
Kay, SR, Opler, LA, Lindenmayer, J-P (1989). The positive and negative syndrome scale (PANSS). Rationale and standardisation. British Journal of Psychiatry 155 (Suppl. 7), 59–65.CrossRefGoogle Scholar
Kinderman, P, Bentall, RP (1997). Causal attributions in paranoia and depression: internal, personal, and situational attributions for negative events. Journal of Abnormal Psychology 106, 341–345.CrossRefGoogle ScholarPubMed
Kinderman, P, Bentall, RP (2000). Self-discrepancies and causal attributions: studies of hypothesized relationships. British Journal of Clinical Psychology 39, 255–273.CrossRefGoogle ScholarPubMed
Kinderman, P, Kaney, S, Morley, S, Bentall, RP (1992). Paranoia and the defensive attributional style: deluded and depressed patients' attributions about their own attributions. British Journal of Medical Psychology 65, 371–383.CrossRefGoogle ScholarPubMed
Lieberman, JA, Stroup, TS, McEvoy, JP, Swartz, MS, Rosenheck, RA, Perkins, DO, Keefe, RS, Davis, SM, Davis, CE, Lebowitz, BD, Severe, J, Hsiao, JK (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine 353, 1209–1223.CrossRefGoogle ScholarPubMed
Lincoln, TM, Lange, J, Burau, J, Exner, C, Moritz, S (in press). The effect of state anxiety on paranoid ideation and jumping to conclusions. An experimental investigation. Schizophrenia Bulletin.Google Scholar
Lincoln, TM, Peter, P, Schäfer, M, Moritz, S (2008 a). Impact of stress on paranoia: an experimental investigation of moderators and mediators. Psychological Medicine. Published online: 22 October 2008. doi:10.1017/S0033291708004613.Google ScholarPubMed
Lincoln, TM, Suttner, C, Nestoriuc, Y (2008 b). Effects of cognitive interventions for schizophrenia: a meta-analysis [in German]. Psychologische Rundschau 59, 217–232.CrossRefGoogle Scholar
McKay, R, Langdon, R, Coltheart, M (2007). Jumping to delusions? Paranoia, probabilistic reasoning, and need for closure. Cognitive Neuropsychiatry 12, 362–376.CrossRefGoogle ScholarPubMed
Moritz, S, Voigt, K, Arzola, GM, Otte, C (2008 a). When the half-full glass is appraised as half empty and memorised as completely empty: mood-congruent true and false recognition in depression is modulated by salience. Memory 16, 810–820.CrossRefGoogle ScholarPubMed
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 (2005). Jumping to conclusions in delusional and non-delusional schizophrenic patients. British Journal of Clinical Psychology 44, 193–207.CrossRefGoogle ScholarPubMed
Moritz, S, Woodward, TS (2006 a). The contribution of metamemory deficits to schizophrenia. Journal of Abnormal Psychology 115, 15–25.CrossRefGoogle ScholarPubMed
Moritz, S, Woodward, TS (2006 b). A generalized bias against disconfirmatory evidence in schizophrenia. Psychiatry Research 142, 157–165.CrossRefGoogle ScholarPubMed
Moritz, S, Woodward, TS (2007). Metacognitive training in schizophrenia: from basic research to knowledge translation and intervention. Current Opinion in Psychiatry 20, 619–625.CrossRefGoogle ScholarPubMed
Moritz, S, Woodward, TS, Burlon, M, Braus, DF, Andresen, B (2007 a). Attributional style in schizophrenia: evidence for a decreased sense of self-causation in currently paranoid patients. Cognitive Therapy and Research 31, 371–383.CrossRefGoogle Scholar
Moritz, S, Woodward, TS, Hausmann, D (2006). Incautious reasoning as a pathogenetic factor for the development of psychotic symptoms in schizophrenia. Schizophrenia Bulletin 32, 327–331.CrossRefGoogle ScholarPubMed
Moritz, S, Woodward, TS, Jelinek, L, Klinge, R (2008 b). Memory and metamemory in schizophrenia: a liberal acceptance account of psychosis. Psychological Medicine 38, 825–832.CrossRefGoogle ScholarPubMed
Moritz, S, Woodward, TS, Lambert, M (2007 b). Under what circumstances do patients with schizophrenia jump to conclusions? A liberal acceptance account. British Journal of Clinical Psychology 46, 127–137.CrossRefGoogle ScholarPubMed
Moritz, S, Woodward, TS; Metacognition Study Group (2007 c). Metacognitive Training for Patients with Schizophrenia (MCT). Manual. VanHam Campus Verlag: Hamburg.Google Scholar
Mujica-Parodi, LR, Corcoran, C, Greenberg, T, Sackheim, HA, Malaspina, D (2002). Are cognitive symptoms mediated by abnormalities in emotional arousal? CNS Spectrums 7, 58–60.CrossRefGoogle ScholarPubMed
Peters, E, Garety, P (2006). Cognitive functioning in delusions: a longitudinal analysis. Behaviour Research and Therapy 44, 481–514.CrossRefGoogle ScholarPubMed
Peters, ER, Thornton, P, Siksou, L, Linney, Y, MacCabe, JH (2008). Specificity of the jump-to-conclusions bias in deluded patients. British Journal of Clinical Psychology 47, 239–244.CrossRefGoogle ScholarPubMed
Roder, V, Mueller, DR, Mueser, KT, Brenner, HD (2006). Integrated psychological therapy (IPT) for schizophrenia: is it effective? Schizophrenia Bulletin 32 (Suppl. 1), S81–S93.CrossRefGoogle ScholarPubMed
Rollinson, R, Haig, C, Warner, R, Garety, P, Kuipers, E, Freeman, D, Bebbington, P, Dunn, G, Fowler, D (2007). The application of cognitive-behavioral therapy for psychosis in clinical and research settings. Psychiatric Services 58, 1297–1302.CrossRefGoogle ScholarPubMed
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R, Dunbar, G (1998). The MINI International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview. Journal of Clinical Psychiatry 59 (Suppl. 20), 22–33.Google ScholarPubMed
Tarrier, N (2005). Cognitive behaviour therapy for schizophrenia: a review of development, evidence and implementation. Psychotherapy and Psychosomatics 74, 136–144.CrossRefGoogle ScholarPubMed
Van Dael, F, Versmissen, D, Janssen, I, Myin-Germeys, I, van Os, J, Krabbendam, L (2006). Data gathering: biased in psychosis? Schizophrenia Bulletin 32, 341–351.CrossRefGoogle ScholarPubMed
van der Gaag, M (2006). A neuropsychiatric model of biological and psychological processes in the remission of delusions and auditory hallucinations. Schizophrenia Bulletin 32, S113–122.CrossRefGoogle ScholarPubMed
Voruganti, LP, Baker, LK, Awad, AG (2008). New generation antipsychotic drugs and compliance behaviour. Current Opinions in Psychiatry 21, 133–139.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle Scholar
Woodward, TS, Moritz, S, Chen, EY (2006 a). The contribution of a cognitive bias against disconfirmatory evidence (BADE) to delusions: a study in an Asian sample with first episode schizophrenia spectrum disorders. Schizophrenia Research 83, 297–298.CrossRefGoogle Scholar
Woodward, TS, Moritz, S, Cuttler, C, Whitman, JC (2006 b). The contribution of a cognitive bias against disconfirmatory evidence (BADE) to delusions in schizophrenia. Journal of Clinical and Experimental Neuropsychology 28, 605–617.CrossRefGoogle ScholarPubMed
Woodward, TS, Moritz, S, Menon, M, Klinge, R (2008). Belief inflexibility in schizophrenia. Cognitive Neuropsychiatry 13, 267–277.CrossRefGoogle ScholarPubMed
Ziegler, M, Rief, W, Werner, SM, Mehl, S, Lincoln, TM (2008). Hasty decision-making in a variety of tasks: does it contribute to the development of delusions? Psychological Psychotherapy 81, 237–245.CrossRefGoogle Scholar
Zimmermann, G, Favrod, J, Trieu, VH, Pomini, V (2005). The effect of cognitive behavioral treatment on the positive symptoms of schizophrenia spectrum disorders: a meta-analysis. Schizophrenia Research 77, 1–9.CrossRefGoogle ScholarPubMed