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Examining belief and confidence in schizophrenia

Published online by Cambridge University Press:  22 March 2013

D. W. Joyce
Cognition Schizophrenia and Imaging Laboratory, Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
B. B. Averbeck
Laboratory of Neuropsychology, NIMH/NIH, Bethesda, MD, USA
C. D. Frith
Wellcome Centre for Imaging Neuroscience, University College London, UK
S. S. Shergill*
Cognition Schizophrenia and Imaging Laboratory, Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
*Address for correspondence: Dr S. S Shergill, Cognition Schizophrenia and Imaging Laboratory, Institute of Psychiatry(PO Box 96), King's College London, De Crespigny Park, London SE5 8AF, UK. (Email:



People with psychoses often report fixed, delusional beliefs that are sustained even in the presence of unequivocal contrary evidence. Such delusional beliefs are the result of integrating new and old evidence inappropriately in forming a cognitive model. We propose and test a cognitive model of belief formation using experimental data from an interactive ‘Rock Paper Scissors’ (RPS) game.


Participants (33 controls and 27 people with schizophrenia) played a competitive, time-pressured interactive two-player game (RPS). Participants' behavior was modeled by a generative computational model using leaky integrator and temporal difference methods. This model describes how new and old evidence is integrated to form a playing strategy to beat the opponent and to provide a mechanism for reporting confidence in one's playing strategy to win against the opponent.


People with schizophrenia fail to appropriately model their opponent's play despite consistent (rather than random) patterns that can be exploited in the simulated opponent's play. This is manifest as a failure to weigh existing evidence appropriately against new evidence. Furthermore, participants with schizophrenia show a ‘jumping to conclusions’ (JTC) bias, reporting successful discovery of a winning strategy with insufficient evidence.


The model presented suggests two tentative mechanisms in delusional belief formation: (i) one for modeling patterns in other's behavior, where people with schizophrenia fail to use old evidence appropriately, and (ii) a metacognitive mechanism for ‘confidence’ in such beliefs, where people with schizophrenia overweight recent reward history in deciding on the value of beliefs about the opponent.

Original Articles
Copyright © Cambridge University Press 2013 

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APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn.American Psychiatric Association: Washington, DC.Google Scholar
Bacon, E, Izaute, M (2009). Metacognition in schizophrenia: processes underlying patients’ reflections on their own episodic memory. Biological Psychiatry 66, 10311037.CrossRefGoogle ScholarPubMed
Barch, CM, Ceaser, A (2012). Cognition in schizophrenia: core psychological and neural mechanisms. Trends in Cognitive Science 16, 2734.CrossRefGoogle ScholarPubMed
Bernardo, JM, Smith, AFM (2000). Bayesian Theory. John Wiley & Sons: Chichester.Google Scholar
Blackwood, NJ, Howard, RJ, Bentall, RP, Murray, RM (2001). Cognitive neuropsychiatric models of persecutory delusions. American Journal of Psychiatry 158, 527539.CrossRefGoogle ScholarPubMed
Bogacz, R, Brown, E, Moehlis, J, Holmes, P, Cohen, JD (2006). The physics of optimal decision making: a formal analysis of models of performance in two-alternative forced-choice tasks. Psychological Review 113, 700765.CrossRefGoogle ScholarPubMed
Bowie, CR, Reichenberg, A, Patterson, TL, Heaton, RK, Harvey, PD (2006). Determinants of real-world functional performance in schizophrenia subjects: correlations with cognition, functional capacity, and symptoms. American Journal of Psychiatry 163, 418425.CrossRefGoogle Scholar
Bowie, CR, Twamley, EW, Anderson, H, Halpern, B, Patterson, TL, Harvey, PD (2007). Self-assessment of functional status in schizophrenia. Journal of Psychiatric Research 41, 10121018.CrossRefGoogle Scholar
Bratman, ME (1987). Intention, Plans and Practical Reason. CSLI Publications, University of Chicago Press: Chicago.Google Scholar
Bruno, N, Sachs, N, Demily, C, Frank, N, Pacherie, E (2012). Delusion and metacognition in patients with schizophrenia. Cognitive Neuropsychiatry 17, 118.CrossRefGoogle ScholarPubMed
Camerer, C (1999). Behavioral economics: reunifying psychology and economics. Proceedings of the National Academy of Sciences USA 96, 1057510577.CrossRefGoogle ScholarPubMed
Camerer, C (2003). Behavioural studies of strategic thinking in games. Trends in Cognitive Science 7, 225231.CrossRefGoogle ScholarPubMed
Cohen, JD, Braver, TS, O'Reilly, RC (1996). A computational approach to prefrontal cortex, cognitive control and schizophrenia: recent developments and current challenges. Proceedings of the Royal Society of London, Series B 351, 15151527.CrossRefGoogle ScholarPubMed
Cools, R, D'Esposito, M (2011). Inverted-U-shaped dopamine actions on human working memory and cognitive control. Biological Psychiatry 69, 113125.CrossRefGoogle ScholarPubMed
Danion, JM, Gokalsing, E, Robert, P, Massin-Krauss, M, Bacon, E (2001). Defective relationship between subjective experience and behavior in schizophrenia. American Journal of Psychiatry 158, 20642066.CrossRefGoogle Scholar
Debruille, JB, Kumar, N, Saheb, D, Chintoh, A, Gharghi, D, Lionnet, C (2007). Delusions and processing of discrepant information: an event-related brain potential study. Schizophrenia Research 89, 261277.CrossRefGoogle Scholar
Dima, D, Roiser, JP, Dietrich, DE, Bonnemann, C, Lanfermann, H, Emrich, HM (2009). Understanding why patients with schizophrenia do not perceive the hollow-mask illusion using dynamic causal modelling. NeuroImage 46, 11801186.CrossRefGoogle Scholar
Doege, K, Bates, AT, White, TP, Das, D, Boks, MP, Liddle, PF (2009). Reduced event-related low frequency EEG activity in schizophrenia during an auditory oddball task. Psychophysiology 46, 566577.CrossRefGoogle ScholarPubMed
Durstewitz, D, Seamans, JK (2008). The dual-state theory of prefrontal cortex dopamine function with relevance to catechol-o-methyltransferase genotypes and schizophrenia. Biological Psychiatry 64, 739749.CrossRefGoogle Scholar
Fehr, E, Camerer, C (2007). Social neuroeconomics: the neural circuitry of social preferences. Trends in Cognitive Science 11, 419427.CrossRefGoogle ScholarPubMed
Fett, A-KJ, Shergill, SS, Joyce, DW, Riedl, A, Strobel, M, Gromann, PM, Krabbendam, L (2012). To trust or not to trust: the dynamics of social interaction in psychosis. Brain 135, 976984.CrossRefGoogle ScholarPubMed
Fletcher, PC, Frith, CD (2009). Perceiving is believing: a Bayesian approach to explaining the positive symptoms of schizophrenia. Nature Reviews Neuroscience 10, 4858.CrossRefGoogle ScholarPubMed
Fodor, JA (1998). Concepts. Oxford University Press: Oxford, UK.CrossRefGoogle Scholar
Freeman, D, Garety, P, Kuipers, E, Colbert, S, Jolley, S, Fowler, D (2006). Delusions and decision-making style: use of the Need for Closure Scale. Behavioural Research and Therapy 44, 11471158.CrossRefGoogle ScholarPubMed
Freeman, D, Pugh, K, Garety, P (2008). Jumping to conclusions and paranoid ideation in the general population. Schizophrenia Research 102, 254260.CrossRefGoogle ScholarPubMed
Friston, K (2002). Functional integration and inference in the brain. Progress in Neurobiology 68, 113143.CrossRefGoogle Scholar
Frith, CD, Done, DJ (1989). Experiences of alien control in schizophrenia reflect a disorder in the central monitoring of action. Psychological Medicine 19, 359363.CrossRefGoogle Scholar
Fudenberg, D, Levine, DK (1995). Consistency and cautious fictitious play. Journal of Economic Dynamics and Control 19, 10651089.CrossRefGoogle Scholar
Fudenberg, D, Levine, DK (1998). The Theory of Learning in Games. MIT Press: Cambridge, MA.Google Scholar
Gallagher, HL, Jack, AI, Roepstorff, A, Frith, CD (2002). Imaging the intentional stance in a competitive game. NeuroImage 16, 814821.CrossRefGoogle Scholar
Garety, PA, Freeman, D (1999). Cognitive approaches to delusions: a critical review of theories and evidence. British Journal of Clinical Psychology 38, 113154.CrossRefGoogle ScholarPubMed
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, 194201.CrossRefGoogle ScholarPubMed
Gray, JA, Feldon, J, Rawlins, JNP, Smith, AD, Hemsley, DR (1991). The neuropsychology of schizophrenia. Behavioral and Brain Sciences 14, 119.CrossRefGoogle Scholar
Hintikka, J, Hendricks, VF, Symons, J (2005). Knowledge and Belief: An Introduction to the Logic of the Two Notions. King's College Publications: London.Google Scholar
Hollerman, JR, Schultz, W (1998). Dopamine neurons report an error in the temporal prediction of reward during learning. Nature Neuroscience 1, 304309.CrossRefGoogle ScholarPubMed
Howes, OD, Kambeitz, J, Kim, E, Stahl, D, Slifstein, M, Abi-Dargham, A, Kapur, S (2012). The nature of dopamine dysfunction in schizophrenia and what this means for treatment: meta-analysis of imaging studies. Archives of General Psychiatry 69, 776786.CrossRefGoogle Scholar
Huq, SF, Garety, PA, Hemsley, DR (1988). Probabilistic judgements in deluded and non-deluded subjects. Quarterly Journal of Experimental Psychology Section A 40, 801812.CrossRefGoogle ScholarPubMed
Kapur, S (2003). Psychosis as a state of aberrant salience: a framework linking biology, phenomenology, and pharmacology in schizophrenia. American Journal of Psychiatry 160, 1323.CrossRefGoogle Scholar
Kapur, S, Mizrahi, R, Li, M (2005). From dopamine to salience to psychosis – linking biology, pharmacology and phenomenology of psychosis. Schizophrenia Research 79, 5968.CrossRefGoogle Scholar
King-Casas, B, Tomlin, D, Anen, C, Camerer, CF, Quartz, SR, Montague, PR (2005). Getting to know you: reputation and trust in a two-person economic exchange. Science 308, 7883.CrossRefGoogle Scholar
Koren, D, Seidman, LJ, Goldsmith, M, Harvey, PD (2006). Real-world cognitive – and metacognitive – dysfunction in schizophrenia: a new approach for measuring (and remediating) more ‘right stuff’. Schizophrenia Bulletin 32, 310326.CrossRefGoogle Scholar
Koren, D, Seidman, LJ, Poyurovsky, M, Goldsmith, M, Viksman, P, Zichel, S (2004). The neuropsychological basis of insight in first-episode schizophrenia: a pilot metacognitive study. Schizophrenia Research 70, 195202.CrossRefGoogle ScholarPubMed
Koriat, A (1997). Monitoring one's own knowledge during study: a cue-utilization approach to judgments of learning. Journal of Experimental Psychology: General 126, 349370.CrossRefGoogle Scholar
Koriat, A (2007). Metacognition and consciousness. In Cambridge Handbook of Consciousness (ed. Zelazo, P. D., Moscovitch, M. and Thompson, E.), pp. 289326. Cambridge University Press: New York.CrossRefGoogle Scholar
Koriat, A, Ackerman, R (2009). Metacognition and mindreading: judgments of learning for Self or Other during self-paced study. Consciousness and Cognition 19, 251264.CrossRefGoogle Scholar
Lysaker, PH, Olesek, KL, Warman, DM, Martin, JM, Salzman, AK, Nicolo, G, Salvatore, G, Dimaggio, G (2011). Meta-cognition in schizophrenia: correlates and stability of deficits in theory of mind and self reflectivity. Psychiatry Research 190, 1822.CrossRefGoogle ScholarPubMed
Mehta, MA, Manes, FF, Magnolfi, G, Sahakian, BJ, Robbins, TW (2004). Impaired set-shifting and dissociable effects on tests of spatial working memory following the dopamine D2 receptor antagonist sulpiride in human volunteers. Psychopharmacology 176, 331342.CrossRefGoogle ScholarPubMed
Metcalfe, J, Shimamura, AP (1994). Metacognition: Knowing About Knowing. MIT Press: Cambridge, MA.Google Scholar
Monestes, JL, Villatte, M, Moore, A, Yon, V, Loas, G (2008). Decisions in conditional situation and theory of mind in schizotypy. Encephale 34, 116122.CrossRefGoogle ScholarPubMed
Moritz, S, Woodward, TS (2006). The contribution of metamemory deficits to schizophrenia. Journal of Abnormal Psychology 115, 1525.CrossRefGoogle Scholar
Moritz, S, Woodward, TS, Ruff, CC (2003). Source monitoring and memory confidence in schizophrenia. Psychological Medicine 33, 131139.CrossRefGoogle Scholar
O'Daly, OG, Joyce, D, Stephan, KE, Murray, RM, Shergill, SS (2011). Functional magnetic resonance imaging investigation of the amphetamine sensitization model of schizophrenia in healthy male volunteers. Archives of General Psychiatry 68, 545554.CrossRefGoogle ScholarPubMed
Paulus, MP, Feinstein, JS, Leland, D, Simmons, AN (2005). Superior temporal gyrus and insula provide response and outcome-dependent information during assessment and action selection in a decision-making situation. NeuroImage 25, 607615.CrossRefGoogle Scholar
Paulus, MP, Feinstein, JS, Tapert, SF, Liu, TT (2004). Trend detection via temporal difference model predicts inferior prefrontal cortex activation during acquisition of advantageous action selection. NeuroImage 21, 733743.CrossRefGoogle ScholarPubMed
Pessiglione, M, Seymour, B, Flandin, G, Dolan, RJ, Frith, CD (2006). Dopamine-dependent prediction errors underpin reward-seeking behaviour in humans. Nature 442, 10421045.CrossRefGoogle ScholarPubMed
Rangel, A, Camerer, C, Montague, PR (2008). A framework for studying the neurobiology of value-based decision making. Nature Reviews Neuroscience 9, 545556.CrossRefGoogle ScholarPubMed
Schneider, U, Borsutzky, M, Seifert, J, Leweke, FM, Huber, TJ, Rollnik, JD (2002). Reduced binocular depth inversion in schizophrenic patients. Schizophrenia Research 53, 101108.CrossRefGoogle ScholarPubMed
Sellen, JL, Oaksford, M, Gray, NS (2005). Schizotypy and conditional reasoning. Schizophrenia Bulletin 31, 105116.CrossRefGoogle ScholarPubMed
Shergill, SS, Samson, G, Bays, PM, Frith, CD, Wolpert, DM (2005). Evidence for sensory prediction deficits in schizophrenia. American Journal of Psychiatry 162, 23842386.CrossRefGoogle Scholar
Simons, CJ, Tracy, DK, Sanghera, KK, O'Daly, O, Gilleen, J, Dominguez, MD, Krabbendam, L, Shergill, SS (2010). Functional magnetic resonance imaging of inner speech in schizophrenia. Biological Psychiatry 67, 232237.CrossRefGoogle Scholar
Smeets, F, Lataster, T, Dominguez, MD, Hommes, J, Lieb, R, Wittchen, HU (2012). Evidence that onset of psychosis in the population reflects early hallucinatory experiences that through environmental risks and affective dysregulation become complicated by delusions. Schizophrenia Bulletin 38, 531542.CrossRefGoogle ScholarPubMed
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, 717.CrossRefGoogle Scholar
Startup, H, Freeman, D, Garety, PA (2008). Jumping to conclusions and persecutory delusions. European Psychiatry 23, 457459.CrossRefGoogle ScholarPubMed
Sutton, R, Barto, A (1998). Reinforcement Learning. MIT Press: Cambridge, MA.Google Scholar
Waltz, JA, Gold, JM (2007). Probabilistic reversal learning impairments in schizophrenia: further evidence of orbitofrontal dysfunction. Schizophrenia Research 93, 296303.CrossRefGoogle ScholarPubMed
Woodward, TS, Moritz, S, Cuttler, C, Whitman, JC (2006). The contribution of a cognitive bias against disconfirmatory evidence (BADE) to delusions in schizophrenia. Journal of Clinical Experimental Neuropsychology 28, 605617.CrossRefGoogle Scholar
Woodward, TS, Moritz, S, Menon, M, Klinge, R (2008). Belief inflexibility in schizophrenia. Cognitive Neuropsychiatry 13, 267277.CrossRefGoogle Scholar
Woodward, TS, Munz, M, LeClerc, C, Lecomte, T (2009). Change in delusions is associated with change in ‘jumping to conclusions’. Psychiatry Research 170, 124127.CrossRefGoogle Scholar
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