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Delusion formation and reasoning biases in those at clinical high risk for psychosis

  • M. R. Broome (a1), L. C. Johns (a1), I. Valli (a1), J. B. Woolley (a1), P. Tabraham (a1), C. Brett (a1), L. Valmaggia (a2), E. Peters (a3), P. A. Garety (a4) and P. K. McGuire (a2)...

Abstract

Background

Cognitive models propose that faulty appraisal of anomalous experiences is critical in developing psychosis, particularly delusions. A data gathering bias may be fundamental to abnormal appraisal

Aims

To examine whether there is a data gathering bias in people at high risk of developing psychosis

Method

Individuals with an at-risk mental state (n=35) were compared with a matched group of healthy volunteers (n=23). Participants were tested using a modified version of the ‘beads’ reasoning task with different levels of task difficulty

Results

When task demands were high, the at-risk group made judgements on the basis of less information than the control group (P < 0.05). Within both groups, jumping to conclusions was directly correlated with the severity of abnormal beliefs and intolerance of uncertainty (P<0.05). In the at-risk group it was also associated with impaired working memory (P<0.05), whereas in the control group poor working memory was associated with a more conservative response style (P<0.05)

Conclusions

People with an at-risk mental state display a jumping to conclusions reasoning style, associated with impaired working memory and intolerance of uncertainty. This may underlie a tendency to develop abnormal beliefs and a vulnerability to psychosis

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Copyright

Corresponding author

Dr Matthew Broome, Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry CV4 7Al, UK. Email: m.broome@iop.kcl.ac.uk

Footnotes

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Declaration of interest

None.

Funding detailed in Acknowledgements.

Footnotes

References

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Delusion formation and reasoning biases in those at clinical high risk for psychosis

  • M. R. Broome (a1), L. C. Johns (a1), I. Valli (a1), J. B. Woolley (a1), P. Tabraham (a1), C. Brett (a1), L. Valmaggia (a2), E. Peters (a3), P. A. Garety (a4) and P. K. McGuire (a2)...
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eLetters

Negative capability: a poetic-based cognitive resource in early psychosis

Massimo Lanzaro, Consultant Psychiatris
23 September 2010

As the authors point out, the "jumping to conclusions" response stylehas been interpreted as reflecting a data gathering reasoning bias and participants with at-risk mental state may present a difficulty in tolerating uncertainty along with impaired working memory. The inability to tolerate ambiguity was encompassed in Keats' theory of "negative capability", expressed in his letter to his brother dated Sunday, 21 December 1817: "I mean Negative Capability, that is when man is capable ofbeing in uncertainties, mysteries, doubts without any irritable reaching after fact and reason - Coleridge, for instance, would let go by a fine isolated verisimilitude caught from the penetralium of mystery, from beingincapable of remaining content with half knowledge (..)". Nearly a centuryago (whilst Kraepelin was postulating that there is a specific brain pathology underlying each of the major psychiatric disorders), Keats had the strong intuition that great (and "sane") people have the ability to accept that not everything can be resolved, that the truths found in the imagination access holy authority. Such authority cannot otherwise be understood, and thus he writes of "uncertainties." This "being in uncertainty" is a place between the mundane, ready reality and the multiple potentials of a more fully understood existence. Negative capability is a state of intentional open-mindedness paralleled in the literary and philosophic stances of other writers. In the 1930s, the American philosopher John Dewey cited Keatsian negative capability as having influenced his own philosophical pragmatism, and said of Keats' letter that it "contains more of the psychology of productive thought thanmany treatises". Encouragingly, modern and contemporary research is beginning to address applications of exciting new cognitive theoretical models for psychosis in clinical practice. I wonder whether there will ever be room for poets arguments, like Johns Keats', to inform cognitive techniques whose target is the faulty appraisal or interpretation of anomalous experiences and events.

References

1. M. R. Broome, L. C. Johns, I. Valli, J. B. Woolley, P. Tabraham, C. Brett, L. Valmaggia, E. Peters, P. A. Garety, And P. K. Mcguire. Delusion formation and reasoning biases in those at clinical high risk forpsychosis.The British Journal of Psychiatry 2007; 191: s38-42s

2. Jacob D. Wigod. "Negative Capability and Wise Passiveness". PMLA, 67, 4, (June 1952), 383–90

3. D. I. Velligan. Cognitive Behavior Therapy for Psychosis: Where Have We Been and Where Are We Going? Schizophr Bull. 2009; 35(5):857-858
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