Targeting symptoms of psychosis

March 14, 2014
Targeting symptoms of psychosis

(Medical Xpress)—A novel psychological treatment to reduce the severity of delusional episodes experienced by people with psychosis is being trialled in a new Flinders University study.

Cognitive psychologist Dr Ryan Balzan is recruiting up to 50 people with psychosis Adelaide-wide to test the effectiveness of metacognitive training to target underlying "cognitive biases", or irregular thinking and reasoning strategies.

Evidence from Dr Balzan's previous studies has shown that cognitive biases cause and maintain delusional beliefs so by targeting these biases, he said the severity – that is the amount of conviction the person has in the delusion and the distress it causes them – should be reduced.

"A common cognitive bias in psychosis is the 'jumping to conclusions' bias, where people make definite decisions on the basis of very limited information or evidence," Dr Balzan, a Vice-Chancellor's Postdoctoral Research Fellow in the School of Psychology, said.

"For example, a person with psychosis might catch their neighbour looking at them strangely and use that as sufficient evidence to support the belief that their neighbour is an intelligence agent," he said.

"We know from previous research that people with tend to over-rely on these and other biased thought patterns and reasoning strategies, and we believe this is what leads to, and sustains, their delusions."

Dr Balzan said study participants will undertake a series of one-on-one metacognitive training modules over four weeks, with a key aim of the therapy to encourage clients to "think about their thinking".

"Metacognitive training helps clients to understand how cognitive biases may explain their beliefs, and offers them strategies to overcome them.

"For instance, in the 'jumping to conclusions' module, we encourage clients to delay making definite judgement decisions until they have the full picture."

As part of the study, some participants will be randomly allocated to a second group to explore the benefits of a "cognitive remediation" computer program to reduce the neuropsychological symptoms of schizophrenia, including memory, language and attention deficits.

Dr Balzan said he hypothesised a "double dissociation", whereby patients allocated to the individual metacognitive sessions will see a reduction in the severity of delusions, and participants in the cognitive remediation will demonstrate greater improvements in neuropsychological domains.

"We hope our findings will assist clinicians to select the most appropriate psychological intervention for their client's symptoms."

Dr Balzan said the two psychological approaches could be useful adjunct therapies to complement existing drug-based forms of treatment.

"While medication can reduce the severity of symptoms, a lot of people are still left with residual symptoms, which is essentially what we're targeting."

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not rated yet Mar 15, 2014
They have not considered the possibility that in psychosis, the feeling or belief that, say, someone is watching you comes well before the evidence they gather for it. In fact they are making the assumption that the psychotic episode starts with an incorrect thought based on an observation. This would be unique in schizophrenia. As anybody who has interacted with schizophrenics can attest, when you disprove one of their theories they simply move on to another one indicating that driver of the delusion is not evidence based.

Science uses evidence based thinking. Religious thinking starts with a belief and then seeks the evidence: the belief comes first. This is why schizophrenics often hold strong religious convictions ~ the form of thinking used is the same in both (although non-psychotic religionists have a balance of thinking methods with a bias toward the faith first whereas the psychotic appears to be obsessed with this form of thinking at the expense of any other).
not rated yet Mar 15, 2014
He is partly correct ~ "jumping to conclusions" but failed to ask why they do this and is proposing to address a possible cause which is rarely, if at all, seen in psychotic patients.

First hand interaction with psychotic individuals indicates to me that the predisposition exists ~ a compelling feeling that one is being monitored or controlled. As the patient assumes that feeling occurs for a reason, then then seek to find out what that reason is, which is why they are so ready to believe that the neighbour is the cause of the existing feeling.

How is the control of the last step going to help the condition?
not rated yet Mar 19, 2014
To clarify, the Jumping to Conclusions (JTC) bias was used as an example as it is one of the most studied and robust effects linked to the delusional symptoms in psychosis (see Fine, et al. (2007) for a recent meta-analysis). However, JTC is perhaps better thought of as a factor towards maintaining a belief once it is adopted, whereby the belief that the neighbour is an intelligence agent is already in place, and the "strangle look" observation is used as sufficient evidence to support that belief. In other words, JTC is not intended to explain why a delusional theme is accepted as fact in the first instance; but it helps to account for how people with delusions foster and maintain their beliefs with limited or weak evidence.
not rated yet Mar 19, 2014
Metacognitive training helps to break this vicious cycle by, for example, showing participants that it is better to collect lots of evidence before reaching definite decisions (e.g., "strange look" isn't sufficient to support a " neighbour = intelligence agent" hypothesis). I must stress that our work does not suggest that "a psychotic episode begins with an incorrect thought based on evidence", as such a claim suggests that cognitive biases are only the factor in the formation and/or maintenance delusional beliefs. Rather, we argue that there are many factors (cognitive and biological) involved in this process, but consistent with 30+ years of cognitive neuropsychiatric research, we also stress that biases play an important role.
not rated yet Mar 19, 2014
Numerous cognitive models have been put forth to explain the specific role that cognitive biases play in the formation and/or maintenance of delusions (e.g., Langdon and Coltheart's two-factory theory), and why people with delusions are more susceptible to them (e.g., hypersalience of evidence-hypothesis matches account; liberal-acceptance theory), but this discussion was well beyond the scope of this article. The central message of the article was that we can help alleviate the severity of delusions by targeting the underlying cognitive biases that foster and maintain them (for recent RCT on the efficacy of MCT, see Moritz, S., Veckenstedt, R., Bohn, F., Hottenrott, B., Scheu, F., Randjbar, S., Roesch-Ely, D. (in press). Complementary group Metacognitive Training reduces delusional ideation in schizophrenia. Schizophrenia Research). I would be happy to discuss these points with you further via email.

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