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Understanding jumping to conclusions in patients with persecutory delusions: working memory and intolerance of uncertainty

Published online by Cambridge University Press:  21 March 2014

D. Freeman ,
H. Startup ,
G. Dunn ,
E. Černis ,
G. Wingham ,
K. Pugh ,
J. Cordwell ,
H. Mander  and
D. Kingdon
D. Freeman*
Affiliation:
Department of Psychiatry, University of Oxford, Oxford, UK
H. Startup
Affiliation:
Department of Psychiatry, University of Oxford, Oxford, UK Sussex Partnership NHS Trust, Worthing, UK
G. Dunn
Affiliation:
Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
E. Černis
Affiliation:
Department of Psychiatry, University of Oxford, Oxford, UK
G. Wingham
Affiliation:
Academic Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
K. Pugh
Affiliation:
Department of Psychiatry, University of Oxford, Oxford, UK
J. Cordwell
Affiliation:
Academic Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
H. Mander
Affiliation:
Academic Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
D. Kingdon
Affiliation:
Academic Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
*
*Address for correspondence: D. Freeman, Oxford Cognitive Approaches to Psychosis, UniversityDepartment of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK. (Email: [email protected])
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Abstract

Background

Persecutory delusions are a key psychotic experience. A reasoning style known as ‘jumping to conclusions’ (JTC) – limited information gathering before reaching certainty in decision making – has been identified as a contributory factor in the occurrence of delusions. The cognitive processes that underpin JTC need to be determined in order to develop effective interventions for delusions. In the current study two alternative perspectives were tested: that JTC partially results from impairment in information-processing capabilities and that JTC is a motivated strategy to avoid uncertainty.

Method

A group of 123 patients with persistent persecutory delusions completed assessments of JTC (the 60:40 beads task), IQ, working memory, intolerance of uncertainty, and psychiatric symptoms. Patients showing JTC were compared with patients not showing JTC.

Results

A total of 30 (24%) patients with delusions showed JTC. There were no differences between patients who did and did not jump to conclusions in overall psychopathology. Patients who jumped to conclusions had poorer working memory performance, lower IQ, lower intolerance of uncertainty and lower levels of worry. Working memory and worry independently predicted the presence of JTC.

Conclusions

Hasty decision making in patients with delusions may partly arise from difficulties in keeping information in mind. Interventions for JTC are likely to benefit from addressing working memory performance, while in vivo techniques for patients with delusions will benefit from limiting the demands on working memory. The study provides little evidence for a contribution to JTC from top-down motivational beliefs about uncertainty.

Keywords

Delusionspersecutoryreasoningschizophreniaworking memory
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 14 , October 2014 , pp. 3017 - 3024
Copyright
Copyright © Cambridge University Press 2014 

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References

Bassett, M, Sperlinger, D, Freeman, D (2009). Fear of madness and persecutory delusions. Psychosis 1, 39–50.Google Scholar
Berenbaum, H, Bredemeier, K, Thompson, R (2008). Intolerance of uncertainty: exploring its dimensionality and associations with need for cognitive closure, psychopathology, and personality. Journal of Anxiety Disorders 22, 117–125.CrossRefGoogle ScholarPubMed
Broome, M, Johns, L, Valli, I, Woolley, J, Tabraham, P, Brett, C, Valmaggia, L, Peters, E, Garety, P, McGuire, P (2007). Delusion formation and reasoning biases in those at clinical high risk for psychosis. British Journal of Psychiatry 191, s38–s42.CrossRefGoogle Scholar
Buhr, K, Dugas, M (2002). The Intolerance of Uncertainty Scale: psychometric properties of the English version. Behaviour Research and Therapy 40, 931–945.CrossRefGoogle ScholarPubMed
Dudley, R, Daley, K, Nicholson, M, Shaftoe, D, Spencer, H, Cavanagh, K, Freeston, M (2013). Jumping to conclusions in first-episode psychosis: a longitudinal study. British Journal of Clinical Psychology 52, 380–393.CrossRefGoogle ScholarPubMed
Dudley, R, John, C, Young, A, Over, D (1997). Normal and abnormal reasoning in people with delusions. British Journal of Clinical Psychology 36, 243–258.CrossRefGoogle ScholarPubMed
Dudley, R, Shaftoe, D, Cavanagh, K, Spencer, H, Ormrod, J, Turkington, D, Freeston, M (2011). ‘Jumping to conclusions’ in first-episode psychosis. Early Intervention in Psychiatry 5, 50–56.CrossRefGoogle ScholarPubMed
Dugas, M, Gagnon, F, Ladouceur, R, Freeston, M (1998). Generalised anxiety disorder: a preliminary test of a conceptual model. Behaviour Research and Therapy 36, 215–226.Google Scholar
Ehring, T, Zetsche, U, Weidacker, K, Wahl, K, Schönfeld, S, Ehlers, A (2011). The Perseverative Thinking Questionnaire (PTQ): validation of a content-independent measure of repetitive negative thinking. Journal of Behaviour Therapy and Experimental Psychiatry 42, 225–232.CrossRefGoogle ScholarPubMed
Falcone, A (2013). Neuropsychological and symptom correlates of the jumping to conclusions reasoning bias. PhD thesis. King's College London: London.Google Scholar
Foster, C, Startup, H, Potts, L, Freeman, D (2010). A randomised controlled trial of a worry intervention for individuals with persistent persecutory delusions. Journal of Behavior Therapy and Experimental Psychiatry 41, 45–51.Google Scholar
Freeman, D, Dunn, G, Startup, H, Kingdon, D (2012 a). The effects of reducing worry in patients with persecutory delusions: study protocol for a randomized controlled trial. Trials 13, 223.Google Scholar
Freeman, D, Evans, N, Lister, R (2012 b). Gut feelings, deliberative thought, and paranoid ideation. Psychiatry Research 197, 119–122.Google Scholar
Freeman, D, Garety, PA (1999). Worry, worry processes and dimensions of delusions. Behavioural and Cognitive Psychotherapy 27, 47–62.Google Scholar
Freeman, D, Garety, PA (2000). Comments on the content of persecutory delusions: does the definition need clarification? British Journal of Clinical Psychology 39, 407–414.Google Scholar
Freeman, D, Garety, PA, Kuipers, E, Colbert, S, Jolley, S, Fowler, D, Dunn, G, Bebbington, PE (2006). Delusions and decision-making style: use of the Need for Closure Scale. Behaviour Research and Therapy 44, 1147–1158.Google Scholar
Freeman, D, Pugh, K, Vorontsova, N, Antley, A, Slater, M (2010). Testing the continuum of delusional beliefs: an experimental study using virtual reality. Journal of Abnormal Psychology 119, 83–92.Google Scholar
Freeman, D, Startup, H, Dunn, G, Černis, E, Wingham, G, Pugh, K, Cordwell, J, Kingdon, D (2013). The interaction of affective with psychotic processes: a test of the effects of worrying on working memory, jumping to conclusions, and anomalies of experience in patients with persecutory delusions. Journal of Psychiatric Research 47, 1837–1842.Google Scholar
Freeston, M, Rhéaume, J, Letarte, H, Dugas, M, Ladouceur, R (1994). Why do people worry? Personality and Individual Differences 17, 791–802.Google Scholar
Garety, P, Freeman, D (1999). Cognitive approaches to delusions: a critical review of theories and evidence. British Journal of Clinical Psychology 38, 113–154.Google Scholar
Garety, P, Freeman, D (2013). The past and future of delusion research: from the inexplicable to the treatable. British Journal of Psychiatry 203, 327–333.CrossRefGoogle Scholar
Garety, PA, Freeman, D, Jolley, S, Dunn, G, Bebbington, PE, Fowler, D, Kuipers, E, Dudley, R (2005). Reasoning, emotions and delusional conviction in psychosis. Journal of Abnormal Psychology 114, 373–384.Google Scholar
Garety, P, Joyce, E, Jolley, S, Emsley, R, Waller, H, Kuipers, E, Bebbington, P, Fowler, D, Dunn, G, Freeman, D (2013). Neuropsychological functioning and jumping to conclusions in delusions. Schizophrenia Research 150, 570–574.Google Scholar
Garety, P, Hemsley, D, 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
Green, C, Freeman, D, Kuipers, E, Bebbington, P, Fowler, D, Dunn, G, Garety, P (2008). Measuring ideas of persecution and social reference. Psychological Medicine 38, 101–111.CrossRefGoogle ScholarPubMed
Haddock, G, McCarron, J, Tarrier, N, Faragher, FB (1999). Scales to measure dimensions of hallucinations and delusions: the Psychotic Symptom Rating Scales (PSYRATS). Psychological Medicine 29, 879–889.Google Scholar
Jacobsen, P, Freeman, D, Salkovskis, P (2012). Reasoning bias and belief conviction in obsessive–compulsive disorder and delusions. British Journal of Clinical Psychology 51, 84–99.CrossRefGoogle ScholarPubMed
Kay, SR (1991). Positive and Negative Syndromes in Schizophrenia. Brunner: New York.Google Scholar
Kruglanski, A, Webster, D (1996). Motivated closing of the mind. Psychological Review 103, 263–283.Google Scholar
Lincoln, T, Ziegler, M, Mehl, S, Rief, W (2010). The jumping to conclusions bias in delusions. Journal of Abnormal Psychology 119, 40–49.Google Scholar
Menon, M, Mizrahi, R, Kapur, S (2008). Jumping to conclusions and delusions in psychosis: relationship and response to treatment. Schizophrenia Research 98, 225–231.Google Scholar
Menon, M, Pomarol-Clotet, E, McKenna, P, McCarthy, R (2006). Probabilistic reasoning in schizophrenia: a comparison of the performance of deluded and nondeluded schizophrenic patients and exploration of possible cognitive underpinnings. Cognitive Neuropsychiatry 11, 521–536.Google Scholar
Meyer, TJ, Miller, ML, Metzger, RL, Borkovec, TD (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy 28, 487–495.Google Scholar
Moritz, S, Vitzthum, F, Randjbar, S, Veckenstedt, R, Woodward, TS (2010). Detecting and defusing cognitive traps: metacognitive intervention in schizophrenia. Current Opinion in Psychiatry 23, 561–569.Google Scholar
Norton, P (2005). A psychometric analysis of the Intolerance of Uncertainty Scale among four racial groups. Journal of Anxiety Disorders 19, 699–707.CrossRefGoogle ScholarPubMed
Nuechterlein, K, Barch, D, Gold, J, Goldberg, T, Green, M, Heaton, R (2004). Identification of separable cognitive factors in schizophrenia. Schizophrenia Research 72, 29–39.CrossRefGoogle ScholarPubMed
Ormrod, J, Shaftoe, D, Cavanagh, K, Freeston, M, Turkington, D, Price, J, Dudley, R (2012). A pilot study exploring the contribution of working memory to “jumping to conclusions” in people with first episode psychosis. Cognitive Neuropsychiatry 17, 97–114.Google Scholar
So, S, Freeman, D, Dunn, G, Kapur, S, Kuipers, E, Bebbington, P, Fowler, D, Garety, P (2012). Jumping to conclusions, a lack of belief flexibility and delusional conviction in psychosis. Journal of Abnormal Psychology 121, 129–139.Google Scholar
Startup, HM, Erickson, TM (2006). The Penn State Worry Questionnaire (PSWQ). In Worry and its Psychological Disorders (ed. Davey, G. C. L. and Wells, A.), pp. 101–120. Wiley: Chichester.Google Scholar
Startup, H, Freeman, D, Garety, PA (2007). Persecutory delusions and catastrophic worry in psychosis: developing the understanding of delusion distress and persistence. Behaviour Research and Therapy 45, 523–537.Google Scholar
Sternheim, L, Startup, H, Schmidt, U (2011). An experimental exploration of behavioural and cognitive–emotional aspects of intolerance of uncertainty in eating disorder patients. Journal of Anxiety Disorders 25, 806–812.Google Scholar
van der Heiden, C, Muris, P, van de Molen, H (2012). Randomized controlled trial on the effectiveness of intolerance-of-uncertainty therapy for generalized anxiety disorder. Behaviour Research and Therapy 50, 100–109.Google Scholar
Ventura, J, Hellemann, G, Thames, A, Koellner, V, Nuechterlein, K (2009). Symptoms as mediators of the relationship between neurocognition and functional outcome in schizophrenia: a meta-analysis. Schizophrenia Research 113, 189–199.Google Scholar
Waller, H, Freeman, D, Jolley, S, Dunn, G, Garety, P (2011). Targeting reasoning biases in delusions. Journal of Behavior Therapy and Experimental Psychiatry 42, 414–421.CrossRefGoogle ScholarPubMed
Warman, D, Lysaker, P, Martin, J, Davis, L, Haudenschield, S (2007). Jumping to conclusions and the continuum of delusional beliefs. Behaviour Research and Therapy 45, 1255–1269.Google Scholar
Wechsler, D (1997). Wechsler Adult Intelligence Scale, 3rd edn. The Psychological Corporation: San Antonio, TX.Google Scholar
Wechsler, D (1999). Wechsler Abbreviated Scale of Intelligence (WASI). The Psychological Corporation: San Antonio, TX.Google Scholar
Wechsler, D (2001). Wechsler Test of Adult Reading (WTAR). The Psychological Corporation: San Antonio, TX.Google Scholar
Woodward, TS, Mizrahi, R, Menon, M, Christensen, BK (2008). Correspondences between theory of mind, jumping to conclusions, neuropsychological measures and the symptoms of schizophrenia. Psychiatry Research 170, 119–123.CrossRefGoogle Scholar