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Stress is a bad advisor. Stress primes poor decision making in deluded psychotic patients

  • Steffen MoritzEmail author
  • Ulf Köther
  • Maike Hartmann
  • Tania M. Lincoln
Original Paper

Abstract

Stress is implicated in the onset of psychosis but the complex links between stress and psychotic breakdown are yet poorly understood. For the present study, we examined whether two prominent cognitive biases in psychosis, jumping to conclusions and distorted attribution, in conjunction with neuropsychological deficits play a role in this process. Thirty participants with schizophrenia and acute delusional symptoms were compared with 29 healthy controls across three conditions involving a noise stressor, a social stressor or no stressor. Under each condition participants had to perform parallel versions of cognitive bias tasks and neuropsychological tests including a probabilistic reasoning task (jumping to conclusions), the revised Internal, Personal and Situational Attributions Questionnaire (IPSAQ-R; attributional style), and the Corsi block-tapping task (nonverbal memory). Stress, particularly noise, aggravated performance differences of patients relative to controls on memory. Participants with psychosis demonstrated an escalated jumping to conclusion bias under stress. At a medium effect size, patients made more monocausal attributions, which increased under social stress. The present study is partially in line with prior studies. It suggests that stress negatively affects cognition in psychosis more than in controls, which is presumably insufficiently realized by patients and thus not held in check by greater response hesitance. Raising patients’ awareness about these response tendencies and encouraging them to be more cautious in their judgments under conditions of increased stress may prove beneficial for improving positive symptoms.

Keywords

Stress Vulnerability Psychosis Jumping to conclusions Monocausal attributions Cognition 

Notes

Conflict of interest

None.

References

  1. 1.
    Beards S, Gayer-Anderson C, Borges S, Dewey ME, Fisher HL, Morgan C (2013) Life events and psychosis: a review and meta-analysis. Schizophr Bull 39:740–747PubMedCentralCrossRefPubMedGoogle Scholar
  2. 2.
    Benjamini Y, Hochberg Y (1995) Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc B 57:289–300Google Scholar
  3. 3.
    Bentall RP (1992) A proposal to classify happiness as a psychiatric disorder. J Med Ethics 18:94–98PubMedCentralCrossRefPubMedGoogle Scholar
  4. 4.
    Bentall RP, Kaney S (1996) Abnormalities of self-representation and persecutory delusions: a test of a cognitive model of paranoia. Psychol Med 26:1231–1237CrossRefPubMedGoogle Scholar
  5. 5.
    Bentall RP, Kaney S, Dewey ME (1991) Paranoia and social reasoning: an attribution theory analysis. Br J Clin Psychol 30:13–23CrossRefPubMedGoogle Scholar
  6. 6.
    Bentall RP, Kinderman P, Kaney S (1994) The self, attributional processes and abnormal beliefs: towards a model of persecutory delusions. Behav Res Ther 32:331–341CrossRefPubMedGoogle Scholar
  7. 7.
    Blackwood NJ, Howard RJ, Bentall RP, Murray RM (2001) Cognitive neuropsychiatric models of persecutory delusions. Am J Psychiatry 158:527–539CrossRefPubMedGoogle Scholar
  8. 8.
    Bleuler E (ed) (1911) Dementia praecox oder die Gruppe der Schizophrenien [Dementia praecox or the group of schizophrenia]. Deuticke, LeipzigGoogle Scholar
  9. 9.
    Brookings JB, Serratelli AJ (2006) Positive illusions: positively correlated with subjective well-being, negatively correlated with a measure of personal growth. Psychol Rep 98:407–413CrossRefPubMedGoogle Scholar
  10. 10.
    Dibben CR, Rice C, Laws K, McKenna PJ (2009) Is executive impairment associated with schizophrenic syndromes? A meta-analysis. Psychol Med 39:381–392CrossRefPubMedGoogle Scholar
  11. 11.
    Fine C, Gardner M, Craigie J, Gold I (2007) Hopping, skipping or jumping to conclusions? Clarifying the role of the jtc bias in delusions. Cogn Neuropsychiatry 12:46–77CrossRefPubMedGoogle Scholar
  12. 12.
    Fioravanti M, Bianchi V, Cinti ME (2012) Cognitive deficits in schizophrenia: an updated metanalysis of the scientific evidence. BMC Psychiatry 12:64PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    Freeman D (2007) Suspicious minds: the psychology of persecutory delusions. Clin Psychol Rev 27:425–457CrossRefPubMedGoogle Scholar
  14. 14.
    Freeman D, Garety P (2014) Advances in understanding and treating persecutory delusions: a review. Soc Psychiatry Psychiatr Epidemiol 49:1179–1189PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Garety PA, Bebbington P, Fowler D, Freeman D, Kuipers E (2007) Implications for neurobiological research of cognitive models of psychosis: a theoretical paper. Psychol Med 37:1377–1391CrossRefPubMedGoogle Scholar
  16. 16.
    Garety PA, Freeman D (1999) Cognitive approaches to delusions: a critical review of theories and evidence. Br J Clin Psychol 38:113–154CrossRefPubMedGoogle Scholar
  17. 17.
    Garety PA, Freeman D (2013) The past and future of delusions research: from the inexplicable to the treatable. Br J Psychiatry 203:327–333CrossRefPubMedGoogle Scholar
  18. 18.
    Garety PA, Hemsley DR, Wessely S (1991) Reasoning in deluded schizophrenic and paranoid patients. Biases in performance on a probabilistic inference task. J Nerv Mental Dis 179:194–201CrossRefGoogle Scholar
  19. 19.
    Hanssen MSS, Bijl RV, Vollebergh W, Van Os J (2003) Self-reported psychotic experiences in the general population: a valid screening tool for dsm-iii-r psychotic disorders? Acta Psychiatr Scand 107:369–377CrossRefPubMedGoogle Scholar
  20. 20.
    Heinrichs RW, Zakzanis KK (1998) Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology 12:426–445CrossRefPubMedGoogle Scholar
  21. 21.
    Kaney S, Bentall RP (1989) Persecutory delusions and attributional style. Br J Med Psychol 62:191–198CrossRefPubMedGoogle Scholar
  22. 22.
    Kay SR, Fiszbein A, Opler LA (1987) The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 13:261–276CrossRefPubMedGoogle Scholar
  23. 23.
    Kay SR, Opler LA, Lindenmayer JP (1989) The positive and negative syndrome scale (PANSS): rationale and standardisation. Br J Psychiatry 155(Suppl. 7):59–67Google Scholar
  24. 24.
    Kimhy D, Myin-Germeys I, Palmier-Claus J, Swendsen J (2012) Mobile assessment guide for research in schizophrenia and severe mental disorders. Schizophr Bull 38:386–395PubMedCentralCrossRefPubMedGoogle Scholar
  25. 25.
    Kinderman P, Bentall RP (1997) Causal attributions in paranoia and depression: internal, personal, and situational attributions for negative events. J Abnorm Psychol 106:341–345CrossRefPubMedGoogle Scholar
  26. 26.
    Klosterkötter J (1992) The meaning of basic symptoms for the genesis of the schizophrenic nuclear syndrome. Jpn J Psychiatry Neurol 46:609–630PubMedGoogle Scholar
  27. 27.
    Konings M, Bak M, Hanssen M, van Os J, Krabbendam L (2006) Validity and reliability of the cape: a self-report instrument for the measurement of psychotic experiences in the general population. Acta Psychiatr Scand 114:55–61CrossRefPubMedGoogle Scholar
  28. 28.
    Kretschmer E (1966) Mensch und Lebensgrund. Gesammelte Aufsätze [Man and purpose in life. Collected works]. Ernst Wunderlich, TübingenGoogle Scholar
  29. 29.
    Lincoln TM, Hartmann M, Köther U, Moritz S (2014) Do people with psychosis have specific difficulties regulating emotions? Clin Psychol Psychother. doi: 10.1002/cpp.1923
  30. 30.
    Lincoln TM, Köther U, Hartmann M, Kempkensteffen J, Moritz S (2015) Responses to stress in patients with psychotic disorders compared to persons with varying levels of vulnerability to psychosis, persons with depression and healthy controls. J Behav Ther Exp Psychiatry 47:92–101CrossRefPubMedGoogle Scholar
  31. 31.
    Lincoln TM, Lange J, Burau J, Exner C, Moritz S (2010) The effect of state-anxiety on paranoid ideation and jumping to conclusions. An experimental investigation. Schizophr Bull 36:1041–1048Google Scholar
  32. 32.
    Lincoln TM, Mehl S, Exner C, Lindenmeyer J, Rief W (2010) Attributional style and persecutory delusions. Evidence for an event independent and state specific external-personal attribution bias for social situations. Cogn Ther Res 34:297–302CrossRefGoogle Scholar
  33. 33.
    Lincoln TM, Salzmann S, Ziegler M, Westermann S (2011) When does jumping-to-conclusions reach its peak? The interaction of vulnerability and situation-characteristics in social reasoning. J Behav Ther Exp Psychiatry 42:185–191CrossRefPubMedGoogle Scholar
  34. 34.
    Mehl S, Landsberg MW, Schmidt AC, Cabanis M, Bechdolf A, Herrlich J, Loos-Jankowiak S, Kircher T, Kiszkenow S, Klingberg S, Kommescher M, Moritz S, Muller BW, Sartory G, Wiedemann G, Wittorf A, Wolwer W, Wagner M (2014) Why do bad things happen to me? Attributional style, depressed mood, and persecutory delusions in patients with schizophrenia. Schizophr Bull 40:1338–1346CrossRefPubMedGoogle Scholar
  35. 35.
    Milner B (1971) Interhemispheric differences in the localization of psychological processes in man. Br Med Bull 27:272–277PubMedGoogle Scholar
  36. 36.
    Moritz S, Andreou C, Schneider BC, Wittekind CE, Menon M, Balzan RP, Woodward TS (2014) Sowing the seeds of doubt: a narrative review on metacognitive training in schizophrenia. Clin Psychol Rev 34:358–366CrossRefPubMedGoogle Scholar
  37. 37.
    Moritz S, Birkner C, Kloss M, Jahn H, Hand I, Haasen C, Krausz M (2002) Executive functioning in obsessive-compulsive disorder, unipolar depression, and schizophrenia. Arch Clin Neuropsychol 17:477–483PubMedGoogle Scholar
  38. 38.
    Moritz S, Burnette P, Sperber S, Kother U, Hagemann-Goebel M, Hartmann M, Lincoln TM (2011) Elucidating the black box from stress to paranoia. Schizophr Bull 37:1311–1317PubMedCentralCrossRefPubMedGoogle Scholar
  39. 39.
    Moritz S, Heeren D, Andresen B, Krausz M (2001) An analysis of the specificity and the syndromal correlates of verbal memory impairments in schizophrenia. Psychiatry Res 101:23–31CrossRefPubMedGoogle Scholar
  40. 40.
    Moritz S, Laroi F (2008) Differences and similarities in the sensory and cognitive signatures of voice-hearing, intrusions and thoughts: voice-hearing is more than a disorder of input. Schizophr Res 102:96–107CrossRefPubMedGoogle Scholar
  41. 41.
    Moritz S, Schilling L, Wingenfeld K, Kother U, Wittekind C, Terfehr K, Spitzer C (2011) Psychotic-like cognitive biases in borderline personality disorder. J Behav Ther Exp Psychiatry 42:349–354CrossRefPubMedGoogle Scholar
  42. 42.
    Moritz S, Veckenstedt R, Hottenrott B, Woodward TS, Randjbar S, Lincoln TM (2010) Different sides of the same coin? Intercorrelations of cognitive biases in schizophrenia. Cogn Neuropsychiatry 15:406–421CrossRefPubMedGoogle Scholar
  43. 43.
    Moritz S, Woodward TS, Burlon M, Braus DF, Andresen B (2007) Attributional style in schizophrenia: evidence for a decreased sense of self-causation in currently paranoid patients. Cogn Ther Res 31:371–383CrossRefGoogle Scholar
  44. 44.
    Myin-Germeys I, Krabbendam L, Jolles J, Delespaul PA, van Os J (2002) Are cognitive impairments associated with sensitivity to stress in schizophrenia? An experience sampling study. Am J Psychiatry 159:443–449CrossRefPubMedGoogle Scholar
  45. 45.
    Myin-Germeys I, Van Os J, Schwartz JE, Stone AA, Delespaul P (2001) Emotional reactivity to daily life stress in psychosis. Arch Gen Psychiatry 58:1137–1144CrossRefPubMedGoogle Scholar
  46. 46.
    Nuechterlein KH, Dawson ME (1984) A heuristic vulnerability/stress model of schizophrenic episodes. Schizophr Bull 10:300–312CrossRefPubMedGoogle Scholar
  47. 47.
    Palmer BW, Dawes SE, Heaton RK (2009) What do we know about neuropsychological aspects of schizophrenia? Neuropsychol Rev 19:365–384PubMedCentralCrossRefPubMedGoogle Scholar
  48. 48.
    Philipps LJ, Francey SM, Edwards J, McMurray N (2007) Stress and psychosis: towards the development of new models of investigation. Clin Psychol Rev 27:307–317CrossRefGoogle Scholar
  49. 49.
    Pohl PF (2004) Cognitive illusions: A handbook on fallacies and biases in thinking, judgement and memory. Psychology Press, Hove (UK)Google Scholar
  50. 50.
    Randjbar S, Veckenstedt R, Vitzthum F, Hottenrott B, Moritz S (2011) Attributional biases in paranoid schizophrenia: further evidence for a decreased sense of self-causation in paranoia. Psychosis 3:74–85CrossRefGoogle Scholar
  51. 51.
    Ross K, Freeman D, Dunn G, Garety P (2011) A randomized experimental investigation of reasoning training for people with delusions. Schizophr Bull 37:324–333PubMedCentralCrossRefPubMedGoogle Scholar
  52. 52.
    Sarid O, Anson O, Yaari A, Margalith M (2004) Academic stress, immunological reaction, and academic performance among students of nursing and physiotherapy. Res Nurs Health 27:370–377CrossRefPubMedGoogle Scholar
  53. 53.
    Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC (1998) The mini-international neuropsychiatric interview (m.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for dsm-iv and icd-10. J Clin Psychiatry 59(Suppl. 20):22–33Google Scholar
  54. 54.
    Sjoberg H (1977) Interaction of task difficulty, activation, and work load. J Human Stress 3:33–38CrossRefPubMedGoogle Scholar
  55. 55.
    Speechley WJ, Whitman JC, Woodward TS (2010) The contribution of hypersalience to the “jumping to conclusions” bias associated with delusions in schizophrenia. J Psychiatry Neurosci 35:7–17PubMedCentralCrossRefPubMedGoogle Scholar
  56. 56.
    Stefanis NC, Hanssen M, Smirnis NK, Avramopoulos DA, Evdokimidis I, Stefanis CN (2002) Evidence that three dimensions of psychosis have a distribution in the general population. Psychol Med 32:347–358CrossRefPubMedGoogle Scholar
  57. 57.
    van der Gaag M (2006) A neuropsychiatric model of biological and psychological processes in the remission of delusions and auditory hallucinations. Schizophr Bull 32(Suppl. 1):113–122CrossRefGoogle Scholar
  58. 58.
    Veckenstedt R, Randjbar S, Vitzthum F, Hottenrott B, Woodward TS, Moritz S (2011) Incorrigibility, jumping to conclusions, and decision threshold in schizophrenia. Cogn Neuropsychiatry 16:174–192CrossRefPubMedGoogle Scholar
  59. 59.
    Ventura J, Thames AD, Wood RC, Guzik LH, Hellemann GS (2010) Disorganization and reality distortion in schizophrenia: a meta-analysis of the relationship between positive symptoms and neurocognitive deficits. Schizophr Res 121:1–14PubMedCentralCrossRefPubMedGoogle Scholar
  60. 60.
    Wright B, Peters E, Ettinger U, Kuipers E, Kumari V (2014) Understanding noise stress-induced cognitive impairment in healthy adults and its implications for schizophrenia. Noise Health 16:166–176CrossRefPubMedGoogle Scholar
  61. 61.
    Wright B, Peters E, Kuipers E, Kumari V (2013) The relationship between stress and cognitive performance in real life environments in patients with schizophrenia Presentation held at the 4th European Conference on Schizophrenia Research (26–28 Sept 2013), BerlinGoogle Scholar
  62. 62.
    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? Psychol Psychother 81:237–245CrossRefPubMedGoogle Scholar
  63. 63.
    Zubin J, Spring B (1977) Vulnerability- a new view of schizophrenia. J Abnorm Psychol 86:103–126CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Steffen Moritz
    • 1
    Email author
  • Ulf Köther
    • 1
  • Maike Hartmann
    • 2
  • Tania M. Lincoln
    • 2
  1. 1.Department of Psychiatry and PsychotherapyUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.Clinical Psychology and Psychotherapy, Department of PsychologyUniversity of HamburgHamburgGermany

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