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Monocausal Attributions Along Cross-Sections of Psychosis Development and Links with Psychopathology and Data Gathering Style

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Abstract

Several attributional biases have been discussed as putative causal factors in psychosis formation and maintenance. The monocausality bias in particular describes the excessive tendency to disregard multifactorial explanations and to instead attribute events to a single cause. To elucidate the role of monocausality in psychosis development, this study compared patients with an at-risk mental state of psychosis (ARMS, n = 49), first-episode patients (FEP, n = 35), chronic schizophrenia patients (SZ, n = 32) and healthy controls (HC, n = 39) on the Internal Personal and Situational Attributions Questionnaire—Revised. FEP patients made significantly more monocausal attributions than HC to the external-personal locus for positive events. Moreover, monocausality was linked with psychotic as well as depressive symptoms and tentatively also with a hasty data gathering style. Future studies should explore associations with other metacognitive deficits and the potential to prevent or correct the monocausality bias through psychological interventions.

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References

  • Addington, D., Addington, J., & Maticka-Tyndale, E. (1993). Assessing depression in schizophrenia: The Calgary Depression Scale. The British Journal of Psychiatry, 163(22), 39–44.

    Article  Google Scholar 

  • An, S. K., Kang, J. I., Park, J. Y., Kim, K. R., Lee, S. Y., & Lee, E. (2010). Attribution bias in ultra-high risk for psychosis and first-episode schizophrenia. Schizophrenia Research, 118(1–3), 54–61.

    Article  PubMed  Google Scholar 

  • Bechdolf, A., Pukrop, R., Kohn, D., Tschinkel, S., Veith, V., Schultze-Lutter, F., … Klosterkotter, J. (2005). Subjective quality of life in subjects at risk for a first episode of psychosis: A comparison with first episode schizophrenia patients and healthy controls. Schizophrenia Research, 79(1), 137–143.

    Article  PubMed  Google Scholar 

  • Bentall, R. P., Kinderman, P., & Kaney, S. (1994). The self, attributional processes and abnormal beliefs: Towards a model of persecutory delusions. Behaviour Research and Therapy, 32(3), 331–341.

    Article  PubMed  CAS  Google Scholar 

  • Broyd, A., Balzan, R. P., Woodward, T. S., & Allen, P. (2017). Dopamine, cognitive biases and assessment of certainty: A neurocognitive model of delusions. Clinical Psychology Review, 54, 96–106.

    Article  PubMed  Google Scholar 

  • Diez-Alegria, C., Vazquez, C., Nieto-Moreno, M., Valiente, C., & Fuentenebro, F. (2006). Personalizing and externalizing biases in deluded and depressed patients: Are attributional biases a stable and specific characteristic of delusions? British Journal of Clinical Psychology, 45(4), 531–544.

    Article  PubMed  Google Scholar 

  • Donohoe, G., Spoletini, I., McGlade, N., Behan, C., Hayden, J., O’Donoghue, T., … Corvin, A. (2008). Are relational style and neuropsychological performance predictors of social attributions in chronic schizophrenia? Psychiatry Research, 161(1), 19–27.

    Article  PubMed  Google Scholar 

  • Eisenacher, S., Rausch, F., Ainser, F., Mier, D., Veckenstedt, R., Schirmbeck, F., … Zink, M. (2015). Investigation of metamemory functioning in the at-risk mental state for psychosis. Psychological Medicine, 45(15), 3329–3340.

    Article  PubMed  CAS  Google Scholar 

  • Eisenacher, S., Rausch, F., Mier, D., Fenske, S., Veckenstedt, R., Englisch, S., … Meyer-Lindenberg, A. (2016). Bias against disconfirmatory evidence in the ‘at-risk mental state’and during psychosis. Psychiatry Research, 238, 242–250.

    Article  PubMed  Google Scholar 

  • Field, A. (2013). Discovering statistics using IBM SPSS statistics. Thousand Oaks: Sage.

    Google Scholar 

  • Freeman, D. (2007). Suspicious minds: The psychology of persecutory delusions. Clinical Psychology Review, 27(4), 425–457.

    Article  PubMed  Google Scholar 

  • Freeman, D., Garety, P. A., Kuipers, E., Fowler, D., & Bebbington, P. E. (2002). A cognitive model of persecutory delusions. British Journal of Clinical Psychology, 41(4), 331–347.

    Article  PubMed  Google Scholar 

  • Fusar-Poli, P., Bonoldi, I., Yung, A. R., Borgwardt, S., Kempton, M. J., Valmaggia, L., … McGuire, P. (2012). Predicting psychosis: Meta-analysis of transition outcomes in individuals at high clinical risk. Archives of General Psychiatry, 69(3), 220–229.

    Article  PubMed  Google Scholar 

  • Garety, P., Joyce, E., Jolley, S., Emsley, R., Waller, H., Kuipers, E., … Freeman, D. (2013). Neuropsychological functioning and jumping to conclusions in delusions. Schizophrenia Research, 150(2), 570–574.

    Article  PubMed  PubMed Central  Google Scholar 

  • Garety, P., Waller, H., Emsley, R., Jolley, S., Kuipers, E., Bebbington, P., … Freeman, D. (2014). Cognitive mechanisms of change in delusions: An experimental investigation targeting reasoning to effect change in paranoia. Schizophrenia Bulletin, 41(2), 400–410.

    Article  PubMed  PubMed Central  Google Scholar 

  • Garety, P. A., & Freeman, D. (2013). The past and future of delusions research: From the inexplicable to the treatable. British Journal of Psychiatry, 203(5), 327–333.

    Article  PubMed  CAS  Google Scholar 

  • Gilbert, D. T., Pelham, B. W., & Krull, D. S. (1988). On cognitive busyness: When person perceivers meet persons perceived. Journal of Personality and Social Psychology, 54(5), 733–740.

    Article  Google Scholar 

  • Haddock, G., McCarron, J., Tarrier, N., & Faragher, E. (1999). Scales to measure dimensions of hallucinations and delusions: The psychotic symptom rating scales (PSYRATS). Psychological Medicine, 29(04), 879–889.

    Article  PubMed  CAS  Google Scholar 

  • Häfner, H., Maurer, K., Löffler, W., An der Heiden, W., Munk-Jørgensen, P., Hambrecht, M., & Riecher-Rössler, A. (1998). The ABC Schizophrenia Study: A preliminary overview of the results. Social Psychiatry and Psychiatric Epidemiology, 33(8), 380–386.

    Article  PubMed  Google Scholar 

  • IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp.

  • Janssen, I., Versmissen, D., Campo, J. A., Myin-Germeys, I., van Os, J., & Krabbendam, L. (2006). Attribution style and psychosis: Evidence for an externalizing bias in patients but not in individuals at high risk. Psychological Medicine, 36(6), 771–778.

    Article  PubMed  CAS  Google Scholar 

  • Kay, S., Opler, R., & Fiszbein, A. (1992). The structured clinical interview for positive and negative syndromes of schizophrenia. New York: Multi-Health Systems.

    Google Scholar 

  • Kendler, K., & Campbell, J. (2009). Interventionist causal models in psychiatry: Repositioning the mind–body problem. Psychological Medicine, 39(06), 881–887.

    Article  PubMed  CAS  Google Scholar 

  • Keshavan, M. S., DeLisi, L. E., & Seidman, L. J. (2011). Early and broadly defined psychosis risk mental states. Schizophrenia Research, 126(1), 1–10.

    Article  PubMed  Google Scholar 

  • Kesting, M. L., & Lincoln, T. M. (2013). The relevance of self-esteem and self-schemas to persecutory delusions: A systematic review. Comprehensive Psychiatry, 54(7), 766–789.

    Article  PubMed  Google Scholar 

  • Kinderman, P., & Bentall, R. P. (1996). A new measure of causal locus: The internal, personal and situational attributions questionnaire. Personality and Individual Differences, 20(2), 261–264.

    Article  Google Scholar 

  • Langdon, R., Still, M., Connors, M. H., Ward, P. B., & Catts, S. V. (2013). Attributional biases, paranoia, and depression in early psychosis. British Journal of Clinical Psychology, 52(4), 408–423.

    Article  PubMed  Google Scholar 

  • Lehrl, S. (2005). Manual zum MWT-B. Balingen: Spitta-Verlag.

    Google Scholar 

  • Lincoln, T. M., Hohenhaus, F., & Hartmann, M. (2013). Can paranoid thoughts be reduced by targeting negative emotions and self-esteem? An experimental investigation of a brief compassion-focused intervention. Cognitive Therapy and Research, 37(2), 390–402.

    Article  Google Scholar 

  • Lincoln, T. M., 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. Cognitive Therapy and Research, 34(3), 297–302.

    Article  Google Scholar 

  • Lincoln, T. M., & Peters, E. (2018). A systematic review and discussion of symptom specific cognitive behavioural approaches to delusions and hallucinations. Schizophrenia Research. https://doi.org/10.1016/j.schres.2017.12.014.

    Article  PubMed  Google Scholar 

  • Mancuso, F., Horan, W. P., Kern, R. S., & Green, M. F. (2011). Social cognition in psychosis: Multidimensional structure, clinical correlates, and relationship with functional outcome. Schizophrenia Research, 125(2–3), 143–151.

    Article  PubMed  Google Scholar 

  • Maurer, K., & Riecher-Rössler, A. (1993). The influence of age and sex on the onset and early course of schizophrenia. The British Journal of Psychiatry, 162(1), 80–86.

    Article  PubMed  Google Scholar 

  • Maurer, K., Zink, M., Rausch, F., & Häfner, H. (2016). The early recognition inventory ERIraos assesses the entire spectrum of symptoms through the course of an at-risk mental state. Early Intervtion in Psychiatry. https://doi.org/10.1111/eip.12305.

    Article  Google Scholar 

  • McGrath, J., Saha, S., Chant, D., & Welham, J. (2008). Schizophrenia: A concise overview of incidence, prevalence, and mortality. Epidemiologic Reviews, 30, 67–76.

    Article  PubMed  Google Scholar 

  • Mehl, S., Landsberg, M. W., Schmidt, A. C., Cabanis, M., Bechdolf, A., Herrlich, J., … Wagner, M. (2014). Why do bad things happen to me? Attributional style, depressed mood, and persecutory delusions in patients with schizophrenia. Schizophrenia Bulletin, 40(6), 1338–1346.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mehl, S., Rief, W., Lullmann, E., Ziegler, M., Muller, M. J., & Lincoln, T. M. (2010). Implicit attributional style revisited: Evidence for a state-specific “self-decreasing” implicit attributional style in patients with persecutory delusions. Cognitive Neuropsychiatry, 15(5), 451–476.

    Article  PubMed  Google Scholar 

  • Merrin, J., Kinderman, P., & Bentall, R. P. (2007). ‘Jumping to Conclusions’ and Attributional Style in Persecutory Delusions. Cognitive Therapy and Research, 31(6), 741–758.

    Article  Google Scholar 

  • Mezulis, A. H., Abramson, L. Y., Hyde, J. S., & Hankin, B. L. (2004). Is there a universal positivity bias in attributions? A meta-analytic review of individual, developmental, and cultural differences in the self-serving attributional bias. Psychological Bulletin, 130(5), 711–747.

    Article  PubMed  Google Scholar 

  • Miller, T. J., McGlashan, T. H., Woods, S. W., Stein, K., Driesen, N., Corcoran, C. M., … Davidson, L. (1999). Symptom assessment in schizophrenic prodromal states. Psychiatric Quarterly, 70(4), 273–287.

    Article  PubMed  CAS  Google Scholar 

  • Mizrahi, R., Addington, J., Remington, G., & Kapur, S. (2008). Attribution style as a factor in psychosis and symptom resolution. Schizophrenia Research, 104(1–3), 220–227.

    Article  PubMed  Google Scholar 

  • Moritz, S., Andreou, C., Schneider, B. C., Wittekind, C. E., Menon, M., Balzan, R. P., & Woodward, T. S. (2014). Sowing the seeds of doubt: A narrative review on metacognitive training in schizophrenia. Clinical Psychology Review, 34(4), 358–366.

    Article  PubMed  Google Scholar 

  • Moritz, S., Bentall, R. P., Kolbeck, K., & Roesch-Ely, D. (2017). Monocausal attribution and its relationship with reasoning biases in schizophrenia. Schizophrenia Research. https://doi.org/10.1016/j.schres.2017.06.057.

    Article  PubMed  Google Scholar 

  • Moritz, S., Kother, U., Hartmann, M., & Lincoln, T. M. (2015). Stress is a bad advisor. Stress primes poor decision making in deluded psychotic patients. European Archives of Psychiatry and Clinical Neuroscience, 265(6), 461–469.

    Article  PubMed  Google Scholar 

  • Moritz, S., & Woodward, T. S. (2007). Metacognitive training in schizophrenia: From basic research to knowledge translation and intervention. Current Opinion in Psychiatry, 20(6), 619–625.

    Article  PubMed  Google Scholar 

  • Moritz, S., Woodward, T. S., Burlon, M., Braus, D. F., & Andresen, B. (2007). Attributional style in schizophrenia: Evidence for a decreased sense of self-causation in currently paranoid patients. Cognitive Therapy and Research, 31(3), 371–383.

    Article  Google Scholar 

  • Nowak, U., Eisenacher, S., Braun, H., Rausch, F., Muszinski, S., Thiem, J., Becker, A., Englisch, S., Kirsch, P., Meyer-Lindenberg, A., & Zink, M. (under review). Attributional style is influenced by mood and cognitive resources in clinical samples of psychosis development.

  • Randall, F., Corcoran, R., Day, J., & Bentall, R. (2003). Attention, theory of mind, and causal attributions in people with persecutory delusions: A preliminary investigation. Cognitive Neuropsychiatry, 8(4), 287–294.

    Article  PubMed  Google Scholar 

  • 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(1), 74–85.

    Article  Google Scholar 

  • Rausch, F., Eisenacher, S., Elkin, H., Englisch, S., Kayser, S., Striepens, N., … Gaebel, W. (2016). Evaluation of the ‘Jumping to conclusions’ bias in different subgroups of the at-risk mental state: From cognitive basic symptoms to UHR criteria. Psychological Medicine, 46(10), 2071–2081.

    Article  PubMed  CAS  Google Scholar 

  • Rausch, F., Mier, D., Eifler, S., Esslinger, C., Schilling, C., Schirmbeck, F., … Zink, M. (2014). Reduced activation in ventral striatum and ventral tegmental area during probabilistic decision-making in schizophrenia. Schizophrenia Research, 156(2–3), 143–149.

    Article  PubMed  Google Scholar 

  • Rausch, F., Mier, D., Eifler, S., Fenske, S., Schirmbeck, F., Englisch, S., … Zink, M. (2015). Reduced activation in the ventral striatum during probabilistic decision-making in patients in an at-risk mental state. Journal of Psychiatry and Neuroscience, 40(3), 163–173.

    Article  PubMed  Google Scholar 

  • Ruhrmann, S., Schultze-Lutter, F., Salokangas, R. K., Heinimaa, M., Linszen, D., Dingemans, P., … Heinz, A. (2010). Prediction of psychosis in adolescents and young adults at high risk: Results from the prospective European prediction of psychosis study. Archives of General Psychiatry, 67(3), 241–251.

    Article  PubMed  Google Scholar 

  • Saß, H., Wittchen, H., & Zaudig, M. (2000). Diagnostisches und statistisches Manual psychischer Störungen DSM-IV. Göttingen: Hogrefe.

    Google Scholar 

  • Schultze-Lutter, F., Ruhrmann, S., Fusar-Poli, P., Bechdolf, A., Schimmelmann, G., B., & Klosterkotter, J. (2012). Basic symptoms and the prediction of first-episode psychosis. Current Pharmaceutical Design, 18(4), 351–357.

    Article  PubMed  CAS  Google Scholar 

  • Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., … Dunbar, G. C. (1998). The Mini-International Neuropsychiatric Interview (MINI): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59(20), 22 33.

    Google Scholar 

  • So, S. H., Tang, V., & Leung, P. W. (2015). Dimensions of delusions and attribution biases along the continuum of psychosis. Public Library of Science One, 10(12), e0144558.

    PubMed  Google Scholar 

  • Thompson, A., Papas, A., Bartholomeusz, C., Allott, K., Amminger, G. P., Nelson, B., … Yung, A. (2012). Social cognition in clinical “at risk” for psychosis and first episode psychosis populations. Schizophrenia Research, 141(2), 204–209.

    Article  PubMed  Google Scholar 

  • van der Gaag, M., Hoffman, T., Remijsen, M., Hijman, R., de Haan, L., van Meijel, B., … Cuijpers, A. (2006). The five-factor model of the Positive and Negative Syndrome Scale II: A ten-fold cross-validation of a revised model. Schizophrenia Research, 85(1), 280–287.

    PubMed  Google Scholar 

  • Vitzthum, F. B., Veckenstedt, R., & Moritz, S. (2014). Individualized metacognitive therapy program for patients with psychosis (MCT+): Introduction of a novel approach for psychotic symptoms. Behavioural and Cognitive Psychotherapy, 42(1), 105–110.

    Article  PubMed  Google Scholar 

  • Waller, H., Emsley, R., Freeman, D., Bebbington, P., Dunn, G., Fowler, D., … Garety, P. (2015). Thinking Well: A randomised controlled feasibility study of a new CBT therapy targeting reasoning biases in people with distressing persecutory delusional beliefs. Journal of Behavior Therapy and Experimental Psychiatry, 48, 82–89.

    Article  PubMed  PubMed Central  Google Scholar 

  • Woodward, T. S., Mizrahi, R., Menon, M., & Christensen, B. K. (2009). Correspondences between theory of mind, jumping to conclusions, neuropsychological measures and the symptoms of schizophrenia. Psychiatry Research, 170(2), 119–123.

    Article  PubMed  Google Scholar 

  • Yung, A., Phillips, L., McGorry, P., Ward, J., Donovan, K., & Thompson, K. (2002). Comprehensive assessment of at risk mental states (CAARMS). Melbourne: University of Melbourne, Department of Psychiatry, Personal Assessment and Crisis Evaluation Clinic.

    Google Scholar 

  • Yung, A. R., & McGorry, P. D. (1996). The prodromal phase of first-episode psychosis: Past and current conceptualizations. Schizophrenia Bulletin, 22(2), 353–370.

    Article  PubMed  CAS  Google Scholar 

  • Ziegler, M., Rief, W., & Lincoln, T. M. (2009). Leistet voreiliges Schlussfolgern einen Beitrag zur Entstehung und Aufrechterhaltung von Wahn? Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, 57(2), 125–136.

    Article  Google Scholar 

  • Zuckerman, M. (1979). Attribution of success and failure revisited, or: The motivational bias is alive and well in attribution theory. Journal of Personality, 47(2), 245 287.

    Article  Google Scholar 

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Acknowledgements

We are grateful to all participants and to the staff of the inpatient clinic who helped support our study appointments. M.Z., A.M.-L., and P.K. were funded by the Deutsche Forschungsgesellschaft (DFG, http://www.dfg.de, projects ZI1253/3-1, ZI1253/3-2, KI 576/14-2, ME1591/6-2). S.Ei. was supported by a grant of Heidelberg University (Landesgraduiertenförderungsgesetz), and U.N. by the Studienstiftung des Deutschen Volkes. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

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Correspondence to S. Eisenacher.

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S.En. has received travel expenses from Lundbeck, Otsuka and Servier and consultant fees from Servier. A.M-L. has received consultant fees from Blueprint Partnership, Boehringer Ingelheim, Daimler und Benz Stiftung, Elsevier, F. Hoffmann-La Roche, ICARE Schizophrenia, K. G. Jebsen Foundation, L.E.K. Consulting, Lundbeck International Foundation (LINF), R. Adamczak, Roche Pharma, Science Foundation, Synapsis Foundation – Alzheimer Research Switzerland, System Analytics, and has received lectures including travel fees from Boehringer Ingelheim, Fama Public Relations, Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Janssen-Cilag, Klinikum Christophsbad, Göppingen, Lilly Deutschland, Luzerner Psychiatrie, LVR Klinikum Düsseldorf, LWL PsychiatrieVerbund Westfalen-Lippe, Otsuka Pharmaceuticals, Reunions I Ciencia S. L., Spanish Society of Psychiatry, Südwestrundfunk Fernsehen, Stern TV, and Vitos Klinikum Kurhessen. M.Z. has received unrestricted scientific grants from German Research Foundation (DFG), and Servier; further speaker and travel grants were provided by Otsuka, Servier, Lundbeck, Roche, Ferrer and Trommsdorff. All other authors declare no conflicts of interest.

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Study approval was obtained from the ethics committee at the Medical Faculty Mannheim of the University of Heidelberg (AZ 2009-296N-MA). Informed consent was obtained from all individuals participating in the study.

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Nowak, U., Eisenacher, S., Braun, H. et al. Monocausal Attributions Along Cross-Sections of Psychosis Development and Links with Psychopathology and Data Gathering Style. Cogn Ther Res 42, 699–710 (2018). https://doi.org/10.1007/s10608-018-9907-8

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