Relation between jumping to conclusions and cognitive functioning in people with schizophrenia in contrast with healthy participants
Introduction
The phenomenon known as ‘jumping to conclusions’ (JTC) is a reasoning bias consisting of a tendency to make a decision about an event without having enough information about it. The most common task for the assessment of JTC is the bead probabilities. The subject receives information about two jars with two different probabilities of color beads; the evaluator indicates that one of the jars has been selected and the subject is asked to indicate which jar it is after removing the number of beads he/she wants. One of the JTC tasks uses an emotional component where subjects extract positive or negative comments from the jars. The following studies have used these tasks for the assessment of JTC. Mortimer et al. (1996) described how 42% of people with schizophrenia only needed to draw one bead from the jar after to take a decision, thus working without sufficient information. Several studies show that patients with delusions have a greater tendency to jump to conclusions than people without mental disorders or with other mental disorders (Dudley et al., 1997, Fear and Healy, 1997, Conway et al., 2002, Garety et al., 2005). Some studies indicate that JTC is stable in people with schizophrenia; it is present even when there are no delusions at the time of the evaluation and it is more frequent in relatives of people with schizophrenia and in people with high risk of psychosis than healthy participants (Peters et al., 1999a, Peters and Garety, 2006, Van Dael et al., 2006, Broome et al., 2007). However, other studies have suggested that JTC improves after pharmacological and psychological interventions (Menon et al., 2008, Moritz et al., 2011). Salvatore et al. (2012) proposed theoretical models suggesting that cognitive bias such as JTC may lead the subject to attend only to information that confirms the patient's hypothesis in contrast to others, so certain interpersonal events could contribute to the emergence of persecutory delusions. The study of JTC, then, is a step toward explaining the forming and maintaining of delusions that may be useful for the design of intervention programs.
Regarding JTC in healthy participants, few studies have been done. Freeman et al. (2008) suggest that people who jump to conclusions present higher levels of subclinical delusional conviction and perceptual anomalies (Freeman et al., 2008). However, Warman and Martin (2006) found that JTC was related to proneness to delusions only in the emotional salient stimulus of the task.
Individuals with schizophrenia have impaired cognitive function, especially in executive function (several subdomains including working memory), and verbal memory (Bilder et al., 2000, Rund et al., 2004, Keefe et al., 2005, Lee and Park, 2005, Forbes et al., 2009). It is to be expected that a cognitive alteration in these areas would affect decision-making in a probabilistic task and this may be useful in order to create intervention strategies. However, few studies have assessed the relationship between cognitive functioning and JTC, and most of these have assessed it as a secondary aim.
The most widely studied cognitive domains related to JTC are Intellectual Quotient (IQ) and impulsivity. Regarding IQ some researchers have found that people with lower intelligence performed worse in JTC tasks (Mortimer et al., 1996, Van Dael et al., 2006). However, Lincoln et al. (2010) found that IQ only mediated the relationship between JTC and symptoms. Regarding impulsivity, the studies did not find a relationship between JTC and impulsivity (Moritz and Woodward, 2005, Rubio et al., 2011).
Few studies have assessed the relationship between JTC and executive function. Woodward et al. (2009) in a small sample of people with schizophrenia found that JTC was associated with executive functioning, using the Rule Extraction Test, which consists in participants being presented with a series of paired drawings and then determining which of the two stimuli presented contains the target element. Rubio et al. (2011) pointed in the same direction, finding a relationship between JTC and the executive control component of the Attentional Network Task, consisting in processing task-relevant information. However, Buck et al. (2012) did not find any relationship between JTC and perseverative errors of the WCST, although they found a correlation between WCST and confidence in the judgment. Specifically in relation to working memory, Garety et al. (2013), in a sample of people with schizophrenia, found a relationship between altered working memory and JTC. In people with high risk, Broome et al. (2007) found a negative relationship between the amount of information required and memory errors. On the other hand, Buck et al. (2012) did not find a relationship between auditory verbal memory and JTC. Moreover, of all the studies reviewed, only Garety et al. (2013) used a specific battery of tests for the assessment of the relationship between JTC and cognitive functioning, including measures of premorbid IQ, verbal learning memory, processing speed and working memory. Previous studies had not collected all of these together in a single study. However, the study of Garety et al. (2013) did not include healthy participants. There are no studies regarding the relationship between the emotional task of JTC and cognitive functioning. Woodward et al. (2009) used the emotional component, but as a unique measure of JTC, mixing this salient task with the other two tasks of JTC.
The relationship between cognitive functioning and JTC in healthy people has barely been studied. Only Freeman et al. (2008) studied IQ in the general population, finding a trend toward worsened functioning in people who jump to conclusions. However, no research has been conducted to assess the relationship with other cognitive domains. It would be interesting to learn whether the same relationship between JTC and cognitive functioning exists in people without any mental disorder as in people with schizophrenia, in order to better establish the mechanisms of JTC.
In summary, few studies have assessed the relationship between cognitive functioning and JTC, and only in one of them was it the main aim; none of them has assessed its functioning in healthy people nor has any assessed the relationship between the emotional component of JTC and cognitive functioning. Therefore, the aim of the present study was to assess the relationship between three different complexity and conceptual tasks of JTC and cognitive functioning in people with schizophrenia and healthy participants. The second aim was to assess which cognitive variables were at play after controlling for symptoms, thereby explaining the presence of JTC in each sample.
Section snippets
Participants
The participants were stable non-acute patients with schizophrenia at the Parc Sanitari Sant Joan de Déu who were attended in a middle and long stay unit of the center. Inclusion criteria were DSM-IV-R criteria for schizophrenia and age between 18 and 65. Exclusion criteria were alcohol abuse/dependence or abuse/dependence of other substances (DSM- IV-R criteria) during the previous 6 months, a history of organic mental disease, intellectual disability, brain injury, dementia, and having a
Results
A total of 57 healthy participants and 43 patients made up the sample. Sociodemographic, clinical and cognitive variables are shown in Table 1. In addition, mean of delusions was 13.27 (SD = 8.03) and of hallucinations 7.32 (SD = 5.16) in patients. Mean of years of evolution of the illness was 19.71 (SD = 12.36).
In the healthy group, 9 (15.8%) jumped to conclusions in Task 1, 5 (8.8%) in Task 2, and 5 (8.8%) in Task 3. The number of patients that jumped to conclusions was 24 (55.8%) in Task 1, 27
Discussion
The present study demonstrates a clear relationship between JTC and some cognitive domains, especially working memory, verbal memory, and cognitive processing speed in people with schizophrenia and in healthy participants. However this relationship was not found in the emotional task of JTC. Moreover, our results show that hallucinations (in people with schizophrenia) and proneness to hallucinations (in the healthy participants) are related to JTC, but not delusions.
The specific cognitive
Role of funding source
This work was supported by a Miguel Servet contract (Spain), research support contract from the Ministerio de Ciencia e Innovación, Spain (PTA2011-4983-I) and CIBERSAM.
Contributors
Gildas Brebion, Josep Maria Haro, Christian Stephan-Otto and Susana Ochoa designed the study and wrote the protocol. Judith Usall, Elena Huerta-Ramos, Susana Ochoa managed the literature searches and analyses. Lourdes Nieto and Jorge Cuevas-Esteban worked in the evaluations of the patients and follow-up. Susana Ochoa, Josep Maria Haro and Gildas Brebion performed the statistical analysis. All authors contributed to the draft of the manuscript and have approved the final version.
Conflict of interest
The authors have no conflict of interests.
Acknowledgments
This work was supported by a Miguel Servet contract (Spain), research support contract from the Ministerio de Ciencia e Innovación, Spain (PTA2011-4983-I), and CIBERSAM. We thank Mercedes Roca, Montserrat Contel, Helena Abellan-Vega, Mireia Pérez del Olmo and Iria Meléndez for their collaboration. We thank Dr. Phillipa Garety for sending us the JTC task and for her help with the back translation of these tasks.
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2022, Journal of Behavior Therapy and Experimental PsychiatryCitation Excerpt :In other words, bias only seems to manifest itself when limited, and mutually exclusive alternatives are presented (Moritz et al., 2020) (Moritz et al., 2016). Doubts have also been expressed as to whether patients adequately comprehend instructions; this may be significant for the overall assessment of bias given the existence of studies that appear to demonstrate a relationship between JTC and cognitive functioning (Ochoa et al., 2014) (Garety et al., 2013) (Krężołek et al., 2019), Furthermore, (Klein & Pinkham, 2018), suggest that faulty probabilistic reasoning explains JTC bias, noting that when probabilistic reasoning ability is controlled for, the observed effects of JTC bias diminish. Finally, In contrast to most research, in which only one or two sets are used, studies with multiple repetitions of the task show fewer differences between study and control groups (Krug et al., 2014) (Rausch et al., 2014).
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2021, Journal of Psychiatric ResearchCitation Excerpt :Interestingly, a recent population-based study found JTC among individuals with both psychotic experiences and affective disturbances but not in people who have either psychotic experiences or affective disturbances, suggesting that JTC is a common marker for combined presence of affective disorders and psychotic symptoms (Reininghaus et al., 2018). JTC has been widely studied in psychosis and mental health (Dudley et al., 2016; Fine et al., 2007; Freeman, 2007; Garety et al., 2011; Garety and Freeman, 2013; Ross et al., 2015), and despite the fact that research on the relation between JTC and psychosis has included moderating variables such as neurocognitive variables, other symptoms beyond psychosis, and personality traits (Garety et al., 2013; Gawęda and Krężołek, 2019; González et al., 2018; Ho-wai So et al., 2008; Hua et al., 2020; Krężołek et al., 2019; Ochoa et al., 2014), so far no works have studied the relationship between JTC and SB as moderating factor. In addition, only one study has been conducted on impaired DM in SB with psychosis (Adan et al., 2017).
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