Cognitive Biases in Schizophrenia
Jumping to Conclusions, Liberal Acceptance, Incorrigibility, and Deviances in Attributional Style
Our group has repeatedly replicated the “jumping-to-conclusions bias” in patients with schizophrenia (Moritz & Woodward, 2005; Moritz et al., 2007b) and demonstrated that not only acute but also remitted patients share a tendency to make hasty decisions, even for delusion-neutral events. In subsequent studies, we have substantiated these findings with alternative paradigms. For example, people with psychotic-like experiences sought less advice from others before making a decision (Scheunemann, 2018) and patients with psychosis rated multiple interpretations of a situation (even very unlikely options) as plausible (Moritz & Woodward, 2004). As a possible explanation for this cognitive bias, we hypothesize that people with schizophrenia have a lowered decision threshold due to liberal acceptance (Moritz et al., 2016; Moritz et al., 2006b; Moritz et al., 2008). In another study, in which patients were repeatedly surveyed over several days, we were also able to show that the tendency to jump to conclusions is variable and precedes fluctuations in paranoid symptoms over the course of the day (Lüdtke et al., 2017).
Incorrigibility, that is, the maintenance of an opinion or attitude despite counterevidence that most would find convincing, is a core feature of delusions. In a series of studies conducted in cooperation with Prof. Todd Woodward (Moritz & Woodward, 2006; Veckenstedt et al., 2011; Woodward et al., 2006a, 2006b; Woodward et al., 2008), we confirmed that people with schizophrenia, especially those with acute positive symptoms, show a decreased ability to integrate disconfirmatory information into their decisions (this is known as ‘bias against disconfirmatory evidence’, or BADE). This response style, along with the aforementioned jumping-to-conclusions bias, may represent a pivotal mechanism in the formation and maintenance of the positive symptoms of schizophrenia. Additionally, we have investigated a hypothesis put forward by Bentall, Kinderman & Kaney (1994) claiming that people with paranoia tend to externalize and, in particular, to personalize failure, which in turn reflects an underlying decreased implicit self-esteem and perhaps a stronger self-serving bias (i.e., success is believed to be due to one’s own efforts, whereas failure is due to others or circumstances).
Although we indeed found evidence for decreased implicit self-esteem (Moritz et al., 2006a), the results do not support the idea that there is a stronger self-serving bias among individuals with psychosis. However, through this work, we found another interesting deviation, which is that people with acute psychosis expressed less personal control/involvement with regard to both positive and negative events (Moritz et al., 2007a). In comparison to healthy and psychiatric controls, they attributed the causes of positive and negative events significantly more often as being outside their control. We also found evidence of mono-causal attributions in individuals with psychosis (Randjbar et al., 2011).
In cooperation with Prof. Tania Lincoln from the University of Hamburg, we investigated whether the cognitive biases discussed above are aggravated under stress (e.g., Lincoln et al., 2010; Moritz et al., 2010), and in collaboration with PD Dr. Daniela Roesch-Ely from Heidelberg, we have assessed the role of cognitive biases for symptomatic and functional outcomes in schizophrenia (Andreou et al., 2013, 2014). Further studies have dealt with other cognitive biases in schizophrenia, such as attentional distortions (e.g., Moritz & Laudan, 2007) and illusion of control (Moritz et al., 2014).
- Prof. Dr. Steffen Moritz
- M.Sc. Jakob Scheunemann
- M.Sc. Thies Lüdtke
- Dr. Ruth Veckenstedt
- Dipl.-Psych. Birgit Hottenrott
- Dipl.-Psych. Francesca Bohn
- PD Dr. Łukasz Gawęda
- PD Dr. Christina Andreou (Universität Basel, Schweiz)
- Prof. Dr. Todd S. Woodward (University of British Columbia and Riverview Hospital, Vancouver, Kanada)
- Dr. Ryan Balzan (Adelaide, Australien)
- Prof. Dr. Tania Lincoln (Psychologisches Institut, Universität Hamburg)
- Dipl.-Psych. Sarah Randjbar (Privatpraxis, Wien)
Andreou, C., Roesch-Ely, D., Veckenstedt, R., Bohn, F., Aghotor, J., Köther, U., Pfueller, U., & Moritz, S. (2013). Predictors of early stable symptomatic remission after an exacerbation of schizophrenia: the significance of symptoms, neuropsychological performance and cognitive biases. Psychiatry Research, 210, 729-734.
Andreou, C., Treszl, A., Roesch-Ely, D., Köther, U., Veckenstedt, R., & Moritz, S. (2014). Investigation of the role of the jumping-to-conclusions bias for short-term functional outcome in schizophrenia. Psychiatry Research, 218, 341-347.
Bentall, R. P., Kinderman, P., & Kaney, S. (1994). The self attributional processes and abnormal beliefs: towards a model of persecutory delusions. Behaviour Research & Therapy, 32, 331-341.
Lincoln, T. M., Peter, N., Schäfer, M., & Moritz, S. (2010). From stress to paranoia: an experimental investigation of the moderating and mediating role of reasoning biases. Psychological Medicine, 40, 169-171.
Lüdtke, T., Kriston, L., Schröder, J., Lincoln, T. M., & Moritz, S. (2017). Negative affect and a fluctuating jumping to conclusions bias predict subsequent paranoia in daily life: an online experience sampling study. Journal of Behavior Therapy and Experimental Psychiatry, 56, 106-112.
Moritz, S., Bentall, R. P., Kolbeck, K., & Roesch-Ely, D. (2018). Monocausal attribution and its relationship with reasoning biases in schizophrenia. Schizophrenia Research, 193, 77–82.
Moritz, S., Burnette, P., Sperber, S., Köther, U., Hagemann-Goebel, M., Hartmann, M., & Lincoln, T. M. (2010). Elucidating the black box from stress to paranoia. Schizophrenia Bulletin, 37, 1311-1317.
Moritz, S. & Laudan, A. (2007). Attention bias for paranoia-relevant visual stimuli in schizophrenia. Cognitive Neuropsychiatry, 12, 381-390.
Moritz, S., Scheu, F., Andreou, C., Pfueller, U., Weisbrod, M., & Roesch-Ely, D. (2016). Reasoning in psychosis: risky but not necessarily hasty. Cognitive Neuropsychiatry, 21, 91-106.
Moritz, S., Thompson, S. C., & Andreou, C. (2014). Illusory control in schizophrenia. Journal of Experimental Psychopathology, 5, 113-122.
Moritz, S., Werner, R., & von Collani, G. (2006). The inferiority complex in paranoia readdressed: a study with the Implicit Association Test. Cognitive Neuropsychiatry, 11, 402-415.
Moritz, S. & Woodward, T. S. (2004). Plausibility judgment in schizophrenic patients: evidence for a liberal acceptance bias. German Journal of Psychiatry, 7, 66-74.
Moritz, S. & Woodward, T. S. (2005). Jumping to conclusions in delusional and non-delusional schizophrenic patients. British Journal of Clinical Psychology, 44, 193-207.
Moritz, S. & Woodward, T. S. (2006). A generalized bias against disconfirmatory evidence in schizophrenia. Psychiatry Research, 142, 157-165.
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 Research & Therapy, 31, 371-383.
Moritz, S., Woodward, T. S., & Hausmann, D. (2006). Incautious reasoning as a pathogenetic factor for the development of psychotic symptoms in schizophrenia. Schizophrenia Bulletin, 32, 327-331.
Moritz, S., Woodward, T. S., Jelinek, L., & Klinge, R. (2008). Memory and metamemory in schizophrenia: a liberal acceptance account of psychosis. Psychological Medicine, 38, 825-832.
Moritz, S., Woodward, T. S., & Lambert, M. (2007). Under what circumstances do patients with schizophrenia jump to conclusions? A liberal acceptance account. British Journal of Clinical Psychology, 46, 127-137.
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, 74-85.
Scheunemann, J. (2018). Advice integration and belief revision in people with psychotic-like experiences. Unpublished master’s thesis, University of Oldenburg, Germany.
Veckenstedt, R., Randjbar, S., Vitzthum, F., Hottenrott, B., Woodward, T. S., & Moritz, S. (2011). Incorrigibility, jumping to conclusions, and decision threshold in schizophrenia. Cognitive Neuropsychiatry, 16, 174-192.
Woodward, T. S., Moritz, S., & Chen E. Y. (2006). The contribution of a cognitive bias against disconfirmatory evidence (BADE) to delusions: a study in an Asian sample with first episode schizophrenia spectrum disorders. Schizophrenia Research, 83, 297-298.
Woodward, T. S., Moritz, S., Cuttler, C., & Whitman, J. C. (2006). The contribution of a cognitive bias against disconfirmatory evidence (BADE) to delusions in schizophrenia. Journal of Clinical & Experimental Neuropsychology, 28, 605-617.
Woodward, T. S., Moritz, S., Menon, M., & Klinge, R. (2008). Belief inflexibility in schizophrenia. Cognitive Neuropsychiatry, 13, 267-277.