Relationships between cognitive biases, decision-making, and delusions

Multiple measures of decision-making under uncertainty (e.g. jumping to conclusions (JTC), bias against disconfirmatory evidence (BADE), win-switch behavior, random exploration) have been associated with delusional thinking in independent studies. Yet, it is unknown whether these variables explain shared or unique variance in delusional thinking, and whether these relationships are specific to paranoia or delusional ideation more broadly. Additionally, the underlying computational mechanisms require further investigation. To investigate these questions, task and self-report data were collected in 88 individuals (46 healthy controls, 42 schizophrenia-spectrum) and included measures of cognitive biases and behavior on probabilistic reversal learning and explore/exploit tasks. Of those, only win-switch rate significantly differed between groups. In regression, reversal learning performance, random exploration, and poor evidence integration during BADE showed significant, independent associations with paranoia. Only self-reported JTC was associated with delusional ideation, controlling for paranoia. Computational parameters increased the proportion of variance explained in paranoia. Overall, decision-making influenced by strong volatility and variability is specifically associated with paranoia, whereas self-reported hasty decision-making is specifically associated with other themes of delusional ideation. These aspects of decision-making under uncertainty may therefore represent distinct cognitive processes that, together, have the potential to worsen delusional thinking across the psychosis spectrum.

Automated summary

This study indicates that decision-making under uncertainty is associated with delusional thinking. However, it is unclear whether these decision-making processes are specific to paranoia or delusional ideation in general, and further investigation into the underlying computational mechanisms is required. By collecting task and self-report data from 88 individuals (46 healthy controls, 42 schizophrenia-spectrum), it was found that reversal learning performance, random exploration, and poor evidence integration in BADE are significantly and independently associated with paranoia. Only self-reported JTC is associated with delusional ideation, controlling for paranoia. Computational parameters increase the proportion of variance explained in paranoia. Overall, decision-making influenced by strong volatility and variability is specifically associated with paranoia, while self-reported hasty decision-making is specifically associated with other themes of delusional ideation. These decision-making processes under uncertainty may represent distinct cognitive processes that, together, have the potential to worsen delusional thinking across the psychosis spectrum.