Placing Cognitive Rigidity in Interpersonal Context in Psychosis: Relationship With Low Cognitive Reserve and High Self-Certainty

Abstract

Introduction: People with psychosis show impairments in cognitive flexibility, a phenomenon that is still poorly understood. In this study, we tested if there were differences in cognitive and metacognitive processes related to rigidity in patients with psychosis. We compared individuals with dichotomous interpersonal thinking and those with flexible interpersonal thinking.Methods: We performed a secondary analysis using two groups with psychosis, one with low levels of dichotomous interpersonal thinking (n = 42) and the other with high levels of dichotomous interpersonal thinking (n = 43). The patients were classified by splitting interpersonal dichotomous thinking (measured using the repertory grid technique) to the median. The groups were administered a sociodemographic questionnaire, a semi-structured interview to assess psychotic symptoms [Positive and Negative Syndrome Scale (PANSS)], a self-report of cognitive insight [Beck Cognitive Insight Scale (BCIS)], neurocognitive tasks [Wisconsin Card Sorting Test (WCST) and Wechsler Adult Intelligence Scale (WAIS)], and the repertory grid technique. We used a logistic regression model to test which factors best differentiate the two groups.Results: The group with high dichotomous interpersonal thinking had earlier age at onset of the psychotic disorder, higher self-certainty, impaired executive functioning, affected abstract thinking, and lower estimated cognitive reserve than the group with flexible thinking. According to the logistic regression model, estimated cognitive reserve and self-certainty were the variables that better differentiated between the two groups.Conclusion: Cognitive rigidity may be a generalized bias that affects not only neurocognitive and metacognitive processes but also the sense of self and significant others. Patients with more dichotomous interpersonal thinking might benefit from interventions that target this cognitive bias on an integrative way and that is adapted to their general level of cognitive abilities.

Influence of Menstrual Cycle Length and Age at Menarche on Symptoms, Cognition, Social Cognition, and Metacognition in Patients with First-Episode Psychosis

“…The women with mean menstrual cycles showed less self-certainty, which was also consistent with a reported association between estrogen levels and cycle length [25]. Selfcertainty is a metacognitive construct that has been associated with the emergence and maintenance of delusions [66,67] as well as neurocognitive performance [13] The age at menarche was associated with personalized bias, a cognitive bias directly implicated in the emergence and maintenance of delusions [68,69]. This suggested that women with lower estrogen levels may attribute others with the consequences of negative events.…”

The Relation between Negative Automatic Thoughts and Psychological Inflexibility in Schizophrenia

“…Consequently, PI has a negative impact on the well-being and quality of life of individuals with psychotic disorders [25,26]. Across the entire ACT model of psychopathology, CF and EA are the processes that were most often correlated with the clinical symptoms of schizophrenia [27,28]. CF is characterized by overt and covert behaviors being excessively determined by cognitions, which means that patients struggle with their thoughts, attempt to control them, and have difficulties finding alternative explanations to these thoughts [29].…”