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Background and Objectives: Quality of reasoning within non-clinical paranoia and mental simulation of future paranoia themed events was investigated by use of a simulation task to determine whether paranoid individuals would be restricted or more adept at reasoning about paranoia relevant material in comparison to a social anxiety group and a group with low paranoia and social anxiety., Method: Participants (N = 63) were divided into the three groups based on paranoia and social anxiety scores. They were presented with the beginning and end of an imaginary situation and were asked to describe, step-by-step, what they imagined would happen between those two points. They were also administered a beads task to evaluate the jumping to conclusion decision making bias., Results: The prediction of more adept reasoning was not supported for paranoia. However, the social anxiety comparison group on average better simulated a scenario with congruent (socially anxious) thematic content compared to ones with non-congruent content. Further, in an exploratory analysis, jumping to conclusions bias was found to be positively related to goodness of simulation for paranoia themed scenarios within the paranoia group., Limitations: Study groups were relatively small and so power was an issue., Conclusion: The results are discussed in the context of the sometimes paradoxical findings in the area of cognitive biases and paranoia., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background and Objectives: Interpersonal stress is key to the development and maintenance of paranoia. Much attention has been given to the impact of interpersonal stressors, such as criticism, on outcomes in psychosis. Less attention has been given to the potentially protective effects of positive interpersonal factors. This study tested experimentally whether criticism and warm comments elicited changes in state paranoia. Whether warm comments provided protective effects when participants faced subsequent social exclusion was also examined., Method: A nonclinical sample (N = 97) was randomised to criticism, warm comments, or neutral comments conditions. Participants then played a virtual ball game (Cyberball), during which they were systematically excluded from the game. State paranoia was measured before and after the affective stimuli and after social exclusion. Self-esteem and trait paranoia were also measured., Results: Paranoia levels increased following exposure to criticism (p = .011). Paranoia was not significantly lower following exposure to warm comments (p = .203). Warm comments did not provide protection against the effects of subsequent social exclusion. The warm comments condition was the only condition in which significant increases in paranoia were seen following social exclusion (p = .004)., Limitations: Use of a non-clinical sample limits generalisation to clinical populations., Conclusions: Criticism is sufficient to elicit increases in paranoia in non-clinical participants. Warm comments are insufficient to significantly reduce paranoia or provide protective effects against subsequent negative interpersonal experiences, highlighting the need to balance therapeutic warmth with amelioration of social stressors in paranoia., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background and Objectives: The Threat Anticipation Model (Freeman, 2007) implicates social anxiety, jumping to conclusions (JTC) and belief inflexibility in persecutory delusions. We investigated whether Cognitive Bias Modification for Interpretation (CBM-I; Turner et al., 2011) improves social anxiety by targeting negative interpretation bias of ambiguous social information. We determined whether the Maudsley Review Training Programme (MRTP; Waller et al., 2011) improves JTC, belief inflexibility and paranoia. We also explored effects of CBM-I on JTC/belief inflexibility and paranoia, as well as the MRTP on social anxiety., Methods: Twelve participants from Early Intervention and Recovery Services in East Anglia completed measures of social anxiety, paranoia, JTC and belief inflexibility. A concurrent multiple baseline case series design was used., Results: Three of twelve participants improved in social anxiety following CBM-I, paranoia improved in 6/12 cases. CBM-I had no effect on JTC/belief inflexibility. The MRTP improved JTC and/or belief inflexibility in 9/12 cases, while improving paranoia for 6/12 individuals. The MRTP improved social anxiety in one case., Limitations: The small sample size and large effects necessary for single case series designs limit the generality of findings. These are discussed in more detail., Conclusions: This study suggests that whilst both CBM-I and the MRTP may have a positive impact on paranoia and social anxiety, the effects on JTC/belief inflexibility are largely specific to the MRTP. Relationships between social anxiety, JTC, belief inflexibility and paranoia existed in 10/12 individuals, supporting the Threat Anticipation Model., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background and Objectives: When asked to evaluate faces of strangers, people with paranoia show a tendency to rate others as less trustworthy. The present study investigated the impact of arousal on this interpersonal bias, and whether this bias was specific to evaluations of trust or additionally affected other trait judgements. The study also examined the impact of eye gaze direction, as direct eye gaze has been shown to heighten arousal., Methods: In two experiments, non-clinical participants completed face rating tasks before and after either an arousal manipulation or control manipulation. Experiment one examined the effects of heightened arousal on judgements of trustworthiness. Experiment two examined the specificity of the bias, and the impact of gaze direction., Results: Experiment one indicated that the arousal manipulation led to lower trustworthiness ratings. Experiment two showed that heightened arousal reduced trust evaluations of trustworthy faces, particularly trustworthy faces with averted gaze. The control group rated trustworthy faces with direct gaze as more trustworthy post-manipulation. There was some evidence that attractiveness ratings were affected similarly to the trust judgements, whereas judgements of intelligence were not affected by higher arousal., Limitations: In both studies, participants reported low levels of arousal even after the manipulation and the use of a non-clinical sample limits the generalisability to clinical samples., Conclusions: There is a complex interplay between arousal, evaluations of trustworthiness and gaze direction. Heightened arousal influences judgements of trustworthiness, but within the context of face type and gaze direction., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background and Objectives: A promising candidate for a vulnerability indicator for psychosis is the restricted scanpath. Restricted scanning of social stimuli, such as faces, might also contribute to misinterpretations of facial expressions and thus increase the likelihood of delusional interpretations. Moreover, similar to other vulnerability indicators of psychosis, scanpaths may be susceptible to stress. Thus, we hypothesized that scanpath restriction would increase as a function of delusion-proneness, stress and their interaction., Methods: Participants were asked to look at neutral faces and rate their trustworthiness under a stress and a non-stress condition, while the eye gaze was recorded. The non-clinical sample was classified into low- and high-paranoia scorers using a median split. Eye-tracking parameters of interest were number of fixations, fixations within emotion-relevant facial areas, scanpath length and duration of fixations., Results: In general, high-paranoia scorers had a significantly shorter scanpath compared to low-paranoia scorers (F(1, 48) = 2.831, p = 0.05, η p 2  = 0.056) and there was a trend towards a further decrease of scanpath length under stress in high-paranoia scorers relative to low-paranoia scorers (interaction effect: F(1, 48) = 2.638, p = 0.056, η p 2  = 0.052). However, no effects were found for the other eye-tracking parameters. Moreover, trustworthiness ratings remained unaffected by group or condition., Limitations: The participants of this study had only slight elevations of delusion-proneness, which might explain the absence of differences in trustworthiness ratings., Conclusions: Restricted scanpaths appear to be partly present in individuals with subclinical levels of paranoia and appear to be susceptible to stress in this group. Nevertheless, further research in high-risk groups is necessary before drawing more definite conclusions., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background and Objectives: Biased processing of negatively valenced, and particularly threat-related material plays an important role in the development of paranoid thinking. This has been demonstrated by superior memory for threat-related information in patients with persecutory delusions and in non-clinical paranoia-prone participants. This study examined how emotional material was recalled having been encoded in relation to one self or to another person, in people high or low in paranoid ideation. It was predicted that people high in paranoia would recall more threat related material about others than people low in paranoia owing to being particularly alert to threats from other people., Methods: Participants who reported high (N = 30) or low (N = 30) levels of sub-clinical paranoid thinking were presented with a series of threat-related and positive words and were asked to process them in terms of the self, or in terms of a fictional character., Results: As predicted, when words were processed in terms of another person, the high paranoia group recalled more threat-related words than positive words, but when words had been processed in terms of the self, recall of threat-related and positive words did not differ. In contrast, there was no interaction between word-valence and referent in the low paranoia group., Limitations: These findings are drawn from an analogue sample. Replication in a sample of clinical participants who report persecutory delusions is required., Conclusions: People high in sub-clinical paranoid ideation recalled threat preferentially in relation to other people. Such information processing biases may help understand the development and maintenance of persecutory beliefs., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background and Objectives: Overconfidence in errors is a well-replicated cognitive bias in psychosis. However, prior studies have sometimes failed to find differences between patients and controls for more difficult tasks. We pursued the hypothesis that overconfidence in errors is exaggerated in participants with a liability to psychosis relative to controls only when they feel competent in the respective topic and/or deem the question easy. Whereas subjective competence likely enhances confidence in those with low psychosis liability as well, we still expected to find more 'residual' caution in the latter group., Methods: We adopted a psychometric high-risk approach to circumvent the confounding influence of treatment. A total of 2321 individuals from the general population were administered a task modeled after the "Who wants to be a millionaire" quiz. Participants were requested to endorse one out of four response options, graded for confidence, and were asked to provide ratings regarding subjective competence for the knowledge domain as well as the subjective difficulty of each item., Results: In line with our assumption, overconfidence in errors was increased overall in participants scoring high on the Paranoia Checklist core paranoia subscale (2 SD above the mean). This pattern of results was particularly prominent for items for which participants considered themselves competent and which they rated as easy., Limitations: Results need to be replicated in a clinical sample., Discussion: In support of our hypothesis, subjective competence and task difficulty moderate overconfidence in errors in psychosis. Trainings that teach patients the fallibility of human cognition may help reduce delusional ideation., (Copyright © 2015. Published by Elsevier Ltd.)

Background and Objectives: The aim of this study was to assess the impact of meta-cognitive training (MCT) on cognitive biases, symptoms, clinical insight, and general functioning among low-level functioning persons diagnosed with chronic schizophrenia who were attending a daily Community Social Support Group Program; we compared the treatment-as-usual (TAU) condition with the MCT + TAU condition., Methods: Forty-four patients diagnosed with chronic schizophrenia were allocated to either the MCT + treatment-as-usual condition or the treatment-as-usual (TAU) condition. Delusion and hallucination severity, cognitive biases, clinical insight, and global functioning were assessed pre- and post-treatment (clinical trial NCT02187692)., Results: No significant changes were found in symptom severity as measured with the PSYRATS. Conversely, a medium to large effect size was observed for delusional ideation changes when assessed by the self-report measure (Paranoia Checklist). MCT was found to ameliorate cognitive biases as measured by the self-report scale at large effect size, however, no changes in jumping to conclusions (the Fish Task) and theory of mind deficits ("Reading the Mind in the Eyes" Test) were found in the behavioral tasks. MCT increased insight at large effect size. No changes in global functioning were found between the two conditions., Limitations: Low intensity intervention. No follow-up assessment was provided. Only PSYRATS was assessed blind to patient allocation., Conclusions: MCT has a beneficial effect on low-functioning chronic schizophrenic patients in ameliorating cognitive biases and increasing clinical insight., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background and Objectives: An experimental design was used to test whether self-reported, psychophysiological and symptomatic stress-responses increase as a function of the underlying vulnerability to psychosis as proposed by vulnerability-stress-models., Methods: Stress-responses of participants with psychotic disorders (PSY, n = 35) were compared to those of participants with attenuated positive symptoms (AS, n = 29), first-degree relatives of persons with psychotic disorders (REL, n = 26), healthy controls (HC, n = 28) and controls with depression (DEP, n = 30). Using a repeated measures design, participants were assigned to a noise stressor, a social stressor and a no stress condition in random order. Stress-responses were assessed via self-report, salivary cortisol levels, heart rate and skin conductance levels. State-paranoia and depression were assessed with clinical scales., Results: PSY reported to be significantly more stressed than HC, AS and REL across all conditions which went along with increased heart rate and decreased overall cortisol release. In contrast, AS showed elevated levels of cortisol. PSY showed a stronger response of self-reported stress to the noise condition compared to the no stress condition than HC, but no stronger response than the other samples. Furthermore, the stressors did not trigger stronger psychophysiological responses or symptom-increases in PSY., Limitations: The social stressor was brief and not individualized and did not have an effect on cortisol., Conclusions: The findings support the notion that subjective stress-responsiveness increases with vulnerability, but not the assumption that symptoms arise directly as a function of stress and vulnerability. Also, the generally high levels of arousal seem to be more relevant to psychosis than the responsiveness to specific stressors., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background and Objectives: A previous study has shown an association of paranoid thinking with a reliance on rapid intuitive ('experiential') reasoning and less use of slower effortful analytic ('rational') reasoning. The objectives of the new study were to replicate the test of paranoia and reasoning styles in a large general population sample and to assess the use of these reasoning styles in patients with persecutory delusions., Method: 30 Patients with persecutory delusions in the context of a non-affective psychotic disorder and 1000 non-clinical individuals completed self-report assessments of paranoia and reasoning styles., Results: The patients with delusions reported lower levels of both experiential and analytic reasoning than the non-clinical individuals (effect sizes small to moderate). Both self-rated ability and engagement with the reasoning styles were lower in the clinical group. Within the non-clinical group, greater levels of paranoia were associated with lower levels of analytic reasoning, but there was no association with experiential reasoning., Limitations: The study is cross-sectional and cannot determine whether the reasoning styles contribute to the occurrence of paranoia. It also cannot be determined whether the patient group's lower reasoning scores are specifically associated with the delusions., Conclusions: Clinical paranoia is associated with less reported use of analytic and experiential reasoning. This may reflect patients with current delusions being unconfident in their reasoning abilities or less aware of decision-making processes and hence less able to re-evaluate fearful cognitions. The dual process theory of reasoning may provide a helpful framework in which to discuss with patients decision-making styles., (Copyright © 2014 Elsevier Ltd. All rights reserved.)