Delusion formation and reasoning biases in those at clinical high risk for psychosis
Open accessAbstract
Background: Cognitive models propose that faulty appraisal of anomalous experiences is critical in developing psychosis, particularly delusions. A data gathering bias may be fundamental to abnormal appraisal Aims: To examine whether there is a data gathering bias in people at high risk of developing psychosis Method: Individuals with an at-risk mental state (n=35) were compared with a matched group of healthy volunteers (n=23). Participants were tested using a modified version of the ‘beads’ reasoning task with different levels of task difficulty Results: When task demands were high, the at-risk group made judgements on the basis of less information than the control group (P < 0.05). Within both groups, jumping to conclusions was directly correlated with the severity of abnormal beliefs and intolerance of uncertainty (P<0.05). In the at-risk group it was also associated with impaired working memory (P<0.05), whereas in the control group poor working memory was associated with a more conservative response style (P<0.05) Conclusions: People with an at-risk mental state display a jumping to conclusions reasoning style, associated with impaired working memory and intolerance of uncertainty. This may underlie a tendency to develop abnormal beliefs and a vulnerability to psychosis
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Intolerance of uncertainty is elevated in those with an at-risk state of psychosis compared to controls.
“Indeed, one study has shown that IU is elevated in those with an at‐risk state of psychosis, compared to controls (Broome et al., 2007).”
From Intolerance of uncertainty, paranoia, and prodromal symptoms: Comparisons between a schizophrenia spectrum disorder, anxiety disorder and non‐clinical sample. (2025) · cites this paper as Broome et al., 2007
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BackgroundAtypical processing of uncertainty in individuals at risk for psychosis
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“Similarly, a greater ‘need for closure’ has been found to be associated with delusional ideation in clinical populations (Colbert et al., 2006; Broome et al., 2007).”
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“Evidence of jumping to conclusions has also been found in populations that are delusion-prone (Colbert & Peters, 2002), at high risk for psychosis (Broome et al., 2007), and with a first episode of psychosis (Falcone et al.”
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“Another study (Broome et al., 2007) found that putatively prodromal individuals jump to conclusions only when task”
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“1996; Peters & Garety, 2006) and in people at high risk of developing psychosis who display more trait-like aberrations (Broome et al., 2007; Lincoln, Salzmann, Ziegler, & Westermann, 2011; Van Dael et al., 2006).”
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“On the draws-to-decision (DTD) version of this task, participants view as many beads as they choose before deciding which jar was selected, whereupon the trial is terminated.”
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“2006), and in people with an ARMS (Broome et al. 2007).”
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“Although certain reasoning biases are more pronounced in deluded and high risk samples (Broome et al., 2007), the explanation of the puzzling nature of delusions has to be found elsewhere.”
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“For individuals at CHR, the JTC bias is associated with more severe positive symptoms, intolerance of uncertainty, and impaired working memory (Broome et al., 2007; Winton-Brown et al., 2015).”
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“…bias has been reported in close relatives of schizophrenia patients (van Dael et al., 2006) and individuals at a high clinical risk of psychosis (Broome et al., 2007), and it may be associated with higher levels of conviction in paranoid thoughts within the general population (Freeman et al.,…”
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“…measured neural activation as subjects responded to 12 It is of some interest to note that, in a study of individuals at high risk for psychosis (Broome et al., 2007), the at-risk group performed significantly worse than healthy control participants on a test of working memory (a simple span…”
BackgroundInvestigation of metamemory functioning in the at-risk mental state for psychosis
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“In patients with schizophrenia, metacognitive abilities have often been found to be biased (Levine et al. 2004; Broome et al. 2007; Fine et al. 2007; So et al. 2012; Eifler et al. 2014b; Rausch et al. 2014), demonstrating deviations in the selection, appraisal and processing of information (Moritz et al.”
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“Such biases occur in individuals who are exhibiting attenuated psychotic symptoms (Broome et al., 2007), individuals in the general population with high levels of delusional ideation (Colbert & Peters, 2002; Warman & Martin, 2006), and in first-degree relatives of individuals with schizophrenia…”
BackgroundMethodInfluentialDelusional evidence-responsiveness
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“…JTC is more frequent in deluded patients than in non-deluded patients (Garety and Freeman, 2013), while it has also been reported in people in remission and in the general population at risk of psychosis (Broome et al., 2007; Freeman et al., 2008; Gawęda and Prochwicz, 2015; Van Dael et al., 2006).”
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“A study by Broome et al. (2007) sought to investigate the hypothesised link between JTC and ‘‘bead-span’’ in individuals identified as being at ‘‘high risk of developing psychoses’’.”
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Andreou, C., Schneider, B. C., Braun, V., Kolbeck, K., Gallinat, J., & Moritz, S. (2015) · Journal of Psychiatry & Neuroscience · doi:10.1503/jpn.140306 · Cited by 31 · see citing works
Rausch, F., Mier, D., Eifler, S., Fenske, S. C., Schirmbeck, F., Englisch, S., Schilling, C., Meyer-Lindenberg, A., Kirsch, P., & Zink, M. (2015) · Journal of Psychiatry & Neuroscience · doi:10.1503/jpn.140191 · Cited by 30 · see citing works
Clinical and Cognitive Correlates of Psychiatric Comorbidity in Delusional Disorder Outpatients
de Portugal, E., Martínez, C., González, N., del Amo, V., Haro, J., & Cervilla, J. (2011) · Australian and New Zealand journal of psychiatry (Print) · doi:10.3109/00048674.2010.551279 · Cited by 30 · see citing works
“We were unable to fi nd a study in DD that specifi cally evaluated working memory, despite the fact that previous studies in schizophrenia have related this function to alterations in the ability to understand the mental states of other people (theory of mind [47,48] and abnormal probabilistic reasoning) a tendency to…”
ResultJumping to Conclusions bias, BADE and Feedback Sensitivity in schizophrenia and schizotypy.
Juárez-Ramos, V., Rubio, J., Delpero, C., Mioni, G., Stablum, F., & Gómez-Milán, E. (2014) · Consciousness and Cognition · doi:10.1016/j.concog.2014.03.006 · Cited by 29 · see citing works
“The dimensional model of schizophrenia predicts unifying cognitive biases or that these cognitive biases may combine to contribute to the formation of the delusional aspects of psychosis (Buchy et al., 2007).”
BackgroundInvestigating the 'jumping to conclusions' bias in people with anorexia nervosa.
McKenna, G., Fox, J. R. E., & Haddock, G. (2014) · European eating disorders review · doi:10.1002/erv.2310 · Cited by 28 · see citing works
Jumping to delusions in early psychosis
Langdon, R., Still, M., Connors, M. H., Ward, P. B., & Catts, S. V. (2014) · Cognitive Neuropsychiatry · doi:10.1080/13546805.2013.854198 · Cited by 27 · see citing works
Rüegg, N., Moritz, S., Berger, T., Lüdtke, T., & Westermann, S. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1644-8 · Cited by 39 · see citing works
“These biases might increase the likelihood of psychotic symptoms [38].”
BackgroundArmando, M., Lin, A., Girardi, P., Righetti, V., Dario, C., Saba, R., Crescenzo, F. D., Mazzone, L., Vicari, S., Birchwood, M., et al. (2013) · Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000000050 · Cited by 27 · see citing works
“The scale has previously been used in studies investigating delusion formation (Broome et al., 2007), anxiety, and depression (Boelen and Reijntjes, 2009; Buhr and Dugas, 2006).”
BackgroundMethodBastiaens, T., Claes, L., Smits, D., Wachter, D. D. D., van der Gaag, M., & de Hert, M. (2013) · Schizophrenia Research · doi:10.1016/j.schres.2013.04.037 · Cited by 27 · see citing works
“As far back as 1988, Huq et al. described biases in data gathering, also known as Jumping To Conclusions (JTC), which appear to be present in ongoing delusional psychosis (Garety et al., 2005) as well as in at-risk state for psychosis (Broome et al., 2007).”
BackgroundBroome, M., Day, F., Valli, I., Valmaggia, L., Johns, L., Howes, O., Garety, P., & McGuire, P. (2012) · European psychiatry · doi:10.1016/j.eurpsy.2010.07.008 · Cited by 27 · see citing works
“These findings support our earlier finding that suggested a link between working memory and cognitive mechanisms of delusion formation [8].”
BackgroundResultSelf-citationKim, K. R., Lee, S. Y., Kang, J. I., Kim, B. R., Choi, S., Park, J. Y., Lee, E. M., An, S. K., & Kwon, J. S. (2011) · Early Intervention in Psychiatry · doi:10.1111/j.1751-7893.2011.00267.x · Cited by 25 · see citing works
Does Intolerance of Uncertainty Affect the Magnitude of Limitations or Pain Intensity?
Donthula, D., Kortlever, J. T. P., Ring, D., Donovan, E. E., Reichel, L. M., & Vagner, G. A. (2019) · Clinical Orthopaedics and Related Research · doi:10.1097/corr.0000000000001042 · Cited by 33 · see citing works
“These high levels were also found in people with obsessive-compulsive disorder, social phobia, posttraumatic stress disorder, major depressive disorders, eating disorders, and psychosis [5, 6, 8, 11, 17, 23, 26, 35, 36, 39, 40, 44].”
BackgroundNeural Correlates of Intolerance of Uncertainty in Clinical Disorders
Wever, M. C. M., Smeets, P. A. M., & Sternheim, L. C. (2015) · Journal of Neuropsychiatry · doi:10.1176/appi.neuropsych.14120387 · Cited by 30 · see citing works
“have demonstrated that elevated intolerance of uncertainty may play a role in a wider range of psychological disorders such as major depressive disorder,(11,12) eating disorders, and psychosis.(16) These findings indicate that intolerance of uncertainty is not a ubiquitous characteristic specific to”
BackgroundData Gathering Bias: Trait Vulnerability to Psychotic Symptoms?
Catalán, A., Simons, C., Bustamante, S., Olazabal, N., Ruiz, E., de Artaza, M. G., Penas, A., Maurottolo, C., González, A., van Os, J., et al. (2015) · PLoS ONE · doi:10.1371/journal.pone.0132442 · Cited by 26 · see citing works
Ermakova, A., Ramachandra, P., Corlett, P., Fletcher, P., & Murray, G. (2014) · PLoS ONE · doi:10.1371/journal.pone.0102683 · Cited by 26 · see citing works
“There is a possible involvement of the working memory impairments in the JTC bias [25,26], and methamphetamine improves at least some types of memory [27].”
Evans, S., Almahdi, B., Sultan, P., Sohanpal, I., Brandner, B., Collier, T., Shergill, S., Cregg, R., & Averbeck, B. (2012) · Journal of Psychopharmacology · doi:10.1177/0269881111435252 · Cited by 26 · see citing works
“There is also evidence of a JTC tendency in prodromal groups (Broome et al., 2007).”
BackgroundCost Evaluation During Decision-Making in Patients at Early Stages of PsychosisPreprint
Ermakova, A., Gileadi, N., Knolle, F., Justicia, A., Anderson, R., Fletcher, P., Moutoussis, M., & Murray, G. (2018) · bioRxiv · doi:10.1101/225920 · Cited by 25 · see citing works
“Motivational factors, such as intolerance of uncertainty (Bentall & Swarbrick, 2003; Broome et al., 2007), a “need for closure” (Colbert & Peters, 2002), a cost to self-esteem of seeming to need more information (Bentall & Swarbrick, 2003), or an abnormal “hypersalience of evidence” (Esslinger et al.”
BackgroundRausch, F., Eisenacher, S., Elkin, H., Englisch, S., Kayser, S., Striepens, N., Lautenschlager, M., Heinz, A., Gudlowski, Y., Janssen, B., et al. (2016) · Psychological Medicine · doi:10.1017/s0033291716000465 · Cited by 25 · see citing works
“…Garety et al. 2014), in patients with first-episode psychosis (Falcone et al. 2014), in patients with current and remitted delusions (Dudley et al. 1997; Colbert et al. 2010), in delusion-prone individuals (Colbert & Peters, 2002; White & Mansell, 2009) and in ARMS patients (Broome et al. 2007).”
BackgroundResultInfluentialPredicting intolerance of uncertainty in individuals with eating disorder symptoms
Sternheim, L. C., Fisher, M., Harrison, A., & Watling, R. (2017) · Journal of Eating Disorders · doi:10.1186/s40337-017-0152-4 · Cited by 30 · see citing works
“Originally studied as a predictor of worry and general anxiety disorder (GAD [18]), in the last decade researchers have recognised IU as a predictor for a wide range of psychopathologies, including anxiety and depression [19–21], obsessive-compulsive symptoms [22], emotional problems [23, 24] and psychosis [25].”
Lincoln, T. M., Salzmann, S., Ziegler, M., & Westermann, S. (2010) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2010.09.005 · Cited by 21 · see citing works
Social relationships and quality of life moderate distress associated with delusional ideation
Lim, M., Gleeson, J., Jackson, H., & Fernandez, K. C. (2013) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-013-0738-3 · Cited by 23 · see citing works
“, individuals with an ‘‘at risk mental state’’) [37].”
Neural correlates of movement generation in the ‘at‐risk mental state’
Broome, M. R., Matthíasson, P., Fusar‐Poli, P., Woolley, J. B., Johns, L., Tabraham, P., Bramon, E., Valmaggia, L., Williams, S., Brammer, M. J., et al. (2010) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2009.01524.x · Cited by 21 · see citing works
“Some neuropsychological deficits in the ARMS may only become evident when the task demands are high (10).”
BackgroundSelf-citationIntolerance of uncertainty and psychosis: A systematic review
Morriss, J., Butler, D., & Ellett, L. (2025) · British Journal of Clinical Psychology · doi:10.1111/bjc.12509 · Cited by 21 · see citing works
“There was one study that used a between-subjects design and found a large effect size ( d = 1.11) for the difference in intolerance of uncertainty between individuals with an ‘at-risk’ mental state of psychosis and matched healthy controls (Broome et al., 2007).”
InfluentialWinton‐Brown, T., Broome, M. R., Allen, P., Valli, I., Howes, O. D., Garety, P. A., Johns, L., & McGuire, P. K. (2014) · European Psychiatry · doi:10.1016/j.eurpsy.2014.09.416 · Cited by 15 · see citing works
“We have previously shown that at clinical presentation, ARMS subjects have both a JTC bias and VSM impairments relative to controls [2,20].”
BackgroundMethodResultInfluentialSelf-citationParanoid induction reduces N400s of healthy subjects with delusional‐like ideation
Prévost, M., Rodier, M., Lionnet, C., Brodeur, M. B., King, S., & Debruille, J. B. (2010) · Psychophysiology · doi:10.1111/j.1469-8986.2010.01160.x · Cited by 22 · see citing works
Andreou, C., Schneider, B. C., Balzan, R., Luedecke, D., Roesch-Ely, D., & Moritz, S. (2015) · Schizophrenia Research: Cognition · doi:10.1016/j.scog.2015.02.001 · Cited by 20 · see citing works
The tendency to stop collecting information is linked to illusions of causality
Moreno-Fernández, M. M., Blanco, F., & Matute, H. (2021) · Scientific Reports · doi:10.1038/s41598-021-82075-w · Cited by 15 · see citing works
Stovell, D., Wearden, A. J., Morrison, A. P., & Hutton, P. (2016) · Psychosis · doi:10.1080/17522439.2016.1145730 · Cited by 21 · see citing works
Golembiewski, J. A. (2013) · Facilities · doi:10.1108/02632771311324981 · Cited by 18 · see citing works
Cole, J. H., Filippetti, M. L., Allin, M. P. G., Walshe, M., Nam, K. W., Gutman, B. A., Murray, R. M., Rifkin, L., Thompson, P. M., & Nosarti, C. (2015) · PLoS ONE · doi:10.1371/journal.pone.0130094 · Cited by 15 · see citing works
“This cognitive bias has been put forward as a possible mechanism of delusion formation and maintenance [85] and has been associated with impaired working memory [86].”
BackgroundA replication study of JTC bias, genetic liability for psychosis and delusional ideation
Henquet, C., van Os, J., Pries, L., Rauschenberg, C., Delespaul, P., Kenis, G., Luykx, J., Lin, B.-C. D., Richards, A., Akdede, B., et al. (2020) · Psychological Medicine · doi:10.1017/s0033291720003578 · Cited by 17 · see citing works
“These general population studies have revealed that JTC is more frequently present in individuals with prodromal symptoms of psychosis (Broome et al., 2007) as well as in individuals scoring high on the CAPE (Lincoln, Lange, Burau, Exner, & Moritz, 2010) and other measures of subclinical delusional ideation (Menon et…”
InfluentialJepsen, J. R. M., Rydkjær, J., Fagerlund, B., Pagsberg, A. K., Jespersen, R. A. F., Glenthoj, B. Y., & Oranje, B. (2017) · Psychological Medicine · doi:10.1017/s0033291717001921 · Cited by 18 · see citing works
“2015), or clinical high-risk for psychosis (Broome et al. 2007).”
Background
- Authors
- Broome, M. R., Johns, L. C., Valli, I., Woolley, J. B., Tabraham, P., Brett, C., Valmaggia, L., Peters, E., Garety, P. A., & McGuire, P. K.
- Affiliations
- King's College London (GB)
- University of Warwick (GB)
- Maastricht University (NL)
- Corresponding author
- Broome, M. R.
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2007-12
- Volume
- 191
- Issue
- S51
- Pages
- s38-s42
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2027555607
- Cited by
- 204
- References
- 29
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 3 · 2023: 4 · 2022: 7 · 2021: 8 · 2020: 23 · 2019: 9 · 2018: 8 · 2017: 15 · 2016: 11 · 2015: 19 · 2014: 14 · 2013: 16 · 2012: 10
- FWCI
- 5.05
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Keywords
- delusion formation, clinical high risk for psychosis, reasoning biases, jumping to conclusions, intolerance of uncertainty, working memory, anomalous experiences, response styles
- MeSH terms
- Adult, Delusions, Humans, Impulsive Behavior, Intelligence, Judgment, Memory, Short-Term, Neuropsychological Tests, Problem Solving, Psychiatric Status Rating Scales, Psychotic Disorders
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