Cited by 794Schizophrenia research and treatmentMental Health and PsychiatryHallucinations in medical conditions

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Cognitive approaches to delusions: a critical review of theories and evidence.

Garety, Philippa A., Freeman, Daniel·1999·British Journal of Clinical Psychology

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Abstract

PURPOSE: To review critically the evidence for three contemporary theories of delusions. METHODS: The theoretical approaches to delusions proposed by Frith and colleagues ('theory of mind' deficits), Garety and colleagues (multi-factorial, but involving probabilistic reasoning biases) and Bentall and colleagues (attributional style and self-discrepancies) are summarised. The findings of empirical papers directly relevant to these proposals are critically reviewed. These papers were identified by computerised literature searches (for the years 1987-1997) and a hand search. RESULTS: The evidence does not unequivocally support any of the approaches as proposed. However, strong evidence is found to support modifications of Garety and colleagues' and Bentall and colleagues' theories. Studies have replicated a 'jumping to conclusions' data-gathering bias and an externalising attributional bias in people with delusions. There is preliminary evidence for a 'theory of mind' deficit, as proposed by Frith, although possibly related to a more general reasoning bias. Evidence for an underlying discrepancy between ideal and actual self-representations is weaker. CONCLUSIONS: A multi-factorial model of delusion formation and maintenance incorporating a data-gathering bias and attributional style, together with other factors (e.g. perceptual processing, meta-representation) is consistent with the current evidence. It is recommended that these findings be incorporated into cognitive therapy approaches. However, there are limitations to existing research. Future studies should incorporate longitudinal designs and first episode studies, and should not neglect the co-morbidity of delusions, including affective processes, or the multi-dimensional nature of delusions.

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Background
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BackgroundMethodInfluential
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Background
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Background
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Method
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BackgroundResult
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Result
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BackgroundInfluential
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Background
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Background
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Background
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Background
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Background
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Background
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Background
Relationships between intra-individual variability and subclinical psychosis
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Background
Neuropsychological aspects of delusional disorder
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Background
Characteristics of cognitive impairment in schizophrenia
Harvey, P. D. (2013) · Cambridge University Press eBooks · doi:10.1017/cbo9781139003872.002 · Cited by 10
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“of this group (Bentall and Fernyhough, 2008; Garety and Freeman, 1999).”
A Fine-Grained Analysis of the Jumping to Conclusions Bias in Schizophrenia: Data-Gathering, Response Confidence, and Information IntegrationPreprint
Glöckner, A., & Moritz, S. (2008) · SSRN Electronic Journal · doi:10.2139/ssrn.1313623 · Cited by 10
“(For an older but still relevant review on this topic, see Garety & Freeman, 1999 .)”
Letter to the editor: metacognitive training and metacognitive therapy. A reply to Lora Capobianco and Adrian Wells.
Andreou, C., Balzan, R. P., Jelinek, L., & Moritz, S. (2018) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2018.01.006 · Cited by 9
Stress and cognitive biases in schizotypy: A two-site study of bias against disconfirmatory evidence and jumping to conclusions
Le, T. P., Fedechko, T. L., Cohen, A. S., Allred, S., Pham, C. N., Lewis, S. W., & Barkus, E. (2019) · European Psychiatry · doi:10.1016/j.eurpsy.2019.08.006 · Cited by 9
“reasoning biases underlie positive symptoms [11,14,15].”
Background
Jumping to conclusions: the association between delusional ideation and reasoning biases in a healthy student population
Cafferkey, K., Murphy, J., & Shevlin, M. E. (2013) · Psychosis · doi:10.1080/17522439.2013.850734 · Cited by 9
“…based on insufficient and inadequate information (Fine, Gardner, Craigie, & Gold, 2007; Freeman, 2007) and various cognitive theorists have focused specifically on this particular reasoning bias (Freeman et al., 2002; Garety & Freeman, 1999) in an attempt to understand delusional experience.”
Background
Differences in Cognitive-Perceptual Factors Arising From Variations in Self-Professed Paranormal Ability
Drinkwater, K. G., Dagnall, N., Denovan, A., & Williams, C. A. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.681520 · Cited by 9
Synergistic pathways to delusions: enduring vulnerabilities, proximal life stressors and maladaptive psychological coping
Goldstone, E., Farhall, J., & Ong, B. (2011) · Early Intervention in Psychiatry · doi:10.1111/j.1751-7893.2011.00264.x · Cited by 9
Inferential-Reasoning Impairment in Schizophrenia-Spectrum Disorders
Kruck, C. L., Roth, R. M., Kumbhani, S. R., Garlinghouse, M. A., Flashman, L. A., & McAllister, T. W. (2011) · Journal of Neuropsychiatry · doi:10.1176/appi.neuropsych.23.2.211 · Cited by 9
Increased hindsight bias in schizophrenia.
Woodward, T. S., Moritz, S., Arnold, M. M., Cuttler, C., Whitman, J. C., & Lindsay, D. S. (2006) · Neuropsychology · doi:10.1037/0894-4105.20.4.461 · Cited by 9
“…Feldon, Rawlins, Hemsley, & Smith, 1991; Hemsley, 1996), (b) the context-processing account of Cohen (Cohen, Barch, Carter, & Servan-Schreiber, 1999; Cohen & Servan-Schreiber, 1992), and (c) the jumping-to-conclusions account of Garety (Garety & Freeman, 1999; Garety, Hemsley, & Wessely, 1991).”
Influential
Psychotic features in the general population. Risk factors for what?
Krabbendam, L., Hanssen, M., Bak, M., & van Os, J. (2004) · Steinkopff eBooks · doi:10.1007/978-3-7985-1953-4_4 · Cited by 9
Monothematic delusion: A case of innocence from experience
Sullivan‐Bissett, E. (2018) · Philosophical Psychology · doi:10.1080/09515089.2018.1468024 · Cited by 8
“Philippa Garety and Daniel Freeman claim that “there is growing evidence of reasoning and attributional biases in people with delusions which suggests they may display systematic differences in cognitive processes from those in the general population” (Garety & Freeman, 1999, p. 116).”
Background
Relationship between cognition and suicidal behavior in recent-onset psychosis
Sastre-Buades, A., Caro‐Cañizares, I., Ochoa, S., Lorente-Rovira, E., Barajas, A., Gutiérrez‐Zotes, A., Sánchez-Alonso, S., López‐Carrilero, R., Grasa, E., Pousa, E., et al. (2023) · Schizophrenia Research · doi:10.1016/j.schres.2022.12.042 · Cited by 9
Neuropsychologische Aspekte wahnhafter Störungen
Bömmer, I., & Brüne, M. (2006) · Der Nervenarzt · doi:10.1007/s00115-006-2213-9 · Cited by 8
Demonic possession and deliverance in the diaspora: phenomenological descriptions from Pentecostal deliverees
Rowan, K., & Dwyer, K. (2015) · Mental Health Religion & Culture · doi:10.1080/13674676.2015.1077211 · Cited by 8
“According to prominent neuropsychological accounts, delusions result from abnormal experiences which are accompanied by additional, milder dysfunctions, such as reasoning biases (Garety & Freeman 1999; Garety, Kuipers, Fowler, Freeman, & Bebbington, 2001).”
Background
An examination and appreciation of the dimensions of locus of control in psychosis: issues and relationships between constructs and measurement
Hutcheson, C., Fleming, M. P., & Martin, C. R. (2014) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12160 · Cited by 9
The relationship between paranoid delusions and compliance
Levy, S., & Gudjonsson, G. H. (2006) · Journal of Forensic Psychiatry and Psychology · doi:10.1080/14789940600841162 · Cited by 8
“However, some researchers (eg, Bowins & Shugar, 1998 ; Garety & Freeman, 1999 ) have argued that low self-esteem is common among paranoid patients and that this opposes the assumption that paranoia serves a defensive function.”
Background
Rationale and protocol for a systematic review and meta-analysis on reduced data gathering in people with delusions
Taylor, P. J., Hutton, P., & Dudley, R. E. J. (2014) · Systematic Reviews · doi:10.1186/2046-4053-3-44 · Cited by 8
“In addition, the reviews of the JTC bias literature by Fine, and colleagues (2007), Dudley and Over [2], Garety and Freeman [3,23] and Freeman [9], will be examined to determine if any additional studies are included that were missed by our own literature searches.”
Background
Are Hearing Voices Networks Compatible with Cognitive Behavioural Therapy for Psychosis?
Kay, G., Kendall, E. A., & Dark, F. L. (2017) · Australian Social Work · doi:10.1080/0312407x.2016.1262883 · Cited by 8
“…awareness of processes that influence thoughts and enabling them to challenge maladaptive beliefs about voices can substantially decrease levels of distress experienced by voice hearers (Garety & Freeman, 1999; Garety, Kuipers, Fowler, Freeman, & Bebbington, 2001; Tarrier & Wykes, 2004).”
Background
Biased interpretation in paranoia and its modification
Savulich, G., Edwards, A., Assadi, S., Guven, H., Leathers-Smith, E., Shergill, S. S., & Yiend, J. (2020) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2020.101575 · Cited by 8
“Measures of delusions and anomalous perceptions were Peter’s Delusions Inventory (PDI; Peters, Joseph, & Garety, 1999) and the Cardiff Anomalous Perceptions Scale (CAPS; Bell et al., 2006).”
Method
Tratamiento cognitivo-conductual de un paciente con diagnóstico de trastorno delirante
Cuevas‐Yust, C., Garcelán, S. P., & Martínez-López, M. J. (2003) · Psicothema · Cited by 8
Recovery, Spirituality and Religiousness in Schizophrenia
Huguelet, P., Mohr, S., & Borras, L. (2009) · Clinical Schizophrenia & Related Psychoses · doi:10.3371/csrp.2.4.4 · Cited by 8
Wahn — Psychologie
Moritz, S., & Lincoln, T. M. (2007) · Springer eBooks · doi:10.1007/978-3-540-71147-6_36 · Cited by 8
I don’t understand how I feel: mediating role of impaired self-mentalizing in the relationship between childhood adversity and psychosis spectrum experiences
Nonweiler, J., Torrecilla, P., Kwapil, T. R., Ballespí, S., & Neus Barrantes-vidal, A. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1268247 · Cited by 8
Conjecturing Harmful Intent and Preemptive Strike in Paranoia
Horita, Y. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.726081 · Cited by 8
Delusions as Storytelling Gone Wrong in Bad Life Situations: Exploring a Discursive Contextual Analysis of Delusions with Clinical Implications
Guérin, B. (2023) · The Psychological Record · doi:10.1007/s40732-023-00549-x · Cited by 7
“…distinction between plausibility and implausibility is almost impossible to resolve (Bentall, 2018; Freeman & Garety, 2014; Freeman et al., 2002; Garety & Freeman, 1999; Harper, 2004; Murphy et al., 2018), and that because of the usual power imbalance between a “client” and an “expert,” it is…”
Mentalizing Functions Provide a Conceptual Link of Brain Function and Social Cognition in Major Mental Disorders
Schnell, K. (2014) · Psychopathology · doi:10.1159/000366134 · Cited by 7
Depressive Primes Stimulate Initial Avoidance of Angry Faces: An Eye-Tracking Study of Paranoid Ideation
Provencio, M., Vázquez, C., Valiente, C., & Hervás, G. (2011) · Cognitive Therapy and Research · doi:10.1007/s10608-011-9388-5 · Cited by 7
“Other models of persecutory thinking have linked paranoid delusions to anxiety (e.g., Garety and Freeman 1999).”
Background
The Effects of Cognitive—Behavioral Therapy on Trait Anger and Paranoid Ideation
González-Prendes, A. A., & Jozefowicz‐Simbeni, D. M. H. (2009) · Research on Social Work Practice · doi:10.1177/1049731509331857 · Cited by 7
“…review of empirical studies investigating cognitive processes associated with delusional thinking on clinical samples (e.g., schizophrenia) by Garety and Freeman (1999) found strong support for the notion that individuals with persecutory ideas in the face of setbacks are likely to jump to…”
Background
La perte de contingence : un concept phénoménologique renseignant les modèles cognitifs du délire de type paranoïaque
Craus, Y. (2013) · L Évolution Psychiatrique · doi:10.1016/j.evopsy.2013.09.007 · Cited by 7
Bias in favour of self-selected hypotheses is associated with delusion severity in schizophrenia
Whitman, J. C., Menon, M., Kuo, S. S., & Woodward, T. S. (2012) · Cognitive Neuropsychiatry · doi:10.1080/13546805.2012.715084 · Cited by 8
“Cognitive accounts of delusions in schizophrenia (reviewed in Bell, Halligan, & Ellis, 2006; Garety & Freeman, 1999) have focused on probabilistic reasoning biases (Garety, Hemsley, & Wessely, 1991; Moritz & Woodward, 2005), theory of mind deficits (Frith, 1994), attributional biases (Bentall,…”
Background
Resist the negation reflex: Minimizing reactance in psychotherapy of delusions
Arnold, K., & Vakhrusheva, J. (2015) · Psychosis · doi:10.1080/17522439.2015.1095229 · Cited by 7
“Because of the drawbacks in defining delusions by their imperviousness, research has increasingly examined faulty reasoning processes that may be characteristic of delusions (Bentall, Kinderman, & Kaney, 1994; Garety & Freeman, 1999).”
Background
Cognitive Insight, Clinical Insight, and Reasoning in Schizophrenia: A Pilot Study in a Forensic Setting
Kuokkanen, R., Lappalainen, R. I., Repo‐Tiihonen, E., Tiihonen, J., & Aho‐Mustonen, K. (2016) · Journal of Forensic Psychology Practice · doi:10.1080/15228932.2016.1192337 · Cited by 7
“When a decision is made after requesting only one or two pieces of evidence, the phenomenon is referred to as the jumping-to-conclusions (JTC) bias (see, e.g., Fine, Gardner, Craigie, & Gold, 2007; Garety & Freeman, 1999).”
BackgroundMethod
Unusual experiences and their association with metacognition: investigating ASMR and Tulpamancy
Palmer-Cooper, E. C., McGuire, N., & Wright, A. C. (2021) · Cognitive Neuropsychiatry · doi:10.1080/13546805.2021.1999798 · Cited by 8
“Delusions are ﬁ xed false beliefs which occur outside of the cultural norm (Garety & Freeman, 1999) and occur frequently in the general population (Freeman et al., 2010).”
Neuropsychological profile of delusional disorder.
Leposavić, I., Leposavić, L., & Jašović‐Gašić, M. (2009) · PubMed · Cited by 7
Who “jumps to conclusions”? A comprehensive assessment of probabilistic reasoning in psychosis following traumatic brain injury (PFTBI), and comparison with TBI, schizophrenia, and nonclinical controls
Batty, R. A., Francis, A., Thomas, N., Hopwood, M., Ponsford, J. L., & Rossell, S. L. (2016) · Cognitive Neuropsychiatry · doi:10.1080/13546805.2015.1127221 · Cited by 7
“The “jumping to conclusions” (JTC) bias describes the tendency to draw conclusions quickly and on the basis of little evidence (Garety & Freeman, 1999; Langdon, Ward, & Coltheart, 2010).”
Background
Identifying, Assessing, and Treating Early Onset Schizophrenia at School
Li, H., Pearrow, M. M., & Jimerson, S. R. (2010) · Springer eBooks · doi:10.1007/978-1-4419-6272-0 · Cited by 7

Authors: Garety, P. A., & Freeman, D.
Affiliations: University of London (GB)
Corresponding author: Garety, Philippa A.
ORCID: Garety, Philippa A.
Freeman, Daniel
Venue: British Journal of Clinical Psychology
Publisher: Wiley
Published: 1999-06
Volume: 38
Issue: 2
Pages: 113-154
ISSN: 0144-6657 (ISSN-L)
2044-8260
DOI: 10.1348/014466599162700
OpenAlex: W2169951193
Cited by: 794
References: 93
Citations by year: 2026: 9 · 2025: 9 · 2024: 13 · 2023: 22 · 2022: 13 · 2021: 24 · 2020: 26 · 2019: 20 · 2018: 32 · 2017: 29 · 2016: 39 · 2015: 27 · 2014: 60 · 2013: 52 · 2012: 45
FWCI: 10.72
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor, 4224 d)
Locations: British Journal of Clinical Psychology (publishedVersion)
PubMed (publishedVersion)
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 › Hallucinations in medical conditions
Keywords: delusions, theory of mind deficits, jumping to conclusions bias, attributional style, self-discrepancy, cognitive therapy, schizophrenia
MeSH terms: Mental Disorders, Cognition Disorders, Cognitive Dissonance, Delusions, Female, Humans, Male, Models, Psychological, Paranoid Disorders, Personality, Self Concept, Cognitive Behavioral Therapy

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Cognitive approaches to delusions: a critical review of theories and evidence.

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