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Cognitive approaches to delusions: a critical review of theories and evidence.
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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“delusional patients “jump to conclusions” in the first version, while they are more willing to revise their decision in light of contradictory evidence in the second (Garety and Freeman, 1999).”
From The Computational Anatomy of Psychosis (2013) · cites this paper as Garety and Freeman, 1999
In the citing paper
“The concept of MCT by Moritz and Woodward was originally inspired by research on cognitive biases in psychosis (65) and aims to convey metacognitive knowledge and raise metacognitive awareness for dysfunctional thought patterns (60, 122).”
From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [65]
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Metadata
- Authors
- Garety, P. A., & Freeman, D.
- Affiliations
- University of London (GB)
- Corresponding author
- Garety, Philippa A.
- 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
- 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
- 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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