The Benefits of Doubt: Cognitive Bias Correction Reduces Hasty Decision-Making in Schizophrenia

Many patients with schizophrenia display neuropsychological deficits in concert with cognitive biases, particularly the tendency to jump to conclusions (JTC). The present study examined the effects of a generic psychoeducational cognitive bias correction (CBC) program. We hypothesized that demonstrating the fallibility of human cognition to patients would diminish their susceptibility to the JTC bias. A total of 70 participants with schizophrenia were recruited online. At baseline, patients were asked to fill out a JTC task (primary outcome) and the Paranoia Checklist before being randomized to either the CBC or a waitlist control condition. The CBC group received six successive pdf-converted PowerPoint presentations teaching them about cognitive biases; we neither placed any emphasis on psychosis-related cognitive distortions nor addressed psychosis. Six weeks after inclusion, subjects were re-administered the JTC task and the Paranoia Checklist. At a medium-to-large effect size the JTC bias was significantly improved under the CBC condition in comparison to controls for both the per protocol and the intention to treat analysis. The Paranoia Checklist remained essentially unchanged over time. No effects were observed for depression. Psychoeducational and cognitive programs are urgently needed as many patients are still deprived of any psychological treatment despite recommendations of most guidelines. Self-help may bridge the large treatment gap in schizophrenia and motivate patients to seek help. The study asserts both the feasibility and effectiveness of self-help programs in schizophrenia.