The role of the cognitive biases along the psychosis continuum: from pathophysiology to treatment options

Schizophrenia and related psychoses is primarily characterized by positive and negative symptoms, as well as cognitive disturbances. Cognitive factors crucial in the pathogenesis of psychosis are specifically studied in terms of cognitive biases that may play a role in the formation and maintenance of psychotic symptoms. Cognitive biases refer to systematic errors in both cognitive processing and content that deviate from logical thinking. Cognitive biases can affect attention, decision-making/reasoning, memory recall, motivation or even attributional style. Psychotic-like experiences and psychotic disorders have been associated with a tendency to jump to conclusions, bias against disconfirmatory evidence and bias against confirmatory evidence as well as liberal acceptance bias. Moreover, patients with schizophrenia tend to present higher belief inflexibility in comparison to healthy individuals and are overconfident in wrong judgments. In the monitoring tasks showing they show a higher tendency to misattribute internally-generated stimuli to external sources (externalizing bias) [1]. Finally, patients with schizophrenia tend to have excessive attention toward irrelevant, neutral or familiar stimuli known as the salience aberrant bias. There are several specific psychological interventions designed to ameliorate cognitive biases, such as Metacognitive Training [2, 3], Thinking Well [4], Social Cognition and Interaction Training [5]. These trainings have been shown to teach patients about cognitive biases and how they contribute to symptoms of psychosis and consequently how they can affect their daily life. There is an increasing number of studies showing results of these interventions in reducing cognitive biases and positive symptoms as well as improving clinical and cognitive insight.