Placing Cognitive Rigidity in Interpersonal Context in Psychosis: Relationship With Low Cognitive Reserve and High Self-Certainty

Helena García-Mieres,Judith Usall,Guillem Feixas,Susana Ochoa

doi:10.3389/fpsyt.2020.594840

Abstract

Introduction: People with psychosis show impairments in cognitive flexibility, a phenomenon that is still poorly understood. In this study, we tested if there were differences in cognitive and metacognitive processes related to rigidity in patients with psychosis. We compared individuals with dichotomous interpersonal thinking and those with flexible interpersonal thinking.Methods: We performed a secondary analysis using two groups with psychosis, one with low levels of dichotomous interpersonal thinking (n = 42) and the other with high levels of dichotomous interpersonal thinking (n = 43). The patients were classified by splitting interpersonal dichotomous thinking (measured using the repertory grid technique) to the median. The groups were administered a sociodemographic questionnaire, a semi-structured interview to assess psychotic symptoms [Positive and Negative Syndrome Scale (PANSS)], a self-report of cognitive insight [Beck Cognitive Insight Scale (BCIS)], neurocognitive tasks [Wisconsin Card Sorting Test (WCST) and Wechsler Adult Intelligence Scale (WAIS)], and the repertory grid technique. We used a logistic regression model to test which factors best differentiate the two groups.Results: The group with high dichotomous interpersonal thinking had earlier age at onset of the psychotic disorder, higher self-certainty, impaired executive functioning, affected abstract thinking, and lower estimated cognitive reserve than the group with flexible thinking. According to the logistic regression model, estimated cognitive reserve and self-certainty were the variables that better differentiated between the two groups.Conclusion: Cognitive rigidity may be a generalized bias that affects not only neurocognitive and metacognitive processes but also the sense of self and significant others. Patients with more dichotomous interpersonal thinking might benefit from interventions that target this cognitive bias on an integrative way and that is adapted to their general level of cognitive abilities.

Highlights

People with psychosis show impairments in cognitive flexibility, a phenomenon that is still poorly understood
Our results show that the group with high dichotomous interpersonal thinking had poorer performance in self-certainty and executive functioning
This group had an earlier age at onset, impaired abstract thinking, and lower estimated cognitive reserve than the group with flexible thinking

Summary

Introduction

People with psychosis show impairments in cognitive flexibility, a phenomenon that is still poorly understood. People with psychosis exhibit impairments in cognitive flexibility [1, 2], a phenomenon considered a fundamental aspect of health with a major contribution on daily well-being. It is a complex higher order reasoning construct It includes an individual’s ability to release from a strongly held belief, once formed, in order to engage in further cognitive operations involved in making judgments under conditions of uncertainty: rethinking the possibility of being mistaken; reviewing the main belief in light of newer evidence/information; and generating and considering other explanations [4]. As a neurocognitive process, it is considered a component of executive functioning In this sense, cognitive flexibility refers to the ability to switch thought and/or response patterns and targetdirected behaviors. In the context of neurocognition, the paradigm has referred to the inability to set-shifting, called “stuck-in-set behavior” [1]

Methods

Results

Discussion

Conclusion