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Cognitive Neuropsychiatry
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Jumping to conclusions and perceptions in early psychosis: Relationship with delusional beliefs
Susannah May Colbert , Emmanuelle Peters Garety
a a b a a b

& Philippa

Department of Psychology, King's College London, Institute of Psychiatry, London, UK

b

NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK Available online: 09 Apr 2010

To cite this article: Susannah May Colbert, Emmanuelle Peters & Philippa Garety (2010): Jumping to conclusions and perceptions in early psychosis: Relationship with delusional beliefs, Cognitive Neuropsychiatry, 15:4, 422-440 To link to this article: http://dx.doi.org/10.1080/13546800903495684

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COGNITIVE NEUROPSYCHIATRY 2010, 15 (4), 422440

Jumping to conclusions and perceptions in early psychosis: Relationship with delusional beliefs
Susannah May Colbert1, Emmanuelle Peters1,2, and Philippa Garety1,2
Department of Psychology, Kings College London, Institute of Psychiatry, London, UK, 2NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
1

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Introduction. Previous research has suggested that biases in cognitive processes involved in everyday reasoning may contribute to the development of delusional beliefs. The aim of this study was to explore jumping to conclusions (JTC), a datagathering bias, and jumping to perceptions (JTP), a bias towards believing ambiguous perceptual events are real and external. Methods. Individuals with current delusions (n017), remitted delusions (n017), both recruited from an early psychosis service, and nonclinical participants (n035) were compared on a probabilistic reasoning task, an auditory perceptual bias task, and the Barely Visible Words task. Results. The deluded participants did not demonstrate the expected JTC bias; therefore the relationship between JTC and JTP could not be examined. However, both clinical groups exhibited a JTP bias on the auditory perceptual bias task. In contrast, the lowered perceptual threshold for threat displayed by the control group was absent in the clinical groups. Conclusions. These results suggest that the JTP bias may be a trait characteristic in those with a propensity to delusions, and that these individuals may also show a bias away from threat.

Keywords: Delusions; Early psychosis; Jumping to conclusions; Jumping to perceptions; Reasoning.

INTRODUCTION
Contemporary theories of delusion formation and maintenance propose that both cognitive and perceptual anomalies are crucial in the development of delusional beliefs (e.g., Davies, Coltheart, Langdon, & Breen, 2001; Garety,
Correspondence should be addressed to Dr Emmanuelle Peters, PO Box 77, Department of Psychology, Henry Wellcome Building, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. E-mail: e.peters@iop.kcl.ac.uk # 2010 Psychology Press, an imprint of the Taylor & Francis Group, an Informa business http://www.psypress.com/cogneuropsychiatry DOI: 10.1080/13546800903495684

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Bebbington, Fowler, Freeman, & Kuipers, 2007; Garety, Kuipers, Fowler, Freeman, & Bebbington, 2001; Green, Williams, & Hemsley, 2000; Langdon & Coltheart, 2000). The present study aimed to investigate the role of two such anomalies (i.e., jumping to perceptions [JTP] and jumping to conclusions [JTC]) in the formation and maintenance of delusions in individuals with early psychosis. One of the most well-established cognitive anomalies associated with delusions is the JTC reasoning bias, whereby deluded participants consider less evidence and are more hasty in their decision making than control groups (Garety, Hemsley, & Wessely, 1991; Huq, Garety, & Hemsley, 1988). This bias may be involved in the development of delusional beliefs in that the individual may consider less evidence and jump to a conclusion or explanation that is delusional (Garety & Freeman, 1999). Numerous studies, employing various tasks, have found a JTC bias in deluded and delusionprone individuals (see Fine, Gardner, Craigie, & Gold, 2007, and Freeman, 2007, for reviews). Overall, the findings of these studies suggest that this reasoning bias is specific rather than general, i.e., hypothesis testing and estimation of probabilities tend to be intact, whereas significant differences emerge on tasks where data gathering is crucial (Linney, Peters, & Ayton, 1998; Peters, Thornton, Siksou, Linney, & MacCabe, 2008). The jumping-to-perceptions (JTP) bias, i.e., the increased likelihood of identifying an ambiguous perceptual event as external and real, rather than internal and imaginary, has more traditionally been associated with hallucinations (Bentall & Slade, 1985; Rankin & OCarroll, 1995; Vercammem, de Haan, & Aleman, 2008). However, the JTP bias may also be related to delusional beliefs. In a task in which individuals with schizophrenia listened to immediate auditory feedback of their own voice distorted in pitch, identification of the auditory stimulus as nonself was found to be related to delusions and delusional severity, and not to hallucinations (Cahill, Silbersweig, & Frith, 1996). Johns et al. (2001) also found that deluded participants made more errors in identifying the source of the voice than a control group, although this bias was increased in deluded individuals who were also experiencing hallucinations. Overall these results suggest an association between delusions and impaired judgements about ambiguous sensory stimuli. Both the JTC and JTP biases have independently been found to be exacerbated with emotionally salient material (e.g., Dudley, John, Young, & Over, 1997b; Laroi, van der Linden, & Marczewski, 2004), although a recent review reported mixed findings (Fine et al., 2007). With threatening material specifically, it may be evolutionarily advantageous for decisions regarding threat to be made on the basis of less evidence than other decisions (e.g., Dudley & Over, 2003; Zajonc, 1980). The JTP bias has also been found to be

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increased when the content of the perceptual events is negative and derogatory (Johns & McGuire, 1999). The present study focused on individuals early in the course of psychosis. This research strategy enables the investigation of cognitive characteristics close to the onset of the delusions, thus minimising the influence of a potential decline, with chronic illness, in psychological, neuropsychological, or social functioning. The investigation of delusional beliefs in early psychosis also reduces the effects of possible confounds of secondary morbidity, long-term medication, institutionalisation, and a generalised performance deficit.

AIMS AND HYPOTHESES

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It was hypothesised that reduced data-gathering and jumping to perceptions would be found in individuals with current delusions, and that these biases would be related to each other. It was also hypothesised that all participants would have lower evidential requirements in both the perceptual and the reasoning arenas for threat-related material, compared to neutral material, but that these biases would be exacerbated in individuals with delusions. The remission group was selected to elucidate whether these biases may constitute state characteristics, which come online only during a psychotic episode to influence reasoning, or whether they may be trait processes, also present in the absence of florid symptoms, and therefore potentially a factor in the development of delusional beliefs.

METHOD Participants
The participants were a group of individuals with delusions (n017), a group with remitted delusions (n017) (both in the context of a first or second episode of psychosis), and a nonclinical control group (n035). The deluded and remitted groups were recruited from the Lambeth Early Onset service (LEO; South London and Maudsley National Health Service Foundation Trust). LEO is a mental health service for people resident in the London borough of Lambeth experiencing their first or second episode of psychosis. In the clinical groups all participants had an International Classification of Diseases (ICD-10; World Health Organization, 1994) schizophrenia spectrum diagnosis, as diagnosed by the consultant psychiatrist. Exclusion criteria were any known organic psychosis or bipolar affective disorder, clinically significant learning difficulties, or a primary diagnosis of alcohol or substance abuse.

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The criterion for current delusions was a score of 3 (moderate) or above, on one of the Scale for the Assessment of Positive Symptoms (SAPS; Andreasen, 1984) delusions items (SAPS definition of moderate; clear consistent delusion that is firmly held). The criterion for remitted delusions was evidence, in medical records, of a delusional belief that would have met SAPS moderate criterion at the height of episode, but that had not been present for a minimum of 8 weeks. An additional inclusion criterion was that all participants in the remission group had a score of 2 (mild) or less, on all other SAPS, i.e., positive symptom, items. The nonclinical control group was recruited through support staff of St. Thomass Hospital, London, and their acquaintances, as well as personal contacts of the first author. None of the control participants had any history of mental health problems that had brought them into contact with mental health services.

Measures
Scale for the Assessment of Positive Symptoms. The Scale for the Assessment of Positive Symptoms (SAPS; Andreasen, 1984) provides a measure of hallucinations, delusions, bizarre behaviour, thought disorder, and inappropriate affect. The items are scored on a 05 scale, with higher scores indicating greater severity. Symptoms are rated for the previous month. Psychotic Symptoms Rating Scale. The Psychotic Symptoms Rating Scale (PSYRATS; Haddock, McCarron, Tarrier, & Faragher, 1999) provides an assessment of the dimensions of delusions and hallucinations, e.g., frequency, distress. The items are scored on a 04 scale, with higher scores indicating greater severity. The potential range of scores are 044 for PSYRATs hallucinations and 024 for PSYRATS delusions. Symptoms are rated for the previous week. The Hospital Anxiety and Depression Scale. The Hospital Anxiety and Depression Scale (HADS; Zigmond & Snaith, 1983) provides an assessment of anxiety and depression. Items are scored on a 03 scale, with higher scores indicating greater emotional disturbance. The potential range of scores is 0 21 for both the depression and anxiety scales. Scores over 11 indicate clinically meaningful degrees of depression and anxiety. Symptoms are rated for the previous week. Quick Test. The Quick Test (Ammons & Ammons, 1962) is a widely used measure for providing an estimate of current verbal IQ. It has been found to be highly correlated with IQ scores obtained on more standard tests

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in participants with schizophrenia (e.g., Frith, Leary, Cahill, & Johnstone, 1991). Participants are shown a total of four pictures depicting various scenes. A list of 50 words of increasing difficulty (e.g., belt, decisive, pungent) is read out and participants are instructed to point to the picture that corresponds best to each word. Auditory Perceptual Bias task. The Auditory Perceptual Bias task (Bentall & Slade, 1985; modified by Peters, Smedley, & Tabraham, 2005) measures the auditory perceptual bias, i.e., JTP. Participants are required to listen to trials of white noise, some of which have a voice embedded within them. Participants are asked to state how sure they are that they heard a voice speaking within each trial. The task assesses perceptual biases in either direction; i.e., whether participants show a bias towards perceiving a voice in the white noise (on trials when the voice is not there), or whether participants show a bias towards perceiving the signal (the voice) as noise. In line with signal detection theory, the data are analysed to give a nonparametric measure of perceptual bias, referred to by the symbol Ba (response bias).1 Ba is low for people who are biased towards classifying internal events as external, whereas people high in Ba are biased towards perceiving the signal (the voice) as noise. A lower Ba therefore indicates greater JTP. This task was presented on a laptop computer. Software for the auditory perceptual task was developed following the model for the stimulus tape described by Bentall and Slade (1985). A program was created that presented computer-generated auditory stimuli. The participants first listened to 10 practice trials presented through headphones. Each trial consisted of a 1 s warning tone, 1 s period of silence, 45 s of white noise, and 5 s of silence, in which the participants recorded their response. A male voice saying the word who was embedded within the white noise on some of the trials. The voice was recorded as an audio file directly onto a computer. When present, the word who appeared after 3 s of white noise. The stimuli in the 10 practice trials were set at varying percentages of the white noise volume, with the following sequence: 20%, 20%, 20%, 0%, 2%, 2%, 0%, 2%, 0%, 2%. Participants were required to rate how sure they were that they had heard a voice within the white noise, on a 15 scale where 10 definitely heard a sound and 50definitely did not hear a sound. On completion of the 10 practice trials, the participants then listened to 40 trials, in 20 of which the voice was presented at a level close to threshold (2% of white noise volume). The trials were presented in a random order, with the constraint that not more than three of the same type of trial occurred
1 D-prime (d? was not calculated because earlier studies in the field did not find any differences between the groups in their sensitivity in detecting the voice when it was actually present (Bentall & Slade, 1985; Rankin & OCarroll, 1995).

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sequentially. Participants were not given any feedback on the accuracy of their performance. The Probabilistic Reasoning task. The Probabilistic Reasoning task (Garety et al., 1991), using the draws to decision measure, assesses data gathering before making a decision. A computerised version of this task was employed. In the first condition, participants were informed that they were required to make a decision as to which of two jars beads were being drawn from. They were told that one jar contained 85 black and 15 orange beads, and the other 15 black and 85 orange beads. The beads were presented on the screen one at a time and the participant could ask to see as many beads as they wanted (to a maximum of 20) before making their decision. The task included a memory aid taken from Dudley et al. (1997b), where previous beads that the participant had seen remained displayed on the screen. The dependent variable was number of draws to decision. The second, more difficult, condition changed the ratio to 60:40 and used an emotionally salient version of the task developed by Dudley, John, Young, and Over (1997a). In this condition, participants were told that two surveys had been taken of a person who is very much like you, and in each of the two surveys there were 100 positive and negative words about the person, in the ratio 60:40. The participant was required to decide which survey the words were being drawn from. The dependent variable was the number of words to decision. Barely Visible Words Ttask. The Barely Visible Words task (BVW; based on Mayseless & Kruglanski, 1987) assesses both the amount of datagathering participants engage in and their tendency to state an ambiguous perceptual event has actually occurred. Participants were required to establish the identity of a word flashed briefly on a computer screen. Participants were told a word would appear on the screen every time they pressed the spacebar, but that the word would flash so quickly it may sometimes seem as if nothing had appeared. They were further told that they could press the spacebar as many times as they wished before identifying the word. After each press of the spacebar, participants were asked to record, using a pen and paper measure, whether they had seen something flashing on the screen, even if they could not identify it. The presentation time of the word did not change throughout the task. Once they felt they knew the identity of the word, they recorded their answer and the researcher moved the program onto the next word. If participants were unable to identify the word they were encouraged to have a guess before proceeding to the next word. The task was piloted on a sample of nonclinical controls (n015) to establish the display time that gave a 50% correct recognition rate (i.e., participants identified correctly 50% of the words after

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pressing the spacebar as many times as they wished for each word), as this was the rate used in Mayseless and Kruglanski (1987). A range of stimulus durations from 15 ms to 100 ms were employed in the pilot. Based on this pilot, a 30 ms display time was chosen. The words were presented in the middle of the screen in font size 35, with a blue font colour, encased in a box with a black background. No masking procedures were used. Fourteen words were presented in pseudorandom order; seven neutral words and seven threat words, taken from Bentall and Kaney (1989) and Kinderman, Prince, Waller, and Peters (2003). The neutral and threat words were matched in word length and frequency in British English (Hofland & Johansson, 1982). Two dependent variables were calculated from this task to represent JTC and JTP respectively. The JTC variable was the number of detected presentations (i.e., instances where the participant reported seeing the word flashed on the screen) before deciding on the identity of the word. Instances where the participant did not report seeing anything flashing were not included, as no information about the words identity could be obtained from those occasions. The JTC variable therefore consisted of the number of times the word was seen before deciding on its identity. The JTP variable consisted of the participants tendency to report they had seen something appear on the screen. It was calculated as the proportion of times they reported seeing something flash on the screen (i.e., the percentage of detected presentations over total presentations), and was named BVW score.

Procedure
It was ascertained that all participants had normal colour vision, and normal, or corrected to normal, visual acuity. All participants were required to give informed consent to take part in the study. Participants were not informed of the hypotheses of the study, to prevent the researchers expectations influencing their performance on the tasks. All participants received a small payment (10) for their expenses in participating in the study. Each participant was tested in a quiet room and completed all tasks and questionnaires in the presence of the researcher. The PSYRATS, HADS, and SAPS were administered by the first author.2 The order of presentation of tasks was counterbalanced across participants, using the balanced Latin Squares technique, to prevent any potential order effects.

The first author was a researcher on the Prevention of Relapse in Psychosis trial (Garety et al., 2008) and was trained to a high level of interrater reliability.

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Statistical analyses were conducted using SPSS for Windows (version 12.0; SPSS, 2003). The data were tested for a normal distribution. Where the data were not normally distributed, attempts were made to transform the data to show a normal distribution. If the data were successfully transformed, ANCOVAs (with all the demographics (age, IQ, and ethnicity), anxiety, and depression as covariates) were performed. However, since none of the covariates had a significant effect in any of the analyses, only ANOVAs are reported here. Least Significant Difference (LSD) tests were selected to carry out comparisons between the groups. Where it was not possible to normalise the data, nonparametric tests were employed.

RESULTS
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Table 1 gives the characteristics of the participants. There were significant differences in demographic characteristics between the groups. There was a significant difference in verbal IQ and age: verbal IQ, F(2, 66)06.84, p0 .002; age: F(2, 66)05.69, p0.005. LSD tests revealed that the remission group had significantly lower IQ scores (p0.001) and was younger than the control group (p0.001). There was a trend for the deluded group to have lower IQ scores than the control group (p0.088). There was also a trend for the remission group to be younger than the deluded group (p0.068). Fishers Exact tests were used to compare gender and ethnicity characteristics between the groups. There was a trend for the control group to have more women than the deluded group (p0.055), but there was no difference between the two clinical groups. Both of the clinical groups had significantly more participants from nonwhite ethnic backgrounds than the control group (deluded: pB.001; remission: pB.001), but did not differ from each other. The deluded group was significantly more anxious (as measured by the HADS) than the remission group, F(2, 66)04.1, p0.021; LSD p0.006, and had a tendency to be more anxious than the control group (p0.083). They also had significantly higher depression scores than both the remission group, Mann-Whitney U076.0, p0.018, and the control group, U0127.5, p0.001. There was no difference between the remission and control groups on either scale: anxiety, LSD p0.124; depression, U0285.0, p0.805. Table 2 gives the clinical characteristics of the clinical groups on the psychosis measures. The deluded group scored in the moderate range on hallucinations and delusions, in the questionable range on formal thought disorder and in the absent range on bizarre behaviour and inappropriate affect. The remission group scored in the absent range for all the categories. There were significant differences between the deluded and remission groups on all of the symptom ratings, with the exception of inappropriate affect. In

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TABLE 1 Participant characteristics

Ethnicity

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Group Deluded Remission Control

N 17 17 35

Verbal IQ (SD) 92.4 (13.2) 86.3 (9.9) 97.9 (9.7)

Mean age 26.5 23.2 28.4

Age range 1939 1834 1842

Female gender (%) 2 (11.8%) 4 (23.5%) 14 (40.0%)

White (%) 6 (35.3%) 4 (23.5%) 34 (97.1%)

Ethnic minority backgrounds HADS*Anxiety (%) (SD) 11 (64.7%) 13 (76.5%) 1 (2.9%) 9.4 (4.8) 5.4 (4.3) 7.3 (3.7)

HADS*Depression (SD) 6.9 (5.1) 3.7 (3.2) 3.2 (2.2)

TABLE 2 Clinical characteristics of the two clinical groups

Deluded (n 017) Remission (n 017) Mann Whitney U (p-value) 11 0 91 99 136 34 0 (B.001) (B.001) (.012) (.056) (.317) (B.001) (B.001)

Median Global rating of hallucinations Global rating of delusions Global rating of bizarre behaviour Global rating of positive formal thought disorder Inappropriate affect PSYRATS total auditory hallucinations PSYRATS total delusions 3 4 0 0 0 25 15

SD 1.3 0.56 1.13 1.2 0.97 13.73 4.10

Median 0 0 0 0 0 0 0

SD 0.53 0.47 0.24 0.79 0 0 0

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addition, the difference between the groups on formal thought disorder was at trend level. There was a significant difference between the groups in inpatient status. Eleven participants in the deluded group and none of the participants in the remission group were inpatients at the time of testing, x2(1)016.3, pB.001.

The Barely Visible Words task

Table 3 gives the mean detected presentations and BVW score for each group. The detected presentations and BVW score are also given for the threat and neutral conditions separately. A 2)3 mixed ANOVA was performed on the detected presentations with word type (threat and neutral) as the within-subjects variable and group as the between-subjects variable. Contrary to the hypothesis, the group effect was not significant, F(2, 66)01.95, p0.150, with all groups demonstrating equal levels of data gathering. The effect of word type was significant, F(1, 66)06.01, p0.017, with participants looking at fewer presentations for threat than neutral words. The interaction was not significant, F(2, 66)0 0.388, p0.680. A 2)3 mixed ANOVA was performed on the BVW score. Again contrary to the hypothesis, the main effect of group was not significant, F(2, 66)0 0.832, p0.440, showing that the groups did not differ in the frequency in which they jumped to perceptions on the BVW task. There was no significant effect of word type, F(1, 66)00.095, p0.759, but the interaction term was significant, F(2, 66)03.17, p0.048. Subsequent comparisons of this interaction between the groups revealed a significant difference between the deluded and control groups, F(1, 50)05.06, p0.029, and the difference between the remission and control groups was at trend level, F(1, 50)03.04, p0.088. There was no significant difference between the deluded and remission groups, F(1, 32)00.182, p0.672. Further analyses revealed that, in the deluded and remission groups, there was no significant difference in the BVW score between the threat and neutral words: deluded, t(16)0(1.04, p0.313; remission, t(16)0(0.380, p0.709. In the control group, however, the threat BVW score was significantly higher than the neutral, t(34)02.48, p0.018, i.e., participants in the control group were more likely to report that they saw the word when it was a threat word rather than a neutral word. Therefore, the nonclinical group was the only group to demonstrate a lowering of perceptual threshold for the threat words relative to the neutral words, contrary to the hypotheses. See Figure 1 for a graphical representation of this effect. There was a significant difference in the number of words the groups identified correctly, F(2, 66)06.72, p0.002. Subsequent LSD comparisons

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TABLE 3 The Barely Visible Words task means (SD)

Mean total detected presentations Group Deluded (n 017) Remission (n 017) Nonclinical control (n035) Threat Neutral Mean BVW score Threat 75.3 (7.8) 73.9 (9.8) 72.1 (6.6) 71.8 (5.5) 71.6 (9.5) 74.2 (12.9) 69.7 (9.2) 6.0 (1.4) 72.7 (10.0) 5.3 (2.6) 11.9 (2.9) 5.9 (1.7) 76.3 (8.4) 4.1 (2.4) 9.8 (5.2) 4.5 (2.7) Neutral Mean total correct Threat 7.6 (4.5) 3.6 (2.2) Neutral

102.2 (92.3) 48.4 (52.8) 53.8 (40.7) 96.2 (43.7) 44.1 (22.3) 52.1 (24.5) 70.9 (45.7) 33.8 (20.0) 37.1 (28.3)

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77 76 75 74

BVW score

73 72 71 70 69 68

deluded remission control

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67 neutral threat

group
Figure 1. Interaction effect of the BVW score.

revealed the deluded and remission groups gave fewer correct answers than the control group, although in the remission group this was at trend level: deluded, pB.001; remission, p0.083. There was no difference between the deluded and remission group (p0.114). There was a significant effect of word type, F(1, 66)09.06, p0.004, with more threat words being identified correctly. The interaction term was at trend level only, F(2, 66)02.4, p0.095.

The Auditory Perceptual Bias task

Table 4 gives the scores of each group on the auditory perceptual bias task and the probabilistic reasoning task. On the auditory perceptual bias task, there was a main effect of group on the response bias (Ba): Kruskal-Wallis test x2(2)09.002, p0.01. Planned comparisons revealed that both clinical groups had significantly lower Ba, i.e., they jumped to perceptions more, than the control group: deluded and control group, Mann-Whitney U0155.0, p0.005; remission and control group, U0194.5, p0.044. There was no significant difference between the deluded and remission groups, U0133.5, p0.703. To establish whether JTP was primarily related to hallucinations, a comparison was made between those who were currently hallucinating in the deluded group, using the remission group as a control group. The mean perceptual bias for the subgroup experiencing current hallucinations (n010) was 2.63 (SD00.73). There was no significant difference in Ba between this group and the remission group, U079.0, p0.762.

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TABLE 4 The auditory perceptual bias task (JTP) and the probabilistic reasoning task (JTC)
85:15 task Number of beads to decision 8.35 (7.82) 9.59 (7.83) 7.03 (5.51) Number correct 13 (76.5%) 17 (100%) 35 (100%) Number of words to decision 10.24 (7.08) 12.0 (6.47) 8.69 (3.73) Salient task Number correct 14 (82.4%) 16 (94.1%) 31 (88.6%) Response bias (Ba) 2.46 (1.1) 2.57 (1.58) 3.44 (1.24)

Group Deluded Remission Nonclinical control

N 17 17 35

JTC 5 (29.4%) 2 (11.8%) 6 (17.1%)

JTC 2 (11.8%) 1 (5.9%) 0 (0%)

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The Probabilistic Reasoning task

In order to compare this study with the results of other studies, e.g., Garety et al. (2005), JTC and non-JTC subgroups were formed within each group. A participant was classified as JTC if they made a decision after one or two items of information. The frequencies of JTC responders in each group are given in Table 4. No significant differences were found between the groups on the number of beads requested on the 85:15 version of the task, Kruskall-Wallis test x2(2)00.978, p0.613, or on the number of words requested on the emotionally salient version, Kruskall-Wallis test x2(2)03.54, p0.170. Fishers Exact tests were used to examine the frequencies of JTC responders in each group on the 85:15 task. There was no significant difference between any of the groups: deluded and remission, p0.398; deluded and nonclinical, p0.470; remission and nonclinical, p01.000. The frequencies of JTC responders on the emotionally salient version of the task were not subjected to statistical analysis as there were too few JTC responders in this version of the task. It was noticed that the mean number of items requested was much higher than in other studies (e.g., in Dudley et al., 1997a, Garety et al., 1991, and Huq et al., 1988, the mean number of beads to decision in the deluded group was three or below), which appeared to be due to a number of individuals requesting the maximum number of information allowed i.e., 20 beads. The data were re-analysed excluding those participants (n04 deluded, 5 remitted, and 3 control participants). The new means (4.77, 5.25, and 5.81 in the deluded, remitted, and control groups, respectively) were more consistent with previous studies. However, the significance of the re-analyses did not differ from those reported earlier. In the 85:15 beads condition, all the participants in the remission and control groups gave the correct answer, whereas this was true for only 76.5% of the deluded group. This represents a significant difference between the deluded and control groups (Fishers Exact test, p0.009) and a nearly significant difference between the deluded and remission groups (p0.051). In the emotionally salient version of the task, there were no significant differences between the frequencies of correct answers given by the groups: deluded and remission group, p0.601; deluded and control group, p0.670; remission and control group, p01.000.

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DISCUSSION
Actively and remitted deluded participants did not show a jumping-toconclusions (JTC) bias in this study, on either the Probabilistic Reasoning

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task or the Barely Visible Words (BVW) task. They did, however, show a jumping-to-perceptions (JTP) bias compared to a nonclinical control group on an auditory perceptual task. On the BVW task, the lowered perceptual threshold for threat words displayed by the nonclinical control group was absent in the two clinical groups. The actively deluded group made more errors on both the BVW and the probability reasoning tasks than the control group, despite gathering the same amount of information as the other groups. The demonstration of a JTP bias on the auditory perceptual bias task in this population suggests that jumping to perceptions may be related to delusional beliefs. It is unlikely that this result was driven solely by the presence of hallucinations, since no differences were found between the hallucinators in the actively deluded group and the remission group. The finding that both the actively and remitted deluded participants displayed a JTP bias further suggests that it may be a trait characteristic in those with a propensity to delusional beliefs, and as such, may contribute to their development. Taken together with previous demonstration of the JTP bias in psychosis-prone individuals (Bentall & Slade, 1985; Tsakanikos & Reed, 2005), the present findings suggest that the JTP bias may represent a vulnerability marker, i.e., it arises before the first psychotic episode and remains even when the client is in remission. Although the clinical groups asked for less information and made fewer errors in the BVW task when the material was threatening compared to neutral, similarly to the control group, these groups did not demonstrate the same perceptual bias for threat words displayed by the control group. The finding that both actively and remitted deluded groups use less material to make a threat-related than a neutral decision, in the absence of a decreased perceptual level at which threat-material is detected (in the context of an overall JTP bias), suggests that they may show a bias away from threatrelated material. Whilst these results were opposite to those predicted, they are consistent with a pattern of vigilance avoidance proposed to be employed by individuals with delusions on encountering threatening material (Green & Phillips, 2004; Green, Williams, & Davidson, 2003a, 2003b). According to this model (which differs slightly from the vigilanceavoidance model of information processing in social anxiety disorders) individuals with delusions may show an initial orienting bias towards threat (i.e., they ask for less threat-related information than for neutral information), similarly to nonclinical controls. However, in the later stages of directed attention, unlike nonclinical controls, who also show a perceptual bias towards threat words, the deluded groups may avoid perceiving threatrelated material, perhaps to reduce anxiety generated by such material. The current findings can be seen tentatively as evidence of the avoidance stage of

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this model, where individuals with delusions fail to show the normal bias towards threat. The expected JTC reasoning style was not found in the clinical groups in this study. On the probabilistic task, this was the case whether the mean number of beads requested was compared for each group, or whether the number of extreme responders in each group was compared. The three groups showed a similar pattern of data gathering on both tasks, whether the stimuli were neutral or emotionally salient, with all participants requesting less information in the BVW task when the decision involved threat-related compared to neutral material. The failure to replicate the JTC reasoning bias may have been due to idiosyncratic methodological differences in the task used in this study compared to previous studies. Previous studies have found variation in the amount of information requested (e.g., Dudley et al., 1997a; Garety et al., 1991; Huq et al., 1988; Peters & Garety, 2006; Peters et al., 2008) and it has been found that subtle differences in the way the task is presented may influence the dependent variable (Dudley, personal communication, 2005). It appeared that, in the present study, a greater proportion of participants in the clinical groups requested all 20 items of information before responding. This led to differing distributions in the data between the clinical and control groups, and may have contributed to the failure to replicate the JTC bias. Although removing outliers (i.e., those who requested 20 items of information) on both tasks did not affect the results, low numbers may have resulted in lack of power to detect any differences. It was also the researchers observation that a proportion of the early psychosis participants seemed to comprehend the task better than groups recruited for other studies with a longer illness history. Individuals who only have had one or two episodes of psychosis, and do not go on to develop a chronic illness, make up a large proportion of the early psychosis sample (Craig et al., 2004). Therefore, the participants in this study are not typical of groups with persistent delusions, usually employed in other studies, and this may have contributed to the difference in findings between the early psychosis group and more chronic groups. Repeated exposure to hallucinations and delusions may increase perceptual and cognitive biases, rendering them less likely to be detected in a first episode group. However, it should be noted that the JTC bias has not only been found in individuals with persistent psychosis but also in one study with an early psychosis sample (Ho-wai So, Freeman, & Garety, 2008) and in studies of individuals at risk of psychosis (e.g., Broome et al., 2003; van Dael et al., 2006), although Broome et al. (2003) found that differences emerged only with a difficult ratio of beads. As this bias was not found in the clinical groups, other hypotheses regarding the relationship with the JTP bias could not be fully investigated.

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Limitations of the study

The sample size in the clinical groups was low, and the study may have been underpowered. We were unable to match our groups, with the remission group having lower verbal IQ levels, being younger and from a more ethnically diverse background than the nonclinical control group. These demographic differences may have influenced some of the results, although none of the variables were significantly related to any of the dependent variables as covariates. The BVW task is a novel task in terms of its use with patients with psychosis, and may require further refinements, such as the use of a wider range of display times to account for the large individual variation in perceptual threshold, and the inclusion of masking procedures.

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CONCLUSIONS
Deluded participants showed a jump-to-perceptions (JTP), but not a jumpto-conclusions (JTC) bias, compared to a nonclinical control group. The lowered perceptual threshold for threat words displayed by the nonclinical control group was absent in the two clinical groups. There were no differences on these measures between currently deluded and remitted groups, suggesting that they represent trait, rather than state, characteristics.
Manuscript received 9 February 2009 Revised manuscript received 26 October 2009 First published online 9 April 2010

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