• Affective theory of mind inferences contextually influence the recognition of emotional facial expressions

      Stewart, Suzanne L. K.; Schepman, Astrid; Haigh, Matthew; McHugh, Rhian; Stewart, Andrew; University of Chester; Northumbria University; University of Manchester (Taylor & Francis, 2018-03-14)
      The recognition of emotional facial expressions is often subject to contextual influence, particularly when the face and the context convey similar emotions. We investigated whether spontaneous, incidental affective theory of mind inferences made while reading vignettes describing social situations would produce context effects on the identification of same-valenced emotions (Experiment 1) as well as differently-valenced emotions (Experiment 2) conveyed by subsequently presented faces. Crucially, we found an effect of context on reaction times in both experiments while, in line with previous work, we found evidence for a context effect on accuracy only in Experiment 1. This demonstrates that affective theory of mind inferences made at the pragmatic level of a text can automatically, contextually influence the perceptual processing of emotional facial expressions in a separate task even when those emotions are of a distinctive valence. Thus, our novel findings suggest that language acts as a contextual influence to the recognition of emotional facial expressions for both same and different valences.
    • Assessment of metacognitive beliefs in an at risk mental state for psychosis: A validation study of the Metacognitions Questionnaire-30

      Bright, Measha; Parker, Sophie; French, Paul; Morrison, Anthony P.; Tully, Sarah; Stewart, Suzanne L. K.; Wells, Adrian; University of Manchester; Greater Manchester Mental Health NHS Foundation Trust; University of Chester (Wiley, 2018-06-07)
      Aim: The Metacognitions Questionnaire-30 (MCQ-30) has been used to assess metacognitive beliefs in a range of mental health problems. The aim of this study is to assess the validity of the MCQ-30 in people at risk for psychosis. Methods: One hundred and eighty-five participants meeting criteria for an at risk mental state (ARMS) completed the MCQ-30 as part of their involvement in a randomised controlled trial. Confirmatory and exploratory factor analyses were conducted to assess factor structure and construct validity. Results: Confirmatory factor analyses confirmed the original 5-factor structure of the MCQ-30. Examination of principal component analysis and parallel analysis outputs also suggested a 5-factor structure. Correlation analyses including measures of depression, social anxiety and beliefs about paranoia showed evidence of convergent validity. Discriminant validity was supported using the normalising subscale of the beliefs about paranoia tool. Conclusions: The MCQ-30 demonstrated good fit using the original 5-factor model, acceptable to very good internal consistency of items was evident and clinical usefulness in those at risk for psychosis was demonstrated.
    • Components of therapy as mechanisms of change in cognitive therapy for people at risk of psychosis: An analysis of the EDIE-2 trial

      Flach, Clare; French, Paul; Dunn, Graham; Fowler, David; Gumley, Andrew I.; Birchwood, Max; Stewart, Suzanne L. K.; Morrison, Anthony P.; University of Manchester ; Greater Manchester West NHS Foundation Trust/Liverpool University ; University of Manchester ; University of Sussex ; University of Glasgow ; University of Warwick ; University of Chester ; Greater Manchester West NHS Foundation Trust/University of Manchester (2015-05-21)
      Background: Research suggests that the way in which cognitive therapy is delivered is an important factor in determining outcomes. We test the hypotheses that the development of a shared problem list, use of case formulation, homework tasks and active intervention strategies will act as process variables. Methods: Presence of these components during therapy is taken from therapist notes. The direct and indirect effect of the intervention is estimated by an instrumental variable analysis. Results: A significant decrease in symptom score for case formulation (coefficient=-23, 95%CI -44 to -1.7, p=0.036) and homework (coefficient=-0.26, 95%CI -0.51 to -0.001, p=0.049) is found. Improvement with the inclusion of active change strategies is of borderline significance (coefficient= -0.23, 95%CI -0.47 to 0.005, p=0.056). Conclusions: There is a greater treatment effect if formulation and homework are involved in therapy. However, high correlation between components means that these may be indicators of overall treatment fidelity.
    • Core Schemas across the Continuum of Psychosis: A Comparison of Clinical and Non-Clinical Groups

      Taylor, Hannah E.; Stewart, Suzanne L. K.; Dunn, Graham; Parker, Sophie; Fowler, David; Morrison, Anthony P.; University of Manchester; Greater Manchester West Mental Health NHS Foundation; University of East Anglia (Cambridge University Press, 2013-08-07)
      Background: Research suggests that core schemas are important in both the development and maintenance of psychosis. Aims: The aim of the study was to investigate and compare core schemas in four groups along the continuum of psychosis and examine the relationships between schemas and positive psychotic symptomatology. Method: A measure of core schemas was distributed to 20 individuals experiencing first-episode psychosis (FEP), 113 individuals with “at risk mental states” (ARMS), 28 participants forming a help-seeking clinical group (HSC), and 30 non-help-seeking individuals who endorse some psychotic-like experiences (NH). Results: The clinical groups scored significantly higher than the NH group for negative beliefs about self and about others. No significant effects of group on positive beliefs about others were found. For positive beliefs about the self, the NH group scored significantly higher than the clinical groups. Furthermore, negative beliefs about self and others were related to positive psychotic symptomatology and to distress related to those experiences. Conclusions: Negative evaluations of the self and others appear to be characteristic of the appraisals of people seeking help for psychosis and psychosis-like experiences. The results support the literature that suggests that self-esteem should be a target for intervention. Future research would benefit from including comparison groups of people experiencing chronic psychosis and people who do not have any psychotic-like experiences.
    • Deception Detection and Truth Detection Are Dependent on Different Cognitive and Emotional Traits: An Investigation of Emotional Intelligence, Theory of Mind, and Attention

      Stewart, Suzanne L. K.; Atherton, Catherine; Wright Whelan, Clea; University of Chester; Bangor University (Sage, 2018-09-28)
      Despite evidence that variation exists between individuals in high-stakes truth and deception detection accuracy rates, little work has investigated what differences in individuals’ cognitive and emotional abilities contribute to this variation. Our study addressed this question by examining the role played by cognitive and affective theory of mind (ToM), emotional intelligence (EI), and various aspects of attention (alerting, orienting, executive control) in explaining variation in accuracy rates among 115 individuals [87 women; mean age = 27.04 years (SD = 11.32)] who responded to video clips of truth-tellers and liars in real-world, high-stakes contexts. Faster attentional alerting supported truth detection, and better cognitive ToM and perception of emotion (an aspect of EI) supported deception detection. This evidence indicates that truth and deception detection are distinct constructs supported by different abilities. Future research may address whether interventions targeting these cognitive and emotional traits can also contribute to improving detection skill.
    • Metacognitive beliefs as psychological predictors of social functioning: an investigation with young people at risk of psychosis

      Bright, Measha; Parker, Sophie; French, Paul; Fowler, David; Gumley, Andrew I.; Morrison, Anthony P.; Birchwood, Max; Jones, Peter B.; Stewart, Suzanne L. K.; Wells, Adrian; et al. (Elsevier, 2017-09-14)
      Poor social functioning has been found to be present in those at risk for psychosis. This study aimed to examine metacognitive beliefs as potential predictors of structured activity (measure of social functioning) in those with an At Risk Mental State (ARMS). Regression and correlation analyses were conducted. The sample included 109 young people. Age was found to be positively correlated to structured activity. Metacognitive beliefs concerning uncontrollability and danger of worry were found to negatively predict structured activity. This was after controlling for age, gender, treatment allocation, cognitive schemas, positive symptom severity, social anxiety, and depression. Metacognitive danger items were most important. Age was the only control variable found to be an independent predictor of structured activity in the regression model, despite negative bi-variate relationships with structured activity found across three cognitive schema subscales and social anxiety. This is the first study to find that higher negative metacognitive beliefs about uncontrollability and danger predict lower social functioning in an ARMS sample, and that the perception of thoughts being dangerous was of particular importance. Psychological interventions should consider targeting this metacognitive dimension to increase social functioning. Future longitudinal research is required to strengthen findings in this area.
    • Negative cognition, affect, metacognition and dimensions of paranoia in people at ultra-high risk of psychosis: A multi-level modelling analysis

      Morrison, Anthony P.; Shryane, Nick; Fowler, David; Birchwood, Max; Gumley, Andrew I.; Taylor, Hannah E.; French, Paul; Stewart, Suzanne L. K.; Jones, Peter B.; Lewis, Shôn W.; et al. (Cambridge University Press, 2015-04-08)
      Background: Paranoia is one of the commonest symptoms of psychosis but has rarely been studied in a population at risk of developing psychosis. Based on existing theoretical models, including the proposed distinction between ‘poor me’ and ‘bad me’ paranoia, we test specific predictions about associations between negative cognition, metacognitive beliefs and negative emotions and paranoid ideation and the belief that persecution is deserved (deservedness). Methods: We used data from 117 participants from the EDIE-2 trial of cognitive behaviour therapy for people at high risk of developing psychosis, comparing them with samples of psychiatric inpatients and healthy students from a previous study. Multi-level modelling was utilised to examine predictors of both paranoia and deservedness, with post-hoc planned comparisons conducted to test whether person-level predictor variables were associated differentially with paranoia or with deservedness. Results: Our sample of ARMS participants was not as paranoid, but reported higher levels of “bad-me” deservedness, compared to psychiatric inpatients. We found several predictors of paranoia and deservedness. Negative beliefs about self were related to deservedness but not paranoia, whereas negative beliefs about others were positively related to paranoia but negatively with deservedness. Both depression and negative metacognitive beliefs about paranoid thinking were specifically related to paranoia but not deservedness. Conclusions: This study provides evidence for the role of negative cognition, metacognition and negative affect in the development of paranoid beliefs, which has implications for psychological interventions and our understanding of psychosis.
    • Predictors of individual differences in emerging adult theory of mind

      Stewart, Suzanne L. K.; Kirkham, Julie A.; University of Chester (SAGE, 2020-05-21)
      Little is known about what factors are associated with emerging adult theory of mind (ToM). We predicted that childhood fantasy play (CFP), need for cognition (NfC), and fiction reading would be positive predictors due to their deliberative, perspective-taking nature while engagement with media and technology would be a negative predictor due to increased interpersonal distance. The best-fit mixed logit model (n = 369) showed that CFP, texting frequency, and NfC were significant positive predictors while smartphone usage and preference for task switching were significant negative predictors. Email and phone call usage were contributing non-significant negative predictors. Our study extends previous findings regarding NfC, and highlights the importance of CFP engagement for ToM beyond immediate childhood. Future research should investigate how subtly different media (e.g., texting vs smartphone use) have differential predictive relationships with social cognition. Data and code are available at doi: 10.17605/OSF.IO/CBD9J.
    • Psychopathology and affect dysregulation across the continuum of psychosis: A multiple comparison group study

      Taylor, Hannah E.; Stewart, Suzanne L. K.; Dunn, Graham; Parker, Sophie; Bentall, Richard P.; Birchwood, Max; Morrison, Anthony P.; University of Manchester; Greater Manchester West Mental Health NHS Foundation Trust; Bangor University; University of Birmingham (Wiley, 2013-06-17)
      Aim: There is evidence that psychotic-like phenomena can be detected within the general population and that psychotic experiences lie on a continuum which also spans affective states. We aimed to investigate comparisons of a first episode psychosis group, an ‘at-risk mental state group’ and a help-seeking control group with non-patients to explore whether affective states lie on a continuum of psychosis. Method: Measures of psychotic-like experiences, social anxiety and depression were administered to 20 patients experiencing first episode psychosis (FEP), 113 patients experiencing an ‘at-risk’ mental state (ARMS), 28 patients who were help-seeking but not experiencing a FEP or ARMS (HSC) and 30 non-clinical participants (NC). Results: For distress in relation to psychotic-like experiences, the FEP, ARMS and HSC groups scored significantly higher than the NC group for the perceptual abnormalities and non-bizarre ideas. In terms of severity of psychotic experiences, the FEP scored the highest, followed by the ARMS group, followed by the HSC and NC group. The clinical groups scored significantly higher for depression than the non-clinical group. Interestingly, only the FEP and the ARMS group scored significantly higher than non-patients for social anxiety. Conclusions: These findings suggest that a psychosis continuum exists, however this does not suggest that both psychosis and affective symptoms lie on the same continuum, rather it would appear that the presence of such affective states that may affect help-seeking behavior and clinical status. The implications of these findings for clinical practice are discussed.
    • Sleep duration and psychotic experiences in patients at risk of psychosis: A secondary analysis of the EDIE-2 trial

      Reeve, Sarah; Nickless, Alecia; Sheaves, Bryony; Stewart, Suzanne L. K.; Gumley, Andrew I.; Fowler, David; Morrison, Anthony P.; Freeman, David; University of Oxford; Oxford Health NHS Foundation Trust; University of Chester; University of Glasgow; University of Sussex; University of Manchester (Elsevier, 2018-08-16)
      Sleep disturbance is common among individuals at risk of psychosis, yet few studies have investigated the relationship between sleep disturbance and clinical trajectory. The Early Detection and Intervention Evaluation (EDIE-2) trial provides longitudinal data on sleep duration and individual psychotic experiences from a cohort of individuals at risk of psychosis, which this study utilises in an opportunistic secondary analysis. Shorter and more variable sleep was hypothesised to be associated with more severe psychotic experiences and lower psychological wellbeing. Mixed effect models were used to test sleep duration and range as predictors of individual psychotic experiences and psychological wellbeing over the 12-24 months (with assessments every 3 months) in 160 participants. Shorter sleep duration was associated with more severe delusional ideas and hallucinations cross-sectionally and longitudinally. The longitudinal relationships did not remain significant after conservative controls were added for the previous severity of psychotic experiences. No significant relationships were found between the sleep variables and other psychotic experiences (e.g. cognitive disorganisation), or psychological wellbeing. The results support a relationship between shorter sleep duration and delusional ideas and hallucinations. Future studies should focus on improving sleep disturbance measurement, and test whether treating sleep improves clinical trajectory in the at-risk group.
    • Tears Evoke the Intention to Offer Social Support: A Systematic Investigation of the Interpersonal Effects of Emotional Crying Across 41 Countries

      Zickfeld, Janis H.; van de Ven, Niels; Pich, Olivia; Schubert, Thomas W.; Berkessel, Jana B.; Pizarro, José J.; Bhushan, Braj; Mateo, Nino Jose; Barbosa, Sergio; Sharman, Leah; et al. (Elsevier, 2021-04-13)
      Tearful crying is a ubiquitous and likely uniquely human phenomenon. Scholars have argued that emotional tears serve an attachment function: Tears are thought to act as a social glue by evoking social support intentions. Initial experimental studies supported this proposition across several methodologies, but these were conducted almost exclusively on participants from North America and Europe, resulting in limited generalizability. This project examined the tears-social support intentions effect and possible mediating and moderating variables in a fully pre-registered study across 7,007 participants (24,886 ratings) and 41 countries spanning all populated continents. Participants were presented with four pictures out of 100 possible targets with or without digitally-added tears. We confirmed the main prediction that seeing a tearful individual elicits the intention to support, d = .49 [.43, .55]. Our data suggest that this effect could be mediated by perceiving the crying target as warmer and more helpless, feeling more connected, as well as feeling more empathic concern for the crier, but not by an increase in personal distress of the observer. The effect was moderated by the situational valence, identifying the target as part of one’s group, and trait empathic concern. A neutral situation, high trait empathic concern, and low identification increased the effect. We observed high heterogeneity across countries that was, via split-half validation, best explained by country-level GDP per capita and subjective well-being with stronger effects for higher-scoring countries. These findings suggest that tears can function as social glue, providing one possible explanation why emotional crying persists into adulthood.
    • Valence of agents and recipients moderates the side-effect effect: Two within-subjects, multi-item conceptual replications

      Stewart, Suzanne L. K.; Kennedy, Bradley J.; Haigh, Matthew.; University of Chester; Northumbria University (Taylor & Francis, 2021-08-27)
      The side-effect effect (SEE) demonstrates that the valence of an unintended side effect influences intentionality judgements; people assess harmful (helpful) side effects as (un)intentional. Some evidence suggests that the SEE can be moderated by factors relating to the side effect’s causal agent and to its recipient. However, these findings are often derived from between-subjects studies with a single or few items, limiting generalisability. Our two within-subjects experiments utilised multiple items and successfully conceptually replicated these patterns of findings. Cumulative link mixed models showed the valence of both the agent and the recipient moderated intentionality and accountability ratings. This supports the view that people represent and consider multiple factors of a SEE scenario when judging intentionality. Importantly, it also demonstrates the applicability of multi-vignette, within-subjects approaches for generalising the effect to the wider population, within individuals, and to a multitude of potential scenarios. For open materials, data, and code, see https://www.doi.org/10.17605/OSF.IO/5MGKN.