Psychosis, Delusions and the "Jumping to Conclusions" Reasoning Bias: A Systematic Review and Meta-analysis

Abstract

We did a systematic review and meta-analysis to investigate the magnitude and specificity of the "jumping to conclusions" (JTC) bias in psychosis and delusions. We examined the extent to which people with psychosis, and people with delusions specifically, required less information before making decisions. We examined (1) the average amount of information required to make a decision and (2) numbers who demonstrated an extreme JTC bias, as assessed by the "beads task." We compared people with psychosis to people with and without nonpsychotic mental health problems, and people with psychosis with and without delusions. We examined whether reduced data-gathering was associated with increased delusion severity. We identified 55 relevant studies, and acquired previously unpublished data from 16 authors. People with psychosis required significantly less information to make decisions than healthy individuals (k= 33,N= 1935,g= -0.53, 95% CI -0.69, -0.36) and those with nonpsychotic mental health problems (k= 13,N= 667,g= -0.58, 95% CI -0.80, -0.35). The odds of extreme responding in psychosis were between 4 and 6 times higher than the odds of extreme responding by healthy participants and participants with nonpsychotic mental health problems. The JTC bias was linked to a greater probability of delusion occurrence in psychosis (k= 14,N= 770, OR 1.52, 95% CI 1.12, 2.05). There was a trend-level inverse association between data-gathering and delusion severity (k= 18;N= 794;r= -.09, 95% CI -0.21, 0.03). Hence, nonaffective psychosis is characterized by a hasty decision-making style, which is linked to an increased probability of delusions.

Keywords: beads task; delusions; jumping to conclusions; reasoning; schizophrenia.

Fig. 1.

PRISMA flowchart.

Fig. 2.

Forest plots for analyses of draws to decision (DTD). (A) Forest plot for comparison of psychosis group vs nonclinical control on DTD. (B) Forest plot for comparison of psychosis group vs clinical control on DTD. (C) Forest plot for comparison of individuals with psychosis and delusions vs those with without current delusions on DTD (mean differences). (D) Correlation between draws to decisions and delusion severity in people with psychosis and delusions.

Fig. 2.

Forest plots for analyses of draws to decision (DTD). (A) Forest plot for comparison of psychosis group vs nonclinical control on DTD. (B) Forest plot for comparison of psychosis group vs clinical control on DTD. (C) Forest plot for comparison of individuals with psychosis and delusions vs those with without current delusions on DTD (mean differences). (D) Correlation between draws to decisions and delusion severity in people with psychosis and delusions.

Fig. 2.

Forest plots for analyses of draws to decision (DTD). (A) Forest plot for comparison of psychosis group vs nonclinical control on DTD. (B) Forest plot for comparison of psychosis group vs clinical control on DTD. (C) Forest plot for comparison of individuals with psychosis and delusions vs those with without current delusions on DTD (mean differences). (D) Correlation between draws to decisions and delusion severity in people with psychosis and delusions.

Fig. 2.

Forest plots for analyses of draws to decision (DTD). (A) Forest plot for comparison of psychosis group vs nonclinical control on DTD. (B) Forest plot for comparison of psychosis group vs clinical control on DTD. (C) Forest plot for comparison of individuals with psychosis and delusions vs those with without current delusions on DTD (mean differences). (D) Correlation between draws to decisions and delusion severity in people with psychosis and delusions.

Fig. 3.

Forest plots for analyses of extreme responding (JTC). (A) Forest plot for comparison of psychosis group vs nonclinical control on number who demonstrate extreme responding. (B) Forest plot for comparison of psychosis group vs clinical control on number who demonstrate extreme responding. (C) Forest plot for comparison of individuals with psychosis and delusions vs those with without current delusions on number who demonstrate extreme responding.

Fig. 3.

Forest plots for analyses of extreme responding (JTC). (A) Forest plot for comparison of psychosis group vs nonclinical control on number who demonstrate extreme responding. (B) Forest plot for comparison of psychosis group vs clinical control on number who demonstrate extreme responding. (C) Forest plot for comparison of individuals with psychosis and delusions vs those with without current delusions on number who demonstrate extreme responding.

Fig. 3.

Forest plots for analyses of extreme responding (JTC). (A) Forest plot for comparison of psychosis group vs nonclinical control on number who demonstrate extreme responding. (B) Forest plot for comparison of psychosis group vs clinical control on number who demonstrate extreme responding. (C) Forest plot for comparison of individuals with psychosis and delusions vs those with without current delusions on number who demonstrate extreme responding.