Introduction: Individuals with schizotypy can experience a number of cognitive biases that may increase their risk in developing schizophrenia-spectrum psychopathology. However, cognitive biases are also present in mood and anxiety disorders, and it is currently unclear which biases are specific to schizotypy and which may be a result of comorbid depression and/or anxiety. Methods: 462 participants completed measures of depression, anxiety, cognitive biases, cognitive schemas, and schizotypy. Correlation analyses were conducted to examine the relationship between these constructs. Three hierarchical regression analyses were conducted to examine if schizotypy, depression, and anxiety explained a statistically significant amount of variance in cognitive biases after controlling for depression and anxiety, schizotypy and anxiety, and schizotypy and depression, respectively. Moderated regression analyses were also conducted to investigate the moderating role of biological sex and ethnicity in the association between cognitive biases and schizotypy. Results: Self-referential processing, belief inflexibility, and attention for threat were associated with schizotypy. The belief inflexibility bias and social cognition problems were specifically associated with schizotypy after controlling for depression and anxiety and were not directly associated with either depression or anxiety. These associations were not moderated by biological sex or ethnicity. Conclusion: The belief inflexibility bias may be an important cognitive bias underlying schizotypal personality, and further research will be important to determine whether this bias is also associated with an increased likelihood of transitioning to psychosis.

© 2023 The Author(s). Published by S. Karger AG, Basel

Introduction

Schizotypy is a personality structure associated with subthreshold phenotypic representations of schizophrenia-spectrum disorders (SSDs) [1, 2] and individuals with high levels of schizotypy have an increased risk of transitioning to psychosis [3]. Even when no mental disorder is present, individuals with high levels of schizotypy experience impaired cognition and functioning, as well as poorer quality of life compared to healthy controls [4]. Examining schizotypy provides an opportunity to examine factors associated with SSDs without the influence of potential confounds such as medication side effects, prolonged hospitalizations, and functional deterioration that occur during the course of illness. Cognitive biases have been suggested to be an early risk factor for developing psychosis [5] and are observed in individuals with high levels of schizotypy [6, 7]. However, schizotypy and SSDs are comorbid with other mental health conditions such as mood and anxiety disorders [8–10] that are similarly characterized by cognitive biases [11–13]. Thus, it is currently unknown which cognitive biases are specific to schizotypy and are not simply a feature of mood and anxiety comorbidities.

Cognitive BiasesSchizotypy

Cognitive biases refer to a deviation in the rationality of one’s judgment [14] and form the filter through which environmental information is processed, resulting in a distorted view of the world. Cognitive biases are associated with the schizophrenia spectrum [15, 16] and have been implicated in the development and/or maintenance of both delusions [17] and hallucinations [18]. Cognitive biases such as the jumping to conclusions bias, self-referential processing, and bias against disconfirmatory evidence have also been observed in individuals with schizotypal personality traits who do not have a diagnosed SSD. Garety and Freeman [19] define the jumping to conclusions bias as the tendency to form decisions based on insufficient information. Self-referential processing is defined as “incorrect interpretations of casual incidents and external events as having a particular and unusual meaning specifically for the person” [20]. As defined by Eisenacher and Zink [21], the bias against disconfirmatory evidence refers to one’s inability to reevaluate their original interpretation of an event despite new contrary evidence.

Depression and Anxiety

Depression and anxiety disorders are not only frequently comorbid with one another [22] but can also co-occur with SSDs [9] and schizotypy [8, 10]. In a study by Addington and colleagues [23], 79% of youth (n = 744) who were at clinical high risk for psychosis had a comorbid diagnosis at baseline, of which depression and anxiety were the most common. In another study conducted by Fusar-Poli and colleagues [24], 73% of individuals at clinical high risk for psychosis (n = 509) presented with a comorbid mental health diagnosis; 26% were diagnosed with a depressive disorder, 8% were diagnosed with an anxiety disorder, and 14% had both depressive and anxiety disorders. Meta-analytic data demonstrates that among clinically high-risk individuals, the prevalence of depressive disorders is 41% and the prevalence of anxiety disorders is 15% [24].

Depression and anxiety are also characterized by cognitive biases. For example, individuals with depression and anxiety engage in the jumping to conclusions bias [12, 13], the belief inflexibility bias [11] which refers to one’s capacity to update one’s beliefs based on new information [25], and self-referential processing [26]. Individuals with depression also engage in other cognitive biases such as catastrophizing, the interpretation bias [27], attentional bias related to extended gazing at dysphoric stimuli [28], and implicit memory bias [29, 30]. Anxiety is also associated with an attentional bias for threatening stimuli [28, 31] and an explicit memory bias for threatening information on recall tests [32].

Thus, similar cognitive biases are observed in schizotypy, depression, and anxiety; high rates of comorbidity leave it unclear which of these biases are specifically associated with schizotypy and not due to comorbid depression or anxiety. Therefore, the specificity of cognitive biases associated with schizotypy is important to determine in order to understand risk for psychosis and develop appropriate intervention options for schizotypy.

Cognitive Schemas

Cognitive schemas are abstract representations of the world which determine the way in which individuals process information and interpret events [33]. Negative self- and other-schemas are observed in individuals at clinical high risk for psychosis [34] and schizotypy [35, 36]. Similarly, negative self- and other-schemas are observed in individuals with depressive symptoms [37] and negative self-schemas in particular predict the onset of depression in women [38]. Negative self-schemas are also positively associated with attachment anxiety [39].

Sex and Ethnicity/Race Differences in Cognitive Biases and Schemas

The prevalence of schizotypy differs by country and race/ethnicity [40]. Asian-Americans report more severe negative symptoms and overall schizotypy symptoms than White, African American, or Hispanic individuals [41]. African-Americans report more severe disorganization symptoms and negative symptoms than white or Asian-American individuals [41, 42].

In the context of sex, females self-report more positive psychotic experiences and symptoms than males [40, 43]; however, the significant difference diminishes when adjusting for depressive symptoms [43]. On the other hand, males report more disorganized symptoms [40, 44] and negative psychotic experiences and symptoms than females [43–45]. To our knowledge, both sex and ethnic differences in cognitive biases and schemas within schizotypy have not been examined to date.

The Present Study

The aim of the current study was to examine relationships between cognitive biases and schizotypy to determine which biases are specifically associated with schizotypy and which associations may be the result of comorbid depression or anxiety. Additionally, we aimed to investigate sex and ethnic differences in the association between cognitive biases and schizotypal personality traits. It was hypothesized that after controlling for depression and anxiety, the jumping to conclusions bias and self-referential processing will be associated with schizotypy. In relation to confirming the specificity of these biases with schizotypy, it was hypothesized that the jumping to conclusions bias and self-referential processing would not be significant predictors of depression or anxiety after controlling for schizotypy.

Materials and MethodsParticipants

462 participants were recruited from an introductory psychology course who receive course credit for their participation. Participants were excluded if they self-reported any mental illness diagnosis (n = 25), if they did not complete the study entirely (n = 40), and if they did not consent to having their data used in this study (n = 4). Apart from the individuals who did not consent to the use of their data in this study (n = 4), participants excluded in this study (n = 65) did not significantly differ from the participants included in the study (n = 393) in terms of age, t(435) = 364, p = 0.716, sex, t(449) = −0.491, p = 0.624, living circumstances, t(447) = −1.316, p = 0.189, years of education, t(326) = −0.350, p = 726, and ethnic group, t(449) = −0.062, p = 0.950. The final sample consisted of 393 participants.

The mean age of participants was 18.67 years (SD = 2.24), and the participants had a mean of 13.33 years of education (SD = 0.82). The sample consisted of 100 males (25.4%) and 293 females (74.6%). 203 participants (51.7%) were born in Canada, and 190 participants (48.3%) were born elsewhere. The sample mainly consisted of participants who identified as South Asian or Southeast Asian (n = 177, 45.0%), followed by East Asian (n = 101, 25.7%), other (n = 73, 18.6%), and white (n = 42, 10.7%).

Materials

The Schizotypal Personality Questionnaire (SPQ) [46] is a 74-item scale to assess schizotypy. Items are rated as “Yes” or “No,” and the total score is calculated by summing all items. A higher total score indicates more schizotypal traits.

The Referential Thinking Scale (REF) [47] is a 34-item questionnaire measuring self-referential processing. Items are rated as “True” or “False,” and the total score is calculated by summing the individual items after reverse-coding item 19. A higher score on the REF indicates greater self-referential processing.

The Davos Assessment of Cognitive Biases Scale (DACOBS) [48] is a self-report measure assessing cognitive biases. Items are rated on a 7-point Likert scale, ranging from “Strongly disagree” to “Strongly agree,” with higher scores indicating more strongly held cognitive biases. The scale consists of seven subscales: jumping to conclusions bias, belief inflexibility bias, attention for threat bias, external attribution bias, social cognition problems, subjective cognitive problems, and safety behaviors.

The Brief Core Schema Scale (BCSS) [49] is a 24-item self-report measure assessing beliefs about the self and others. This measure includes four subscales: negative-self, positive-self, negative-other, and positive-other. To calculate the scores of each subscale, the individual scores are summed with higher scores indicating greater strength of the schema.

The Center for Epidemiologic Studies Depression Scale (CES-D) [50] is a 20-item self-report measure of depressive symptomology. Items are rated on a 4-point Likert scale, ranging from “Rarely or none of the time” to “Most of all of the time.” The total score is calculated by first reverse coding the positive items and then summing all items, and a higher total score on the CES-D indicates more depressive symptoms.

The Beck Anxiety Inventory (BAI) [51] is a 21-item self-report measure of anxiety symptoms over the last month. Items are scored on a 4-point Likert scale, ranging from “Not at all” to “Severe.” The total score is calculated by summing the items, and higher scores indicate greater anxiety.

Procedure

This study was approved by the University of Toronto Research Ethics Board. The data were collected remotely through the Qualtrics platform. After consenting to participating in this study, participants were instructed to complete a demographic questionnaire and the six measures stated previously. Upon completion of all measures, participants were provided the debriefing form.

Data Analysis

Pearson correlation analyses were conducted to examine the association between schizotypy, depression, anxiety, cognitive biases, and schemas. The relationship between cognitive biases and mental health was examined using hierarchical regression analyses. Three hierarchical regression analyses were conducted to examine schizotypy, depression, and anxiety as dependent variables. In the first hierarchical regression, the CES-D and the BAI were entered in the first step to control for depression and anxiety when examining the relationship between cognitive biases and schizotypy. In the second hierarchical regression analysis, the CES-D and the SPQ were entered in the first step to examine which cognitive biases were uniquely associated with anxiety. In the third hierarchical regression analysis, the BAI and the SPQ were entered in the first step to examine which cognitive biases were uniquely associated with depression. In all three hierarchical regression analyses, the cognitive bias measures (DACOBS, REF, BCSS) were entered in the second step.

Moderated regression analyses were conducted using the PROCESS macro [52] to examine whether biological sex or ethnicity played a moderating role in the association between cognitive biases and schizotypy. A Bonferroni correction was applied to control for multiple comparisons; as there were 12 comparisons made in the moderated regression analyses, the critical p value was set at p = 0.004.

ResultsCorrelation Analyses

The correlation matrix for all variables is presented in Table 1. Schizotypy was significantly and positively correlated with self-referential processing (r = 0.616), belief inflexibility bias (r = 0.278), attention for threat bias (r = 0.448), external attribution bias (r = 0.396), social cognition problems (r = 0.592), subjective cognitive problems (r = 0.562), safety behaviors (r = 0.317), negative self-schemas (r = 0.461), and negative other-schemas (r = 0.406). Schizotypy was significantly and negatively correlated with positive self-schemas (r = −0.335) and positive other-schemas (r = −0.173).

Table 1.

Pearson correlations among all measures

SPQ TSREF TSDACOBS JTCDACOBS BIBDACOBS ATBDACOBS EABDACOBS SOCPDACOBS SUBPDACOBS SBDACOBS TSBCSS NSBCSS PSBCSS NOBCSS POCES-D TSREF TS0.616**DACOBS JTC0.0980.291**DACOBS BIB0.278**0.361**0.330**DACOBS ATB0.448**0.428**0.403**0.345**DACOBS EAB0.396**0.462**0.382**0.562**0.520**DACOBS SOCP0.592**0.626**0.276**0.576**0.524**0.612**DACOBS SUBP0.562**0.432**0.105*0.498**0.396**0.492**0.650**DACOBS SB0.317**0.277**0.174**0.453**0.445**0.460**0.446**0.438**DACOBS
TS0.549**0.575**0.506**0.738**0.726**0.797**0.820**0.732**0.694**BCSS
NS0.461**0.345**0.0250.312**0.250**0.344**0.430**0.466**0.256**0.423**BCSS
PS−0.335**−0.127*0.186**−0.250**−0.118*−0.206**−0.322**−0.424**−0.226**−0.284**−0.592**BCSS
NO0.406**0.379**−0.188**0.267**0.432**0.463**0.402**0.343**0.280**0.476**0.397**−0.117*BCSS
PO−0.173**−0.0470.068−0.138**−0.144**−0.232**−0.164**−0.160**−0.175**−0.193**−0.174**0.374**−0.008CES-D
TS0.524**0.351**0.0200.292**0.332**0.420**0.435**0.539**0.240**0.464**0.652**−0.472**0.380**−0.240**BAI
TS0.541**0.440**0.109*0.189**0.380**0.314**0.403**0.438**0.202**0.414**0.481**−0.217**0.359**−0.0620.676**Hierarchical Regression AnalysesSchizotypy

In block 1, the CES-D and BAI were significantly associated with the SPQ and accounted for 33.9% of the variance (see Table 2). Adding the DACOBS, BCSS, and REF in the second step accounted for an additional 24.6% of the variance. The REF total score, DACOBS belief inflexibility bias scale, DACOBS attention for threat bias scale, DACOBS social cognition problems scale, and the DACOBS subjective cognitive problems scale were all significant predictors of SPQ.

Table 2.

Hierarchical regression analyses for association between cognitive biases and schizotypy

Variableβtp valueRR2ΔR2p valueStep 10.5820.3390.339<0.001* CES-D0.2915.201<0.001* BAI0.3456.166<0.001*Step 20.7650.5850.246<0.001* CES-D0.0721.2780.202 BAI0.1513.0630.002* REF0.3407.489<0.001* DACOBS jumping to conclusions bias−0.061−1.4940.136 DACOBS belief inflexibility bias−0.113−2.4740.014* DACOBS attention for threat bias0.1022.2380.026* DACOBS external attribution bias−0.071−1.4060.161 DACOBS social cognition problems0.1632.8690.004* DACOBS subjective cognitive problems0.1773.550<0.001* DACOBS safety behaviors0.0220.5320.595 BCSS negative-self0.0190.3730.709 BCSS negative-other0.0771.8570.064 BCSS positive-self−0.072−1.5010.134 BCSS positive-other−0.054−1.4550.146Depression

In block 1, the BAI and SPQ were significantly associated with the CES-D and accounted for 49.3% of the variance (see Table 3). Adding the DACOBS, BCSS, and REF in the second step accounted for an additional 16.7% of the variance. The DACOBS external attribution bias scale, DACOBS subjective cognitive problems scale, BCSS negative-self scale, BCSS positive-self scale, and BCSS positive-other were all significant predictors of CES-D.

Table 3.

Hierarchical regression analyses for association between cognitive biases and depression

Variableβtp valueRR2ΔR2p valueStep 10.7020.4930.493<0.001* BAI0.55612.956<0.001* SPQ0.2235.201<0.001*Step 20.8120.6600.167<0.001* BAI0.43210.991<0.001* SPQ0.0591.2780.202 REF−0.065−1.4700.142 DACOBS jumping to conclusions bias−0.055−1.4960.135 DACOBS belief inflexibility bias0.0120.2960.767 DACOBS attention for threat bias0.0100.2340.815 DACOBS external attribution bias0.1513.335<0.001* DACOBS social cognition problems−0.061−1.1730.241 DACOBS subjective cognitive problems0.1423.1310.002* DACOBS safety behaviors−0.068−1.8300.068 BCSS negative-self0.2746.165<0.001* BCSS negative-other0.0310.8360.404 BCSS positive-self−0.101−2.3330.020* BCSS positive-other−0.078−2.3040.022*Anxiety

In block 1, the CES-D and SPQ were significantly associated with the BAI and accounted for 50.6% of the variance (see Table 4). Adding the DACOBS, BCSS, and REF in the second step accounted for an additional 5.2%. The REF total score, DACOBS attention for threat bias scale, and the BCSS positive-self scale were all significant predictors of BAI.

Table 4.

Hierarchical regression analyses for association between cognitive biases and anxiety

Variableβtp valueRR2ΔR2p valueStep 10.7110.5060.506<0.001* CES-D0.54112.956<0.001* SPQ0.2586.166<0.001*Step 20.7470.5580.052<0.001* CES-D0.56110.991<0.001* SPQ0.1613.0630.002* REF0.1212.4210.016* DACOBS jumping to conclusions bias0.0170.3950.693 DACOBS belief inflexibility bias−0.072−1.5100.132 DACOBS attention for threat bias0.1122.3800.018* DACOBS external attribution bias−0.076−1.4620.145 DACOBS social cognition problems−0.002−0.0360.971 DACOBS subjective cognitive problems0.0510.9760.330 DACOBS safety behaviors−0.004−0.1050.916 BCSS negative-self0.0951.7900.074 BCSS negative-other0.0030.0700.944 BCSS positive-self0.1472.9910.003* BCSS positive-other0.0621.6090.109Moderated Regression Analyses

There was no significant moderation by biological sex or ethnicity on any of the relationships between cognitive biases and schizotypy (see Tables 5, 6). See online supplementary Tables at www.karger.com/doi/10.1159/000529742 for the moderation of biological sex and ethnicity on the relationships between cognitive biases and depression and between cognitive biases and anxiety.

Table 5.

Moderated regression analyses for sex moderation of schizotypy and cognitive biases

Predictorβtp value95% CIREF total score1.2013.545<0.001*0.5351.867 Sex0.4750.2580.797−3.1474.097 REF total score × Sex0.0690.3630.717−0.3050.444BCSS negative-self0.9111.8860.060−0.0381.860 Sex−0.779−0.4390.661−4.2682.710 BCSS negative-self × Sex−0.1760.6540.513−0.3540.706BCSS negative-other1.5943.350<0.001*0.6592.529 Sex