Cognitive and social processes in the pathway to psychosis

Lead Research Organisation: King's College London
Department Name: Psychology


Surveys have shown that there is a continuity between ?normality? and ?psychosis?: some people report unusual experiences such as hearing voices, without it becoming a problem for them. Psychological models of psychosis have suggested that it is the meaning or interpretation given to such experiences that determine whether or not they develop into a diagnosable mental illness.

Our research has shown that specific types of interpretations are important in differentiating between people who stay well and those who become ill. However, these studies are based on interviews, and we now need to investigate more systematically people?s interpretations of different types of experiences using experimental tasks.

We know that some psychological (e.g., specific reasoning styles) and social (e.g., social deprivation) factors make people more vulnerable to developing psychosis. However, we do not know whether these factors are linked to developing unusual experiences, or to their unhelpful interpretations.

We will carry out two studies to look at these issues. The first will compare the interpretations of healthy people with individuals reporting unusual experiences, both with and without a diagnosed mental illness, on tasks inducing unusual experiences. The second will look at which psychological and social factors are linked to unhelpful interpretations.

Technical Summary

There is a high incidence of seemingly benign psychotic symptoms, such as hearing voices, in the general population, in accordance with the continuum view of psychosis. Cognitive models of psychosis propose that interpretations (?appraisals?) of these experiences are key to determining the transition from anomalous experience to psychotic symptom. Our pilot data show that psychotic patients are more likely to think their experiences are caused by someone else (?personalising? appraisals), and less likely to have ?normalising? or ?psychological? appraisals (eg that they are part of the normal range of human experience), than individuals displaying psychotic-like experiences with a diagnosed mental illness.

However, few studies have investigated appraisals in controlled experimental studies, or the psychosocial factors associated with maladaptive appraisals: rather, they are based on interviews asking individuals to reflect on their own, intermingled experiences and appraisals, or on factors related to the presence of psychotic experiences, but not their appraisals.

Two studies are proposed to bridge this gap. The first will compare appraisals in healthy individuals with those experiencing psychotic-like anomalies with and without ?need for care? on experimental tasks inducing anomalous experiences. The second will investigate which psychosocial vulnerabilities proposed by cognitive models are related to pathological appraisals.

Our central research question is this: do specific interpretations (i.e., ?appraisals?) of psychotic-like experiences differentiate individuals with clinical psychosis from those with benign anomalous experiences, as postulated by recent cognitive models of psychosis? Secondly, which psychosocial and cognitive risk factors identified by cognitive models are related to maladaptive appraisals of anomalous experiences?
Description Clinical Research Training Fellowship
Amount £219,357 (GBP)
Funding ID MR/L01677X/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 06/2014 
End 05/2020
Description Doctoral Research Fellowship
Amount £284,639 (GBP)
Funding ID DRF-2014-07-003 
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 01/2015 
End 12/2017
Description Research for Patients Benefit (RfPB)
Amount £264,664 (GBP)
Funding ID PB-PG-0213-30125 
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 10/2014 
End 09/2017