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The Complex Interplay Between Schizotypy and Emotional, Cognitive and Psychological Factors

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The Complex Interplay Between Schizotypy and Emotional, Cognitive and Psychological Factors The complex interplay between schizotypy and emotional, cognitive and psychological factors Lucy Webster Thesis submitted in partial fulfilment of the requirements of Nottingham Trent University for the degree of Doctor of Philosophy September 2019 Copyright Statement This work is the intellectual property of the author. You may copy up to 5% of this work for private study, or personal, non-commercial research. Any re-use of the information contained within this document should be fully referenced, quoting the author, title, university, degree level and pagination. Queries or requests for any other use, or if a more substantial copy is required, should be directed in the owner(s) of the Intellectual Property Rights. i Abstract This thesis is focused on the complex relationships between schizotypy and a host of emotional, cognitive and psychological factors suggested to be risk factors or adverse outcomes for psychosis. The factors of interest included: cognitive insight, negative affect, psychological wellbeing, self-stigma for seeking psychological help, dysfunctional metacognitive beliefs, neurocognition and social cognition. The complex interplay of these factors has remained relatively unexplored in schizotypy and was investigated in this thesis by utilising multiple regression and complex mediation models in five empirical study chapters. Study one found multidimensional schizotypy traits had differential relationships with the cognitive insight subcomponents- self-reflectiveness and self-certainty. Furthermore, the results indicated that the relationship between schizotypy and psychological wellbeing was mediated in serial by self-reflectiveness and negative affect, extending the “insight paradox” to schizotypy. Study two found that schizotypy was associated with greater self-stigma for seeking psychological help, and psychological wellbeing and the cognitive insight subcomponent- self-certainty mediated these relationships. Study three found that multidimensional schizotypy traits had differential relationships with dysfunctional metacognitive beliefs, and these beliefs mediated the relationship between schizotypy and both cognitive insight subcomponents, negative affect and psychological wellbeing. Against expectations, study four found only weak associations between a small number of neurocognition domains and one schizotypy trait (impulsive non- conformity), cognitive insight and psychological wellbeing. Study five found that out of four social cognition domains (theory of mind, emotion processing, social perception and attribution bias), only attribution bias was associated with schizotypy. Attribution bias also mediated the relationships between schizotypy and both cognitive insight subcomponents, negative affect and psychological wellbeing. Combined, the findings of the thesis not only provide a more ii coherent understanding of the complex relationships occurring in schizotypy, but also provide additional evidence for patterns that are potentially occurring across the psychosis continuum. iii Acknowledgements I would firstly like to thank my Director of Studies, Dr Christine Norman for always believing in me. Chris, I cannot thank you enough for your kindness, patience and expertise. It must be a relief to know that I will no longer be bursting through your office door at any given moment with a question or query! Jokes aside, you have provided me with so many opportunities and have been a continual support during both my Masters and PhD. For all of those things, I will be forever grateful. To the boys, my supervisors, Dr Mike Marriott and Dr Gary Jones. Your knowledge, guidance and support have been invaluable, and you have helped me develop the most important skills necessary, for a (hopefully) successful research career. I could not have asked for a better supervisory team, thank you. Mum, Dad and Megan. What a journey this has been! Even now it doesn’t seem real that I could achieve something like this, yet your belief in me has never once faltered. Mum and Dad, you have supported every decision I have made (the good and the bad) and experienced every emotion that I have during this process. You have taught me to have courage, to work hard and to persevere. Everything I have achieved, I owe to you. Kess, there are no amount of words that can express how grateful I am for you. You have supported me during this whole journey and have shown so much patience and kindness throughout. You deserve a medal and I cannot wait for our next chapter (which hopefully does not include working weekends). I love you very much. iv Conference presentations Webster, L., Norman, C., Jones, G., Marriott, M. (2017). Effects of schizotypy personality traits on psychological well-being through serial mediation of cognitive insight and depression. Poster presented at the International Society for the Study of Individual Differences, Warsaw, Poland. Webster, L., Norman, C., Jones, G., Marriott, M. (2017). Subclinical psychosis symptoms and their relationship with psychological wellbeing: The mediating effects of cognitive insight and depression. Poster presented at the WPA XVII World Congress of Psychiatry, Berlin, Germany. Webster, L., Norman, C., Jones, G., Marriott, M. (2017). Subclinical psychosis symptoms in the general population and their relationship with psychological wellbeing: Is cognitive insight a potential moderator? Presentation at the School Research Conference, Nottingham Trent University. v Contents Abstract………………………………………………………………….............................ii List of Figures……………………………………………………………………………..x List of Tables……………………………………………………………………………....xii Chapter 1. Introduction to the thesis…………………………………………………….1 1.1 Introduction……………………………………………………………………..1 1.2 Unique contribution of the thesis……………………………………………….3 1.3. Synopsis of the remaining thesis chapters……………………………………..5 1.4 Conclusion to chapter…………………………………………………………..7 Chapter 2. Literature review……………………………………………………………..8 2.1 Schizotypy……………………………………………………………………...8 2.2 A review of cognitive insight, negative affect and wellbeing and the psychosis continuum…………………………………………………………………………..13 2.2.1 Cognitive insight……………………………………………………...13 2.2.2 Negative affect and wellbeing………………………………………...19 2.2.3 Cognitive insight, negative affect and wellbeing……………………..23 2.3 A review of self-stigma, metacognition, neurocognition and social cognition....26 2.3.1 Self-stigma…………………………………………………………….27 2.3.1.1 Self-stigma and the psychosis continuum…………………..28 2.3.1.2 Self-stigma and cognitive insight…………………………...31 2.3.1.3 Self-stigma, negative affect and wellbeing………………....32 2.3.2 Metacognition………………………………………………………...34 2.3.2.1 Metacognition and the psychosis continuum……………….37 2.3.2.2 Metacognition and cognitive insight………………………..41 vi 2.3.2.3 Metacognition and negative affect………………………….43 2.3.2.4 Metacognition and wellbeing……………………………….45 2.3.3 Neurocognition………………………………………………………..48 2.3.3.1 Neurocognition and the psychosis continuum………………49 2.3.3.2 Neurocognition and cognitive insight……………………….57 2.3.3.3 Neurocognition and negative affect…………………………59 2.3.3.4 Neurocognition and wellbeing………………………………61 2.3.4 Social cognition……………………………………………………….63 2.3.4.1 Social cognition and the psychosis continuum……………...64 2.3.4.2 Social cognition and cognitive insight………………………73 2.3.4.3 Social cognition and negative affect………………………...76 2.3.4.4 Social cognition and wellbeing……………………………...77 2.4 Thesis Research Aims …………………………………………………………..79 3. Methods…………………………………………………………………………………..85 3.1. Measuring schizotypy…………………………………………………………..85 3.2. Measuring cognitive insight…………………………………………………….92 3.3 Measuring negative affect……………………………………………………….93 3.4 Measuring psychological wellbeing……………………………………………..95 3.5 Measuring self-stigma…………………………………………………………...96 3.6 Measuring metacognition………………………………………………………..99 3.7 Measuring neurocognition………………………………………………………101 3.8 Measuring social cognition……………………………………………………..103 3.9 Description of psychometric measures used in the thesis………………………107 3.10 Procedural overview…………………………………………………………...116 3.11 Statistical analyses……………………………………………………………..119 vii 3.12 Methods summary……………………………………………………………124 Chapter 4. Study 1: Associations between schizotypy, cognitive insight, negative affect and psychological wellbeing……………………………………………………………..126 4.1 Overview………………………………………………………………………126 4.2 Methods………………………………………………………………………..131 4.3 Results…………………………………………………………………………132 4.4 Discussion……………………………………………………………………...141 Chapter 5. Study 2: Exploring the interplay between schizotypy, cognitive insight, negative affect, psychological wellbeing and self-stigma for seeking psychological Help………………………………………………………………………………………..146 5.1 Overview………………………………………………………………………146 5.2 Methods………………………………………………………………………. 150 5.3 Results…………………………………………………………………………151 5.4 Discussion……………………………………………………………………..159 Chapter 6. Study 3: Exploring the interplay between schizotypy, cognitive insight, negative affect, psychological wellbeing and metacognitive beliefs…………………..165 6.1 Overview………………………………………………………………………165 6.2 Methods………………………………………………………………………..173 6.3 Results…………………………………………………………………………174 6.4 Discussion……………………………………………………………………..184 Chapter 7. Study 4: Exploring the interplay between schizotypy, cognitive insight, negative affect, psychological wellbeing and neurocognition………………………….193 7.1 Overview………………………………………………………………………193 7.2 Methods………………………………………………………………………..199 7.3 Results…………………………………………………………………………200 viii 7.4 Discussion…………………………………………………………………….204
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