Thursday, May 22, 2014

The Misattribution of Misattribution: Analysis of the Cognitive models of Hallucinations, Part IV [Conclusion]

A further study provides an integrative account of several previously discussed constructs.  Again using the misattribution theory as their springboard, Larøi, Linden and Marczewski (2004) explored the relationship between meta-cognitive beliefs, cognitive effort and emotional pertinence on a reality monitoring test of hallucination prone participants. This study is notable for its attempt, not simply to confirm the already well documented misattribution theory, but rather to explain the underlying cognitive mechanism of this process. This study is based primarily on the earlier theoretical work of Morrison, Haddock and Tarrier (1995), who argue that an affect laden cognitive dissonance occurs when an unwanted and intrusive thought contradicts a particular meta-cognitive belief system. This in turn triggers an aversive state of arousal and anxiety. Either unable or unwilling to existentially face this cognitive dissonance, the individual attributes the intrusive thought to an external source (i.e., the event becomes hallucinatory). One example of a meta-cognitive framework ripe for this phenomenon may be, “Not being able to control my thoughts is a sign of weakness” (Larøi, 2007). Finally, the researchers note cautiously that even if such cognitive stars do indeed align they should be seen within the larger context of predisposing factors to hallucinations.
            The researchers tested this hypothesis by first screening 100 undergraduates on the Launay-Slade Hallucinations Scale (LSHS). Those scoring in the upper 25th percentile were considered hallucination prone (HP; N = 25) and those on the lower 25th percentile were considered non-hallucination prone (NHP; N = 25). There was no significant distribution difference between genders. A French translation of the Meta-Cognitive Questionnaire (MCQ) was administered to assess participant’s meta-cognitive beliefs systems. Based on a 4-point Likert scale, the 64 question MCQ purports to assesses internal positive and negative beliefs regarding intrusive thoughts and meta-cognitive monitoring based on the following five sub-scales: 1) Positive beliefs about worry (PB), 2) Negative beliefs about the uncontrollability of thoughts and corresponding danger (UD), 3) Cognitive confidence (CC), 4) Negative beliefs about thoughts in general (specifically thoughts related to superstition, punishment and responsibility; SPR), and 5) Cognitive self-consciousness (CSC).
            Participants were then given a reality monitoring test. Similar to other such procedures, the participants were orally presented with 30 words (10 positive, 10 negative, and 10 neutral), and were asked to speak the first word that came to mind. The affect laden words were chosen based in part on the previous work of Braun, Marczewski and Van der Linden (2000). Examples include “bankrupt, suicide, cancer” for negative words, and “paradise, seduce and succeed” as positive words. Neutral words included, “pencil, domain, sheet.” Subjects could provide any verbal response except a proper noun. After a 20 minute delay, participants were shown a computer screen with the original word list, their verbal responses, and distractor words and asked to identify whether the words were from the previous list or not. If the word was from the previous list, participants were instructed to indicate the source—whether participant response or experimenter.
            As predicted, the results indicated a significant difference between the HP group and the NHP group in terms of source discrimination errors, particularly when the material was self-generated (U = 43, p < .05). Again, a significant difference was found between the HP group and the NHP group on MCQ scores. Specifically, the researchers found positive correlations between LSHS scores and all five MCQ sub-scales. Also, interestingly, positive correlations between scores on the UD sub-scale (negative beliefs about uncontrollable thoughts; Spearman r = .49, p < .05), the CC sub-scale (cognitive confidence; Spearman r = .45, p < .05) and source discrimination errors were found. Results were interpreted to support the misattribution theory, as well providing further support for the previously mentioned continuum model of hallucinations.
            While commendable for the testing of multiple constructs relating to hallucinations in normal populations and thus validating previous research, this study’s largest deficit is its inability to explain the cognitive processes involved. As I have argued, this is related to the lack of a systematic account of cognitional operations with which to validate. The implications of this critique are described more fully in the following conclusion.
            Finally, a brief but pertinent study considers the source of hallucinations in individuals with remitted schizophrenia from an information-processing deficit perspective. Miller and Saccuzzo (1979) employed a backward-masking paradigm to assess the initial stages of information-processing in individuals with schizophrenia in remission. In general, visual masking happens when one visual stimulus obstructs discernibility of another visual stimulus. Backward masking, then, is the experimental procedure whereby the target stimulus is presented first, before the masking stimulus (Skottun and Skoyles, 2009). Although somewhat dated, the Miller and Saccuzzo (1979) study is an important contribution to the study of hallucinations in schizophrenic individuals. Additional research has suggested that individuals with schizophrenia have a particular deficiency in the magno-cellular level of the visual system (Green, Nuechterlein, & Mintz, 1994), and abnormal backward visual masking is interpreted as evidence of this claim (Butler & Javitt, 2005).
            Participants included a mere 10 individuals in the normal control group, and an equally sparse 10 individuals with schizophrenia. The schizophrenic individuals, all on anti-psychotic medication, were residents at a care facility with over one year of hospitalization, and three months symptom-free prior to testing. Before testing, participant’s vision was assessed by means of the Snellen Eyey Chart, and language comprehension was measured by the Wechsler Vocabulary subscale.
            In terms of the procedure of backward masking, the researchers employed both a blank masking condition as well a pattern mask by means of a tachistoscope. Each masking condition was affixed to the tachistoscope so that the stimulus was located centrally in the field of vision. The pattern mask was two capital “W’s” adjacent to each other as well as a small, back-lit cross just above the Ws. As Miller and Saccuzzo report, “The fixation field remained constantly illuminated (1.0 ftL or 3.43 cd/m2) providing a lighted background between trials. Luminance in both the stimulus and masking fields was set at 16.33 ftL (55.95 cd/m2) throughout the experiment” (Miller and Saccuzzo, 1979, p. 447). Participants were to detect either a “T” or an “A” from a two-alternative forced choice task. Finally, each masking task was administered under five stages: a no mask control, and subsequent 10, 75, 150, and 250 millisecond delay of the mask to the stimulus presentation. 
            Results indicated that the normal control group made significantly more correct decisions on both masking conditions (p < .01). Similarly, the normal control group scored significantly higher than schizophrenic individuals on both the 2 millisecond delay (p < .01) and the 4 millisecond (p < .05) delay trials. Clearly, individuals with schizophrenia, even though they were non-symptomatic for three months, had more difficulty with detection in the presence of the masking stimulus. These results were interpreted to implicate the possible role pre-cortical processing deficiency. Miller and Saccuzzo argue that, while their conclusions are still tentative, this may be a possible means of measurement of clinical symptomology as well.
Conclusion
            In addition to the over-arching epistemological problem, several specific directions for future research have already been noted throughout this paper: the inclusion of emotionally charged stimuli in experimentation, further investigation into the mediating factors of hallucinations—particularly trauma—as well further examination of the role of cognitive effort and meta-cognitive beliefs.  
Although the hypothesis that misattributed vivid mental images were the origins of VH was proposed by Galton over than 100 years ago (Galton, 1883), a review of the literature reveals that attempts to verify and replicate this claim have been either contradictory or have failed to specify the cognitive mechanism of action. I have argued that the cause for this lack of scientific progress is due to a combination of a fundamental disagreement as well a definite absence of explicit theory of knowledge guiding such cognitive research.
            In the above discussion of the Aleman et al. article, I noted a possible underlying position of positivism. Positivism has arguably been the prevailing philosophical paradigm since inception of modern psychology (Breen and Darlaston-Jones, 2010), since it provides support for psychology as a justified scientific endeavor that is observable, replicable and objective. Recent research into the nature of human consciousness further exemplifies the still current prevalence of positivism. Chalmers (1996), for instance, argues that while attempts to explain the invisible are all well and good, what is physical is ultimately real. Ironically, even researchers in the hard sciences that psychology strives to emulate—say, physics for instance—understand that the particles they investigate are often times simply constructs of human intelligence. Such constructs, while not ultimately tangible, are ways to explain what must indeed be so if they are to offer an explanation of what has actually been observed. In other words, as the history of psychology has shown, despite its limited and initial benefits, the narrowness of positivism is not rich enough to account for the complexities of the human condition, and the future of the science of psychology may be contingent upon the integration of both the objective and subjective components inherent in human cognition.
            Although again constrained by the scope of this paper, future research would do well in looking to the seminal work of the philosopher Bernard Lonergan for a unifying epistemological foundation. Lonergan, by grounding objectivity within one’s own subjectivity and rational self-consciousness, provides a plausible, reliable and indeed first person empirical alternative to the varied epistemological and methodological approaches currently present in psychological theory (Brannick, 2006). With a unified epistemological framework in place, future research would be able to advance by constructing more specialized experiments consistent with such integrated theory of knowledge.  
            In conclusion, this was a cursory treatment of a vast and growing body of literature, and should not be considered a comprehensive review. A complete analysis would entail more detailed comparisons between the theoretical and epistemological underpinnings, especially in instances of conflicting results. Based on this preliminary research, however, I hypothesize that crux of the inconsistencies in the literature are based on a pervasive positivism that mistakenly equates knowledge to ocular vision. That is, as was seen in the Aleman et al. article, the assumption is that internal data are subjective, private events that cannot be understood since they cannot be observed. The difficulty with this position, however,  is that if knowing is simply a matter of taking a good look, then knowing knowing (i.e., meta-cognition) would be nothing more than looking at looking (cf. Lonergan, 1967a). As such, future research would do well to investigate, explicate and unify these often subtle epistemological claims underpinning psychological theory and research.












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By Phillip J. Kuna, PhD (abd)
for John G. Kuna, Psy.D. and Associates Counseling

www.drjohngkuna.com




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