**1. Introduction**

Throughout this chapter we will focus on the great influence of some cognitive biases in the study of schizophrenia disorder. In this chapter we will describe how these cognitive biases are involved in the cognitive processes, which lead to the onset, maintenance and recover of this disorder. Therefore, we will mark the importance of studying these biases to understand, reduce

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and avoid them. As a result, this knowledge would produce an improvement of the symptoms of schizophrenia, increasing the quality of life of these patients.

Schizophrenia is a mental disorder characterized by a set of psychotic disorders which usually involve abnormal social behavior and cognitive deficit [1]. Schizophrenia includes environ‐ mental and genetic factors. In general, the onset of this disorder would be due to environmental factors such as stress, cannabis, poor nutrition during pregnant and some traumatic episodes or infections, among others [2]. Genetic factors include a variety of common and rare genetic variants [3]. However, the genetic influence must be studied in the context of interaction with environmental, social and cognitive effects [4].

In general, the symptoms of schizophrenia are usually divided into two main groups: positive or negative psychotic symptoms. However, these disorders also have other important aspects, which must be observed such as behavioral, affective and cognitive symptoms [5].

On the one hand, the positive symptoms would be typified by failure to understand what is real. In this category we will find, for example, delusions, hallucinations and disorganized speech. On the other hand, the negative symptoms would be typified by diminished emotional expression or avolition such as apathy or alogia. The emotional symptoms would be affective flattening, dysphoria and depression, among others. The behavioral symptoms would be hostility, impulsivity, aggressive attitudes and antisocial behavior [6, 7]. And finally, cognitive symptoms would include cognitive deficits, for example, in the executive functions [1]. In 2013, the American Psychiatric Association removed all subclassifications of schizophrenia in the new publication of DSM‐5 [8].

Focusing in the factors which are involved in the onset and maintenance of schizophrenia disorder, many studies have found multiple implicated psychological mechanisms. However, we will talk about some implied cognitive biases such as jumping to conclusions (JTC) and overconfidence bias, among others.

In 1974, Tervsky and Kahneman defined the term of cognitive bias [9]. In a general definition, we can say that a cognitive bias would be a pattern of deviation in judgment, in which the inferences we make about other people and/or situations can be illogical [10]. Besides, diverse studies have found that these cognitive biases can be influenced by the context, personal motivation, failure in the information processing and social/culture factors [11, 12].

In schizophrenia research, throughout years cognitive behavioral models have established a strong relationship between some cognitive biases and schizophrenia disorders especially in those patients with positive symptomatology [13, 14]. One of the origins and maintenance of delusions are the cognitive biases or deficits in probabilistic reasoning processes of individuals.

However, these biases have been also studied in healthy populations with high scores on schizotypy [13]. Schizotypy would be qualitatively analogous but quantitatively more moderate than schizophrenia. Schizotypy trait could give us a possible explanation about the possible etiological mechanisms underlying schizophrenia spectrum disorders and may permit us to get better strategies for prevention and early detection of this disorder. Diverse studies have found that people with high schizotypy trait have more probability to display these cognitive biases [13].

In addition, several cognitive biases have been identified in those with the diagnosis or those at risk, especially when under stress or in confusing situations [15]. Therefore, it is necessary to know how these cognitive biases work in the onset, maintenance and relapse or recovery from this disorder.

and avoid them. As a result, this knowledge would produce an improvement of the symptoms

Schizophrenia is a mental disorder characterized by a set of psychotic disorders which usually involve abnormal social behavior and cognitive deficit [1]. Schizophrenia includes environ‐ mental and genetic factors. In general, the onset of this disorder would be due to environmental factors such as stress, cannabis, poor nutrition during pregnant and some traumatic episodes or infections, among others [2]. Genetic factors include a variety of common and rare genetic variants [3]. However, the genetic influence must be studied in the context of interaction with

In general, the symptoms of schizophrenia are usually divided into two main groups: positive or negative psychotic symptoms. However, these disorders also have other important aspects,

On the one hand, the positive symptoms would be typified by failure to understand what is real. In this category we will find, for example, delusions, hallucinations and disorganized speech. On the other hand, the negative symptoms would be typified by diminished emotional expression or avolition such as apathy or alogia. The emotional symptoms would be affective flattening, dysphoria and depression, among others. The behavioral symptoms would be hostility, impulsivity, aggressive attitudes and antisocial behavior [6, 7]. And finally, cognitive symptoms would include cognitive deficits, for example, in the executive functions [1]. In 2013, the American Psychiatric Association removed all subclassifications of schizophrenia in the

Focusing in the factors which are involved in the onset and maintenance of schizophrenia disorder, many studies have found multiple implicated psychological mechanisms. However, we will talk about some implied cognitive biases such as jumping to conclusions (JTC) and

In 1974, Tervsky and Kahneman defined the term of cognitive bias [9]. In a general definition, we can say that a cognitive bias would be a pattern of deviation in judgment, in which the inferences we make about other people and/or situations can be illogical [10]. Besides, diverse studies have found that these cognitive biases can be influenced by the context, personal

In schizophrenia research, throughout years cognitive behavioral models have established a strong relationship between some cognitive biases and schizophrenia disorders especially in those patients with positive symptomatology [13, 14]. One of the origins and maintenance of delusions are the cognitive biases or deficits in probabilistic reasoning processes of individuals. However, these biases have been also studied in healthy populations with high scores on schizotypy [13]. Schizotypy would be qualitatively analogous but quantitatively more moderate than schizophrenia. Schizotypy trait could give us a possible explanation about the possible etiological mechanisms underlying schizophrenia spectrum disorders and may permit us to get better strategies for prevention and early detection of this disorder. Diverse studies have found that people with high schizotypy trait have more probability to display

motivation, failure in the information processing and social/culture factors [11, 12].

which must be observed such as behavioral, affective and cognitive symptoms [5].

of schizophrenia, increasing the quality of life of these patients.

environmental, social and cognitive effects [4].

new publication of DSM‐5 [8].

96 Schizophrenia Treatment - The New Facets

overconfidence bias, among others.

these cognitive biases [13].

Following this line, multiple studies have found bidirectional effects in these cognitive biases, that is, one bias or its results could influence another bias or the effects of that second bias and vice versa [16]. For example, Buchy et al. [17] investigated the relationship between jumping to conclusions (JTC) bias and bias against disconfirmatory evidence (BADE) based on the dimensional model of schizophrenia which bodes unifying cognitive biases or that these cognitive biases may combine to contribute to the formation of the delusional aspects of psychosis. Having said that, it is easy supposing there will have combinations of cognitive biases that together would be involved in the onset, maintenance, relapse and/or recovery from this disorder.

Another enriching way of studying cognitive biases in schizophrenia is through the compar‐ ison between the involved cognitive biases in other mental disorders. This study may give us important clues. For example, we could know how these operate in different mental disorders and its symptoms. In fact, we could find specific cognitive biases, which are implicated in a mental disorder but not in other disorders. An example of this type of studio, which tried to compare some psychiatric disorders and its relationship with the cognitive biases, was carried out by Wittorf et al. [18]. These authors did a cross‐sectional study about jumping to conclusion (JTC) and attributional biases (AB) with 20 patients with paranoid schizophrenia, 20 patients with depression, 15 patients with anorexia nervosa and 55 nonclinical controls. Participants completed a modified version of the beads task, a revised German version of the Internal, Personal and Situational Attributions Questionnaire (AB) and several symptoms and neuro‐ cognitive measures. The findings showed that patients with schizophrenia evidenced that they are more likely to exhibit a jumping to conclusions bias than the other groups (patients with depression or anorexia nervosa and healthy controls). With respect to attentional bias, there were no significant differences between the clinical groups in personalizing bias, but patients with schizophrenia exhibited greater externalizing than the other clinical groups. The inno‐ vation of this studio is that it compared two cognitive biases in different psychiatric disorders and this can help us in understanding them better. Therefore, the ultimate purpose of the study of cognitive biases and their influence on schizophrenia is to better understand how these biases are involved in cognitive processes of patients with schizophrenia and how we can get to avoid, know and reduce them. This will result in a recovery of this disorder more effective and faster. In addition, we will achieve an active role of the patient with schizophrenia in his recovery and prevention of a possible relapse. Due to this multiple cognitive behavioral therapies work on the avoidance and reduction of cognitive biases in their programs. For instance, we can name the metacognitive training/therapy [19] or the famous cognitive bias modification therapy [20]. The objective of these therapies is to detect, reduce and avoid the cognitive bias implicated in the onset and maintenance of schizophrenia in order to get an effective recovery and preventing a relapse. For that, different modules are used to work in different biases where the patient knows the bias, becomes aware of it and works on its reduction and avoidance.
