An app designed to test whether positive feedback in a cognitive task could lead to improved self-efficacy in salience attribution, which may in turn contribute towards a reduction in frequency or severity of psychosis or PTSD-related symptoms such as hypervigilance or aberrant salience.
Please note that I am NOT a psychology professional and this app has NOT been tested scientifically. The results of using this app long term are not known and the app should not be considered dependable for providing favourable results without stringent scrutiny and scientific validation. The overall hypothesis and concept have been reached through the experiences and research of the author who is a suffererer of psychosis symptoms and draws on those experiences along with the statements and works cited below.
See the live app here: https://vincor1986.github.io/word-eliminator/
Built using create-react-app and deployed using gh-pages, the app asks the user to select words that are related / unrelated to the subject. The app uses canvas-confetti for positive feedback.
canvas-confetti: https://github.com/catdad/canvas-confetti
Other attributions:
Magnifying Glass image: Joel Winter (https://icon-icons.com/users/GbSTMcgT8Emx7r4A8GkTE/icon-sets/)
Thumbs Up image: Alexander Madyankin, Roman Shamin (https://icon-icons.com/users/ckc5R7MfpwSvI3vWuY2JC/icon-sets/)
Tick image: Zendesk Garden (https://icon-icons.com/users/JlcNk1ZhwZ25hmdJ8NKHq/icon-sets/)
Overview:
This project focuses on the role of hypervigilance in cases of psychosis and PTSD, and how symptoms may be maintained in some cases by low self-efficacy in terms of appropriate salience attribution.
Self-efficacy refers to an individual's assessment of their own capabilities to effectively cope with future demands (Bandura, 1983).
Psychosis has many associations with trauma (Stevens, Spencer, & Turkington, 2017) including links to childhood trauma, experiences associated with specific genetic and/or organic neurodevelopmental vulnerabilities, psychosis as a result of PTSD and PTSD triggered as a result of acute psychosis.
One hypothesis that attempts to explain how trauma relates to the development of psychosis is that emotional regulation and autobiographical memory can lead to intrusions, appraisals and coping responses in psychosis (Garety et al., 2001; Morrison, 2001). Maher (1974) proposed biopsychosocial vulnerabilities could trigger intrusions, which result in a search for meaning, leading to psychotic experiences maintained by attempts to cope. For instance, someone experiencing psychosis may then experience a hypervigilance to danger and a reduced threshold for threat detection in everyday background noise, leading to intrusions and anomalous experiences (Hardy, 2017).
In a 2014 experiment, an experimental group suffering with hypervigilance were shown to be fixating on a greater amount of visual stimuli than the control group, even where stimuli was neutral (nonsalient). Pupil size was also recorded to be significantly larger in the hypervigilance group (Kimble, 2014). This indicates that the experimental group were less able (or less willing) to disregard nonsalient information from their environment.
Scientists know little about the specific cognitive processes potentially underlying salience attribution. Salience processing - including cognitive, perceptual and experiential levels - is thought to involve different mechanisms (Chun, Brugger, & Kwapil, 2019). Aberrant salience is the unusual or incorrect assignment of salience, significance, or importance to otherwise innocuous stimuli. It is hypothesised to be important for psychosis and psychotic disorders (Cicero et al., 2010).
The "Word Eliminator" app aims to test the hypothesis that aberrant salience attribution and hypervigilance may be maintained by an individual's perceived self-efficacy in salience processing. Such self-assessments could be the result of an individual's repraisals of traumatic experience(s) and of their coping strategies in processing fear related stimuli.
I suggest that some cases of hypervigilance are maintained by a sufferer's lack of confidence in the effectiveness of their salience attribution mechanisms, and in particular: their efficiency to appropriately disregard information.
Even though others might deem the same information to be irrelevant, unimportant or unhelpful - a sufferer might have a general distrust of their own ability to evaluate information effectively, resulting in ultracautious salience processing. Beck, Emery & Greenberg (2005) posited that hypervigilance can lead sufferers to misinterpret ambiguous situations and exaggerate minor threats.
Beevers et al. (2011) found that a propensity to avoid fear related information prior to deployment predicted the onset of PTSD and hypervigilance in military personnel. They concluded that the avoidance of thinking about trauma could inhibit recovery. However, I suggest that sufferers of hypervigilance may attribute their traumatic experiences to their former tendencies to disregard information, resulting in a "stepping up" of their salience processing in response to a self-perceived naivety or flaw.
Cognitive Processing Therapy assumes that survivors of traumatic events do attempt to re-appraise and make sense of what happened, often leading to distorted perspectives or beliefs about themselves or the world in general (Watkins, Sprang and Rothbaum, 2018). It has also been suggested that a disturbance in cognition can result in anxious disturbances in feeling and behaviour (Beck, Emery, & Greenberg, 2005).
A lack of confidence in such fundamental and essential cognition as salience attribution (in combination with other factors) could manifest contributive beliefs such as 'danger is usually difficult to detect', 'I need to be more cautious than others' or that 'constant vigilance is critical', as well as feelings of helplessness, vulnerability and worthlessness. These could be examples of over-accomodation as discussed by Resick and Schnicke (1992), whereby exaggerated and extreme conclusions are drawn by sufferers of trauma as a result of reappraising those traumatic events. Through rumination and other coping strategies, these beliefs might create and/or maintain paranoias and delusions that place great demands on the sufferer's perceptiveness and vigilence, in response to the importance placed on (and self-perceived inadequecies in) the individual's salience processing.
The "Word Eliminator" App:
"Word Eliminator" attempts to reinforce a more positive self assessment of the sufferer's ability to disregard irrelevant information through repetition of a word task, where the user is asked to dismiss unrelated words. Positive feedback is provided to the user upon each correct answer and the completion of a round.
Positive feedback has been found to be an efficient mechanism to improve perceived self-efficacy (Brown et al., 2012). Positive feedback is delivered in the form of: (a) correct answers turning from blue to green, (b) a tick image appearing in place of the answer, (c) commending messages upon the completion of a round (such as "Good job!", "You're doing great!", and "You're a pro at this!"), (d) a rising progress bar that shows progress in green, (e) a final message to congratulate and commend the user upon completion of all rounds, and (f) animated multi-coloured confetti appearing on the screen (also raining down upon completion of all rounds).
This experiment could be performed by participants remotely using the internet. Participants should be adults, and should have been diagnosed with a mental health condition resulting in persistant hypervigilance and/or aberrant salience attribution.
Before beginning their first session, participants should complete a questionnaire containing all questions from the Aberrant Salience Inventory (Cicero et al., 2010), the Cognitive Biases Questionnaire for Psychosis (Corral et al., 2021) and the Hypervigilance Scale (Knight & Herwitz, 2010) along with questions about the participant's perceived self-efficacy relating to a number of cognitive processes including "identifying what is relevant in a situation" and "disregarding unimportant information".
Participants should proceed to use the app once per day, playing through all 20 rounds until completion, for a period of five weeks. At the end of this time, the participants should complete the same questionnaire once more.
It is hoped that through repetition, the user might take away an increased confidence in their ability to correctly identify and disregard irrelevant information, and potentially, an eventual decrease of aberrant salience attribution and/or hypervigilance. These positive outcomes are hoped to be demonstrated within their self-report measures.
The repeated action of successfully identifying irrelevant information might also reinforce this behaviour in the user. It is unusual, in my opinion, that positive feedback is received in everyday life for identifying that some specific information is irrelevant. It occurs to me that immediate positive feedback for effectively performing this essential behaviour might rarely be available to sufferers.
Users are encouraged to scan all available words to identify the three words related to the shown subject, and then click each of the unrelated words to "eliminate" them. There is no time-limit and no negative feedback is provided other than an answer briefly shaking when it is clicked incorrectly.
References:
Bandura A. "Self-efficacy determinants of anticipated fears and calamities." J. Pers. Soc. Psychol. 1983;45 464–469. 10.1037/0022-3514.45.2.464
Beck AT, Emery G, Greenberg RL. "Anxiety disorders and phobias: A cognitive perspective." Basic Books; New York, NY: 2005.
Beevers CG, Marti CN, Lee H, Stote DL, Ferrel RE, Hariri AR, Telch MJ. "Associations between serotonin transporter gene promoter region (5-HTTLPR) polymorphism and gaze bias for emotional information." Journal of Abnormal Psychology. 2011;120(1):187–197.
Brown AD, Dorfman ML, Marmar CR, Bryant RA. "The impact of perceived self-efficacy on mental time travel and social problem solving." Conscious. Cogn. 2012;21:299–306. 10.1016/j.concog.2011.09.023
Chun CA, Brugger P, Kwapil TR. "Aberrant Salience Across Levels of Processing in Positive and Negative Schizotypy." Frontiers in Psychology 2019;10:2073 doi:10.3389/fpsyg.2019.02073
Cicero DC, Kerns JG, McCarthy DM. "The Aberrant Salience Inventory: A New Measure of Psychosis Proneness". Psychological Assessment 2010; 22(3):688-701 doi:10.1037/a0019913
Corral L, Labad J, Ochoa S, Cabezas A, Muntané G, Valero J, Sanchez-Gistau V, Ahuir M, Gallardo-Pujol D, Crosas JM, Palao D, Vilella E, Gutierrez-Zotes A. "Cognitive Biases Questionnaire for Psychosis (CBQp): Spanish Validation and Relationship With Cognitive Insight in Psychotic Patients." Front Psychiatry. 2021 Feb 18;11:596625. doi: 10.3389/fpsyt.2020.596625.
Dalgleish T, Moradi AR, Taghavi MR, Neshat-Doost HT, Yule W. "An experimental investigation of hypervigilance for threat in children and adolescents with post-traumatic stress disorder." Psychological Medicine. 2001;31(3):541–547.
Garety PA, Kuipers E, Fowler D, Freeman D, Bebbington PE. "A cognitive model of the positive symptoms of psychosis." Psychol. Med. 2001 31:189–195 doi: 10.1017/S0033291701003312
Hardy A. "Pathways from Trauma to Psychotic Experiences: A Theoretically Informed Model of Posttraumatic Stress in Psychosis". Frontiers in Psychology 2017 8:697 doi:10.3389/fpsyg.2017.00697
Kimble, Matthew et al. "The impact of hypervigilance: evidence for a forward feedback loop." Journal of anxiety disorders vol. 28,2 (2014): 241-5 doi:10.1016/j.janxdis.2013.12.006
Knight, JA, Herwitz, C. "Measuring clinical hypervigilance: Psychometric properties of the Hypervigilance Scale." American Psychological Association. 2010, August.
Maher BA. "Delusional thinking and perceptual disorder." J. Individ. Psychol. 1974 30:98–113.
Morrison AP. "The interpretation of intrusions in psychosis: an integrative approach to hallucinations and delusions." Behav. Cogn. Psychother. 2001 29:257–276 doi: 10.1017/S1352465801003010
Resick PA, Schnicke MK. (1992). "Cognitive processing therapy for sexual assault victims." J. Consult. Clin. Psychol. 60, 748–756 doi: 10.1037/0022-006x.60.5.748
Stevens LH, Spencer HM, Turkington D. "Identifying Four Subgroups of Trauma in Psychosis: Vulnerability, Psychopathology, and Treatment." Front Psychiatry. 2017;8:21. Published 2017 Feb 13. doi:10.3389/fpsyt.2017.00021
Watkins LE, Sprang KR, Rothbaum BO. "Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions." Frontiers in Behavioral Neuroscience vol. 12 (2018):258. doi:10.3389/fnbeh.2018.00258