Cognitive Therapy and Research

, Volume 42, Issue 5, pp 699–710 | Cite as

Monocausal Attributions Along Cross-Sections of Psychosis Development and Links with Psychopathology and Data Gathering Style

  • U. Nowak
  • S. Eisenacher
  • H. Braun
  • F. Rausch
  • S. Muszinski
  • J. Thiem
  • A. Becker
  • S. Englisch
  • P. Kirsch
  • A. Meyer-Lindenberg
  • M. Zink
Original Article


Several attributional biases have been discussed as putative causal factors in psychosis formation and maintenance. The monocausality bias in particular describes the excessive tendency to disregard multifactorial explanations and to instead attribute events to a single cause. To elucidate the role of monocausality in psychosis development, this study compared patients with an at-risk mental state of psychosis (ARMS, n = 49), first-episode patients (FEP, n = 35), chronic schizophrenia patients (SZ, n = 32) and healthy controls (HC, n = 39) on the Internal Personal and Situational Attributions Questionnaire—Revised. FEP patients made significantly more monocausal attributions than HC to the external-personal locus for positive events. Moreover, monocausality was linked with psychotic as well as depressive symptoms and tentatively also with a hasty data gathering style. Future studies should explore associations with other metacognitive deficits and the potential to prevent or correct the monocausality bias through psychological interventions.


Attribution Cognition Metacognition Monocausality Psychosis 



We are grateful to all participants and to the staff of the inpatient clinic who helped support our study appointments. M.Z., A.M.-L., and P.K. were funded by the Deutsche Forschungsgesellschaft (DFG,, projects ZI1253/3-1, ZI1253/3-2, KI 576/14-2, ME1591/6-2). S.Ei. was supported by a grant of Heidelberg University (Landesgraduiertenförderungsgesetz), and U.N. by the Studienstiftung des Deutschen Volkes. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Compliance with Ethical Standards

Conflict of Interest

S.En. has received travel expenses from Lundbeck, Otsuka and Servier and consultant fees from Servier. A.M-L. has received consultant fees from Blueprint Partnership, Boehringer Ingelheim, Daimler und Benz Stiftung, Elsevier, F. Hoffmann-La Roche, ICARE Schizophrenia, K. G. Jebsen Foundation, L.E.K. Consulting, Lundbeck International Foundation (LINF), R. Adamczak, Roche Pharma, Science Foundation, Synapsis Foundation – Alzheimer Research Switzerland, System Analytics, and has received lectures including travel fees from Boehringer Ingelheim, Fama Public Relations, Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Janssen-Cilag, Klinikum Christophsbad, Göppingen, Lilly Deutschland, Luzerner Psychiatrie, LVR Klinikum Düsseldorf, LWL PsychiatrieVerbund Westfalen-Lippe, Otsuka Pharmaceuticals, Reunions I Ciencia S. L., Spanish Society of Psychiatry, Südwestrundfunk Fernsehen, Stern TV, and Vitos Klinikum Kurhessen. M.Z. has received unrestricted scientific grants from German Research Foundation (DFG), and Servier; further speaker and travel grants were provided by Otsuka, Servier, Lundbeck, Roche, Ferrer and Trommsdorff. All other authors declare no conflicts of interest.

Informed Consent

Study approval was obtained from the ethics committee at the Medical Faculty Mannheim of the University of Heidelberg (AZ 2009-296N-MA). Informed consent was obtained from all individuals participating in the study.

Animal Rights

No animal studies were carried out by the authors for this article.


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Authors and Affiliations

  1. 1.Central Institute of Mental Health, Department of Psychiatry and PsychotherapyUniversity of Heidelberg/Medical Faculty MannheimMannheimGermany
  2. 2.Institute of Psychology, Clinical Psychology and PsychotherapyUniversity of HamburgHamburgGermany
  3. 3.Central Institute of Mental Health, Department of Clinical PsychologyUniversity of Heidelberg/Medical Faculty MannheimMannheimGermany
  4. 4.Department of Psychiatry, Psychotherapy and Psychosomatic MedicineBezirkskliniken MittelfrankenAnsbachGermany

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