Childhood sexual abuse in first-episode psychosis: The relevance in cognitive bias

Abstract

Cognitive biases and childhood trauma have been associated with psychotic outcomes; however, the combined effect of these two variables on psychosis has been minimally explored. This study investigates differences in cognitive biases and the presence of sexual abuse between people with first episode of psychosis (FEP) and healthy controls and explores the relationship between childhood sexual abuse and cognitive biases in individuals with FEP, controlling for sociodemographic and clinical confounders. A sample of 85 FEP patients and 87 healthy controls were assessed using the Spanish version of the Cognitive Biases Questionnaire for Psychosis (CBQp) and the Childhood Trauma Questionnaire (CTQ). Participants with FEP exhibited higher levels of cognitive biases (p = .006), including in threatening situations, (p = .022), anomalous perceptions (p = .005), intentionality (p = .007), jumping to conclusions (p = .009), and emotional reasoning (p = .001), compared to healthy controls, while no significant differences were found in catastrophism and dichotomous thinking. FEP participants also reported a higher incidence of childhood sexual abuse (p = .024). Regressions models using enter method indicated that childhood sexual abuse was associated with dichotomous thinking, a pattern of “all-or-nothing” thinking, and emotional reasoning biases, even after adjusting for age, education, psychotic symptoms, and perceived stress. These results highlight the importance of addressing trauma history in early psychosis interventions, emphasizing cognitive-behavioral strategies like Metacognitive Training and Eye Movement Desensitization and Reprocessing.