Coalitional Cognition and Emotional Factors: An Exploration of the Underlying Factors in Delusional Beliefs

Systematic Review:

Background and Aims
Delusions of Reference (DoR) are a common delusion type; however little is known about which emotional factors lead to their development and maintenance. A systematic review was conducted to gain an overview of the literature on DoR and emotional factors. It aimed to answer the question: what emotions and self-related emotional factors are associated with DoR?

Method
Following registration on Prospero (ID: CRD42024494557), a systematic search of Medline, Scopus and PsycINFO was conducted on the 12th of March 2024. Studies were screened against inclusion and exclusion criteria. Risk of bias was assessed using a quality assessment tool and a narrative synthesis was conducted by emotion type.

Results
A total of 15 studies met the criteria. There was variation in the methodology of the included studies. The findings tentatively identified that 11 emotions were associated with DoR (anxiety, depression, elation, emotional instability, negative affect, phobic anxiety, shame, self-consciousness, social anhedonia, social anxiety, and threat) and four emotions were not associated with DoR (anger, aggression, physical anhedonia, and self-esteem).
However, due to low study quality the results should be interpreted with caution.

Conclusion
The review provided an initial insight into the association between DoR and emotional factors. It also highlighted a scarcity of research. Future research should focus on using more sophisticated designs to understand emotion in DoR as it could provide important
information about their underlying and maintaining factors, which has theoretical and clinical implications.

Empirical Project:

Aims
Coalitional cognition is the set of cognitive abilities that help us navigate complex social environments. It is a new area of exploration in delusional beliefs. One aspect of coalitional cognition is reality sharing, which requires people to share their beliefs with others and agree about reality. This study explored two novel aspects of reality sharing in people living with delusional beliefs: belief sharing and judgements of similarity. As part of this, social networks were explored.

Method
A cross-sectional experimental study was conducted to measure between-group differences. Participants (n=66) were recruited to three groups: a delusional belief group, a mental health control group, or a general population control group (22 per group).
Participants took part in a screening phase to determine eligibility and an experimental phase. A series of ANOVAs, MANOVAs and Chi-square tests explored between-group differences.

Results
People with delusions had impairments in belief sharing and tentative results were found for impairments in judgements of similarity. Furthermore, against expectations, people with delusions had larger social networks.

Conclusion
The findings suggest that there is some evidence that people with delusions have impairments in reality sharing. Future research is required to confirm the accuracy of the results and to explore other novel areas of coalitional cognition. Understanding more about coalitional cognition could open a novel avenue for understanding how delusional beliefs are formed and maintained.