Misinterpreting reality: cognitive insight, biases, and the risk for psychosis proneness

Background This cross-sectional study explored the roles of cognitive insight, cognitive biases, and cognitive limitations in predicting psychosis risk, hypothesizing that biases and limitations mediate the relationship between insight and risk.Methods Data from 251 general-population adults (aged 18–65) were collected via the Beck Cognitive Insight Scale, Davos Assessment of Cognitive Biases Scale, and Aberrant Salience Inventory. Analysis used SPSS and the Process Macro v4.1.Results Psychosis risk correlated positively with cognitive insight dimensions (self-certainty and self-reflectiveness), all measured cognitive biases (jumping to conclusions, attention to threat), and cognitive limitations (social cognition difficulties, subjective cognitive issues). Multiple linear regression identified jumping to conclusions, attention to threat, and social cognition problems as significant predictors of psychosis risk. Mediation analyses revealed distinct pathways: self-reflectiveness linked to psychosis risk both directly and indirectly through social cognition problems, but not via cognitive biases. Conversely, self-certainty showed no direct link to psychosis risk but was indirectly associated through jumping to conclusions and attention to threat, rather than social cognition problems.Discussion The distinct pathways of self-certainty and self-reflectiveness suggest that mitigating psychosis risk requires targeted interventions addressing specific cognitive insights, biases, and social cognitive limitations.