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Learning to trust: trust and attachment in early psychosis

Published online by Cambridge University Press:  22 February 2016

A.-K. J. Fett
Department of Educational Neuroscience and LEARN! Research Institute for Learning and Education, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
S. S. Shergill
Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
N. Korver-Nieberg
Department of Early Psychosis, AMC, Academic Psychiatric Centre, Amsterdam, The Netherlands
F. Yakub
Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
P. M. Gromann
Department of Educational Neuroscience and LEARN! Research Institute for Learning and Education, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
L. Krabbendam
Department of Educational Neuroscience and LEARN! Research Institute for Learning and Education, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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Distrust and social dysfunction are characteristic in psychosis and may arise from attachment insecurity, which is elevated in the disorder. The relationship between trust and attachment in the early stages of psychosis is unknown, yet could help to understand interpersonal difficulties and disease progression. This study aimed to investigate whether trust is reduced in patients with early psychosis and whether this is accounted for by attachment avoidance and attachment anxiety.


We used two trust games with a cooperative and unfair partner in a sample of 39 adolescents with early psychosis and 100 healthy controls.


Patients had higher levels of attachment anxiety, but the groups did not differ in attachment avoidance. Basic trust was lower in patients than controls, as indicated by lower initial investments. During cooperation patients increased their trust towards levels of controls, i.e. they were able to learn and to override initial suspiciousness. Patients decreased their trust less than controls during unfair interactions. Anxious attachment was associated with higher basic trust and higher trust during unfair interactions and predicted trust independent of group status.


Patients showed decreased basic trust but were able to learn from the trustworthy behaviour of their counterpart. Worries about the acceptance by others and low self-esteem are associated with psychosis and attachment anxiety and may explain behaviour that is focused on conciliation, rather than self-protection.

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Copyright © Cambridge University Press 2016 

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