A related empirical literature shows that many individuals
with delusions produce few alternative explanations
for the evidence cited for their beliefs,32 do not think that
they could be mistaken in their belief,33 and report that
they would not change their belief in a hypothetical contradiction
task.34 These findings have recently been incorporated
into the concept of belief flexibility. Belief
flexibility refers to ‘‘a meta-cognitive process about
thinking about one’s own delusional beliefs, changing
them in the light of reflection and evidence and generating
and considering alternatives (Garety et al).16(p374)
There have been indications that belief flexibility predicts
a positive response to both antipsychotic medication35
and CBT.33,36,37 We recently found evidence that belief
inflexibility mediates the effect of JTC on delusional conviction.
16 It is proposed that JTC limits belief flexibility