Effort shapes social cognition and behaviour: A neuro-cognitive framework

Reduced prosocial motivation and effort in adolescents with conduct problems and callous-unemotional traits

BACKGROUND

Prosocial behaviours - acts that benefit others - are of crucial importance for many species including humans. However, adolescents with conduct problems (CP), unlike their typically developing (TD) peers, demonstrate markedly reduced engagement in prosocial behaviours. This pattern is particularly pronounced in adolescents with CP and high levels of callous-unemotional traits (CP/HCU) who are at increased risk of developing psychopathy in adulthood. While a substantial amount of research has investigated the cognitive-affective mechanisms thought to underlie antisocial behaviour, much less is known about the mechanisms that could explain reduced prosocial behaviours in adolescents with CP.

METHODS

Here we examined the willingness to exert effort to benefit oneself (self) and another person (other, prosocial condition) in children with CP/HCU, CP and lower levels of CU traits (CP/LCU) and their TD peers. The task captured both prosocial choices, and actual effort exerted following prosocial choices, in adolescent boys aged 11-16 (27 CP/HCU; 34 CP/LCU; 33 TD). We used computational modelling to reveal the mechanistic processes involved when choosing prosocial acts.

RESULTS

We found that both CP/HCU and CP/LCU groups were more averse to initiating effortful prosocial acts than TD adolescents - both at a cognitive and at a behavioural level. Strikingly, even if they chose to initiate a prosocial act, the CP/HCU group exerted less effort following this prosocial choice than other groups.

CONCLUSIONS

Our findings indicate that reduced exertion of effort to benefit others may be an important factor that differentiates adolescents with CP/HCU from their peers with CP/LCU. They offer new insights into what might drive low prosocial behaviour in adolescents with CP, including vulnerabilities that may particularly characterise those with high levels of CU traits.

How effort-based self-interest motivation shapes altruistic donation behavior and brain responses

Prosocial behaviors are central to individual and societal well-being. Although the relationship between effort and prosocial behavior is increasingly studied, the impact of effort-based self-interested motivation on prosocial behavior has received less attention. In the current study, we carried out two experiments to examine the effect of motivation to obtain a reward for oneself on donation behavior and brain response. We observed that individuals who accumulated more money in the effort-expenditure rewards task (EEfRT) donated a lower proportion of their earnings. The sigmoid model fitted participants' choices in the EEfRT task, and the effort-reward bias and sigma parameters negatively correlated with the amount of money donated in the donation task. Additionally, the effort-reward bias and sigma parameters negatively predicted N2 amplitude during processing of charitable donation-related information. We propose that individuals who exhibit a lower level of effort-based self-interest motivation may allocate more cognitive control or attentional resources when processing information related to charitable donations. Our work adds weight to understanding the relationship between effort-based self-interest motivation and prosocial behavior and provides electrophysiological evidence.

Enhancing social-emotional functioning in adolescents with developmental language disorder or deaf or hard of hearing through a Theory of Mind intervention

BACKGROUND

This study examines the effect of a Theory of Mind (ToM) intervention on ToM abilities and social-emotional functioning in adolescents with developmental language disorder (DLD) or who are deaf/hard of hearing (D/HH). It emphasizes the importance of self-reflection and measurement for personal growth. The research design incorporates both subjective and objective measures to evaluate the intervention's efficacy.

AIMS

To investigate the impact of the ToM intervention on ToM abilities and social-emotional functioning in adolescents with DLD or who are D/HH. It hypothesizes that participants in the intervention groups will show improved ToM and social-emotional functioning compared with those in the control groups.

METHODS & PROCEDURES

Adolescents with DLD or who are D/HH were recruited through collaboration with educational institutions. The study utilized a pre-/post-test design, assigning participants to either the intervention or the control group. The ToM intervention involved targeted activities to enhance ToM abilities. ToM abilities and social-emotional functioning were assessed using standardized tests and self-report questionnaires. Statistical analyses compared outcomes between the intervention and no intervention groups.

OUTCOMES & RESULTS

The findings reveal subjective improvements in social-emotional functioning among the D/HH intervention group. However, no significant effects on objective ToM measures were observed. These results highlight the need for further investigation and refinement of interventions in these areas. Future research should focus on improving intervention strategies and exploring additional objective measures to gain a comprehensive understanding of the intervention's impact on ToM and social-emotional functioning in this population.

CONCLUSIONS & IMPLICATIONS

The ToM intervention shows subjective benefits in improving social-emotional functioning among D/HH adolescents. However, it does not yield significant effects on objective ToM measures. These findings emphasize the ongoing need to refine interventions targeting ToM abilities and social-emotional functioning in this population. Future studies should explore alternative strategies and incorporate additional objective measures to enhance understanding and outcomes.

WHAT THIS PAPER ADDS

What is already known on this subject Before this study, it was known that ToM interventions have the potential to enhance ToM abilities. However, the specific effects of such interventions on subjective and objective measures for ToM and social-emotional functioning in adolescents with DLD or who are D/HH remained unclear, necessitating further research. What this paper adds to the existing knowledge This study adds to the existing knowledge by demonstrating subjective improvements in social-emotional functioning among adolescents who are D/HH and underwent a ToM intervention. However, no significant effects on objective ToM measures were observed. These findings highlight the need for refining interventions and exploring additional measures to better understand the intervention's impact. What are the potential or actual clinical implications of this work? The subjective improvements in social-emotional functioning observed in this study have important clinical implications. They suggest that ToM interventions can positively impact the social well-being of adolescents who are D/HH. However, the lack of significant effects on objective ToM measures emphasizes the need for further research and intervention refinement to address specific areas of improvement in this population.

Mindreading quality versus quantity: A theoretically and empirically motivated two-factor structure for individual differences in adults' mindreading

Existing methods for studying individual differences in adults' mindreading often lack good psychometric characteristics. Moreover, it remains unclear, even in theory, how mindreading varies in adults who already possess an understanding of mental states. In this pre-registered study, it was hypothesised that adults vary in their motivation for mindreading and in the degree to which their answers on mindreading tasks are appropriate (context-sensitive). These factors are confounded in existing measures as they do not differentiate between the frequency of mental state terms (MST), indicative of motivation, and the quality of an explanation. Using an innovative scoring system, the current study examined whether individual differences in adult undergraduate psychology students' (N = 128) answer quality and / or quantity of explicit references to others' mental states on two open-ended response mindreading tasks were separable constructs, accounted for by mindreading motivation, and related differentially to measures previously linked with mindreading (e.g., religiosity, loneliness, social network size). A two-factor and one-factor model both provided acceptable fit. Neither model showed significant associations with mindreading motivation. However, a two-factor model (with MST and response appropriateness loading onto separate factors) provided greater explanatory power. Specifically, MST was positively associated with religiosity and response appropriateness was negatively associated with religiosity, whilst the one-factor solution did not predict any socially relevant outcomes. This provides some indication that mindreading quantity and mindreading quality may be distinguishable constructs in the structure of individual differences in mindreading.

Social environment-based opportunity costs dictate when people leave social interactions

There is an ever-increasing understanding of the cognitive mechanisms underlying how we process others' behaviours during social interactions. However, little is known about how people decide when to leave an interaction. Are these decisions shaped by alternatives in the environment - the opportunity-costs of connecting to other people? Here, participants chose when to leave partners who treated them with varying degrees of fairness, and connect to others, in social environments with different opportunity-costs. Across four studies we find people leave partners more quickly when opportunity-costs are high, both the average fairness of people in the environment and the effort required to connect to another partner. People's leaving times were accounted for by a fairness-adapted evidence accumulation model, and modulated by depression and loneliness scores. These findings demonstrate the computational processes underlying decisions to leave, and highlight atypical social time allocations as a marker of poor mental health.

Acute stress reduces effortful prosocial behaviour

Acute stress can change our cognition and emotions, but what specific consequences this has for human prosocial behaviour is unclear. Previous studies have mainly investigated prosociality with financial transfers in economic games and produced conflicting results. Yet a core feature of many types of prosocial behaviour is that they are effortful. We therefore examined how acute stress changes our willingness to exert effort that benefits others. Healthy male participants - half of whom were put under acute stress - made decisions whether to exert physical effort to gain money for themselves or another person. With this design, we could independently assess the effects of acute stress on prosocial, compared to self-benefitting, effortful behaviour. Compared to controls (n = 45), participants in the stress group (n = 46) chose to exert effort more often for self- than for other-benefitting rewards at a low level of effort. Additionally, the adverse effects of stress on prosocial effort were particularly pronounced in more selfish participants. Neuroimaging combined with computational modelling revealed a putative neural mechanism underlying these effects: more stressed participants showed increased activation to subjective value in the dorsal anterior cingulate cortex and anterior insula when they themselves could benefit from their exerted effort relative to when someone else could. By using an effort-based task that better approximates real-life prosocial behaviour and incorporating trait differences in prosocial tendencies, our study provides important insights into how acute stress affects prosociality and its associated neural mechanisms.

Higher subjective socioeconomic status is linked to increased charitable giving and mentalizing-related neural value coding

Socioeconomic status (SES), a concept related to an individual's economic and social position relative to others, can shape social interactions like altruistic behaviors. However, little is known about the exact neurocognitive mechanisms that link SES with altruism. Our study aimed to provide a comprehensive account of the sociocognitive and neural mechanisms through which SES affects charitable giving - an important variant of human altruism. To this end, participants completed a charitable donation task while their brain activity was measured using functional magnetic resonance imaging (fMRI). We also assessed participants' socio-cognitive ability to infer other people's mental states (i.e., mentalizing) - a driver of prosocial behavior - in an independent social task. Behaviorally, we found that both charitable giving and social cognition were status-dependent, as subjective SES positively predicted donations and mentalizing capacity. Moreover, the link between SES and charitable giving was mediated by individuals' mentalizing capacity. At the neural level, a multivariate pattern analysis of fMRI data revealed that higher subjective SES was associated with stronger value coding in the right temporoparietal junction (rTPJ). The strength of this value representation predicted charitable giving and was linked to mentalizing. Furthermore, we observed an increased negative functional coupling between rTPJ and left putamen with higher SES. Together, increased charitable giving in higher-status individuals could be explained by status-dependent recruitment of mentalizing-related value coding and altered functional connectivity in the brain. Our findings provide insights into the socio- and neurocognitive mechanisms explaining why and when higher SES leads to prosociality, which might ultimately inform targeted interventions to promote prosocial behavior in human societies.

Social Motivation in Schizophrenia: What's Effort Got to Do With It?

BACKGROUND AND HYPOTHESIS

Social motivation, defined as the fundamental human desire to seek out, engage in, and maintain interpersonal bonds, has become a growing area of research in schizophrenia. The major focus has been on understanding the impact of social reward-related processes. An obvious but rarely acknowledged fact is that social interactions, much like other goal-directed acts, require the exertion of effort. In this Review Article, we argue that social motivation in schizophrenia can be conceptualized through the lens of an established framework: effort-based decision-making (EBDM).

STUDY DESIGN

We conducted a literature review on social reward processing in schizophrenia, then extended these findings by applying concepts and insights from the literature on EBDM to the study of social motivation.

STUDY RESULTS

Within the EBDM framework, decisions about whether or not to pursue social interactions are bound by cost/benefit calculations. That is, people do not pursue social behaviors when the estimated "cost" of the required effort outweighs the anticipated "benefit" or reward. We propose that people with schizophrenia are less likely to engage in social interaction compared with healthy samples because they: (1) underestimate the benefits of relationships (based on expectations of reward/punishment), (2) overestimate the effort costs associated with social interaction, and/or (3) fail to integrate cost-benefit information in an optimal manner.

CONCLUSIONS

EBDM is an especially promising framework of social motivation that goes beyond the current focus on social reward processing to include a focus on effort.

People are curious about immoral and morally ambiguous others

Looking to the popularity of superheroes, true crime stories, and anti-heroic characters like Tony Soprano, we investigated whether moral extremity, especially moral badness, piques curiosity. Across five experiments (N = 2429), we examine moral curiosity, testing under what conditions the moral minds of others spark explanation-seeking behavior. In Experiment 1, we find that among the most widely watched Netflix shows in the US over a five-month period, the more immoral the protagonist, the more hours people spent watching. In Experiments 2a and 2b, we find that when given a choice to learn more about morally good, bad, ambiguous, or average others, people preferred to learn more about morally extreme people, both good and bad. Experiment 3 reveals that people are more curious for explanations about (vs. descriptions of) morally bad and ambiguous people compared to morally good ones. Finally, Experiment 4 tests the uniqueness of curiosity for moral ambiguity. We find that people are more drawn to moral rather than aesthetic ambiguity, suggesting that ambiguity, which is cognitively taxing and sometimes avoided, preferentially engenders information seeking in the moral domain. These findings suggest deviations from moral normativity, especially badness, spur curiosity. People are curious about immorality and agents who differ from the norm.

Neural representations of vicarious rewards are linked to interoception and prosocial behaviour

Every day we constantly observe other people receiving rewards. Theoretical accounts posit that vicarious reward processing might be linked to people's sensitivity to internal body states (interoception) and facilitates a tendency to act prosocially. However, the neural processes underlying the links between vicarious reward processing, interoception, and prosocial behaviour are poorly understood. Previous research has linked vicarious reward processing to the anterior cingulate gyrus (ACCg) and the anterior insula (AI). Can we predict someone's propensity to be prosocial or to be aware of interoceptive signals from variability in how the ACCg and AI process rewards? Here, participants monitored rewards being delivered to themselves or a stranger during functional magnetic resonance imaging. Later, they performed a task measuring their willingness to exert effort to obtain rewards for others, and a task measuring their propensity to be aware and use interoceptive respiratory signals. Using multivariate similarity analysis, we show that people's willingness to be prosocial is predicted by greater similarity between self and other representations in the ACCg. Moreover, greater dissimilarity in self-other representations in the AI is linked to interoceptive propensity. These findings highlight that vicarious reward is linked to bodily signals in AI, and foster prosocial tendencies through the ACCg.

Altered empathy correlates with reduced social and non-social reward anticipation in individuals with high social anhedonia

This study examined the correlations of affective and cognitive components of empathy with reward anticipation toward monetary and social incentives in individuals with social anhedonia (SocAnh). According to the scores on the Revised Social Anhedonia Scale, 109 participants were divided into high (n = 57) and low (n = 52) SocAnh groups. Empathy was assessed with the Questionnaire of Cognitive and Affective Empathy (QCAE) and the Interpersonal Reactivity Index (IRI) Scale. Social and non-social reward anticipations were assessed by the Social and Monetary Incentive Delay Tasks, respectively. We performed independent-sample t tests and repeated-measures ANOVAs to examine the group differences on empathy and reward anticipation. Correlation analyses between empathy and reward anticipation were conducted. Results showed that the high SocAnh group reported reduced scores on empathy and reward anticipation for monetary and social incentives compared to their low SocAnh counterparts. Correlation analysis further indicated that monetary reward anticipation correlated with cognitive empathy, while social reward anticipation correlated with affective empathy. Our findings suggested that participants with high SocAnh exhibited poorer empathy and reduced reward anticipation than those with low SocAnh level. More importantly, social and non-social reward anticipation may distinctly contribute to affective and cognitive components of empathy.

The association between acute stress & empathy: A systematic literature review

Empathy is a fundamental component of our social-emotional experience. Over the last decade, there has been increased interest in understanding the effects of acute stress on empathy. We provide a first comprehensive-and systematic-overview identifying emerging patterns and gaps in this literature. Regarding affective empathy, there is abundant evidence for stress contagion-the 'spillover' of stress from a stressed target to an unstressed perceiver. We highlight contextual factors that can facilitate and/or undermine these effects. Fewer studies have investigated the effects of acute stress on affective empathy, revealing a nuanced picture, some evidence suggests acute stress can block contagion of other's emotions; but again contextual differences need to be considered. Regarding cognitive empathy, most studies find no conclusive effects for simplistic measures of emotion recognition; however, studies using more complex empathy tasks find that acute stress might affect cognitive empathy differentially for men and women. This review provides an important first step towards understanding how acute stress can impact social-togetherness, and aims to aid future research by highlighting (in)congruencies and outstanding questions.

Preferences for seeking effort or reward information bias the willingness to work

Research suggests that the temporal order in which people receive information about costs and benefits whilst making decisions can influence their choices. But, do people have a preference for seeking information about costs or benefits when making effort-based decisions, and does this impact motivation? Here, participants made choices about whether to exert different levels of physical effort to obtain different magnitudes of reward, or rest for low reward. Prior to each effort-based choice, they also had to decide which information they wanted to see first: how much physical effort would be required, or how large the reward would be. We found no overall preference for seeking reward or effort information first, but motivation did change when people saw reward or effort information first. Seeking effort information first, both someone's average tendency to do so and their choice to see effort first on a given trial, was associated with reductions in the willingness to exert higher effort. Moreover, the tendency to prefer effort information first was associated with reduced vigorous exercise and higher levels of fatigue in everyday life. These findings highlight that preferences for seeking effort information may be a bias that reduces people's willingness to exert effort in the lab and in everyday life.

Placebo Analgesia Reduces Costly Prosocial Helping to Lower Another Person's Pain

Painkiller administration lowers pain empathy, but whether this also reduces prosocial behavior is unknown. In this preregistered study, we investigated whether inducing analgesia through a placebo painkiller reduced effortful helping. When given the opportunity to reduce the pain of another person, individuals experiencing placebo analgesia (n = 45 adults from Austria; 21 male, 24 female) made fewer prosocial choices at the lowest helping level and exerted less physical effort when helping, compared with controls whose pain sensitivity was unaltered (n = 45; 21 male, 24 female). Self-reported empathic unpleasantness positively correlated with prosocial choices across the whole sample. While not replicating group differences in empathy, a mediation analysis revealed that the level of unpleasantness to other people's pain fully mediated the effect of placebo analgesia on prosocial choices. Given the importance of prosociality for social cohesion, these findings have broad potential implications both for individuals under the influence of painkillers and for society at large.

Distinct neural representations for prosocial and self-benefiting effort

Prosocial behaviors-actions that benefit others-are central to individual and societal well-being. Although the mechanisms underlying the financial and moral costs of prosocial behaviors are increasingly understood, this work has often ignored a key influence on behavior: effort. Many prosocial acts are effortful, and people are averse to the costs of exerting them. However, how the brain encodes effort costs when actions benefit others is unknown. During fMRI, participants completed a decision-making task where they chose in each trial whether to "work" and exert force (30%-70% of maximum grip strength) or "rest" (no effort) for rewards (2-10 credits). Crucially, on separate trials, they made these decisions either to benefit another person or themselves. We used a combination of multivariate representational similarity analysis and model-based univariate analysis to reveal how the costs of prosocial and self-benefiting efforts are processed. Strikingly, we identified a unique neural signature of effort in the anterior cingulate gyrus (ACCg) for prosocial acts, both when choosing to help others and when exerting force to benefit them. This pattern was absent for self-benefiting behaviors. Moreover, stronger, specific representations of prosocial effort in the ACCg were linked to higher levels of empathy and higher subsequent exerted force to benefit others. In contrast, the ventral tegmental area and ventral insula represented value preferentially when choosing for oneself and not for prosocial acts. These findings advance our understanding of the neural mechanisms of prosocial behavior, highlighting the critical role that effort has in the brain circuits that guide helping others.

Cost-benefit considerations have limited effect on the decision to exert cognitive effort in real-world computer-programming tasks

Recent research shows that people usually try to avoid exerting cognitive effort yet they are willing to exert effort to gain rewards. This cost-benefit framework provides predictions for behaviour outside the laboratory. Nevertheless, the extent to which such considerations affect real-life decisions is not clear. Here we experimentally examined computer-programmers' decisions to write code in a reusable manner, using functions, which demands an initial investment of cognitive effort or to clone and tweak code, a strategy whose cost increases with repetitions. Only a small portion of our participants demonstrated sensitivity to the benefits and costs of programming strategies. When asked to solve the tasks, participants tended to avoid using functions, demonstrating biased effort estimation. By contrast, when asked how they planned to solve the tasks, participants tended to demonstrate an opposite trend, overestimating effort, in line with an injunctive norm involving the overuse of functions. In the context of real-world problems, the effect of cost-benefit considerations may therefore be limited by task-irrelevant factors. Our interdisciplinary approach may be useful in providing novel theoretical insights and in promoting cognitive-effort investments outside the laboratory.

Altered reward and effort processing in children with maltreatment experience: a potential indicator of mental health vulnerability

In this longitudinal study of children and adolescents with a documented history of maltreatment, we investigated the impact of maltreatment on behavioral and neural indices of effort-based decision making for reward and examined their associations with future internalizing symptoms. Thirty-seven children with a documented history of maltreatment (MT group) and a carefully matched group of 33 non-maltreated children (NMT group) aged 10-16, completed an effort-based decision-making task during functional magnetic resonance imaging (fMRI). Internalizing symptoms were assessed at baseline and again 18 months later. Computational models were implemented to extract individual estimates of reward and effort sensitivity, and neural signals during decision-making about different levels of reward and effort were analyzed. These were used to predict internalizing symptoms at follow-up. We identified lower effort-related activation in the anterior cingulate cortex (ACC), a prespecified region-of-interest, in the MT relative to the NMT group. No group differences were observed in the striatum, or in behavioral indices of reward and effort processing. Lower effort-related ACC activation significantly predicted elevated internalizing symptoms at follow-up in the MT group. These findings suggest that disrupted effort-related activation may index latent vulnerability to mental illness in children who have experienced maltreatment.

Adaptive Empathy: Empathic Response Selection as a Dynamic, Feedback-Based Learning Process

Empathy allows us to respond to the emotional state of another person. Considering that an empathic interaction may last beyond the initial response, learning mechanisms may be involved in dynamic adaptation of the reaction to the changing emotional state of the other person. However, traditionally, empathy is assessed through sets of isolated reactions to another's distress. Here we address this gap by focusing on adaptive empathy, defined as the ability to learn and adjust one's empathic responses based on feedback. For this purpose, we designed a novel paradigm of associative learning in which participants chose one of two empathic strategies (reappraisal or distraction) to attenuate the distress of a target person, where one strategy had a higher probability of relieving distress. After each choice, participants received feedback about the success of their chosen strategy in relieving the target person's distress, which they could use to inform their future decisions. The results show that the participants made more accurate choices in the adaptive empathy condition than in a non-social control condition, pointing to an advantage for learning from social feedback. We found a correlation between adaptive empathy and a trait measure of cognitive empathy. These findings indicate that the ability to learn about the effectiveness of empathic responses may benefit from incorporating mentalizing abilities. Our findings provide a lab-based model for studying adaptive empathy and point to the potential contribution of learning theory to enhancing our understanding of the dynamic nature of empathy.

Ageing is associated with disrupted reinforcement learning whilst learning to help others is preserved

Reinforcement learning is a fundamental mechanism displayed by many species. However, adaptive behaviour depends not only on learning about actions and outcomes that affect ourselves, but also those that affect others. Using computational reinforcement learning models, we tested whether young (age 18-36) and older (age 60-80, total n = 152) adults learn to gain rewards for themselves, another person (prosocial), or neither individual (control). Detailed model comparison showed that a model with separate learning rates for each recipient best explained behaviour. Young adults learned faster when their actions benefitted themselves, compared to others. Compared to young adults, older adults showed reduced self-relevant learning rates but preserved prosocial learning. Moreover, levels of subclinical self-reported psychopathic traits (including lack of concern for others) were lower in older adults and the core affective-interpersonal component of this measure negatively correlated with prosocial learning. These findings suggest learning to benefit others is preserved across the lifespan with implications for reinforcement learning and theories of healthy ageing.

Willing and able? Theory of mind, social motivation, and social competence in middle childhood and early adolescence

This study investigated the links between theory of mind, social motivation, and children's social competence in middle childhood and early adolescence. Two hundred and sixty four children (136 girls, 128 boys) aged between 8 and 13 years (M Age = 10.88 years, SD = 1.45) completed theory-of-mind tests and self-report questionnaires measuring social motivation. Teachers rated children's social competence at school. Teacher-rated social competence was associated with individual differences in both theory of mind and children's motivation to develop and maintain social relationships. Results suggest that while individual differences in social motivation and theory of mind are partially overlapping, both theory of mind ability and social motivation contribute to successful social interaction at school.

Large-scale functional brain networks for consciousness

The generation and maintenance of consciousness are fundamental but difficult subjects in the fields of psychology, philosophy, neuroscience, and medicine. However, recent developments in neuro-imaging techniques coupled with network analysis have greatly advanced our understanding of consciousness. The present review focuses on large-scale functional brain networks based on neuro-imaging data to explain the awareness (contents) and wakefulness of consciousness. Despite limitations, neuroimaging data suggests brain maps for important psychological and cognitive processes such as attention, language, self-referential, emotion, motivation, social behavior, and wakefulness. We considered a review of these advancements would provide new insights into research on the neural correlates of consciousness.

Preliminary Outcomes of an Ecological Momentary Intervention for Social Functioning in Schizophrenia: Pre-Post Study of the Motivation and Skills Support App

BACKGROUND

People with schizophrenia and other serious mental illnesses often lack access to evidence-based interventions, particularly interventions that target meaningful recovery outcomes such as social functioning and quality of life. Mobile technologies, including smartphone apps, have the potential to provide scalable support that places elements of evidence-based interventions at the palm of patients' hands.

OBJECTIVE

We aim to develop a smartphone app-called Motivation and Skills Support-to provide targeted social goal support (eg, making new friends and improving existing relationships) for people with schizophrenia enrolled in a stand-alone open trial.

METHODS

In this paper, we presented preliminary outcomes of 31 participants who used the Motivation and Skills Support app for 8 weeks, including social functioning pre- to postintervention, and momentary reports of treatment targets (eg, social motivation and appraisals) during the intervention.

RESULTS

The findings suggest that the intervention improved self-reported social functioning from baseline to treatment termination, particularly in female participants. Gains were not maintained at the 3-month follow-up. Furthermore, increased social functioning was predicted by momentary reports of social appraisals, including perceived social competence and the extent to which social interactions were worth the effort.

CONCLUSIONS

The implications of these findings and future directions for addressing social functioning in schizophrenia using mobile technology have been discussed.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03404219; https://clinicaltrials.gov/ct2/show/NCT03404219.

Grasping Social Apathy: The Role of Reach-To-Grasp Action Kinematics for the Assessment of Social Apathy in Mild Neurocognitive Disorders

BACKGROUND

Social apathy, a reduction in initiative in proposing or engaging in social activities or interactions, is common in mild neurocognitive disorders (MND). Current apathy assessment relies on self-reports or clinical scales, but growing attention is devoted to defining more objective, measurable and non-invasive apathy proxies.

OBJECTIVE

In the present study we investigated the interest of recording action kinematics in a social reach-to-grasp task for the assessment of social apathy.

METHODS

Thirty participants took part in the study: 11 healthy controls (HC; 6 females, mean age = 68.3±10.5 years) and 19 subjects with MND (13 females, mean age = 75.7±6.3 years). Based on the Diagnostic Criteria for Apathy, MND subjects were classified as socially apathetic (A-MND, N = 9) versus non-apathetic (NA-MND, N = 10). SensRing, a ring-shaped wearable sensor, was placed on their index finger, and subjects were asked to reach and grasp a can to place it into a cup (individual condition) and pass it to a partner (social condition).

RESULTS

In the reach-to-grasp phase of the action, HC and NA-MND showed different acceleration and velocity profiles in the social versus individual condition. No differences were found for A-MND.

CONCLUSION

Previous studies showed the interest of recording patients' level of weekly motor activity for apathy assessment. Here we showed that a 10-min reach-to-grasp task may provide information to differentiate socially apathetic and non-apathetic subjects with MND, thus providing a tool easily usable in the clinical practice. Future studies with a bigger sample are needed to better characterize these findings.