Measuring theory of mind in schizophrenia research: Cross-cultural validation

Two Sides of Theory of Mind: Mental State Attribution to Moving Shapes in Paranoid Schizophrenia Is Independent of the Severity of Positive Symptoms

BACKGROUND

Theory of Mind (ToM) impairment has repeatedly been found in paranoid schizophrenia. The current study aims at investigating whether this is related to a deficit in ToM (undermentalizing) or an increased ToM ability to hyperattribute others' mental states (overmentalizing).

METHODS

Mental state attribution was examined in 24 patients diagnosed with schizophrenia (12 acute paranoid (APS) and 12 post-acute paranoid (PPS)) with regard to positive symptoms as well as matched healthy persons using a moving shapes paradigm. We used 3-T-functional magnetic resonance imaging (fMRI) to provide insights into the neural underpinnings of ToM due to attributional processes in different states of paranoid schizophrenia.

RESULTS

In the condition that makes demands on theory of mind skills (ToM condition), in patients with diagnosed schizophrenia less appropriate mental state descriptions have been used, and they attributed mental states less often to the moving shapes than healthy persons. On a neural level, patients suffering from schizophrenia exhibited within the ToM network hypoactivity in the medial prefrontal cortex (MPFC) and hyperactivity in the temporo-parietal junction (TPJ) as compared to the healthy sample.

CONCLUSIONS

Our results indicate both undermentalizing and hypoactivity in the MPFC and increased overattribution related to hyperactivity in the TPJ in paranoid schizophrenia, providing new implications for understanding ToM in paranoid schizophrenia.

The Social Shapes Test as a Self-Administered, Online Measure of Social Intelligence: Two Studies with Typically Developing Adults and Adults with Autism Spectrum Disorder

The Social Shapes Test (SST) is a measure of social intelligence which does not use human faces or rely on extensive verbal ability. The SST has shown promising validity among adults without autism spectrum disorder (ASD), but it is uncertain whether it is suitable for adults with ASD. We find measurement invariance between adults with (n = 229) or without ASD (n = 1,049) on the 23-item SST. We also find that adults without ASD score higher on the SST than adults with ASD (d = 0.21). We also provide two, 14-item versions which demonstrated good parallel test-retest reliability and are positively related to scores on the Frith-Happé task. The SST is suitable for remote, online research studies.

Assessing social cognition in patients with schizophrenia and healthy controls using the reading the mind in the eyes test (RMET): a systematic review and meta-regression

The reading the mind in the eyes test (RMET) - which assesses the theory of mind component of social cognition - is often used to compare social cognition between patients with schizophrenia and healthy controls. There is, however, no systematic review integrating the results of these studies. We identified 198 studies published before July 2020 that administered RMET to patients with schizophrenia or healthy controls from three English-language and two Chinese-language databases. These studies included 41 separate samples of patients with schizophrenia (total n = 1836) and 197 separate samples of healthy controls (total n = 23 675). The pooled RMET score was 19.76 (95% CI 18.91-20.60) in patients and 25.53 (95% CI 25.19-25.87) in controls (z = 12.41, p < 0.001). After excluding small-sample outlier studies, this difference in RMET performance was greater in studies using non-English v. English versions of RMET (Chi [Q] = 8.54, p < 0.001). Meta-regression analyses found a negative association of age with RMET score and a positive association of years of schooling with RMET score in both patients and controls. A secondary meta-analysis using a spline construction of 180 healthy control samples identified a non-monotonic relationship between age and RMET score - RMET scores increased with age before 31 and decreased with age after 31. These results indicate that patients with schizophrenia have substantial deficits in theory of mind compared with healthy controls, supporting the construct validity of RMET as a measure of social cognition. The different results for English versus non-English versions of RMET and the non-monotonic relationship between age and RMET score highlight the importance of the language of administration of RMET and the possibility that the relationship of aging with theory of mind is different from the relationship of aging with other types of cognitive functioning.

Patients with chronic bipolar disorder show impairments in interpreting literary fiction - A preliminary explorative study with the short story task

INTRODUCTION

Theory of mind (ToM) is a crucial skill in navigating and functioning in the social world. Significant ToM impairment was consistently found in bipolar disorder; it can be both a state and trait marker of the disorder. However, most of the ToM tests are not sensitive enough to detect subtle individual differences, which would be necessary for an individualized treatment plan. The Short Story Task (SST) is a new way to sensitively assess individual differences in ToM performance. The aim of the study was to test the feasibility of SST in patients with bipolar disorder.

METHOD

31 persons (11 male, 20 female) with bipolar I disorder and 31 healthy individuals (15 males and 16 females) as a control group were recruited. SST was used to evaluate ToM performance. The SST uses a Hemingway novel, in which the patient is presented with a realistic social situation, where the motivations of the characters and the underlying relationships of events are not explicitly described.

RESULTS

In the explicit mental state reasoning questions the CG (M = 8.06) had significantly higher (p < 0.001) scores than the persons with bipolar I disorder (M = 5.03). There was no ceiling effect for explicit ToM scores in either group. Participants in CG (M = 8.03) also significantly outperformed (p = 0.006) the BG participants (M = 6.55) in the comprehension questions. The spontaneous mental state inference question was performed equally (M = 0.23) in both groups. Group assignment (t = -3.503, p < 0.001), comprehension score (t = 2.864, p = 0.006), and spontaneous mentalization (t = 2.846, p = 0.006) significantly predicted the explicit ToM performance.

CONCLUSIONS

Overall, we found that the Short Story Task is a promising tool for measuring ToM in patients with bipolar disorder without ceiling effect. Primarily explicit ToM was found to be deficient, which corresponds well with the ToM literature in bipolar disorder. Contrary to our hypothesis we could not detect impairment in spontaneous ToM and found that patients living with bipolar disorder also showed deficits in comprehension. The lack of assessment of neurocognitive skills is a significant limitation of the current study.

An Evaluation of Cross-Cultural Adaptations of Social Cognition Testing: A Systematic Review

Social cognition remains one of the most difficult cognitive domains to assess in diverse populations due to a lack of culturally appropriate tools. This study systematically reviewed literature on neuropsychological tests for social cognition that have been translated, adapted, are cross-cultural, or are assembled for diverse, specifically "Global South," populations. The aim was to identify assessments appropriate for diverse populations, outline and evaluate their methodological approaches, and provide procedural recommendations for future research. The PRISMA systematic review search strategy produced 10,957 articles, of which 287 were selected for full-text screening. The study had to include a neuropsychological assessment of social cognition. The full text of the resulting 287 articles was then screened; the study had to include a translated, adapted, cross-cultural test, or an assembled test for Global South populations. Eighty-four articles were included in this study: 24 for emotion recognition, 45 for theory of mind, 9 for moral reasoning, and six for social cognition in general. Overall, there were 31 translations, 27 adaptations, 14 cross-cultural tests, and 12 assembled tests for Global South populations. Regarding quality, 35 were of low quality, 27 were of moderate quality, and 22 were high quality. This study provides an overview of social cognition tests modified or assembled for diverse populations and gives examples of methodological procedures. It highlights the variability in procedure quality and provides possible reasons for this variability. Finally, it suggests a need to report rigorous modification and assembly procedure in order to have modified and assembled social cognition tests appropriate for diverse populations.

Disentangling the Relationships Between the Clinical Symptoms of Schizophrenia Spectrum Disorders and Theory of Mind: A Meta-analysis

BACKGROUND AND HYPOTHESIS

Previous studies have suggested links between clinical symptoms and theory of mind (ToM) impairments in schizophrenia spectrum disorders (SSD), but it remains unclear whether some symptoms are more strongly linked to ToM than others.

STUDY DESIGN

A meta-analysis (Prospero; CRD42021259723) was conducted to quantify and compare the strength of the associations between ToM and the clinical symptoms of SSD (Positive, Negative, Cognitive/Disorganization, Depression/Anxiety, Excitability/Hostility). Studies (N = 130, 137 samples) including people with SSD and reporting a correlation between clinical symptoms and ToM were retrieved from Pubmed, PsycNet, Embase, Cochrane Library, Science Direct, Proquest, WorldCat, and Open Gray. Correlations for each dimension and each symptom were entered into a random-effect model using a Fisher's r-to-z transformation and were compared using focused-tests. Publication bias was assessed with the Rosenthal failsafe and by inspecting the funnel plot and the standardized residual histogram.

STUDY RESULTS

The Cognitive/Disorganization (Zr = 0.28) and Negative (Zr = 0.24) dimensions revealed a small to moderate association with ToM, which was significantly stronger than the other dimensions. Within the Cognitive/Disorganization dimension, Difficulty in abstract thinking (Zr = 0.36) and Conceptual disorganization (Zr = 0.39) showed the strongest associations with ToM. The association with the Positive dimension (Zr = 0.16) was small and significantly stronger than the relationship with Depression/Anxiety (Zr = 0.09). Stronger associations were observed between ToM and clinical symptoms in younger patients, those with an earlier age at onset of illness and for tasks assessing a combination of different mental states.

CONCLUSIONS

The relationships between Cognitive/Disorganization, Negative symptoms, and ToM should be considered in treating individuals with SSD.

The animated assessment of theory of mind for people with schizophrenia (AToMS): development and psychometric evaluation

Theory of mind (ToM) deficits in people with schizophrenia have been reported and associated with impaired social interactions. Thus, ToM deficits may negatively impact social functioning and warrant consideration in treatment development. However, extant ToM measures may place excessive cognitive demands on people with schizophrenia. Therefore, the study aimed to develop a comprehensible Assessment of ToM for people with Schizophrenia (AToMS) and evaluate its psychometric properties. The AToMs was developed in 5 stages, including item formation, expert review, content validity evaluation, animation production, and cognitive interviews of 25 people with schizophrenia. The psychometric properties of the 16-item AToMS (including reliability and validity) were then tested on 59 people with schizophrenia. The newly developed animated AToMS assesses 8 ToM concepts in the cognitive and affective dimensions while placing minimal neurocognitive demands on people with schizophrenia. The AToMS presented satisfactory psychometric properties, with adequate content validity (content validity index = 0.91); mostly moderate item difficulty (item difficulty index = 0.339-0.966); good discrimination (coefficients = 0.379-0.786), internal consistency (Cronbach's α = 0.850), and reliability (intraclass correlation coefficient = 0.901 for test-retest, 0.997 for inter-rater); and satisfactory convergent and divergent validity. The AToMS is reliable and valid for evaluating ToM characteristics in people with schizophrenia. Future studies are warranted to examine the AToMS in other populations (e.g., people with affective disorders) to cross-validate and extend its utility and psychometric evidence.

Perceptions of and subjective difficulties with social cognition in schizophrenia from an internet survey: Knowledge, clinical experiences, and awareness of association with social functioning

AIM

Social cognition impacts social functioning in schizophrenia; however, little is known about how patients with schizophrenia themselves perceive social cognition. This study, using an internet survey, aimed to investigate their knowledge of social cognition, clinical experiences related to social cognition, awareness of social cognition's role in one's social life, and the relationships between subjective difficulties with social cognition and social functioning.

METHODS

Data from 232 outpatients with schizophrenia (SZ) and 494 healthy controls (HC) were obtained through an internet survey and were weighted according to the demographics of the national population. A newly developed survey questionnaire on knowledge, experience, and awareness of social cognition was administered. Subjective difficulties were evaluated using the Self-Assessment of Social Cognition Impairments and the Observable Social Cognition Rating Scale.

RESULTS

Less than a quarter of both groups were familiar with the term or concept of social cognition. Less than 5% of both groups had experienced being assessed or treated for social cognition. More than half of both groups were aware of the relationship between social cognition and social functioning. The SZ group had higher levels of subjective difficulties than the HC group across all social cognitive domains. The attributional bias domain of subjective difficulties was negatively associated with social functioning.

CONCLUSION

Patients with schizophrenia had substantial subjective difficulties in social cognition, which they perceived as being related to social functioning. However, their knowledge of social cognition was limited, and the assessment and treatment might not be widespread in regular clinical practice.

A psychometric investigation of the multiple-choice version of Animated Triangles Task to measure Theory of Mind in adolescence

The Animated Triangles Task (AT) is commonly used to measure Theory of Mind (ToM). AT can be scored by clinicians based on participants’ verbal responses (AT-verbal) or using a multiple-choice paradigm (AT-MCQ). This study aimed to evaluate the validity of the less time-consuming AT-MCQ. To do this, we examined agreement and correlations between the AT-MCQ and the original AT-verbal scores in 1546 adolescents from a population-based sample. As a supplementary analysis of known-groups validity, we examined if AT-MCQ was as sensitive as AT-verbal in detecting ToM-limitations in 54 adolescents with autism spectrum disorder (ASD), using register-data. The agreement between AT-verbal and AT-MCQ varied markedly across test items. Scores on the two scoring methods were weakly correlated. Both scoring methods weakly detected differences between adolescents with and without ASD in this population-based sample. Most participants had appropriate responses on both AT-MCQ and AT-verbal, which yielded overall acceptable agreement. However, the feasibility of using either scoring methods to measure ToM-limitations in adolescents from the general population is questionable.

Using game-like animations of geometric shapes to simulate social interactions: An evaluation of group score differences

This study introduces a novel, game-like method for measuring social intelligence: the Social Shapes Test. Unlike other existing video or game-based tests, the Shapes Test uses animations of abstract shapes to represent social interactions. We explore demographic differences in Shapes Test scores compared to a written situational judgment test. Gender and race/ethnicity only had meaningful effects on written SJT scores while no effects were found for Shapes Test scores. This pattern of results remained after controlling for general mental ability and English language exposure. We also found metric invariance between demographic groups for both tests. Our results demonstrate the potential for using animated shape tasks as an alternative to written SJTs when designing future game-based assessments.

Study Protocol: The Evaluation Study for Social Cognition Measures in Japan (ESCoM)

In schizophrenia, social cognitive impairment is considered one of the greatest obstacles to social participation. Although numerous measures have been developed to assess social cognition, only a limited number of them have become available in Japan. We are therefore planning this evaluation study for social cognition measures in Japan (ESCoM) to confirm their psychometric characteristics and to promote research focused on social cognition. Participants in the cross-sectional observational study will be 140 patients with schizophrenia recruited from three Japanese facilities and 70 healthy individuals. In our primary analysis, we will calculate several psychometric indicators with a focus on whether they can independently predict social functioning. In secondary analyses, we will assess the reliability and validity of the Japanese translations of each measure and conduct an exploratory investigation of patient background, psychiatric symptoms, defeatist performance belief, and gut microbiota as determinants of social cognition. The protocol for this study is registered in UMIN-CTR, unique ID UMIN000043777.

Evaluation of Social Cognition Measures for Japanese Patients with Schizophrenia Using an Expert Panel and Modified Delphi Method

Social cognition is strongly linked to social functioning outcomes, making it a promising treatment target. Because social cognition measures tend to be sensitive to linguistic and cultural differences, existing measures should be evaluated based on their relevance for Japanese populations. We aimed to establish an expert consensus on the use of social cognition measures in Japanese populations to provide grounds for clinical use and future treatment development. We assembled a panel of experts in the fields of schizophrenia, social psychology, social neuroscience, and developmental disorders. The panel engaged in a modified Delphi process to (1) affirm expert consensus on the definition of social cognition and its constituent domains, (2) determine criteria to evaluate measures, and (3) identify measures appropriate for Japanese patients with a view toward future quantitative research. Through two online voting rounds and two online video conferences, the panel agreed upon a definition and four-domain framework for social cognition consistent with recent literature. Evaluation criteria for measures included feasibility and tolerability, reliability, clinical effectiveness, validity, and international comparability. The panel finally identified nine promising measures, including one task originally developed in Japan. In conclusion, we established an expert consensus on key discussion points in social cognition and arrived at an expert-selected set of measures. We hope that this work facilitates the use of these measures in Japanese clinical scenarios. We plan to further examine these measures in a psychometric evaluation study.

Attributing social meaning to animated shapes: A new experimental study of apparent behavior

In 1944, Heider and Simmel reported that observers could perceive simple animated geometric shapes as characters with emotions, intentions, and other social attributes. This work has been cited over 3000 times and has had wide and ongoing influence on the study of social cognition and social intelligence. However, many researchers in this area have continued to use the original Heider and Simmel black-and-white video. We asked whether the original findings could be reproduced 75 years later by creating 32 new colored animated shape videos designed to depict various social plots and testing whether they can evoke similar spontaneous social attributions. Participants (N = 66) viewed our videos and were asked to write narratives which we coded for indicia of different types of social attributions. Consistent with Heider and Simmel, we found that participants spontaneously attributed social meaning to the videos. We observed that responses to our videos were also similar to responses to the original video reported by Klin (2000), despite being only 13-23 s and portraying a broader range of social plots. Participants varied in how many social attributions they made in response, and the videos varied in how much they elicited such responses. Our set of animated shape videos is freely available online for all researchers to use and forms the basis of a multiple-choice assessment of social intelligence (Brown et al., 2019).

Cross-cultural differences in intercultural mindreading: Evidence from a sample of Palestinian, Italian, and German adolescents

Despite the fact that the "Reading the Mind in the Eyes" Test (RMET) is now available in more than 20 languages, there are only very few cross-cultural researchers using this test, and these researchers generally focus on North American versus East Asian cultures. Considering that the RMET stimuli were selected and constructed in the United Kingdom, this research explored cross-cultural differences in intercultural mindreading with a large sample of adolescents from Palestine (PAL), Italy (ITA), and Germany (GER). In addition to significant main effects of age (younger < older) and gender (male < female), we found a significant main effect of country (PAL < ITA < GER) and a significant interaction between gender and country. Individualism was not related to mindreading in any of the three countries whereas collectivism was positively related in PAL, but not in ITA or GER, accounting only for a very small amount of the variance. Our results suggest that (a) there may be cultural ingroup effects on mindreading, (b) the known female superiority in mindreading may be moderated by cultural factors, and (c) depending on cultural factors, individualism and collectivism may be differently related to mindreading.

Benefits of social cognitive skills training within routine community mental health services: Evidence from a non-randomized parallel controlled study

Although social cognitive impairments are evident in patients with schizophrenia across many cultures, psychosocial interventions are less used in Eastern countries. Despite a growing emphasis on community care in mental health services in Eastern countries, the synergistic effects of social cognitive intervention strategies on routine community mental health services are not well documented. This study aimed to adapt a group-based social cognitive skills training (SCST) program for use in a Korean context and evaluate its feasibility and preliminary effects among community-dwelling individuals with schizophrenia. Forty-seven patients were assigned to either the SCST + treatment as usual (TAU) group (n = 21) or the TAU only group (n = 24). Participants completed tasks to assess social cognition, social functioning, neurocognition, and psychiatric symptoms before and after treatment. Over a period of approximately 12 weeks, drop-out rates were comparably low in both groups, and the attendance rates for the SCST program were high (85.7 %, mean sessions attended = 20.56/24 sessions). The SCST + TAU group demonstrated significant improvements in facial affect recognition, social functioning, and psychiatric symptoms compared to the TAU only group. A non-significant trend in theory of mind was observed, along with no improvements in social perception and neurocognition. The adapted version of the SCST program is feasible for implementation and demonstrates promise for enhancing social cognition and functioning in Korean outpatients with schizophrenia.

Evaluation of social cognitive measures in an Asian schizophrenia sample

BACKGROUND

Converging evidence has indicated that deficits in social cognition may manifest as poor functioning; therefore, social cognition has emerged as an important research area and treatment target. However, few studies have examined the psychometrics of multiple social cognition measures in an Asian population. This study aims to evaluate the psychometrics of measures indexing the four core social cognition domains.

METHODS

Schizophrenia outpatients (n = 116) and healthy controls (n = 73) completed a battery of nine social cognitive measures, twice, four weeks apart. Psychometric properties were examined via test-retest reliability, internal consistency, utility as a repeated measure, time administration, and tolerability. Logistic regression was performed to identify psychometrically sound tasks that best discriminated case-control status. PCA was conducted to explore social cognition dimensional structure.

RESULTS

The Bell Lysaker Emotion Recognition Task (BLERT), Penn Emotion Recognition Task (ER40), and The Awareness of Social Inference Test, branch III (TASIT-3) showed strongest psychometrics. The Ambiguous Intentions and Hostility Questionnaire, Hostility Bias subscale (AIHQ-HB) showed slightly weaker properties, requiring further evaluation. The Hinting task, Mini Profile of Nonverbal Sensitivity (MiniPONS), Relationships Across Domains (RAD), Internal Personal and Situational Attributions Questionnaire (IPSAQ), and Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) showed poorer psychometrics in our sample. PCA revealed a two-factor solution comprising social cognition skills and attributional style/bias.

CONCLUSION

Here, we examined the psychometric properties of a comprehensive social cognition battery based on the SCOPE study in an Asian schizophrenia population. Continued evaluation and standardization of social cognitive measures are needed to refine our understanding of this construct in schizophrenia.

Cross-cultural comparison of theory of mind deficits in patients with schizophrenia from China and Denmark: different aspects of ToM show different results

Introduction: Theory of mind (ToM) has been established as one of the most investigated and pronounced social cognitive deficits in schizophrenia. Yet, knowledge on whether measures of ToM can be used and compared across cultures is sparse. In this study, we used two simple, non-verbal ToM tests in patients with schizophrenia and non-clinical controls from China and Denmark to investigate whether culture has an impact on ToM performance.Methods: Sixty-six patients with schizophrenia (35 Chinese) and 67 matched non-clinical controls (38 Chinese) from China and Denmark were tested with Brünés Picture Sequencing Task and Animated Triangles Task. We compared three models for each outcome variable in order to investigate which model best fitted the data: the first model included group (controls, patients) as a predictor variable, the second included group and nationality (Chinese, Danish), and the third included both predictors and their interaction.Results: On most ToM subtests, culture seemed to play a role. Only performance on Brüne's 1st order ToM were best described as similar in both countries. The second model had the best fit for most of the subtests indicating that the difference between patients and controls in China and Denmark, respectively, is similar.Conclusions: Caution to cultural differences should be taken when comparing ToM in Asian and Western patients with schizophrenia as well as healthy individuals.

Social cognition or social class and culture? On the interpretation of differences in social cognitive performance

BACKGROUND

The ability to understand others' mental states carries profound consequences for mental and physical health, making efforts at validly and reliably assessing mental state understanding (MSU) of utmost importance. However, the most widely used and current NIMH-recommended task for assessing MSU - the Reading the Mind in the Eyes Task (RMET) - suffers from potential assessment issues, including reliance on a participant's vocabulary/intelligence and the use of culturally biased stimuli. Here, we evaluate the impact of demographic and sociocultural factors (age, gender, education, ethnicity, race) on the RMET and other social and non-social cognitive tasks in an effort to determine the extent to which the RMET may be unduly influenced by participant characteristics.

METHODS

In total, 40 248 international, native-/primarily English-speaking participants between the ages of 10 and 70 completed one of five measures on TestMyBrain.org: RMET, a shortened version of RMET, a multiracial emotion identification task, an emotion discrimination task, and a non-social/non-verbal processing speed task (digit symbol matching).

RESULTS

Contrary to other tasks, performance on the RMET increased across the lifespan. Education, race, and ethnicity explained more variance in RMET performance than the other tasks, and differences between levels of education, race, and ethnicity were more pronounced for the RMET than the other tasks such that more highly educated, non-Hispanic, and White/Caucasian individuals performed best.

CONCLUSIONS

These data suggest that the RMET may be unduly influenced by social class and culture, posing a serious challenge to assessing MSU in clinical populations given shared variance between social status and psychiatric illness.

Persons With Schizophrenia Misread Hemingway: A New Approach to Study Theory of Mind in Schizophrenia

INTRODUCTION

Theory of Mind (ToM) is a key component of social cognition. Recently the Short Story Task (SST) was developed as a new measurement of ToM. SST uses a short story of Ernest Hemingway to assess ToM skills. SST proved to be a suitable tool, and sensitive to individual differences among healthy subjects. Our aim was to test SST to evaluate the ToM skills of persons with schizophrenia.

MATERIALS AND METHODS

SST was used to assess ToM skills. After reading the short story "The End of Something" a structured interview was done with 14 questions. Spontaneous mental state reasoning, explicit mental state inference and comprehension of nonmental aspects of the story were evaluated. 47 persons with schizophrenia in remission and 48 healthy controls were assessed and compared.

RESULTS

Persons with schizophrenia performed significantly more poorly in the explicit mental state inference questions. Ceiling effect was not detectable in explicit ToM scores. Patients made less spontaneous mental state references as well, although the occurrence of spontaneous mental state terms was infrequent in both groups. Patients were also less accurate in answering comprehension questions, but the difference was not significant after Bonferroni correction.

DISCUSSION

Our results lined up with the original findings and we found SST to be a sensitive tool to explore the individual differences in ToM performance, not only among healthy subjects, but also among persons with schizophrenia especially in explicit mental state inferences without observing the ceiling effect. We found, however, SST to be less sensitive to measure spontaneous mental state reasoning and also the lack of the use of another ToM test to assess convergent validity of SST for indicating ToM deficits in schizophrenia stands as a limitation of current study.

Differences between individuals with schizophrenia or obsessive-compulsive disorder and healthy controls in social cognition and mindfulness skills: A controlled study

The study of social cognition (SC) has emerged as a key domain of mental health, supporting the notion that poorer performance in SC tasks is linked to psychopathology, although most studies have primarily addressed only schizophrenia (SZ). Some recent studies have also shown deficits of SC in obsessive-compulsive disorder (OCD) patients; however, little is known about how individuals with OCD may differ on SC performance from individuals with SZ. Moreover, initial research in this field suggests that mindfulness skills may be related to SC abilities such as theory of mind (ToM), emotion processing and empathy. Given the potential benefits of mindfulness for treating OCD and SZ, further efforts are needed to understand the association between mindfulness and SC in these populations. The main objective of this study was to compare samples of patients with SZ and OCD to healthy controls (HCs) on several social cognition (SC) domains and mindfulness measures. In total, 30 outpatients diagnosed with SZ, 31 outpatients diagnosed with OCD and 30 healthy controls were assessed in emotion recognition (the Eyes Test), ToM (the Hinting Task), attributional style (the Ambiguous Intentions and Hostility Questionnaire), empathy (the Interpersonal Reactivity Index) and dispositional mindfulness (the MAAS and the FFMQ). Both clinical groups showed poorer performance in emotion recognition and ToM than the HCs. The OCD and SZ patients did not significantly differ in impairment in SC, but the OCD group had higher scores in attributional style (intentionality and anger bias). With regard to mindfulness, the results found lower levels of acting with awareness for the HCs than for either clinical group and higher non-reactivity to inner experience for the HCs than for the individuals with OCD; the results also yielded significant correlations between SC and mindfulness. In conclusion, these findings revealed that SC abilities were impaired in the SZ and OCD groups compared to the HC group, suggesting a similar disrupted pattern in both clinical groups. Aspects of dispositional mindfulness were differentially associated with SC, which may suggest their potential role in novel transdiagnostic interventions.