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Franco-Rubio L, Puente-Martínez A, Ubillos-Landa S. Factors associated with recovery during schizophrenia and related disorders: A review of meta-analysis. Schizophr Res 2024; 267:201-212. [PMID: 38569393 DOI: 10.1016/j.schres.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/01/2024] [Accepted: 03/15/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND The spectrum of schizophrenia disorders (SSD) is a severe mental disorder. It is one of the main medical causes of disability that generates high health and social costs. OBJECTIVE To analyze the factors associated with clinical recovery (CR) (symptomatic remission-SR and functional recovery-FR) and personal recovery (PR) in people diagnosed with SSD. METHODS 14 meta-analyses focused on recovery were reviewed following the PRISMA model statements. 95 % of CI was established. RESULTS Shorter Duration of Untreated Psychosis (Zr = 0.24, [0.17, 0.30]) and total Duration of Untreated Illness (Zr = 0.34, [0.20, 0.48]) were related to greater SR and general functioning, respectively. Resilience was the variable with the greatest effect on FR (Zr = 0.67, [0.63, 0.71]). Premorbid adjustment (Zr = 0.34, [0.18, 0.49]) and physical intervention (Zr = 0.71, [0.55, 0.86]) had the greatest effect on occupational and social functioning, respectively. Less severe affective symptoms were related to greater PR (Zr = 0.46, [0.42, 0.50]). There are differences between affective SR and the other types of SR (Zr(SR-A - SR-) = 0.13, Qb = 6.51, p = 0.011), (Zr(SR-A - SR+) = 0.20, Qb = 8.52, p = 0.004), (Zr(SR-A - SR) = 0.18, Qb = 19.29, p = 0.0001). In all, resilience was associated with greater recovery (Zr = 0.67, [0.53, 0.80]), with the global effect being greater on PR than on CR (Zr(PR-CR) = 0.07, Qb = 3.45, p = 0.05). CONCLUSIONS Resilience was the variable most strongly associated with recovery. Symptomatic or functional improvement obtained less statistical weight.
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Affiliation(s)
- Laura Franco-Rubio
- Department of Psychiatry, Complejo Asistencial Universitario de Burgos, Fuente Bermeja Hospital, C/Francisco Salinas s/n, 09003 Burgos, Spain.
| | - Alicia Puente-Martínez
- Department of Social Psychology and Anthropology, University of Salamanca (USAL), Faculty of Social Sciences, Campus Miguel de Unamuno, Paseo Francisco Tomás y Valiente, s/n, 37007 Salamanca, Spain.
| | - Silvia Ubillos-Landa
- Department of Social Psychology, University of Burgos (UBU), Faculty of Health Science, c/Villadiego, s/n, 09001 Burgos, Spain.
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Li Y, Zhou Y, Li Y, Luo RCX, B Ganapathi P, Wu HE, Liu H, Wang D, Zhang X. Gender differences in empathy and clinical symptoms in chronic schizophrenia patients: a large sample study based on a Chinese Han population. Int J Psychiatry Clin Pract 2023; 27:264-271. [PMID: 36719702 DOI: 10.1080/13651501.2023.2171889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/28/2022] [Accepted: 01/18/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Empathy is social cognition and reduced empathy in schizophrenia (SCZ) has been noted; however, whether there are gender differences in empathy remains unclear. Therefore, the purpose of this study was to explore this issue by examining a large sample of the population with SCZ. METHODS We recruited 987 SCZ patients (M/F = 638/349). The empathy was assessed by The Interpersonal Reactivity Index (IRI). The Positive and Negative Syndrome Scale (PANSS) was adopted to assess their clinical psychiatric symptoms and their ability to recognise the facial emotions of others was assessed by the Pictures Of Facial Affect (POFA). RESULTS Female SCZ patients had higher IRI total score than male patients. In male patients, Pearson correlation analysis showed that empathy was negatively correlated with PANSS total score and negative symptom subscale scores, but positively correlated with anger identification. In female patients, IRI total score was negatively correlated with PANSS total score as well as its positive and negative symptom subscale scores (all p < 0.05). CONCLUSION There are gender differences in the empathy of SCZ patients, with female patients having greater empathy and a correlation with their clinical symptoms. This gender difference may provide potential clinical value for the treatment of SCZ.KEY POINTSFemale SCZ were more likely to empathise than males;Female patients had more severe clinical symptoms than males;There were gender differences in the association between certain specific clinical presentations and empathy.In future studies, it may be useful to investigate gender differences in schizophrenia empathy for the diagnosis and treatment of the disorder.
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Affiliation(s)
- Yanli Li
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Yongjie Zhou
- Department of Psychiatric Rehabilitation, Shenzhen Kangning Hospital, Shenzhen, China
| | - Yuchen Li
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Rui-Chen-Xi Luo
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Pallavi B Ganapathi
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center, Houston, TX, USA
| | - Hanjing Emily Wu
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center, Houston, TX, USA
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xiangyang Zhang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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Li Y, Luo R, Wang D, Zhang X. Association between Empathy and Clinical Symptoms among Overweight and Non-Overweight Chinese Chronic Schizophrenia Patients. Brain Sci 2023; 13:1075. [PMID: 37509007 PMCID: PMC10377734 DOI: 10.3390/brainsci13071075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Patients with schizophrenia are afflicted by severe clinical symptoms and serious cognitive dysfunction. The aim of this study is to investigate the potential relationships between clinical symptoms and empathy and their variations between overweight and non-overweight schizophrenia patients. To address this problem, a group of 776 inpatients diagnosed with chronic schizophrenia (504 overweight patients and 272 non-overweight patients) was recruited. The Positive and Negative Syndrome Scale (PANSS) and its five-factor model were employed to assess clinical symptoms, while empathy levels were measured using the Interpersonal Reactivity Index (IRI). The overweight patients had lower education levels but higher positive symptoms than the non-overweight patients (all p < 0.05). In addition, the overweight patients performed significantly better with respect to empathy (FDR-corrected p < 0.05). Additional multiple regression analyses indicated significant associations between the total score of the IRI and PANSS negative symptoms, gender, and family history of psychiatric disorders among the overweight group; among non-overweight patients, there was a significant correlation between suicide and the total score of the IRI. This study provides evidence suggesting that chronic schizophrenia patients who are overweight may have distinct clinical characteristics, particularly with respect to their empathy, compared with non-overweight patients. Moreover, different variables are associated with empathy in different groups.
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Affiliation(s)
- Yuchen Li
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China
| | - Ruichenxi Luo
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China
| | - Dongmei Wang
- Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing 100101, China
| | - Xiangyang Zhang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China
- Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing 100101, China
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4
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Gong M, Yao L, Ge X, Liu Z, Zhang C, Yang Y, Amdanee N, Wang C, Zhang X. Empathy deficit in male patients with schizophrenia and its relationships with impulsivity and premeditated violence. Front Psychiatry 2023; 14:1160357. [PMID: 37398588 PMCID: PMC10308378 DOI: 10.3389/fpsyt.2023.1160357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/22/2023] [Indexed: 07/04/2023] Open
Abstract
Objective To explore the pattern of empathy characteristics in male patients with schizophrenia (SCH) and to examine whether empathy deficit is associated with impulsivity and premeditated violence. Methods One hundred and fourteen male SCH patients were enrolled in this study. The demographic data of all patients were collected and the subjects were divided into two groups, namely, the violent group, including 60 cases, and the non-violent group, comprising 54 cases, according to the Modified Overt Aggression Scale (MOAS). The Chinese version of the Interpersonal Reactivity Index-C (IRI-C) was used to evaluate empathy and the Impulsive/Predicted Aggression Scales (IPAS) was employed to assess the characteristics of aggression. Results Among the 60 patients in the violent group, 44 patients had impulsive aggression (IA) and 16 patients had premeditated aggression (PM) according to the IPAS scale. In the violent group, the scores of the four subfactors of the IRI-C, i.e., perspective taking (PT), fantasy (FS), personal distress (PD), and empathy concern (EC), were significantly lower than in the non-violent group. Stepwise logistic regression showed that PM was independent influencing factor for violent behaviors in SCH patients. Correlation analysis revealed that EC of affective empathy was positively correlated with PM but not with IA. Conclusion SCH patients with violent behavior had more extensive empathy deficits compared with non-violent SCH patients. EC, IA and PM are independent risk factors of violence in SCH patients. Empathy concern is an important index to predict PM in male patients with SCH.
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Affiliation(s)
- Muxin Gong
- Department of Psychiatry, The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Psychiatry, Xuzhou Medical University, Xuzhou, China
| | - Lei Yao
- Department of Psychiatry, The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xiaodan Ge
- Department of Psychiatry, The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zhenru Liu
- Department of Psychiatry, Xuzhou Medical University, Xuzhou, China
| | - Caiyi Zhang
- Department of Psychiatry, The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yujing Yang
- Department of Psychiatry, The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Nousayhah Amdanee
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chengdong Wang
- Department of Psychiatry, The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xiangrong Zhang
- Department of Psychiatry, The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Psychiatry, Xuzhou Medical University, Xuzhou, China
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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5
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Liu J, Tian Y, Wei S, Wang W, Wang D, Zhou H, Zhang XY. Association of empathy with clinical symptoms and cognitive function in Chinese chronic schizophrenia patients with and without deficit syndrome. Prog Neuropsychopharmacol Biol Psychiatry 2022; 119:110592. [PMID: 35716800 DOI: 10.1016/j.pnpbp.2022.110592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/09/2022] [Accepted: 06/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with deficit syndrome (DS) are known to experience cognitive impairment. However, there is no consistent conclusion on the impairment of neurocognitive features in DS patients, and no studies have examined their empathy. The purpose of this study was to compare neurocognition and empathy in patients with DS and non-DS schizophrenia. METHODS Totally, 665 patients with chronic schizophrenia were enrolled. DS patients were identified by the Proxy Scale for Deficit Syndrome (PDS). Neurocognition and social cognition were assessed by Repeatable Battery for the measurement of Neuropsychological Status (RBANS) and the Interpersonal Reactivity Index (IRI), respectively. In addition, psychopathological symptom severity was assessed by the Positive and Negative Syndrome Scale (PANSS). RESULTS Participants included 150 patients with DS and 140 patients with non-DS. DS patients performed significantly worse on the all RBANS domain (except for visuospatial) and total scores as well as IRI scores. Regression analysis showed that PANSS general psychopathology and education were associated with RBANS total score in the DS group (adjusted R2 = 0.29), while education and PANSS negative symptoms were correlated with RBANS total score in non-DS patients (adjusted R2 = 0.33). In the non-DS group, suicide attempts and PANSS negative symptom score were independently associated with IRI total score (adjusted R2 = 0.06), whereas in the DS group, no variable was associated with IRI total score. CONCLUSIONS Our findings suggest that patients with DS may have poor neurocognitive and empathy performance. In chronic schizophrenia patients, negative symptoms may play a different role in cognition between DS and non-DS groups.
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Affiliation(s)
- Junyao Liu
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yang Tian
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Shuochi Wei
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Wenjia Wang
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dongmei Wang
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Huixia Zhou
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xiang-Yang Zhang
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China..
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6
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Stinson J, Wolfe R, Spaulding W. Social Connectedness in Schizotypy: The Role of Cognitive and Affective Empathy. Behav Sci (Basel) 2022; 12:bs12080253. [PMID: 35892353 PMCID: PMC9394355 DOI: 10.3390/bs12080253] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/27/2022] [Accepted: 07/19/2022] [Indexed: 12/30/2022] Open
Abstract
Social connectedness is increasingly understood to be a resilience factor that moderates vulnerability to poor physical and mental health. This study examines cognitive and affective processes that support normal socialization and social connectedness, and the impact of schizotypy, in well-functioning college students. In this study, a total of 824 college students completed a series of self-report questionnaires, and structural equation modeling was then employed to identify relationships between cognitive and affective empathy, alexithymia, distress tolerance, social connectedness, and schizotypy. Schizotypy is a trait-like condition, presumed to be genetic in origin, associated with the risk for schizophrenia. Like schizophrenia, schizotypy is thought to have three distinct dimensions or categories, termed positive, negative, and disorganized. Results indicate that the respective dimensions of schizotypy have different pathways to social connectedness, through both direct and indirect effects. Positive schizotypy exerts a counterintuitive positive influence on social connectedness, mediated by positive effects on cognitive empathy, but this is obscured by the high correlations between the schizotypal dimensions and the strong negative influences on empathy and social connectedness of the negative and disorganized dimensions, unless all those intercorrelations are taken into account. Overall, the pathways identified by structural equation modeling strongly support the role of empathy in mediating the impact of schizotypy on social connectedness. Implications for the etiology of social impairments in schizotypy, and for interventions to enhance social connectedness to improve quality of life and reduce health disparities in people at risk for severe mental illness, are discussed.
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Affiliation(s)
- Jessica Stinson
- Department of Psychology, College of Arts and Sciences, University of Nebraska–Lincoln, Lincoln, NE 68588, USA; (R.W.); (W.S.)
- South Texas Veterans Healthcare System, San Antonio, TX 78229, USA
- Correspondence:
| | - Rebecca Wolfe
- Department of Psychology, College of Arts and Sciences, University of Nebraska–Lincoln, Lincoln, NE 68588, USA; (R.W.); (W.S.)
| | - Will Spaulding
- Department of Psychology, College of Arts and Sciences, University of Nebraska–Lincoln, Lincoln, NE 68588, USA; (R.W.); (W.S.)
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7
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Guo XD, Wang Y, Chan RCK. Mediating role of emotion regulation in the relationship between schizotypy and empathy. Psych J 2022; 11:335-343. [PMID: 35437901 DOI: 10.1002/pchj.551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 12/28/2021] [Accepted: 03/11/2022] [Indexed: 11/11/2022]
Abstract
Schizotypy is a set of personality traits existing in the general population that represents vulnerability for developing psychosis. Previous studies have suggested that negative schizotypy correlates with empathy, but mixed results have been shown for positive schizotypy. The present study aimed to explore the potential mediating role of emotion regulation upon schizotypy and empathy. The valid sample consisted of 595 college students who completed the Interpersonal Reactivity Index, the Emotion Regulation Questionnaire, and the Chapman Psychosis Proneness Scales. Pearson correlations between schizotypy, emotion regulation, and empathy were performed to build potential mediating models. Structural equation modeling and bootstrap analyses were used to examine the mediation effects of emotion regulation. Our results showed that negative schizotypy was correlated with both cognitive and affective empathy whereas positive schizotypy only correlated with the Fantasy and Personal Distress subscales after multiple comparisons corrections. The Cognitive Reappraisal subscale of the Emotion Regulation Questionnaire was positively correlated with empathy whereas the Expressive Suppression subscale was negatively associated with affective empathy. More importantly, there was a significant mediating effect of cognitive reappraisal on the relationship between negative schizotypy and cognitive empathy. Our findings suggest that a higher level of negative schizotypy is associated with poorer cognitive and affective empathy, and cognitive reappraisal may mediate the effect of negative schizotypy on cognitive empathy. These findings highlight the optimal usage of cognitive reappraisal in social interactions, and may help to improve empathy, especially for individuals with a high level of negative schizotypy.
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Affiliation(s)
- Xiao-Dong Guo
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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8
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Maaßen E, Büttner M, Bröcker AL, Stuke F, Bayer S, Hadzibegovic J, Just SA, Bertram G, Rau R, von Haebler D, Lempa G, Montag C. Measuring Emotional Awareness in Patients With Schizophrenia and Schizoaffective Disorders. Front Psychol 2021; 12:725787. [PMID: 34858263 PMCID: PMC8632138 DOI: 10.3389/fpsyg.2021.725787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
The ability to mentalize (i.e., to form representations of mental states and processes of oneself and others) is often impaired in people with schizophrenia spectrum disorders. Emotional awareness (EA) represents one aspect of affective mentalizing and can be assessed with the Levels of Emotional Awareness Scale (LEAS), but findings regarding individuals with schizophrenia spectrum disorders are inconsistent. The present study aimed at examining the usability and convergent validity of the LEAS in a sample of N = 130 stabilized outpatients with schizophrenia or schizoaffective disorders. An adequacy rating was added to the conventional LEAS rating to account for distortions of content due to, for example, delusional thinking. Scores of the patient group were compared with those of a matched healthy control sample. Correlation with symptom clusters, a self-report measure of EA, a measure of synthetic metacognition (MAS-A-G), and an expert rating capturing EA from the psychodynamic perspective of psychic structure (OPD-LSIA) were examined. Regarding self-related emotional awareness, patients did not score lower than controls neither in terms of conventional LEAS nor in terms of adequacy. Regarding other-related emotional awareness, however, patients showed a reduced level of adequacy compared to controls whereas no such difference was found for conventional LEAS scores. Higher conventional LEAS scores were associated with fewer negative symptoms, and higher structural integration of self-perceptions measured by the OPD-LSIA. Higher adequacy of responses correlated with fewer symptoms of disorganization as well as excitement, higher scores of self-reflection on the MAS-A-G as well as self- and object-perception and internal and external communication as measured by the subscales of the OPD-LSIA. Findings suggest that the LEAS might not be sensitive enough to detect differences between mildly symptomatic patients with schizophrenia or schizoaffective disorders and healthy controls. However, LEAS ratings are still suitable to track intraindividual changes in EA over time. Observing the adequacy of patients’ responses when using the LEAS may be a promising way to increase diagnostical utility and to identify patterns of formal and content-related alterations of mentalizing in this patient group. Methodological indications for future studies are discussed.
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Affiliation(s)
- Eva Maaßen
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marielle Büttner
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anna-Lena Bröcker
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Frauke Stuke
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Samuel Bayer
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Psychoanalytic University Berlin, Berlin, Germany
| | - Jasmina Hadzibegovic
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sandra Anna Just
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Gianna Bertram
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Richard Rau
- Department of Psychology, University of Münster, Münster, Germany
| | - Dorothea von Haebler
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Psychoanalytic University Berlin, Berlin, Germany
| | | | - Christiane Montag
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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9
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Corbera S, Wexler BE, Bell MD, Pearlson G, Mayer S, Pittman B, Belamkar V, Assaf M. Predictors of social functioning and quality of life in schizophrenia and autism spectrum disorder. Psychiatry Res 2021; 303:114087. [PMID: 34246005 PMCID: PMC8373814 DOI: 10.1016/j.psychres.2021.114087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/18/2021] [Accepted: 06/26/2021] [Indexed: 10/21/2022]
Abstract
Schizophrenia (SZ) and Autism Spectrum Disorder (ASD) show overlap in social cognitive and functioning impairments. Proposed predictors of social functioning (SF) and quality of life (QL) have been symptom severity, IQ and social cognition. Empathy has rarely been compared between ASD and SZ and its predictive power on functional outcomes is unclear. We investigated general, affective, and cognitive empathy in 46 SZ, 30 ASD and 51 healthy controls (HC) and examined their relationship to SF and QL in addition to IQ and symptoms. SZ and ASD shared deficits in general and cognitive empathy, and personal distress, but only SZ showed deficits in affective empathy. Both groups showed lower performance-based empathy scores and only ASD showed slower responses compared to HC. Negative symptoms predicted QL in both groups, the more negative symptoms the worse QL (ASD t=-3.22; SZ t= -3.43; p<0.01), and only in ASD, IQ predicted QL, the higher the IQ the higher QL (t = 2.1; p<0.05). In ASD only, negative symptoms predicted SF, the greater negative symptoms the worse SF (t=-3.45; p<0.01), and communication deficits predicted SF, the higher deficits, the higher SF (t = 2.9; p<0.01). Negative symptoms but not empathy were the shared predictors of functioning across ASD and SZ.
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Affiliation(s)
- Silvia Corbera
- Department of Psychological Science, Central Connecticut State University, New Britain, CT, United States; Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital, Hartford, CT, United States.
| | - Bruce E. Wexler
- Department of Psychiatry, Yale University, New Haven, CT,
USA
| | - Morris D. Bell
- Department of Psychiatry, Yale University, New Haven, CT,
USA,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Godfrey Pearlson
- Department of Psychiatry, Yale University, New Haven, CT,
USA,Olin Neuropsychiatry Research Center, Institute of Living,
Hartford Hospital, Hartford, CT, USA
| | - Sophy Mayer
- Olin Neuropsychiatry Research Center, Institute of Living,
Hartford Hospital, Hartford, CT, USA
| | - Brian Pittman
- Department of Psychiatry, Yale University, New Haven, CT,
USA
| | - Vaishali Belamkar
- Department of Psychological Science, Central Connecticut
State University, New Britain, CT, USA
| | - Michal Assaf
- Department of Psychiatry, Yale University, New Haven, CT,
USA,Olin Neuropsychiatry Research Center, Institute of Living,
Hartford Hospital, Hartford, CT, USA
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10
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Wang W, Zhou Y, Liu R, Wei S, Xu H, Wang J, Wang L, Trinh TH, Wu HE, Wang D, Zhang X. Association between empathy and clinical symptoms in chronic schizophrenia: A large sample study based on Chinese Han population. J Psychiatr Res 2021; 139:106-112. [PMID: 34058648 DOI: 10.1016/j.jpsychires.2021.05.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/01/2021] [Accepted: 05/19/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND In patients with schizophrenia, clinical symptoms and cognitive impairment are its core features, both of which have a significant impact on the prognosis and functional outcome. Empathy, as an important social cognition, has been found to be associated with the clinical symptoms in schizophrenia, but the conclusions on this issue are inconsistent. Therefore, this study will continue to explore it through a large sample of inpatients with chronic schizophrenia in the Chinese Han population. METHODS We obtained the sociodemographic characteristics of 987 inpatients, measured their clinical symptoms using the Positive and Negative Syndrome Scale (PANSS), and assessed their self-reported empathy using the Interpersonal Reactivity Index (IRI). The factor score for negative symptoms (FSNS) of PANSS was additionally calculated. RESULTS Correlation and linear regression analysis showed that patients' PANSS scores were widely correlated with their IRI scores. In particular, the negative symptoms of patients were significantly correlated to IRI total score (r = -0.131, p < .001) and subscales such as Perspective Taking (PT) (r = -0.233, p < .001). FSNS had close relationships with empathy as well. There are also many significant associations between other dimensions, such as general psychopathology and Perspective Taking (PT) or Fantasy (FS) (all p < .05). CONCLUSIONS Our results indicated that clinical symptoms, especially negative symptoms, were closely related to their current empathy in patients with schizophrenia, suggesting that the severity of clinical symptoms may be a powerful factor in predicting social cognition such as empathy of schizophrenia.
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Affiliation(s)
- Wenjia Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yongjie Zhou
- Department of Psychiatric Rehabilitation, Shenzhen Kangning Hospital, Shenzhen, China
| | - Ran Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Shuochi Wei
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Hang Xu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Jiesi Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Li Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Tammy H Trinh
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Hanjing E Wu
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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11
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Bonfils KA, Luther L, Lysaker PH. Metacognition & social cognition differentially influence experiential & expressive negative symptoms in schizophrenia. Schizophr Res 2021; 233:13-15. [PMID: 34216940 DOI: 10.1016/j.schres.2021.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 06/14/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Kelsey A Bonfils
- The University of Southern Mississippi, School of Psychology, 118 College Dr., #5025, Hattiesburg, MS 39406, USA.
| | - Lauren Luther
- Massachusetts General Hospital, Department of Psychiatry, 149 13th Street, Room 2603, Charlestown, MA 02129, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Paul H Lysaker
- Richard L. Roudebush VA Medical Center, Day Hospital 116H, 1481 W. 10th Street, Indianapolis, IN 46202, USA; Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th Street, Suite 4800, Indianapolis, IN 46202, USA
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12
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Canty AL, Cao Y, Neumann D, Shum DHK. The functional significance of cognitive empathy and theory of mind in early and chronic schizophrenia. Psychiatry Res 2021; 299:113852. [PMID: 33761402 DOI: 10.1016/j.psychres.2021.113852] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/28/2021] [Indexed: 02/04/2023]
Abstract
Theoretical models suggest that it is the interplay between social cognitive processes that result in adaptive social functioning in schizophrenia. This study explored the relative contributions of, and interplay between, cognitive empathy, affective theory of mind (ToM), neurocognition, and severity of clinical symptoms, in predicting the social functioning of individuals with schizophrenia. Clinical participants (early schizophrenia n = 26, chronic schizophrenia n = 32) were administered an ecologically valid measure of ToM (viz., the Virtual Assessment of Mentalising Ability or VAMA) and the Empathy Quotient (EQ) as part of a larger neuropsychological and social functioning assessment battery. Results indicated that individuals with early schizophrenia reported significantly better cognitive empathy than individuals with chronic schizophrenia. ToM was found to have added value in predicting both community functioning and functional capacity that was beyond that accounted for by cognitive empathy, clinical symptoms, and neurocognition for both clinical groups. Further, our results indicated that the capacity to demonstrate empathic understanding of another's situation (i.e., cognitive empathy) mediates the relationship between ToM and social functioning. Together, our findings highlight the intricate and compounding nature of social cognition constructs, and their effect on social functioning for individuals with schizophrenia.
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Affiliation(s)
- Allana L Canty
- School of Applied Psychology, Griffith University, Queensland, Australia
| | - Yuan Cao
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - David Neumann
- School of Applied Psychology, Griffith University, Queensland, Australia
| | - David H K Shum
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China.
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13
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Thibaudeau É, Cellard C, Turcotte M, Achim AM. Functional Impairments and Theory of Mind Deficits in Schizophrenia: A Meta-analysis of the Associations. Schizophr Bull 2021; 47:695-711. [PMID: 33433606 PMCID: PMC8084438 DOI: 10.1093/schbul/sbaa182] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Schizophrenia is associated with major functioning difficulties. Theory of mind (ToM), the ability to infer the mental states of others, is an important determinant of functioning. However, the contribution of ToM to each specific domain of functioning remains to be better understood. The objectives of this meta-analysis were to document and compare the magnitude of the associations between ToM and (1) different domains of functioning (social functioning, productive activities, and instrumental activities of daily living), each assessed separately for functional performance and functional outcome and (2) different aspects of functioning (functional performance and functional outcome) in schizophrenia. Fifty-nine studies (N = 4369) published between 1980 and May 2019 targeting patients with schizophrenia or schizoaffective disorder aged between 18 and 65 years old were included. Studies were retrieved from seven databases. Correlations were extracted from the articles, transformed into effect sizes Zr and combined as weighted and unweighted means. The strength of the associations between the domains and aspects of functioning were compared using focused tests. A moderate association was observed between ToM and all domains of functioning, with a stronger association between ToM and productive activities compared with social functioning (only for functional outcome [χ2(2) = 6.43, P = 0.040]). Regarding the different aspects of functioning, a stronger association was observed between ToM and functional performance, compared with functional outcome, for overall functioning (χ2(1) = 13.77, P < 0.001) and social functioning (χ2(1) = 18.21, P < 0.001). The results highlight a stronger association of ToM with productive activities and with functional performance, which should be considered in future studies to improve functional recovery in schizophrenia.
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Affiliation(s)
- Élisabeth Thibaudeau
- École de psychologie, Université Laval, Québec, Québec, Canada,CERVO Brain Research Center, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, Québec, Canada,To whom correspondence should be addressed; Pavillon Félix-Antoine-Savard, 2325 Allée des Bibliothèques, local 1528, Québec, QC G1V 0A6, Canada; tel: 418-656-2131, e-mail:
| | - Caroline Cellard
- École de psychologie, Université Laval, Québec, Québec, Canada,CERVO Brain Research Center, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, Québec, Canada
| | | | - Amélie M Achim
- CERVO Brain Research Center, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, Québec, Canada,Département de psychiatrie et neurosciences, Université Laval, Québec, Québec, Canada
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14
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Karpouzian-Rogers T, Cobia D, Petersen J, Wang L, Mittal VA, Csernansky JG, Smith MJ. Cognitive Empathy and Longitudinal Changes in Temporo-Parietal Junction Thickness in Schizophrenia. Front Psychiatry 2021; 12:667656. [PMID: 34054621 PMCID: PMC8160364 DOI: 10.3389/fpsyt.2021.667656] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/15/2021] [Indexed: 01/04/2023] Open
Abstract
Objective: Deficits in cognitive empathy are well-documented in individuals with schizophrenia and are related to reduced community functioning. The temporoparietal junction (TPJ) is closely linked to cognitive empathy. We compared the relationship between baseline cognitive empathy and changes in TPJ thickness over 24 months between individuals with schizophrenia and healthy controls. Methods: Individuals with schizophrenia (n = 29) and healthy controls (n = 26) completed a cognitive empathy task and underwent structural neuroimaging at baseline and approximately 24 months later. Symmetrized percent change scores were calculated for right and left TPJ, as well as whole-brain volume, and compared between groups. Task accuracy was examined as a predictor of percent change in TPJ thickness and whole-brain volume in each group. Results: Individuals with schizophrenia demonstrated poorer accuracy on the cognitive empathy task (p < 0.001) and thinner TPJ cortex relative to controls at both time points (p = 0.01). In schizophrenia, greater task accuracy was uniquely related to less thinning of the TPJ over time (p = 0.02); task accuracy did not explain changes in left TPJ or whole-brain volume. Among controls, task accuracy did not explain changes in right or left TPJ, or whole-brain volume. Conclusions: Our findings suggest that greater cognitive empathy may explain sustained integrity of the right TPJ in individuals with schizophrenia, suggesting a contributory substrate for the long-term maintenance of this process in psychosis. Cognitive empathy was not related to changes in whole-brain volume, demonstrating the unique role of the TPJ in cognitive empathy.
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Affiliation(s)
- Tatiana Karpouzian-Rogers
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Derin Cobia
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT, United States
| | - Julie Petersen
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Lei Wang
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, United States
| | - John G Csernansky
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Matthew J Smith
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
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15
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Chuang SP, Wu JYW, Wang CS. Metacognitive Beliefs, Cognitive Functioning, Psychiatric Symptoms and Empathy in People with Schizophrenia. Neuropsychiatr Dis Treat 2021; 17:2209-2217. [PMID: 34262281 PMCID: PMC8274239 DOI: 10.2147/ndt.s313932] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/17/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND People with schizophrenia often exhibit deficits in empathy, which plays a major role in social cognition and interpersonal relationship. However, little work has investigated potential factors that influence empathy in schizophrenia. The study aimed to investigate the relationship among metacognition, psychiatric symptoms, cognitive functioning and empathy in patients diagnosed with schizophrenia. METHODS Forty-eight people with schizophrenia were enrolled in the study group. All subjects participated in the metacognitions questionnaire-30 (MCQ-30), brief psychiatric rating scale (BPRS), neurocognitive functioning, interpersonal reactivity index (IRI), and the pictorial empathy test (PET). RESULTS Stepwise regression analysis revealed that cognitive self-consciousness (domain of metacognitions questionnaire-30) accounted for 37% of the variance in perspective taking scores (domain of interpersonal reactivity index). Resistance (subscale of brief psychiatric rating scale) and positive beliefs about worry (domain of metacognitions questionnaire-30) accounted for 34% of the variance in fantasy (domain of interpersonal reactivity index). Activation (subscale of brief psychiatric rating scale) was a significant predictor for empathic concern (domain of interpersonal reactivity index). Resistance, cognitive confidence (domain of metacognitions questionnaire-30), intellectual processes and inhibitory control (go-no-go task) accounted for 38% of the variance in personal distress. Negative symptoms (subscale of brief psychiatric rating scale) and cognitive self-consciousness were significant predictors for the pictorial empathy test. CONCLUSION The study was aimed to examine self-perception of metacognitive beliefs and empathy. More research is needed to explore the association between metacognitive beliefs, cognitive functioning and psychiatric symptoms on empathy in people with schizophrenia.
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Affiliation(s)
- Shu Ping Chuang
- Department of Psychiatry, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | | | - Chien Shu Wang
- Department of Psychiatry, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
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16
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Shi LJ, Zhou HY, Wang Y, Shen YM, Fang YM, He YQ, Ou JJ, Li HB, Luo XR, Cheung EFC, Pantelis C, Chan RCK. Altered empathy-related resting-state functional connectivity in adolescents with early-onset schizophrenia and autism spectrum disorders. Asian J Psychiatr 2020; 53:102167. [PMID: 32474345 DOI: 10.1016/j.ajp.2020.102167] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 12/22/2022]
Abstract
Empathy refers to the ability to understand other people's feelings and reacting emotionally to others. Impaired empathy has been reported in both individuals with schizophrenia and autism spectrum disorders (ASD). Despite overlaps, few studies have directly examined the neural mechanisms of impaired empathy in these two clinical groups. We used resting-state fMRI to investigate the neural correlates of empathic functioning in adolescents with ASD (N = 11), early-onset schizophrenia (EOS) (N = 20), and typically developing (TD) controls (N = 26). Their parents completed the Griffith Empathy Measure (GEM) to assess the adolescents' empathic capacity. We found that EOS and ASD participants both exhibited impaired empathy as measured by the GEM, especially in cognitive empathy (post-hoc ps < 0.05). Regions-of-interest-based functional connectivity revealed decreased connectivity between the salience network (SN) (i.e., the anterior insula and the anterior cingulate cortex) and core regions of the mentalizing network (e.g., the temporal-parietal junction and the precuneus), and among the SN and the bilateral superior temporal gyri (STG) and the left cerebellum in EOS participants. Subsequent comparisons revealed reduced grey matter volume in the STG bilaterally in both clinical groups. Increased resting-state functional connectivity within the social brain network was correlated with higher parent-reported scores of empathic capacity in TD adolescents, but such a brain-phenotype relationship was absent in the two clinical groups. These findings indicate that structural alterations and disturbed resting-state functional connectivity in the core empathy network may be the neural correlates of social cognitive deficits in individuals with EOS and ASD.
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Affiliation(s)
- Li-Juan Shi
- School of Education, Hunan University of Science and Technology, Xiangtan, Hunan, China; Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Han-Yu Zhou
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yan-Mei Shen
- Mental Health Institute, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yu-Min Fang
- Mental Health Institute, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yu-Qiong He
- Mental Health Institute, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jian-Jun Ou
- Mental Health Institute, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hua-Bing Li
- Mental Health Institute, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xue-Rong Luo
- Mental Health Institute, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Eric F C Cheung
- Castle Peak Hospital, Hong Kong, Special Administrative Region, China
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Carlton South, VIC, Australia; Florey Institute for Neurosciences and Mental Health, Parkville, VIC, Australia
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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17
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Li Q, Liu P, Yan N, Feng T. Executive Function Training Improves Emotional Competence for Preschool Children: The Roles of Inhibition Control and Working Memory. Front Psychol 2020; 11:347. [PMID: 32210880 PMCID: PMC7077513 DOI: 10.3389/fpsyg.2020.00347] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/14/2020] [Indexed: 11/21/2022] Open
Abstract
The study examined how executive function (EF) training could improve children's emotional competence (EC). Children (N = 55; M age = 50.64 months) were assigned into two groups, namely the EF training group and the no-training group. The present study attempted to use a 2 (group: EF training VS no-training) × 2 (test time: pretest VS post-test) between-and- within-subjects experimental design to investigate the effect of EF training on the improvement of EC for 4-year-old children. Results showed that, (1) children in EF training group had significantly higher scores on EC than that of no-training group; (2) The change of inhibition control and working memory could significantly predict their variation of EC. These results suggested that the improvement of EC caused by EF training could be linked to the ability of inhibition control and working memory.
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Affiliation(s)
- Quan Li
- Collage of Teacher Education, Qujing Normal University, Qujing, China
- Faculty of Psychology, Southwest University, Chongqing, China
| | - Peiwei Liu
- Department of Psychology, University of Florida, Gainesville, FL, United States
| | - Ni Yan
- Faculty of Psychology, Southwest University, Chongqing, China
| | - Tingyong Feng
- Faculty of Psychology, Southwest University, Chongqing, China
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18
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Bonfils KA, Haas GL, Salyers MP. Emotion-specific performance across empathy tasks in schizophrenia: Influence of metacognitive capacity. Schizophr Res Cogn 2020; 19:100139. [PMID: 31828016 PMCID: PMC6889363 DOI: 10.1016/j.scog.2019.100139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/06/2019] [Accepted: 03/17/2019] [Indexed: 11/18/2022]
Abstract
People with schizophrenia exhibit deficits in emotion recognition that are associated with community and social functioning. Emotion-specific performance within emotion recognition tasks has been investigated, suggesting differential patterns of recognition for positive and negative emotions. However, no study has yet examined emotion-specific performance for a higher-order social cognitive construct such as empathy. This study aimed to: 1) examine emotion-specific performance on an empathy task, and 2) elucidate associations with four metacognitive domains: self-reflectivity, understanding of others' minds, decentration, and mastery. Fifty-seven people with schizophrenia or schizoaffective disorder participated. All were administered a computerized, performance-based measure of empathy and an interview-based measure of metacognitive capacity. Results revealed that, consistent with research on facial affect recognition, participants performed significantly better when recognizing happiness in empathic stimuli than all other emotions. Results also revealed positive associations between empathic performance and metacognitive self-reflectivity, across types of emotions. Other metacognitive domains were also associated with performance, but in a less consistent manner. Together, results indicate that not all emotions are created equal - happiness is easier to recognize for those with schizophrenia, suggesting that social cognitive interventions may be more helpful if focused on recognizing negative emotions. Results also emphasize the importance of metacognitive capacity for basic and higher-order social cognitive skills.
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Affiliation(s)
- Kelsey A. Bonfils
- VISN 4 Mental Illness Research, Education, & Clinical Center (MIRECC), VA Pittsburgh Healthcare System, 4100 Allequippa St., Pittsburgh, PA, United States
- University of Pittsburgh Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA, United States
| | - Gretchen L. Haas
- VISN 4 Mental Illness Research, Education, & Clinical Center (MIRECC), VA Pittsburgh Healthcare System, 4100 Allequippa St., Pittsburgh, PA, United States
- University of Pittsburgh Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA, United States
| | - Michelle P. Salyers
- Psychology Department, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, Indianapolis, IN, United States
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19
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Thibaudeau É, Achim AM, Parent C, Turcotte M, Cellard C. A meta-analysis of the associations between theory of mind and neurocognition in schizophrenia. Schizophr Res 2020; 216:118-128. [PMID: 31899095 DOI: 10.1016/j.schres.2019.12.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 12/27/2022]
Abstract
Theory of mind (ToM) refers to the ability to infer the mental states of others. ToM is impaired in schizophrenia and these deficits seem to hinder functional recovery. ToM is thus an important, but complex treatment target, supported by several processes. A large number of studies report significant associations between ToM and neurocognition (e.g. memory, attention), but the neurocognitive domains that are most closely linked to ToM remain to be identified. A meta-analysis was conducted to estimate the magnitude of the associations between ToM and neurocognition in people with schizophrenia. Correlations were extracted from the relevant literature, transformed into effect sizes Zr and pooled as weighted means. Focused-tests were employed to test for differences between neurocognitive domains and for differences linked to the characteristics of ToM tasks. Ninety-one studies (N = 5462) were included. Moderate associations emerged between ToM and each neurocognitive domain (Zrs 0.27-0.43), with no significant difference between domains (χ2(8) = 11.89, p = 0.156). Within the domain of executive functions, abstraction showed a stronger association with ToM (χ2(4) = 18.93, p = 0.001). Several ToM tasks characteristics (e.g. modality of stimuli, type of mental state), were significantly related to the magnitude of the associations between ToM and executive functions, visuospatial/problem solving, attention and episodic memory. These results suggest that ToM is linked to a wide range of neurocognitive abilities in schizophrenia, and that ToM tasks are a significant moderator of these associations. The assessment and treatment of ToM should consider the neurocognitive profile of each patient to understand his difficulties and to tailor interventions.
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Affiliation(s)
- Élisabeth Thibaudeau
- CERVO Brain Research Center, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), 2601 Chemin de la Canardière, G1J 2G3 Québec, Québec, Canada; École de psychologie, Université Laval, Pavillon Félix-Antoine-Savard, 2325 Allée des Bibliothèques, G1V 0A6 Québec, Québec, Canada.
| | - Amélie M Achim
- CERVO Brain Research Center, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), 2601 Chemin de la Canardière, G1J 2G3 Québec, Québec, Canada; Département de psychiatrie et neurosciences, Université Laval, Pavillon Ferdinand-Vandry, 1050 avenue de la Médecine, local 4873, G1V 0A6 Québec, Québec, Canada.
| | - Carolane Parent
- CERVO Brain Research Center, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), 2601 Chemin de la Canardière, G1J 2G3 Québec, Québec, Canada; Département de psychiatrie et neurosciences, Université Laval, Pavillon Ferdinand-Vandry, 1050 avenue de la Médecine, local 4873, G1V 0A6 Québec, Québec, Canada.
| | - Mélissa Turcotte
- École de psychologie, Université Laval, Pavillon Félix-Antoine-Savard, 2325 Allée des Bibliothèques, G1V 0A6 Québec, Québec, Canada.
| | - Caroline Cellard
- CERVO Brain Research Center, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), 2601 Chemin de la Canardière, G1J 2G3 Québec, Québec, Canada; École de psychologie, Université Laval, Pavillon Félix-Antoine-Savard, 2325 Allée des Bibliothèques, G1V 0A6 Québec, Québec, Canada.
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20
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Varga E, Herold R, Tényi T, Endre S, Fekete J, Bugya T. Social Cognition Analyzer Application-A New Method for the Analysis of Social Cognition in Patients Diagnosed With Schizophrenia. Front Psychiatry 2019; 10:912. [PMID: 31920759 PMCID: PMC6934064 DOI: 10.3389/fpsyt.2019.00912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 11/18/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Because of the importance of the assessment of social cognitive impairments in schizophrenia in clinical settings, a new computer application called SCAN (Social Cognition Analyzer applicatioN) was developed. Our first aim was to examine if patients diagnosed with schizophrenia could be differentiated from healthy individuals based on the results of SCAN, taking into consideration both response rates and response times. Our second aim was to create Scanalizer, as part of SCAN, to produce social cognitive profiles of individual patients. Materials and Methods: 86 patients (SG) and 101 healthy participants (CG) were examined with SCAN. The domains were: ToM, irony, metaphor, emotion perception from prosody and social perception. SCAN displayed the tasks, recorded the answers and the response times. For the differentiation of the two groups a two-dimensional scatter plot was used. For the graphical presentation of the social cognitive profile of patients, the calculation of the distributions of CG's results was made with Kolmogorov-Smirnov Goodness-of-fit Test and with the sum of squared residuals (SSR). Results: We found that the SG's response rates were significantly lower and the SG's response times were significantly slower compared to the CG in every condition. With the two-dimensional comparison of the summary response rates and the summary response times of the participants, the SG could be differentiated from the CG and this differentiation worked irrespective of age and education. For the graphical representation of social cognitive functions of patients, distributions of the results of the CG were calculated. We found normal distributions in the response times of all conditions and in the response rates of the ToM condition. In the low-end tail of the irony condition, and in the metaphor, social perception and emotional prosody conditions, power-law distributions were found. We also found that the summary response rates of the lowest performing 10% of the CG was in the same range as the summary response rates of all examined patients. Discussion: Scanalizer enables clinicians to measure and analyse social cognitive profiles of patients diagnosed with schizophrenia. Moreover, SCAN could also be used to detect social cognitive disabilities of vulnerable individuals.
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Affiliation(s)
- Eszter Varga
- Department of Psychiatry and Psychotherapy, Medical School, University of Pécs, Pécs, Hungary
- Department of Paediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Róbert Herold
- Department of Psychiatry and Psychotherapy, Medical School, University of Pécs, Pécs, Hungary
| | - Tamás Tényi
- Department of Psychiatry and Psychotherapy, Medical School, University of Pécs, Pécs, Hungary
| | - Szilvia Endre
- Department of Psychology, University of Pécs, Pécs, Hungary
| | - Judit Fekete
- Department of Psychiatry and Psychotherapy, Medical School, University of Pécs, Pécs, Hungary
| | - Titusz Bugya
- Department of Cartography and Geoinformatics, University of Pécs, Pécs, Hungary
- CityScience Lab, Hafencity University, Hamburg, Germany
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21
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Haut KM, Dodell-Feder D, Guty E, Nahum M, Hooker CI. Change in Objective Measure of Empathic Accuracy Following Social Cognitive Training. Front Psychiatry 2019; 10:894. [PMID: 31920748 PMCID: PMC6914938 DOI: 10.3389/fpsyt.2019.00894] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/13/2019] [Indexed: 01/27/2023] Open
Abstract
Background: The capacity for empathy plays an important role in interpersonal relationships and social functioning, and impairments in empathy can have negative effects on social interactions and overall social adjustment. This suggests that empathy may be a critical target for intervention in individuals who struggle with social interactions, yet it is unclear if the skills required for empathy are malleable. This study investigates the efficacy of targeted social cognitive training for improving empathic skills. Methods: Forty-five individuals (mean age = 24) were included in this study. Twenty-four individuals were allocated to the active social cognition training group and 21 individuals were allocated to a computer games control condition. Subjects completed approximately 10.5 h of training over two weeks. Pre- and post- training, they completed measures of empathy and emotion recognition, including the Interpersonal Reactivity Inventory (IRI) and an empathic accuracy task. ANOVA and regression analyses tested changes in participants' performance on the empathic accuracy task and scores on the IRI subscales were used to assess the effect of the social cognitive training. Results: Repeated measures ANOVA show that there is a significant group by timepoint interaction on the Empathic Accuracy task, with individuals who completed the social cognition training showing a significant improvement in performance following training. There were no significant changes for either group on any of the self-report IRI subscales. Individuals in the active training group show significant improvement on negative valence videos and a trend towards improvement on positive valence videos. In addition, individuals in social cognition active training group who reported higher intrinsic motivation demonstrated greater improvement on the Empathic Accuracy task. Conclusions: Individuals who completed a computerized social cognition training program demonstrated improved performance on a rater objective measure of empathic accuracy while individuals who completed a computer game control condition did not demonstrate any significant changes in their performance on the empathic accuracy task. These results suggest that targeted training in social cognition may increase empathic abilities, even in healthy individuals, and that this training may be beneficial to individuals with social cognitive deficits.
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Affiliation(s)
- Kristen M. Haut
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - David Dodell-Feder
- Department of Psychology, University of Rochester, Rochester, NY, United States
| | - Erin Guty
- Department of Psychology, Pennsylvania State University, State College, PA, United States
| | - Mor Nahum
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem,Israel
| | - Christine I. Hooker
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
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22
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Li X, Chu MY, Lv QY, Hu HX, Li Z, Yi ZH, Wang JH, Zhang JY, Lui SSY, Cheung EFC, Shum DHK, Chan RCK. The remediation effects of working memory training in schizophrenia patients with prominent negative symptoms. Cogn Neuropsychiatry 2019; 24:434-453. [PMID: 31583951 DOI: 10.1080/13546805.2019.1674644] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: Negative symptoms, particularly amotivation and anhedonia, are important predictors of poor functional outcome in patients with schizophrenia. There has been interest in the efficacy and mechanism of non-pharmacological interventions to alleviate these symptoms. The present study aimed to examine the remediation effect of working memory (WM) training in patients with schizophrenia with prominent negative symptoms.Methods: Thirty-one schizophrenia patients with prominent negative symptoms were recruited and assigned to either a WM training group or a treatment-as-usual (TAU) control group. The WM training group underwent 20 sessions of training using the dual n-back task over one month. A functional neuroimaging paradigm of the Affective Incentive Delay (AID) task was administered before and after the training intervention to evaluate the remediation effect of the intervention.Results: Our results showed that the WM training group demonstrated significant improvement in the WM training task and inattention symptoms. Compared with the TAU group, increased brain activations were observed at the right insula and the right frontal sub-gyral after WM training in the training group.Conclusions: These findings support the efficacy of WM training in ameliorating hedonic dysfunction in schizophrenia patients with prominent negative symptoms.
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Affiliation(s)
- Xu Li
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, People's Republic of China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, People's Republic of China.,Key Laboratory of Adolescent Cyberpsychology and Behavior(CCNU), Ministry of Education, School of Psychology, Central China Normal University, Wuhan, People's Republic of China
| | - Min-Yi Chu
- Translational Neuropsychology and Applied Cognitive Neuroscience Laboratory, Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Qin-Yu Lv
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Hui-Xin Hu
- Translational Neuropsychology and Applied Cognitive Neuroscience Laboratory, Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Zhi Li
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, People's Republic of China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Zheng-Hui Yi
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Jin-Hong Wang
- MRI Center, Shanghai Mental Health Centre, Shanghai, People's Republic of China
| | - Jian-Ye Zhang
- MRI Center, Shanghai Mental Health Centre, Shanghai, People's Republic of China
| | - Simon S Y Lui
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, People's Republic of China.,Castle Peak Hospital, Hong Kong Special Administration Region, People's Republic of China
| | - Eric F C Cheung
- Castle Peak Hospital, Hong Kong Special Administration Region, People's Republic of China
| | - David H K Shum
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, People's Republic of China.,Menzies Health Institute Queensland and School of Applied Psychology, Griffith University, Gold Coast, Australia.,Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, People's Republic of China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, People's Republic of China.,Translational Neuropsychology and Applied Cognitive Neuroscience Laboratory, Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Menzies Health Institute Queensland and School of Applied Psychology, Griffith University, Gold Coast, Australia
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23
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Social brain, social dysfunction and social withdrawal. Neurosci Biobehav Rev 2019; 97:10-33. [DOI: 10.1016/j.neubiorev.2018.09.012] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 05/31/2018] [Accepted: 09/17/2018] [Indexed: 01/07/2023]
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24
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Smith MJ, Smith JD, Fleming MF, Jordan N, Oulvey EA, Bell MD, Mueser KT, McGurk SR, Spencer ES, Mailey K, Razzano LA. Enhancing individual placement and support (IPS) - Supported employment: A Type 1 hybrid design randomized controlled trial to evaluate virtual reality job interview training among adults with severe mental illness. Contemp Clin Trials 2019; 77:86-97. [PMID: 30576841 PMCID: PMC6396298 DOI: 10.1016/j.cct.2018.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/03/2018] [Accepted: 12/16/2018] [Indexed: 10/27/2022]
Abstract
Individual Placement and Support (IPS) is the evidence-based model of supported employment that increases employment rates in adults with severe mental illness (SMI). Although IPS is largely successful, over 80% of adults with SMI remain unemployed. An enhancement to high fidelity IPS could be an evidence-based job interview training component. To meet this training need, our group recently completed a series of randomized controlled efficacy trials funded by the National Institute of Mental Health to develop and test virtual reality job interview training (VR-JIT) in a lab setting. The results demonstrated that the intervention was efficacious at helping trainees improve their job interview skills and receive job offers within six months of completing VR-JIT compared to non-trainees. The overarching goal of this study is to evaluate the effectiveness of VR-JIT as an enhancement to IPS when delivered in a large community-based mental health service provider via a randomized controlled trial and initial process evaluation. Our aims are to: evaluate whether IPS services-as-usual in combination with VR-JIT, compared to IPS services-as-usual alone, enhances IPS outcomes for adults with SMI; evaluate mechanisms of employment outcomes and psychological distress; and conduct a multilevel, multidisciplinary, and mixed-method process evaluation of VR-JIT adoption and implementation to assess the acceptability, scalability, generalizability, and affordability of VR-JIT.
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Affiliation(s)
| | - Justin D Smith
- Department of Psychiatry and Behavioral Sciences, Northwestern University, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, USA
| | - Michael F Fleming
- Department of Psychiatry and Behavioral Sciences, Northwestern University, USA
| | - Neil Jordan
- Department of Psychiatry and Behavioral Sciences, Northwestern University, USA
| | - Eugene A Oulvey
- Illinois Department of Human Services, Division of Rehabilitation Services, USA
| | - Morris D Bell
- Department of Psychiatry, Yale School of Medicine, USA
| | | | | | | | | | - Lisa A Razzano
- Thresholds Inc, USA; Chicago Department of Psychiatry, University of Illinois, USA
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25
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Bonfils KA, Lysaker PH, Minor KS, Salyers MP. Metacognition, Personal Distress, and Performance-Based Empathy in Schizophrenia. Schizophr Bull 2019; 45:19-26. [PMID: 30281088 PMCID: PMC6293236 DOI: 10.1093/schbul/sby137] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND People with schizophrenia experience significant deficits in the kinds of empathic skills that are the foundation for interpersonal relationships. Researchers have speculated that deficits in empathic skills in schizophrenia may be related to disturbances in metacognition and heightened levels of personal distress. To explore this issue, this study examined whether better metacognition and reduced personal distress would be associated with improved performance on cognitive and affective empathy tasks. Further, we tested whether metacognition moderated the relationship between personal distress and empathy. METHOD Fifty-eight participants with schizophrenia-spectrum disorders receiving community-based treatment completed a self-report questionnaire of personal distress, a performance-based measure of empathy, and an observer-rated interview to assess metacognitive capacity. RESULTS Correlation analyses revealed that metacognitive capacity, but not personal distress, was significantly associated with cognitive and affective empathy performance. Moderation results suggest the relationship between personal distress and affective empathy performance was significant for those with low metacognition, but that the relationship was the opposite of hypotheses-increased personal distress predicted better performance. This relationship changed at higher levels of metacognition, when increased personal distress became associated with reduced performance. CONCLUSIONS This study is the first of its kind to examine performance-based empathy with metacognition and personal distress. Results suggest interventions targeted to improve metacognition may be useful in enhancing empathic skills.
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Affiliation(s)
- Kelsey A Bonfils
- VISN 4 Mental Illness Research, Education, and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA,To whom correspondence should be addressed; Research Office Building–MIRECC (Mailcode: 151R), University Drive C, Pittsburgh, PA 15240, US; tel: 412-360-2827, fax: 412-360-2369, e-mail:
| | - Paul H Lysaker
- Roudebush VA Medical Center, Indianapolis, IN,Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Kyle S Minor
- Department of Psychology, Indiana University–Purdue University Indianapolis, Indianapolis, IN
| | - Michelle P Salyers
- Department of Psychology, Indiana University–Purdue University Indianapolis, Indianapolis, IN
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26
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Wu X, Xu F, Chen X, Wang L, Huang W, Wan K, Ji GJ, Xiao G, Xu S, Yu F, Zhu C, Xi C, Wang K. The Effect of High-Definition Transcranial Direct Current Stimulation of the Right Inferior Frontal Gyrus on Empathy in Healthy Individuals. Front Hum Neurosci 2018; 12:446. [PMID: 30483081 PMCID: PMC6240690 DOI: 10.3389/fnhum.2018.00446] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 10/17/2018] [Indexed: 01/09/2023] Open
Abstract
Empathy, including cognitive and emotional empathy, refers to the ability to infer the mental states of others and to the capacity to share emotions. The neural mechanisms involved in empathy are complex and not yet fully understood, and previous studies have shown that both cognitive and emotional empathy are closely associated with the inferior frontal gyrus (IFG). In this study, we examined whether empathy can be modulated by high-definition transcranial direct current stimulation (HD-tDCS) of the right IFG. Twenty-three healthy participants took part in all three experimental conditions (i.e., anodal, cathodal and sham stimulation) in a randomized order. Participants then completed the Chinese version of the Multifaceted Empathy Test (MET), which assesses both cognitive and emotional empathy. The results show that scores obtained for cognitive empathy following cathodal stimulation are significantly lower than those obtained following sham stimulation. In addition, scores obtained for cognitive empathy following anodal stimulation are higher than those obtained following sham stimulation, though the difference is only marginally significant. However, the results fail to show whether the stimulation of the right IFG via HD-tDCS plays a role in emotional empathy. Our results suggest that the right IFG plays a key role in cognitive empathy and indicate that HD-tDCS can regulate cognitive empathy by inducing excitability changes in the right IFG.
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Affiliation(s)
- Xiaoling Wu
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, Anhui, China
| | - Feifei Xu
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, Anhui, China
| | - Xingui Chen
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, Anhui, China.,Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lu Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wanling Huang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ke Wan
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Gong-Jun Ji
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, Anhui, China
| | - Guixian Xiao
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Sheng Xu
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, China
| | - Fengqiong Yu
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, Anhui, China
| | - Chunyan Zhu
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, Anhui, China
| | - Chunhua Xi
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, Anhui, China.,Department of Neurology, The Third Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Kai Wang
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, Anhui, China.,Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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27
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Metacognition in schizophrenia disorders: Comparisons with community controls and bipolar disorder: Replication with a Spanish language Chilean sample. Psychiatry Res 2018; 267:528-534. [PMID: 29980133 DOI: 10.1016/j.psychres.2018.06.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/11/2018] [Accepted: 06/18/2018] [Indexed: 02/07/2023]
Abstract
Metacognition refers to the activities which allow for the availability of a sense of oneself and others in the moment. Research mostly in North America with English-speaking samples has suggested that metacognitive deficits are present in schizophrenia and are closely tied to negative symptoms. Thus, replication is needed in other cultures and groups. The present study accordingly sought to replicate these findings in a Spanish speaking sample from Chile. Metacognition and symptoms were assessed among 26 patients with schizophrenia, 26 with bipolar disorder and 36 community members without serious mental illness. ANCOVA controlling for age and education revealed that the schizophrenia group had greater levels of metacognitive deficits than the bipolar disorder and community control groups. Differences in metacognition between the clinical groups persisted after controlling for symptom levels. Spearman correlations revealed a unique pattern of associations of metacognition with negative and cognitive symptoms. Results largely support previous findings and provide added evidence of the metacognitive deficits present in schizophrenia and the link to outcome cross culturally. Implications for developing metacognitively oriented interventions are discussed.
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28
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Bonfils KA, Minor KS, Leonhardt BL, Lysaker PH. Metacognitive self-reflectivity moderates the relationship between distress tolerance and empathy in schizophrenia. Psychiatry Res 2018; 265:1-6. [PMID: 29679792 PMCID: PMC6309172 DOI: 10.1016/j.psychres.2018.04.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/30/2018] [Accepted: 04/12/2018] [Indexed: 10/17/2022]
Abstract
Deficits in empathy seen in schizophrenia are thought to play a major role in the social dysfunction seen in the disorder. However, little work has investigated potential determinants of empathic deficits. This study aimed to fill that gap by examining the effects of two variables on empathy - distress tolerance and metacognitive self-reflectivity. Fifty-four people with schizophrenia-spectrum disorders receiving services at an urban VA or community mental health center were assessed for empathy, metacognition, and distress tolerance. Bivariate correlations and moderation methods were used to ascertain associations amongst these variables and examine interactions. Results revealed that, against hypotheses, empathy was not related at the bivariate level to either distress tolerance or metacognitive self-reflectivity. However, consistent with hypotheses, moderation analyses revealed that participants with higher self-reflectivity showed no relationship between distress tolerance and empathy, while those with lower self-reflectivity showed a relationship such that reduced ability to tolerate distress predicted reduced empathy. Taken together, results of this study suggest that lack of distress tolerance can negatively affect empathy in people with schizophrenia with lesser capacity for metacognitive self-reflection; thus, fostering self-reflectivity may help overcome that negative impact. Future work is needed investigating the impact of metacognitively-tailored interventions on empathy in this population.
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Affiliation(s)
- Kelsey A. Bonfils
- Psychology Department, Indiana University-Purdue University Indianapolis
| | - Kyle S. Minor
- Psychology Department, Indiana University-Purdue University Indianapolis
| | | | - Paul H. Lysaker
- Psychiatry Department, Indiana University School of Medicine,Psychiatry Department, Richard L. Roudebush VA Medical Center,Correspondence concerning this article should be addressed to Paul H. Lysaker, Roudebush VA Medical Center 1481 West 10th St., Indianapolis. IN 46202.
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29
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Pflum MJ, Gooding DC. Context matters: Social cognition task performance in psychometric schizotypes. Psychiatry Res 2018; 264:398-403. [PMID: 29679842 DOI: 10.1016/j.psychres.2018.03.075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 12/16/2022]
Abstract
Patients with schizophrenia show performance deficits on tasks requiring empathy-related social cognition. The extent to which empathy impairments are observed in psychometric schizotypy is unclear. We compared accuracy and reaction time in three groups of individuals characterized by positive schizotypy (n = 79), negative schizotypy (n = 123), or low schizotypy group (n = 137). On a social cognition task that provided context, namely, the Emotion Perspective Taking Task, the positive schizotypes showed poorer performance than the negative schizotypy and control groups. These results suggest that some schizotypes differ in their ability to make use of context (e.g., social cues from the environment) to affect their social cognitive performance. However, on the Affective Responsiveness Task, in which no context was given, both groups of psychometric schizotypes displayed lower performance than the controls. These findings highlight the importance of assessing multiple groups of schizotypes as well as the value of including several social cognition tasks in order to reveal relative performance deficits.
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Affiliation(s)
| | - Diane C Gooding
- Department of Psychology, University of Wisconsin-Madison, USA; Department of Psychiatry, University of Wisconsin-Madison, USA.
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30
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Zhao G, Chen F, Zhang Q, Shen M, Gao Z. Feature-based information filtering in visual working memory is impaired in Parkinson's disease. Neuropsychologia 2018; 111:317-323. [PMID: 29427571 DOI: 10.1016/j.neuropsychologia.2018.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 02/05/2018] [Accepted: 02/05/2018] [Indexed: 12/22/2022]
Abstract
Increasing attention has been given to working memory (WM) impairment in Parkinson's disease (PD) patients. Previous studies revealed that the space-orientated feature-based filtering (target and distractors in distinct locations) was impaired in PD patients. However, the object-orientated feature-based filtering (target and distractor information pertaining to one object) ability in PD patients remains unclear. In this study, we examined the object-orientated feature-based filtering ability of 14 PD patients and 14 healthy controls in a change detection task under EEG monitoring. Participants were asked to remember the colors of two different objects while ignoring their shapes. Critically, the irrelevant feature could be changed in the probe. A failure in complete feature-based filtering would lead to an "irrelevant-change distracting effect," where the change of the irrelevant feature would impair the performance of the target feature, and lead to an enhanced anterior N2. We found that the distracting effect was larger in PD patients than in the control group in terms of d'; however, the N2 amplitude evoked by the irrelevant change was smaller in PD patients than in the control group. These results suggested that the object-orientated feature-based filtering ability was impaired in PD, which might derive from the deficit of their executive control.
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Affiliation(s)
- Guohua Zhao
- Department of Neurology, Second Affiliated Hospital, College of Medicine, Zhejiang University, China
| | - Feiyan Chen
- Bio-X Laboratory, Department of Physics, Zhejiang University, China
| | - Qiong Zhang
- Department of Psychology and Behavioral Sciences, Zhejiang University, China.
| | - Mowei Shen
- National Key Lab of Human Factors, Department of Psychology and Behavioral Sciences, Zhejiang University, China; Department of Psychology and Behavioral Sciences, Zhejiang University, China.
| | - Zaifeng Gao
- National Key Lab of Human Factors, Department of Psychology and Behavioral Sciences, Zhejiang University, China; Department of Psychology and Behavioral Sciences, Zhejiang University, China
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31
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Exploring functioning in schizophrenia: Predictors of functional capacity and real-world behaviour. Psychiatry Res 2017; 251:118-124. [PMID: 28199909 DOI: 10.1016/j.psychres.2017.02.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/19/2017] [Accepted: 02/08/2017] [Indexed: 02/06/2023]
Abstract
Impairment in daily functioning still represents a major treatment issue in schizophrenia and a more in-depth knowledge of underlying constructs is crucial for interventions to translate into better outcomes. This study aims to model factors influencing both functional capacity and real-life behaviour in a sample of outpatients with chronic schizophrenia, through a comprehensive assessment including evaluations of psychopathology, cognitive and social cognitive abilities, premorbid adjustment, family environment and early childhood experiences. No significant correlation was observed between functional capacity and real-life behaviour. Functional capacity was significantly predicted by IQ, while real-life behaviour was significantly predicted by empathy, affect recognition and symptoms. Functional capacity seems mainly related to neurocognition, whereas real-life behaviour appears more complex, requiring the integration of different factors including symptoms, with a major role of empathy. Results thus support a divergence between the two constructs of functioning and their underlying components and highlight the need to target both dimensions through individualized sequential rehabilitation programs in order to optimize functional outcome.
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32
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Fox JM, Abram SV, Reilly JL, Eack S, Goldman MB, Csernansky JG, Wang L, Smith MJ. Default mode functional connectivity is associated with social functioning in schizophrenia. JOURNAL OF ABNORMAL PSYCHOLOGY 2017; 126:392-405. [PMID: 28358526 DOI: 10.1037/abn0000253] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Individuals with schizophrenia display notable deficits in social functioning. Research indicates that neural connectivity within the default mode network (DMN) is related to social cognition and social functioning in healthy and clinical populations. However, the association between DMN connectivity, social cognition, and social functioning has not been studied in schizophrenia. For the present study, the authors used resting-state neuroimaging data to evaluate connectivity between the main DMN hubs (i.e., the medial prefrontal cortex [mPFC] and the posterior cingulate cortex-anterior precuneus [PPC]) in individuals with schizophrenia (n = 28) and controls (n = 32). The authors also examined whether DMN connectivity was associated with social functioning via social attainment (measured by the Specific Levels of Functioning Scale) and social competence (measured by the Social Skills Performance Assessment), and if social cognition mediates the association between DMN connectivity and these measures of social functioning. Results revealed that DMN connectivity did not differ between individuals with schizophrenia and controls. However, connectivity between the mPFC and PCC hubs was significantly associated with social competence and social attainment in individuals with schizophrenia but not in controls as reflected by a significant group-by-connectivity interaction. Social cognition did not mediate the association between DMN connectivity and social functioning in individuals with schizophrenia. The findings suggest that fronto-parietal DMN connectivity in particular may be differentially associated with social functioning in schizophrenia and controls. As a result, DMN connectivity may be used as a neuroimaging marker to monitor treatment response or as a potential target for interventions that aim to enhance social functioning in schizophrenia. (PsycINFO Database Record
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Affiliation(s)
- Jaclyn M Fox
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
| | | | - James L Reilly
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
| | - Shaun Eack
- School of Social Work, University of Pittsburgh
| | - Morris B Goldman
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
| | - John G Csernansky
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
| | - Lei Wang
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
| | - Matthew J Smith
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
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Abram SV, Wisner KM, Fox JM, Barch DM, Wang L, Csernansky JG, MacDonald AW, Smith MJ. Fronto-temporal connectivity predicts cognitive empathy deficits and experiential negative symptoms in schizophrenia. Hum Brain Mapp 2017; 38:1111-1124. [PMID: 27774734 PMCID: PMC6866816 DOI: 10.1002/hbm.23439] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 09/03/2016] [Accepted: 10/05/2016] [Indexed: 01/10/2023] Open
Abstract
Impaired cognitive empathy is a core social cognitive deficit in schizophrenia associated with negative symptoms and social functioning. Cognitive empathy and negative symptoms have also been linked to medial prefrontal and temporal brain networks. While shared behavioral and neural underpinnings are suspected for cognitive empathy and negative symptoms, research is needed to test these hypotheses. In two studies, we evaluated whether resting-state functional connectivity between data-driven networks, or components (referred to as, inter-component connectivity), predicted cognitive empathy and experiential and expressive negative symptoms in schizophrenia subjects. Study 1: We examined associations between cognitive empathy and medial prefrontal and temporal inter-component connectivity at rest using a group-matched schizophrenia and control sample. We then assessed whether inter-component connectivity metrics associated with cognitive empathy were also related to negative symptoms. Study 2: We sought to replicate the connectivity-symptom associations observed in Study 1 using an independent schizophrenia sample. Study 1 results revealed that while the groups did not differ in average inter-component connectivity, a medial-fronto-temporal metric and an orbito-fronto-temporal metric were related to cognitive empathy. Moreover, the medial-fronto-temporal metric was associated with experiential negative symptoms in both schizophrenia samples. These findings support recent models that link social cognition and negative symptoms in schizophrenia. Hum Brain Mapp 38:1111-1124, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Samantha V. Abram
- Department of PsychologyUniversity of Minnesota, Twin Cities75 East River ParkwayMinneapolisMinnesota
| | - Krista M. Wisner
- Department of PsychologyUniversity of Minnesota, Twin Cities75 East River ParkwayMinneapolisMinnesota
| | - Jaclyn M. Fox
- Department of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of Medicine710 North Lakeshore DriveChicagoIllinois
| | - Deanna M. Barch
- Department of PsychologyWashington University School of MedicineSt. LouisMissouri
- Department of PsychiatryWashington University School of MedicineSt. LouisMissouri
- Department of RadiologyWashington University School of MedicineSt. LouisMissouri
| | - Lei Wang
- Department of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of Medicine710 North Lakeshore DriveChicagoIllinois
| | - John G. Csernansky
- Department of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of Medicine710 North Lakeshore DriveChicagoIllinois
| | - Angus W. MacDonald
- Department of PsychologyUniversity of Minnesota, Twin Cities75 East River ParkwayMinneapolisMinnesota
- Department of PsychiatryUniversity of Minnesota, Twin CitiesMinneapolisMinnesota
| | - Matthew J. Smith
- Department of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of Medicine710 North Lakeshore DriveChicagoIllinois
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Bonfils KA, Lysaker PH, Minor KS, Salyers MP. Empathy in schizophrenia: A meta-analysis of the Interpersonal Reactivity Index. Psychiatry Res 2017; 249:293-303. [PMID: 28142103 DOI: 10.1016/j.psychres.2016.12.033] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 12/18/2016] [Accepted: 12/24/2016] [Indexed: 12/26/2022]
Abstract
Empathy is a complex construct, thought to contain multiple components. One popular measurement paradigm, the Interpersonal Reactivity Index (IRI), has been used extensively to measure empathic tendencies in schizophrenia research across four domains: empathic concern, perspective-taking, personal distress, and fantasy. However, no recent meta-analysis has been conducted for all four factors of this scale. The goal of this meta-analysis was to examine self-reported empathic tendencies for each factor of the IRI in people with schizophrenia as compared to healthy controls. A literature search revealed 32 eligible schizophrenia studies. The Hedges' g standardized difference effect size was calculated for each component using a random effects meta-analytic model. Compared to healthy controls, schizophrenia samples reported significantly reduced tendencies for empathic concern, perspective-taking, and fantasy, but significantly greater tendencies for personal distress. Duration of illness significantly moderated the results for perspective-taking such that those with a longer duration exhibited greater deficits; percent female significantly moderated the results for personal distress such that samples with more females exhibited reduced effect sizes. Future work is needed to examine the impact of heightened personal distress on the empathic tendencies and abilities of those with schizophrenia, including the possible role of emotion regulation.
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Affiliation(s)
- Kelsey A Bonfils
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford St., Indianapolis, IN, United States.
| | - Paul H Lysaker
- Psychiatric Rehabilitation and Recovery Center, Roudebush VA Medical Center, 1481 W. 10th St., Indianapolis, IN, United States; Department of Psychiatry, Indiana University School of Medicine, 340 W. 10th St., Indianapolis, IN, United States
| | - Kyle S Minor
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford St., Indianapolis, IN, United States
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford St., Indianapolis, IN, United States
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Massey SH, Stern D, Alden EC, Petersen JE, Cobia DJ, Wang L, Csernansky JG, Smith MJ. Cortical thickness of neural substrates supporting cognitive empathy in individuals with schizophrenia. Schizophr Res 2017; 179:119-124. [PMID: 27665257 PMCID: PMC5222696 DOI: 10.1016/j.schres.2016.09.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 09/14/2016] [Accepted: 09/17/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cognitive empathy is supported by the medial prefrontal cortex (mPFC), inferior frontal gyrus (IFG), anterior mid-cingulate cortex (aMCC), insula (INS), supplementary motor area (SMA), right temporo-parietal junction (TPJ), and precuneus (PREC). In healthy controls, cortical thickness in these regions has been linked to cognitive empathy. As cognitive empathy is impaired in schizophrenia, we examined whether reduced cortical thickness in these regions was associated with poorer cognitive empathy in this population. METHODS 41 clinically-stable community-dwelling individuals with schizophrenia and 46 healthy controls group-matched on demographic variables completed self-report empathy questionnaires, a cognitive empathy task, and structural magnetic resonance imaging. We examined between-group differences in study variables using t-tests and analyses of variance. Next, we used Pearson correlations to evaluate the relationship between cognitive empathy and cortical thickness in the mPFC, IFG, aMCC, INS, SMA, TPJ, and PREC in both groups. RESULTS Individuals with schizophrenia demonstrated cortical thinning in the IFG, INS, SMA, TPJ, and PREC (all p<0.05) and impaired cognitive empathy across all measures (all p<0.01) relative to controls. While cortical thickness in the mPFC, IFC, aMCC, and INS (all p<0.05) was related to cognitive empathy in controls, we did not observe these relationships in individuals with schizophrenia (all p>0.10). CONCLUSIONS Individuals with schizophrenia have reduced cortical thickness in empathy-related neural regions and significant impairments in cognitive empathy. Interestingly, cortical thickness was related to cognitive empathy in controls but not in the schizophrenia group. We discuss other mechanisms that may account for cognitive empathy impairment in schizophrenia.
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Affiliation(s)
- Suena H. Massey
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 E. Ontario, Suite 7-100, Chicago, IL 60611, USA,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N Saint Clair Street, 19th Floor, Chicago, IL 60611, USA
| | - Daniel Stern
- Department of Neuroscience, University of California-San Diego, San Diego, CA, USA
| | - Eva C. Alden
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 E. Ontario, Suite 7-100, Chicago, IL 60611, USA
| | - Julie E. Petersen
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 E. Ontario, Suite 7-100, Chicago, IL 60611, USA
| | - Derin J. Cobia
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 E. Ontario, Suite 7-100, Chicago, IL 60611, USA
| | - Lei Wang
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 E. Ontario, Suite 7-100, Chicago, IL 60611, USA,Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair Street, Suite 800, Chicago, IL 60611
| | - John G. Csernansky
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 E. Ontario, Suite 7-100, Chicago, IL 60611, USA
| | - Matthew J. Smith
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 E. Ontario, Suite 7-100, Chicago, IL 60611, USA,Corresponding Author: Dr. Matthew J. Smith, PhD, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Abbott Hall, 13th Floor, 710 N Lake Shore Drive, Chicago, IL 60611, Phone: 1-312-503-2542, Fax: 1-312-503-0527,
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Affective empathy in schizophrenia: a meta-analysis. Schizophr Res 2016; 175:109-117. [PMID: 27094715 DOI: 10.1016/j.schres.2016.03.037] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/24/2016] [Accepted: 03/30/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Affective empathy, or the emotional response one has to the experiences or emotional states of others, contributes to relationship-maintaining behaviors and is key in fostering social connections, yet no work has synthesized the body of literature for people with schizophrenia. The aim of the present meta-analysis was to determine the extent to which those diagnosed with schizophrenia experience deficits in affective empathy. METHODS A literature search was conducted of studies examining empathy. Data were analyzed using a random effects meta-analytic model with Hedges' g standardized mean difference effect size. RESULTS Individuals with schizophrenia exhibited significant, medium deficits in affective empathy (k=37). Measurement type moderated the affective empathy deficit such that performance-based measures showed larger schizophrenia group deficits than self-report measures. CONCLUSION Consistent, significant deficits in affective empathy were found comparing people with schizophrenia to healthy controls, especially when using performance-based assessments. The medium effect suggests an important role for empathy in the realm of social cognitive research, and points to the need for further investigation of measurement techniques and associations with functional outcomes.
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37
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Brief report: vocational outcomes for young adults with autism spectrum disorders at six months after virtual reality job interview training. J Autism Dev Disord 2016; 45:3364-9. [PMID: 25986176 DOI: 10.1007/s10803-015-2470-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Young adults with high-functioning autism spectrum disorder (ASD) have low employment rates and job interviewing presents a critical barrier to employment for them. Results from a prior randomized controlled efficacy trial suggested virtual reality job interview training (VR-JIT) improved interviewing skills among trainees with ASD, but not controls with ASD. We conducted a brief survey with 23 of 26 participants from this study to evaluate their vocational outcomes at 6-month follow-up with a focus on whether or not they attained a competitive position (employment or competitive volunteering). Logistic regression indicated VR-JIT trainees had greater odds of attaining a competitive position than controls (OR 7.82, p < 0.05). Initial evidence suggests VR-JIT is a promising intervention that enhances vocational outcomes among young adults with high-functioning ASD.
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38
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Karpouzian TM, Alden EC, Reilly JL, Smith MJ. High functioning individuals with schizophrenia have preserved social perception but not mentalizing abilities. Schizophr Res 2016; 171:137-9. [PMID: 26827130 DOI: 10.1016/j.schres.2016.01.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 01/11/2016] [Accepted: 01/14/2016] [Indexed: 10/22/2022]
Abstract
Social perception and mentalizing are fundamental social cognitive abilities that are related to functioning and are impaired in schizophrenia. A novel approach to examine the relationship between social cognition and community functioning is to first functionally categorize individuals with schizophrenia and then evaluate social cognitive performance. We evaluated differences in social perception and mentalizing among controls (CON, n=45), high functioning individuals with schizophrenia (HF-SCZ, n=36), and individuals with low functioning schizophrenia (LF-SCZ, n=24). Analyses revealed that HF-SCZ had preserved social perceptual abilities compared to LF-SCZ. Both schizophrenia groups had impaired mentalizing abilities compared to CON, but did not differ from each other. These results suggest that HF-SCZ and LF-SCZ are characterized by differences in the perceptual aspects of social cognition and encourage future research to evaluate the neural basis underlying this preserved ability.
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Affiliation(s)
- Tatiana M Karpouzian
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, 710 N Lake Shore Drive, Chicago, IL 60611, United States
| | - Eva C Alden
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, 710 N Lake Shore Drive, Chicago, IL 60611, United States
| | - James L Reilly
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, 710 N Lake Shore Drive, Chicago, IL 60611, United States; Northwestern University Feinberg School of Medicine, Warren Wright Adolescent Center, 710 N Lake Shore Drive, Chicago, IL 60611, United States
| | - Matthew J Smith
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, 710 N Lake Shore Drive, Chicago, IL 60611, United States; Northwestern University Feinberg School of Medicine, Warren Wright Adolescent Center, 710 N Lake Shore Drive, Chicago, IL 60611, United States.
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Hagiya K, Sumiyoshi T, Kanie A, Pu S, Kaneko K, Mogami T, Oshima S, Niwa SI, Inagaki A, Ikebuchi E, Kikuchi A, Yamasaki S, Iwata K, Nakagome K. Facial expression perception correlates with verbal working memory function in schizophrenia. Psychiatry Clin Neurosci 2015; 69:773-81. [PMID: 26129706 DOI: 10.1111/pcn.12329] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 06/15/2015] [Accepted: 06/26/2015] [Indexed: 11/29/2022]
Abstract
AIMS Facial emotion perception is considered to provide a measure of social cognition. Numerous studies have examined the perception of emotion in patients with schizophrenia, and the majority has reported impaired ability to recognize facial emotion perception. We aimed to investigate the correlation between facial expression recognition and other domains of social cognition and neurocognition in Japanese patients with schizophrenia. METHODS Participants were 52 patients with schizophrenia and 53 normal controls with no history of psychiatric diseases. All participants completed the Hinting Task and the Social Cognition Screening Questionnaire. The Brief Assessment of Cognition in Schizophrenia was administered only to the patients. Facial emotion perception measured by the Facial Emotion Selection Test (FEST) was compared between the patients and normal controls. RESULTS Patients performed significantly worse on the FEST compared to normal control subjects. The FEST total score was significantly positively correlated with scores of the Brief Assessment of Cognition in Schizophrenia attention subscale, Hinting Task, Social Cognition Screening Questionnaire Verbal Working Memory and Metacognition subscales. Stepwise multiple regression analysis revealed that verbal working memory function was positively related to the facial emotion perception ability in patients with schizophrenia. CONCLUSIONS These results point to the concept that facial emotion perception and some types of working memory use common cognitive resources. Our findings may provide implications for cognitive rehabilitation and related interventions in schizophrenia.
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Affiliation(s)
- Kumiko Hagiya
- Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Neuropsychiatry, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
| | - Tomiki Sumiyoshi
- Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Ayako Kanie
- Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Shenghong Pu
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University Faculty of Medicine, Tottori, Japan
| | - Koichi Kaneko
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University Faculty of Medicine, Tottori, Japan
| | - Tamiko Mogami
- Department of Clinical Psychology, Graduate School of Medical Sciences, Tottori University, Tottori, Japan
| | - Sachie Oshima
- Department of Neuropsychiatry, Fukushima Medical University, Fukushima, Japan
| | - Shin-ichi Niwa
- Department of Neuropsychiatry, Fukushima Medical University, Fukushima, Japan
| | - Akiko Inagaki
- Department of Psychiatric Nursing, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,Department of Neuropsychiatry, Teikyo University School of Medicine, Tokyo, Japan
| | - Emi Ikebuchi
- Department of Neuropsychiatry, Teikyo University School of Medicine, Tokyo, Japan
| | - Akiko Kikuchi
- Department of Forensic Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Syudo Yamasaki
- Department of Psychiatry & Behavioral Science, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Kazuhiko Iwata
- Department of Psychiatry, Osaka Psychiatric Medical Center, Osaka, Japan
| | - Kazuyuki Nakagome
- Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan
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Smith MJ, Fleming MF, Wright MA, Jordan N, Humm LB, Olsen D, Bell MD. Job Offers to Individuals With Severe Mental Illness After Participation in Virtual Reality Job Interview Training. Psychiatr Serv 2015; 66:1173-9. [PMID: 26130002 PMCID: PMC4630147 DOI: 10.1176/appi.ps.201400504] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Individuals with severe mental illness have low employment rates, and the job interview presents a critical barrier for them to obtain competitive employment. Prior randomized controlled trials (RCTs) indicated that virtual reality job interview training (VR-JIT) improved job interviewing skills among trainees. This study assessed whether VR-JIT participation was associated with greater odds of receiving job offers in the six-months after completion of training. METHODS To assess the efficacy of VR-JIT, trainees (N=39) in the method and a comparison group (N=12) completed a brief survey approximately six months after participating in the RCTs. Primary vocational outcome measures included receiving a job offer and number of weeks searching for employment. RESULTS A larger proportion of trainees than comparison participants received a job offer (51% versus 25%, respectively). Trainees were more likely to receive a job offer than comparison participants (odds ratio=9.64, p=.02) after analyses accounted for cognition, recency of last job, and diagnosis. Trainees had greater odds of receiving a job offer for each completed VR-JIT trial (odds ratio=1.41, p=.04), and a greater number of completed VR-JIT trials predicted fewer weeks of searching for employment (β=-.74, p=.02). CONCLUSIONS Results provide preliminary support that VR-JIT is a promising intervention associated with enhanced vocational outcomes among individuals with severe mental illness. Given that participants had minimal access to standardized vocational services, future research could evaluate the effectiveness of VR-JIT among individuals with and without access to standardized vocational services as well as evaluate strategies to implement VR-JIT within a large community mental health service provider.
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Affiliation(s)
- Matthew J Smith
- Dr. Smith, Dr. Fleming, Mr. Wright, and Dr. Jordan are with the Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago (e-mail: ). Ms. Boteler Humm and Dr. Olsen are with SIMmersion, LLC, Columbia, Maryland. Dr. Bell is with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, and with the Psychology Service, Department of Veterans Affairs Connecticut Healthcare System, West Haven
| | - Michael F Fleming
- Dr. Smith, Dr. Fleming, Mr. Wright, and Dr. Jordan are with the Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago (e-mail: ). Ms. Boteler Humm and Dr. Olsen are with SIMmersion, LLC, Columbia, Maryland. Dr. Bell is with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, and with the Psychology Service, Department of Veterans Affairs Connecticut Healthcare System, West Haven
| | - Michael A Wright
- Dr. Smith, Dr. Fleming, Mr. Wright, and Dr. Jordan are with the Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago (e-mail: ). Ms. Boteler Humm and Dr. Olsen are with SIMmersion, LLC, Columbia, Maryland. Dr. Bell is with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, and with the Psychology Service, Department of Veterans Affairs Connecticut Healthcare System, West Haven
| | - Neil Jordan
- Dr. Smith, Dr. Fleming, Mr. Wright, and Dr. Jordan are with the Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago (e-mail: ). Ms. Boteler Humm and Dr. Olsen are with SIMmersion, LLC, Columbia, Maryland. Dr. Bell is with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, and with the Psychology Service, Department of Veterans Affairs Connecticut Healthcare System, West Haven
| | - Laura Boteler Humm
- Dr. Smith, Dr. Fleming, Mr. Wright, and Dr. Jordan are with the Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago (e-mail: ). Ms. Boteler Humm and Dr. Olsen are with SIMmersion, LLC, Columbia, Maryland. Dr. Bell is with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, and with the Psychology Service, Department of Veterans Affairs Connecticut Healthcare System, West Haven
| | - Dale Olsen
- Dr. Smith, Dr. Fleming, Mr. Wright, and Dr. Jordan are with the Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago (e-mail: ). Ms. Boteler Humm and Dr. Olsen are with SIMmersion, LLC, Columbia, Maryland. Dr. Bell is with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, and with the Psychology Service, Department of Veterans Affairs Connecticut Healthcare System, West Haven
| | - Morris D Bell
- Dr. Smith, Dr. Fleming, Mr. Wright, and Dr. Jordan are with the Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago (e-mail: ). Ms. Boteler Humm and Dr. Olsen are with SIMmersion, LLC, Columbia, Maryland. Dr. Bell is with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, and with the Psychology Service, Department of Veterans Affairs Connecticut Healthcare System, West Haven
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Cluster analysis differentiates high and low community functioning in schizophrenia: Subgroups differ on working memory but not other neurocognitive domains. Schizophr Res 2015. [PMID: 26215505 DOI: 10.1016/j.schres.2015.07.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Schizophrenia is characterized by impairment in multiple aspects of community functioning. Available literature suggests that community functioning may be enhanced through cognitive remediation, however, evidence is limited regarding whether specific neurocognitive domains may be treatment targets. We characterized schizophrenia subjects based on their level of community functioning through cluster analysis in an effort to identify whether specific neurocognitive domains were associated with variation in functioning. METHODS Schizophrenia (SCZ, n=60) and control (CON, n=45) subjects completed a functional capacity task, social competence role-play, functional attainment interview, and a neuropsychological battery. Multiple cluster analytic techniques were used on the measures of functioning in the schizophrenia subjects to generate functionally-defined subgroups. MANOVA evaluated between-group differences in neurocognition. RESULTS The cluster analysis revealed two distinct groups, consisting of 36 SCZ characterized by high levels of community functioning (HF-SCZ) and 24 SCZ with low levels of community functioning (LF-SCZ). There was a main group effect for neurocognitive performance (p<0.001) with CON outperforming both SCZ groups in all neurocognitive domains. Post-hoc tests revealed that HF-SCZ had higher verbal working memory compared to LF-SCZ (p≤0.05, Cohen's d=0.78) but the two groups did not differ in remaining domains. CONCLUSION The cluster analysis classified schizophrenia subjects in HF-SCZ and LF-SCZ using a multidimensional assessment of community functioning. Moreover, HF-SCZ demonstrated rather preserved verbal working memory relative to LF-SCZ. The results suggest that verbal working memory may play a critical role in community functioning, and is a potential cognitive treatment target for schizophrenia subjects.
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Influence of empathetic pain processing on cognition in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2015; 265:623-31. [PMID: 25476407 DOI: 10.1007/s00406-014-0565-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 11/24/2014] [Indexed: 12/19/2022]
Abstract
Deficits in both empathy and cognition have been reported widely in patients with schizophrenia. However, little is known about how these deficits interact among such patients. In the present study, we used pain portraying pictures preceding a color-word Stroop task to investigate the effect of empathetic pain observation on cognition among patients with schizophrenia. Twenty patients with schizophrenia and twenty healthy controls were included. The control group showed increased Stroop facilitation and decreased interference during the empathetic pain condition compared with the non-empathetic condition. Although patients with schizophrenia exhibited deficits in cognition, they demonstrated a similar empathy effect to controls on Stroop facilitation, but a somewhat larger empathy effect on Stroop interference (a more decreased effect). In particular, the groups did not differ in either automatic or controlled processing during the non-empathetic condition, suggesting general rather than specific cognitive deficits in schizophrenia. Together, we interpret our findings in terms of two opposing effects of empathy on cognition in schizophrenia, with possible neuromodulatory mechanism. Whereas prior studies showed empathy to be impaired, our outcomes indicate that at least some components of empathetic pain processing are preserved in such patients.
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Smith MJ, Fleming MF, Wright MA, Roberts AG, Humm LB, Olsen D, Bell MD. Virtual reality job interview training and 6-month employment outcomes for individuals with schizophrenia seeking employment. Schizophr Res 2015; 166:86-91. [PMID: 26032567 PMCID: PMC4512907 DOI: 10.1016/j.schres.2015.05.022] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/12/2015] [Accepted: 05/12/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Individuals with schizophrenia have low employment rates and the job interview presents a critical barrier for them to obtain employment. Virtual reality training has demonstrated efficacy at improving interview skills and employment outcomes among multiple clinical populations. However, the effects of this training on individuals with schizophrenia are unknown. This study evaluated the efficacy of virtual reality job interview training (VR-JIT) at improving job interview skills and employment outcomes among individuals with schizophrenia in a small randomized controlled trial (n=21 VR-JIT trainees, n=11 waitlist controls). METHODS Trainees completed up to 10h of virtual interviews using VR-JIT, while controls received services as usual. Primary outcome measures included two pre-test and two post-test video-recorded role-play interviews scored by blinded raters with expertise in human resources and self-reported interviewing self-confidence. Six-month follow-up data on employment outcomes were collected. RESULTS Trainees reported that the intervention was easy-to-use, helpful, and prepared them for future interviews. Trainees demonstrated increased role-play scores between pre-test and post-test while controls did not (p=0.001). After accounting for neurocognition and months since prior employment, trainees had greater odds of receiving a job offer by 6month follow-up compared to controls (OR: 8.73, p=0.04) and more training was associated with fewer weeks until receiving a job offer (r=-0.63, p<0.001). CONCLUSIONS Results suggest that VR-JIT is acceptable to trainees and may be efficacious for improving job interview skills in individuals with schizophrenia. Moreover, trainees had greater odds of receiving a job offer by 6-month follow-up. Future studies could evaluate the effectiveness of VR-JIT within community-based services.
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Affiliation(s)
- Matthew J. Smith
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL USA,Northwestern University Feinberg School of Medicine, Warren Wright Adolescent Center, Chicago, IL USA
| | - Michael F. Fleming
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL USA,Northwestern University Feinberg School of Medicine, Department of Family Medicine, Chicago, IL USA
| | - Michael A. Wright
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL USA
| | - Andrea G. Roberts
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL USA,Northwestern University Feinberg School of Medicine, Warren Wright Adolescent Center, Chicago, IL USA
| | | | | | - Morris D. Bell
- Yale School of Medicine, Department of Psychiatry, Department of Veteran Affairs, West Haven, CT USA
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Smith MJ, Humm LB, Fleming MF, Jordan N, Wright MA, Ginger EJ, Wright K, Olsen D, Bell MD. Virtual Reality Job Interview Training for Veterans with Posttraumatic Stress Disorder. JOURNAL OF VOCATIONAL REHABILITATION 2015; 42:271-279. [PMID: 27721645 DOI: 10.3233/jvr-150748] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Veterans with posttraumatic stress disorder (PTSD) have low employment rates and the job interview presents a critical barrier for them to obtain competitive employment. OBJECTIVE To evaluate the acceptability and efficacy of virtual reality job interview training (VR-JIT) among veterans with PTSD via a small randomized controlled trial (n=23 VR-JIT trainees, n=10 waitlist treatment-as-usual (TAU) controls). METHODS VR-JIT trainees completed up to 10 hours of simulated job interviews and reviewed information and tips about job interviewing, while wait-list TAU controls received services as usual. Primary outcome measures included two pre-test and two post-test video-recorded role-play interviews scored by blinded human resource experts and self-reported interviewing self-confidence. RESULTS Trainees attended 95% of lab-based VR-JIT sessions and found the intervention easy-to-use, helpful, and prepared them for future interviews. VR-JIT trainees demonstrated significantly greater improvement on role-play interviews compared with wait-list TAU controls (p=0.04) and demonstrated a large effect for within-subject change (Cohen's d=0.76). VR-JIT performance scores increased significantly over time (R-Squared=0.76). Although VR-JIT trainees showed a moderate effect for within-subject change on self-confidence (Cohen's d=0.58), the observed difference between conditions did not reach significance (p=0.09). CONCLUSIONS Results provide preliminary support that VR-JIT is acceptable to trainees and may be efficacious for improving job interview skills and self-confidence in veterans with PTSD.
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Affiliation(s)
- Matthew J Smith
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL USA
| | | | - Michael F Fleming
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL USA; Northwestern University Feinberg School of Medicine, Department of Family Medicine, Chicago, IL USA
| | - Neil Jordan
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL USA; Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL USA
| | - Michael A Wright
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL USA
| | - Emily J Ginger
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL USA
| | - Katherine Wright
- Northwestern University Feinberg School of Medicine, Department of Family Medicine, Chicago, IL USA
| | | | - Morris D Bell
- Yale School of Medicine, Department of Psychiatry, Department of Veteran Affairs, West Haven, CT USA
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Some markers of mirroring appear intact in schizophrenia: evidence from mu suppression. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2015; 14:1049-60. [PMID: 24415272 DOI: 10.3758/s13415-013-0245-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Although schizophrenia is associated with impairments in social cognition, the scope and neural correlates of these disturbances are largely unknown. In this study, we investigated whether schizophrenia patients show impaired functioning of the mirror neuron system (MNS), as indexed by electroencephalographic (EEG) mu (8-13 Hz) suppression, a hypothesized biomarker of MNS activity that is sensitive to the degree of social interaction depicted in visual stimuli. A total of 32 outpatients and 26 healthy controls completed an EEG paradigm that included six action observation or execution conditions that differed in their degrees of social interaction. Participants also completed a validated empathy questionnaire. Across both groups, we found a significant linear increase in mu suppression across the conditions involving greater levels of social engagement and interaction, but no significant group or interaction effects. Patients self-reported diminished empathic concern and perspective taking, which showed some moderate relations to mu suppression levels. Thus, the schizophrenia group showed generally intact modulation of MNS functioning at the electrophysiological level, despite self-reporting empathic disturbances. The disturbances commonly seen on self-report, performance, and neuroimaging measures of mentalizing in schizophrenia may largely reflect difficulties with higher-level inferential processes about others' emotions, rather than a basic incapacity to share in these experiences.
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46
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Fett AKJ, Shergill SS, Krabbendam L. Social neuroscience in psychiatry: unravelling the neural mechanisms of social dysfunction. Psychol Med 2015; 45:1145-1165. [PMID: 25335852 DOI: 10.1017/s0033291714002487] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Social neuroscience is a flourishing, interdisciplinary field that investigates the underlying biological processes of social cognition and behaviour. The recent application of social neuroscience to psychiatric research advances our understanding of various psychiatric illnesses that are characterized by impairments in social cognition and social functioning. In addition, the upcoming line of social neuroscience research provides new techniques to design and evaluate treatment interventions that are aimed at improving patients' social lives. This review provides a contemporary overview of social neuroscience in psychiatry. We draw together the major findings about the neural mechanisms of social cognitive processes directed at understanding others and social interactions in psychiatric illnesses and discuss their implications for future research and clinical practice.
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Affiliation(s)
- A K J Fett
- Department of Educational Neuroscience & Research Institute LEARN!,Faculty of Psychology and Education,VU University Amsterdam,Van der Boechorststraat 1,Amsterdam,The Netherlands
| | - S S Shergill
- Department of Psychosis Studies,Institute of Psychiatry, King's College London,De Crespigny Park,London,UK
| | - L Krabbendam
- Department of Educational Neuroscience & Research Institute LEARN!,Faculty of Psychology and Education,VU University Amsterdam,Van der Boechorststraat 1,Amsterdam,The Netherlands
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Xin F, Lei X. Competition between frontoparietal control and default networks supports social working memory and empathy. Soc Cogn Affect Neurosci 2015; 10:1144-52. [PMID: 25556209 DOI: 10.1093/scan/nsu160] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 12/24/2014] [Indexed: 01/10/2023] Open
Abstract
An extensive body of literature has indicated that there is increased activity in the frontoparietal control network (FPC) and decreased activity in the default mode network (DMN) during working memory (WM) tasks. The FPC and DMN operate in a competitive relationship during tasks requiring externally directed attention. However, the association between this FPC-DMN competition and performance in social WM tasks has rarely been reported in previous studies. To investigate this question, we measured FPC-DMN connectivity during resting state and two emotional face recognition WM tasks using the 2-back paradigm. Thirty-four individuals were instructed to perform the tasks based on either the expression [emotion (EMO)] or the identity (ID) of the same set of face stimuli. Consistent with previous studies, an increased anti-correlation between the FPC and DMN was observed during both tasks relative to the resting state. Specifically, this anti-correlation during the EMO task was stronger than during the ID task, as the former has a higher social load. Intriguingly, individual differences in self-reported empathy were significantly correlated with the FPC-DMN anti-correlation in the EMO task. These results indicate that the top-down signals from the FPC suppress the DMN to support social WM and empathy.
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Affiliation(s)
- Fei Xin
- Key Laboratory of Cognition and Personality, Ministry of Education, Chongqing, China and Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing, China
| | - Xu Lei
- Key Laboratory of Cognition and Personality, Ministry of Education, Chongqing, China and Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing, China
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Smith MJ, Schroeder MP, Abram SV, Goldman MB, Parrish TB, Wang X, Derntl B, Habel U, Decety J, Reilly JL, Csernansky JG, Breiter HC. Alterations in brain activation during cognitive empathy are related to social functioning in schizophrenia. Schizophr Bull 2015; 41:211-22. [PMID: 24583906 PMCID: PMC4266286 DOI: 10.1093/schbul/sbu023] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Impaired cognitive empathy (ie, understanding the emotional experiences of others) is associated with poor social functioning in schizophrenia. However, it is unclear whether the neural activity underlying cognitive empathy relates to social functioning. This study examined the neural activation supporting cognitive empathy performance and whether empathy-related activation during correctly performed trials was associated with self-reported cognitive empathy and measures of social functioning. Thirty schizophrenia outpatients and 24 controls completed a cognitive empathy paradigm during functional magnetic resonance imaging. Neural activity corresponding to correct judgments about the expected emotional expression in a social interaction was compared in schizophrenia subjects relative to control subjects. Participants also completed a self-report measure of empathy and 2 social functioning measures (social competence and social attainment). Schizophrenia subjects demonstrated significantly lower accuracy in task performance and were characterized by hypoactivation in empathy-related frontal, temporal, and parietal regions as well as hyperactivation in occipital regions compared with control subjects during accurate cognitive empathy trials. A cluster with peak activation in the supplementary motor area (SMA) extending to the anterior midcingulate cortex (aMCC) correlated with social competence and social attainment in schizophrenia subjects but not controls. These results suggest that neural correlates of cognitive empathy may be promising targets for interventions aiming to improve social functioning and that brain activation in the SMA/aMCC region could be used as a biomarker for monitoring treatment response.
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Affiliation(s)
- Matthew J. Smith
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; ,Department of Psychiatry, Warren Wright Adolescent Center at Stone Institute of Psychiatry, Northwestern Memorial Hospital, Chicago, IL; ,*To whom correspondence should be addressed; Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 N. Lakeshore Dr, Abbott Hall 13th floor, Chicago, IL 60611, US; tel: 1-312-503-2542, fax: 1-312-503-0527, e-mail:
| | - Matthew P. Schroeder
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Morris B. Goldman
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Todd B. Parrish
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Xue Wang
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Birgit Derntl
- Department of Psychiatry, Psychotherapy, and Psychosomatics, RWTH Aachen University (Germany), Aachen, Germany
| | - Ute Habel
- Department of Psychiatry, Psychotherapy, and Psychosomatics, RWTH Aachen University (Germany), Aachen, Germany
| | - Jean Decety
- Department of Psychology, University of Chicago, Chicago, IL; ,Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL
| | - James L. Reilly
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; ,Department of Psychiatry, Warren Wright Adolescent Center at Stone Institute of Psychiatry, Northwestern Memorial Hospital, Chicago, IL; , These authors shared senior authorship
| | - John G. Csernansky
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; , These authors shared senior authorship
| | - Hans C. Breiter
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; ,Department of Psychiatry, Warren Wright Adolescent Center at Stone Institute of Psychiatry, Northwestern Memorial Hospital, Chicago, IL; , These authors shared senior authorship
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Horan WP, Reise SP, Kern RS, Lee J, Penn DL, Green MF. Structure and correlates of self-reported empathy in schizophrenia. J Psychiatr Res 2015; 66-67:60-6. [PMID: 25985922 PMCID: PMC4458171 DOI: 10.1016/j.jpsychires.2015.04.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 04/17/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
Abstract
Research on empathy in schizophrenia has relied on dated self-report scales that do not conform to contemporary social neuroscience models of empathy. The current study evaluated the structure and correlates of the recently-developed Questionnaire of Cognitive and Affective Empathy (QCAE) in schizophrenia. This measure, whose structure and validity was established in healthy individuals, includes separate scales to assess the two main components of empathy: Cognitive Empathy (assessed by two subscales) and Affective Empathy (assessed by three subscales). Stable outpatients with schizophrenia (n = 145) and healthy individuals (n = 45) completed the QCAE, alternative measures of empathy, and assessments of clinical symptoms, neurocognition, and functional outcome. Exploratory and confirmatory factor analyses provided consistent support for a two-factor solution in the schizophrenia group, justifying the use of separate cognitive and affective empathy scales in this population. However, one of the three Affective Empathy subscales was not psychometrically sound and was excluded from further analyses. Patients reported significantly lower Cognitive Empathy but higher Affective Empathy than controls. Among patients, the QCAE scales showed significant correlations with an alternative self-report empathy scale, but not with performance on an empathic accuracy task. The QCAE Cognitive Empathy subscales also showed significant, though modest, correlations with negative symptoms and functional outcome. These findings indicate that structure of self-reported empathy is similar in people with schizophrenia and healthy subjects, and can be meaningfully compared between groups. They also contribute to emerging evidence that some aspects of empathy may be intact or hyper-responsive in schizophrenia.
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Affiliation(s)
- William P. Horan
- VA Greater Los Angeles Healthcare System,Semel Institute for Neuroscience and Human Behavior, UCLA
| | | | - Robert S. Kern
- VA Greater Los Angeles Healthcare System,Semel Institute for Neuroscience and Human Behavior, UCLA
| | - Junghee Lee
- VA Greater Los Angeles Healthcare System,Semel Institute for Neuroscience and Human Behavior, UCLA
| | - David L. Penn
- University of North Carolina, Chapel Hill,Australian Catholic University, Melbourne, VI
| | - Michael F. Green
- VA Greater Los Angeles Healthcare System,Semel Institute for Neuroscience and Human Behavior, UCLA
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Smith MJ, Ginger EJ, Wright K, Wright MA, Taylor JL, Humm LB, Olsen DE, Bell MD, Fleming MF. Virtual reality job interview training in adults with autism spectrum disorder. J Autism Dev Disord 2014; 44:2450-63. [PMID: 24803366 PMCID: PMC4167908 DOI: 10.1007/s10803-014-2113-y] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The feasibility and efficacy of virtual reality job interview training (VR-JIT) was assessed in a single-blinded randomized controlled trial. Adults with autism spectrum disorder were randomized to VR-JIT (n = 16) or treatment-as-usual (TAU) (n = 10) groups. VR-JIT consisted of simulated job interviews with a virtual character and didactic training. Participants attended 90 % of laboratory-based training sessions, found VR-JIT easy to use and enjoyable, and they felt prepared for future interviews. VR-JIT participants had greater improvement during live standardized job interview role-play performances than TAU participants (p = 0.046). A similar pattern was observed for self-reported self-confidence at a trend level (p = 0.060). VR-JIT simulation performance scores increased over time (R(2) = 0.83). Results indicate preliminary support for the feasibility and efficacy of VR-JIT, which can be administered using computer software or via the internet.
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Affiliation(s)
- Matthew J Smith
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 E. Ontario Suite 7-100, Chicago, IL, 60611, USA,
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