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Cowan HR, McAdams DP, Ouellet L, Jones CM, Mittal VA. Self-concept and Narrative Identity in Youth at Clinical High Risk for Psychosis. Schizophr Bull 2024; 50:848-859. [PMID: 37816626 PMCID: PMC11283199 DOI: 10.1093/schbul/sbad142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
BACKGROUND AND HYPOTHESIS Disturbances of the narrative self and personal identity accompany the onset of psychotic disorders in late adolescence and early adulthood (a formative developmental stage for self-concept and personal narratives). However, these issues have primarily been studied retrospectively after illness onset, limiting any inferences about their developmental course. STUDY DESIGN Youth at clinical high risk for psychosis (CHR) (n = 49) and matched healthy comparison youth (n = 52) completed a life story interview (including self-defining memory, turning point, life challenge, and psychotic-like experience) and questionnaires assessing self-esteem, self-beliefs, self-concept clarity, and ruminative/reflective self-focus. Trained raters coded interviews for narrative identity themes of emotional tone, agency, temporal coherence, context coherence, self-event connections, and meaning-making (intraclass correlations >0.75). Statistical analyses tested group differences and relationships between self-concept, narrative identity, symptoms, and functioning. STUDY RESULTS CHR participants reported more negative self-esteem and self-beliefs, poorer self-concept clarity, and more ruminative self-focus, all of which related to negative symptoms. CHR participants narrated their life stories with themes of negative emotion and passivity (ie, lack of personal agency), which related to positive and negative symptoms. Reflective self-focus and autobiographical reasoning were unaffected and correlated. Autobiographical reasoning was uniquely associated with preserved role functioning. CONCLUSIONS This group of youth at CHR exhibited some, but not all, changes to self-concept and narrative identity seen in psychotic disorders. A core theme of negativity, uncertainty, and passivity ran through their semantic and narrative self-representations. Preserved self-reflection and autobiographical reasoning suggest sources of resilience and potential footholds for cognitive-behavioral and metacognitive interventions.
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Affiliation(s)
- Henry R Cowan
- Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Dan P McAdams
- Psychology, Northwestern University, Evanston, IL, USA
| | - Leah Ouellet
- Human Development and Social Policy, Northwestern University, Evanston, IL, USA
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Cheli S, Cavalletti V, Hopwood CJ. Threatening Beliefs About Self and Others Moderate the Association Between Psychoticism and Psychological Distress. J Nerv Ment Dis 2023; 211:819-827. [PMID: 37738457 DOI: 10.1097/nmd.0000000000001726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
ABSTRACT Psychoticism is a multidimensional personality construct involving odd or eccentric behavior, quasi-psychotic experiences, mistrust, interpersonal detachment, and liability for schizophrenia-spectrum disorders, as well as significant distress. Recent advances suggest it can be understood as a dimension that is continuously distributed in the population, leading to questions about factors that contribute to distress and dysfunction among people with a schizotypal liability. We investigated in a large nonclinical sample of young adults whether associations between psychoticism and psychological distress would increase in the presence of threatening beliefs. In our study ( N = 2127), we found that the association between psychoticism and psychological distress is moderated by threatening beliefs including self-criticism, fear of compassion, and socially prescribed perfectionism. These results suggest that distress increases among people with schizotypal traits in the context of negative beliefs about self and others. We discuss implications for clinical practice and directions for further research.
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Cowan HR, Lundin NB, Moe AM, Breitborde NJK. Discrepancies between self and caregiver perceptions of agency in first-episode psychosis. J Psychiatr Res 2023; 162:220-227. [PMID: 37201222 PMCID: PMC10225345 DOI: 10.1016/j.jpsychires.2023.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 05/20/2023]
Abstract
Personal agency-a key element of recovery from psychotic disorders-is formed and maintained in large part through interactions with others. Interactions with caregivers are particularly important in first-episode psychosis (FEP), as these interactions form the foundations for lifelong caregiving relationships. The present study examined shared understandings of agency (operationalized as efficacy to manage symptoms and social behaviors) within families affected by FEP. Individuals with FEP (n = 46) completed the Self-Efficacy Scale for Schizophrenia (SESS) and measures of symptom severity, social functioning, social quality of life, stigma, and discrimination. Caregivers (n = 42) completed a caregiver version of the SESS assessing perceptions of their affected relative's self-efficacy. Self-rated efficacy was higher than caregiver-rated efficacy in all domains (positive symptoms, negative symptoms, and social behavior). Self- and caregiver-rated efficacy correlated only in the social behavior domain. Self-rated efficacy was most associated with lower depression and stigmatization, whereas caregiver-rated efficacy was most associated with better social functioning. Psychotic symptoms did not relate to self- or caregiver-rated efficacy. Individuals with FEP and caregivers have discrepant perceptions of personal agency, perhaps because they base perceptions of agency on different sources of information. These findings highlight specific targets for psychoeducation, social skills training, and assertiveness training to develop shared understandings of agency and facilitate functional recovery.
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Affiliation(s)
- Henry R Cowan
- Psychiatry and Behavioral Health, The Ohio State University, USA.
| | - Nancy B Lundin
- Psychiatry and Behavioral Health, The Ohio State University, USA
| | - Aubrey M Moe
- Psychiatry and Behavioral Health, The Ohio State University, USA; Psychology, The Ohio State University, USA
| | - Nicholas J K Breitborde
- Psychiatry and Behavioral Health, The Ohio State University, USA; Psychology, The Ohio State University, USA
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Interactions between the cortical midline structures and sensorimotor network track maladaptive self-beliefs in clinical high risk for psychosis. SCHIZOPHRENIA 2022; 8:74. [PMID: 36114173 PMCID: PMC9481626 DOI: 10.1038/s41537-022-00279-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/17/2022] [Indexed: 12/02/2022]
Abstract
Individuals at clinical high risk for psychosis (CHR) report a maladaptive self-concept—with more negative and less positive self-beliefs—linked to clinical symptoms and functional impairment. Alterations have also been reported in brain networks associated with intrinsic (cortical midline structures, CMS) and extrinsic (sensorimotor network, SMN) self-processing. Theoretical accounts of multiple levels of self-experience in schizophrenia suggest that interactions between these networks would be relevant for self-beliefs. This study tested whether self-beliefs related to resting-state functional connectivity within and between the CMS and SMN. Participants were 56 individuals meeting CHR criteria and 59 matched healthy community participants (HC). Pearson correlations examined potential mediators and outcomes. The CHR group reported more negative and less positive self-beliefs. Greater resting-state functional connectivity between the posterior CMS (posterior cingulate cortex) and the SMN was associated with less positive self-beliefs in CHR, but more positive self-beliefs in HC. Attenuated negative symptoms and poorer social functioning were associated with CMS-SMN connectivity (trend level after FDR-correction) and self-beliefs. Reduced connectivity between the left and right PCC was associated with lower positive self-beliefs in CHR, although this effect was specific to very low levels of positive self-beliefs. Left-right PCC connectivity did not correlate with outcomes. Dynamic interactions between intrinsic and extrinsic self-processing supported positive self-beliefs in typically developing youth while undermining positive self-beliefs in CHR youth. Implications are discussed for basic self-fragmentation, narrative self-related metacognition, and global belief updating. Interventions for self-processing may be beneficial in the CHR syndrome.
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Mitchell J, Meehan T. How art-as-therapy supports participants with a diagnosis of schizophrenia: A phenomenological lifeworld investigation. ARTS IN PSYCHOTHERAPY 2022. [DOI: 10.1016/j.aip.2022.101917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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6
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Lysaker PH, Lysaker JT. Disturbances in dialogue and metacognition: A renewed way to understand and respond to alterations in self-experience in psychosis. THEORY & PSYCHOLOGY 2020. [DOI: 10.1177/0959354320973752] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A dialogical model of psychosis proposed that the collapse of dialogue may explain the alterations in sense of self and agency observed in psychosis. This view was hampered by lack of clarity regarding the processes that support or hinder dialogue. Since then, research on metacognition has offered an alternative but also partially complementary approach. To explore this issue a brief history of the original dialogical conceptualization of psychosis and the difficulties that it confronts is offered along with the essential contributions of research on metacognition in psychosis. Next, we explore how this more recent research has deepened the exploration of some core ideas of dialogical self theory, including the multiplicity of the self, while calling into question other aspects of that theory. Lastly, we discuss issues awaiting future research including models linking disturbances in basic brain function, social injustice, community connection, and self-experience in psychosis from the frame of a network.
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Affiliation(s)
- Paul H. Lysaker
- Richard L. Roudebush VA Medical Center and Indiana University School of Medicine
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Conneely M, McNamee P, Gupta V, Richardson J, Priebe S, Jones JM, Giacco D. Understanding Identity Changes in Psychosis: A Systematic Review and Narrative Synthesis. Schizophr Bull 2020; 47:309-322. [PMID: 32989443 PMCID: PMC7965068 DOI: 10.1093/schbul/sbaa124] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Experiencing psychosis can be associated with changes in how people see themselves as individuals and in relation to others (ie, changes in their identity). However, identity changes receive little attention in treatment, possibly due to a lack of clarity or consensus around what identity change means in people with psychosis. We aimed to create a conceptual framework synthesizing how identity changes are understood in the psychosis literature. METHODS Electronic databases were searched up to April 2020. Studies about identity changes among people with psychotic disorders were analyzed using narrative synthesis by a collaborative review team, including researchers from different disciplines, clinicians, and people who have experienced psychosis. RESULTS Of 10 389 studies screened, 59 were eligible. Identity changes are understood in 5 ways as (1) characteristics of psychosis, (2) consequences of altered cognitive functioning, (3) consequences of internalized stigma, (4) consequences of lost roles and relationships, and (5) reflections of personal growth. These 5 understandings are not mutually exclusive. Across a heterogeneous literature, identity changes were mostly framed in terms of loss. CONCLUSIONS Our conceptual framework, comprising 5 understandings, highlights the complexity of studying identity changes and suggests important implications for practice and research. For clinicians, this framework can inform new therapeutic approaches where the experience and impact of identity changes are acknowledged and addressed as part of treatment. For researchers, the conceptual framework offers a way of locating their understandings of identity changes when undertaking research in this area.
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Affiliation(s)
- Maev Conneely
- Unit for Social and Community Psychiatry, WHO Collaboration Centre, Queen Mary University of London, London, UK,To whom correspondence should be addressed; Unit for Social and Community Psychiatry, Newham Centre for Mental Health, London E13 8SP, UK; tel: +44 020 7540 4380 (ext.: 2308), fax: +44 020 7540 4380, e-mail:
| | - Philip McNamee
- Unit for Social and Community Psychiatry, WHO Collaboration Centre, Queen Mary University of London, London, UK
| | - Veenu Gupta
- Department of Primary Care and Mental health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - John Richardson
- Unit for Social and Community Psychiatry, WHO Collaboration Centre, Queen Mary University of London, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaboration Centre, Queen Mary University of London, London, UK
| | - Janelle M Jones
- Department of Biological and Experimental Psychology, School of Biological and Chemical Sciences, Queen Mary University of London, London, UK
| | - Domenico Giacco
- Unit for Social and Community Psychiatry, WHO Collaboration Centre, Queen Mary University of London, London, UK,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Lysaker PH, Keane JE, Culleton SP, Lundin NB. Schizophrenia, recovery and the self: An introduction to the special issue on metacognition. Schizophr Res Cogn 2020; 19:100167. [PMID: 31832347 PMCID: PMC6890971 DOI: 10.1016/j.scog.2019.100167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 10/27/2019] [Indexed: 12/28/2022]
Abstract
In this special issue, work is presented linking metacognition among persons with schizophrenia with a range of psychosocial outcomes including vocational functioning, empathy, motivation, self-evaluation, and other cognitive functions. This overview will highlight how these works allow for the quantitative study of processes which underpin alterations in self-experience in schizophrenia, which in turn allows self-experience to be studied as part of a larger set of brain-based and social phenomena whose interaction influences the trajectory of one's life and illness. We explore the hypothesis that metacognitive capacity, as a node in a larger biopsychosocial network, may be accessible by psychosocial treatment and, if successfully targeted, may disrupt the processes which perpetuate disability. Limitations and directions for future research are also discussed.
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Affiliation(s)
- Paul H. Lysaker
- Roudebush Veteran Affairs Medical Center, Indiana University School of Medicine, USA
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Bellido-Zanin G, Perona-Garcelán S, Senín-Calderón C, López-Jiménez AM, Rodríguez-Testal JF. Relationship between inner dialog and ideas of reference and the mediating role of dissociation. Scand J Psychol 2016; 58:100-106. [PMID: 27925220 DOI: 10.1111/sjop.12344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 10/04/2016] [Indexed: 11/29/2022]
Abstract
Recent lines of research have begun to concentrate on internal dialogue and its relationship to a diversity of psychopathological phenomena present in psychotic disorders. This study was intended as a preliminary exploration of the relationship of internal dialogue, dissociation and ideas of reference. To do this, a sample of 318 students filled in an internal dialogue scale (the VISQ, McCarthy-Jones & Fernyhough), one for dissociation (DES-II, Carlson & Putnam) and another for ideas of reference (REF, Lenzenweger, Bennett & Lilenfeld). The results confirm the hypothesis posed in the sense that internal dialogue was positively associated with dissociation and with ideas of reference. A partial mediation effect of dissociation was also found between inner speech and ideas of reference. Lines of future research this study opens and its possible integration in a model on ideas of reference are discussed.
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Affiliation(s)
| | - Salvador Perona-Garcelán
- University Hospital Virgen del Rocío, Seville, Spain.,Department of Personality, Evaluation and Psychological Treatment, University of Seville, Seville, Spain
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Fielding-Smith SF, Hayward M, Strauss C, Fowler D, Paulik G, Thomas N. Bringing the "self" into focus: conceptualising the role of self-experience for understanding and working with distressing voices. Front Psychol 2015; 6:1129. [PMID: 26300821 PMCID: PMC4528282 DOI: 10.3389/fpsyg.2015.01129] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 07/20/2015] [Indexed: 01/22/2023] Open
Abstract
A primary goal of cognitive behavior therapy for psychosis (CBTp) is to reduce distress and disability, not to change the positive symptoms of psychosis, such as hearing voices. Despite demonstrated associations between beliefs about voices and distress, the effects of CBTp on reducing voice distress are disappointing. Research has begun to explore the role that the psychological construct of "self" (which includes numerous facets such as self-reflection, self-schema and self-concept) might play in causing and maintaining distress and disability in voice hearers. However, attempts to clarify and integrate these different perspectives within the voice hearing literature, or to explore their clinical implications, are still in their infancy. This paper outlines how the self has been conceptualised in the psychosis and CBT literatures, followed by a review of the evidence regarding the proposed role of this construct in the etiology of and adaptation to voice hearing experiences. We go on to discuss some of the specific intervention methods that aim to target these aspects of self-experience and end by identifying key research questions in this area. Notably, we suggest that interventions specifically targeting aspects of self-experience, including self-affection, self-reflection, self-schema and self-concept, may be sufficient to reduce distress and disruption in the context of hearing voices, a suggestion that now requires further empirical investigation.
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Affiliation(s)
| | - Mark Hayward
- School of Psychology, University of Sussex , Brighton, UK ; Sussex Partnership NHS Foundation Trust , Hove, UK
| | - Clara Strauss
- School of Psychology, University of Sussex , Brighton, UK ; Sussex Partnership NHS Foundation Trust , Hove, UK
| | - David Fowler
- School of Psychology, University of Sussex , Brighton, UK ; Sussex Partnership NHS Foundation Trust , Hove, UK
| | - Georgie Paulik
- School of Psychology, University of Western Australia , Perth, WA, Australia ; Schizophrenia Research Institute, Darlinghurst , NSW, Australia
| | - Neil Thomas
- Brain and Psychological Sciences Research Centre, Swinburne University, Melbourne , VIC, Australia ; Monash Alfred Psychiatry Research Centre, The Alfred, Melbourne , VIC, Australia
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Perona-Garcelán S, Pérez-Álvarez M, García-Montes JM, Cangas AJ. Auditory Verbal Hallucinations as Dialogical Experiences. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2015. [DOI: 10.1080/10720537.2014.938847] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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12
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Solli HP, Rolvsjord R. "The Opposite of Treatment": A qualitative study of how patients diagnosed with psychosis experience music therapy. NORDIC JOURNAL OF MUSIC THERAPY 2015; 24:67-92. [PMID: 26157200 PMCID: PMC4467245 DOI: 10.1080/08098131.2014.890639] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 01/29/2014] [Indexed: 10/31/2022]
Abstract
Previous research studies regarding music therapy and severe mental illness have mainly adopted quantitative methodologies in order to study the effectiveness of music therapy interventions. Studies that have explored service users' experiences of participation in music therapy are small in number, and almost nonexistent in the field of psychosis. This study aimed to explore how mental health patients with a diagnosis of psychosis experienced participation in music therapy, in general, and more specifically how they experienced music therapy in relation to their current mental state and life situation. Nine inpatients with psychosis were interviewed using a semi-structured interview focusing on the participants' experiences of music therapy in individual sessions, groups, and performances. Through the use of interpretative phenomenological analysis, four super-ordinate themes central to the participants' experiences were found: freedom, contact, well-being, and symptom reduction. Based on the findings, mental health recovery, positive mental health, and agency are proposed as constituting a better framework for music therapy in mental healthcare than a primary focus on symptom remission and functional improvement.
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Affiliation(s)
- Hans Petter Solli
- Lovisenberg Diakonale Hospital, Oslo, Norway
- GAMUT, The Grieg Academy, University of Bergen, Bergen, Norway
| | - Randi Rolvsjord
- GAMUT, The Grieg Academy, University of Bergen, Bergen, Norway
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Hamm JA, Leonhardt BL, Fogley RL, Lysaker PH. Literature as an exploration of the phenomenology of schizophrenia: disorder and recovery in Denis Johnson's Jesus' Son. MEDICAL HUMANITIES 2014; 40:84-89. [PMID: 24567424 DOI: 10.1136/medhum-2013-010464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
When read as a fictional psychosis narrative, Jesus' Son, a collection of short stories by Denis Johnson, reveals important elements of the phenomenology of schizophrenia and recovery. It is possible that Jesus' Son, as a work of fiction, may be able to uniquely add depth and nuance to an understanding of the phenomenology of schizophrenia involving a state of psychological fragmentation, an ever-changing interpersonal field and a loss of personal agency. In addition, by following the protagonist in Jesus' Son as he begins to resolve some of his difficulties, the book also offers an individualised account of recovery. The authors detail how the book reveals these insights about schizophrenia and recovery and suggest that these elements are intertwined in such a manner that leads to a profound disruption of self-experience, characterised by a collapse of metacognitive processes. Jesus' Son may add depth to our understanding of the subjective experience of schizophrenia and recovery, and also may serve as one example in which the study of humanities offers an opportunity to explore the human elements in the most profound forms of suffering.
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Affiliation(s)
- Jay A Hamm
- Midtown Community Mental Health Center, Eskenazi Health, Indianapolis, Indiana, USA
| | - Bethany L Leonhardt
- School of Psychological Sciences, University of Indianapolis, Indianapolis, Indiana, USA
| | - Rebecca L Fogley
- School of Psychological Sciences, University of Indianapolis, Indianapolis, Indiana, USA
| | - Paul H Lysaker
- Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USA Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Hur JW, Kwon JS, Lee TY, Park S. The crisis of minimal self-awareness in schizophrenia: a meta-analytic review. Schizophr Res 2014; 152:58-64. [PMID: 24055201 DOI: 10.1016/j.schres.2013.08.042] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/28/2013] [Accepted: 08/30/2013] [Indexed: 11/26/2022]
Abstract
Disturbances of the minimal self, characterized by abnormal sense of the body, body ownership and agency have been proposed as the phenomenological phenotype of schizophrenia. However, self-disturbances have not been extensively investigated, in part, due to the subjective nature of such processes, and the associated difficulty of studying these phenomena using empirical methodology. Of 115 potential studies on self-awareness in schizophrenia, a total of 25 studies met the inclusion criteria for the meta-analysis comprising 690 patients with schizophrenia and 979 healthy controls. We calculated Hedge's g to obtain a better estimate for the standardized mean difference in small samples. We identified significant basic self-disturbance in schizophrenia, as compared with healthy controls (25 studies, effect size=0.51). Additional comparison of three sub-categories of the sense of body ownership (4 studies, effect size=0.91), the sense of agency (15 studies, effect size=0.49), and self-reported subjective experiences (6 studies, effect size=0.57) also confirmed group differences. The complete set of 25 studies, and the studies in the sub-categories showed the statistical homogeneity of the characteristics. After a correction for potential publication bias using the trim-and-fill method, the main findings for all studies combined remained significant. Overall, patients with schizophrenia showed deficits in the sense of the minimal self, driven by abnormal sense of body ownership and sense of agency. Interestingly, the disturbed sense of agency in schizophrenia suggests an exaggerated self-consciousness rather than a diminished sense of self. Further research that utilizes sophisticated study designs is needed to examine the nature of self-disturbances in schizophrenia.
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Affiliation(s)
- Ji-Won Hur
- Department of Brain and Cognitive Sciences, World Class University Program, College of Natural Sciences, Seoul National University, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Brain and Cognitive Sciences, World Class University Program, College of Natural Sciences, Seoul National University, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae Young Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sohee Park
- Department of Psychology, Vanderbilt University, Nashville, TN 37240, USA; Department of Psychiatry, Vanderbilt University, Nashville, TN 37240, USA.
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