Counterfactual Reasoning Deficits in Schizophrenia Patients

Abstract

BackgroundCounterfactual thinking is a specific type of conditional reasoning that enables the generation of mental simulations of alternatives to past factual events. Although it has been broadly studied in the general population, research on schizophrenia is still scarce. The aim of the current study was to further examine counterfactual reasoning in this illness.MethodsForty schizophrenia patients and 40 controls completed a series of tests that assessed the influence of the “causal order effect” on counterfactual thinking, and the ability to generate counterfactual thoughts and counterfactually derive inferences from a hypothetical situation. Socio-demographic and clinical characteristics, as well as neurocognitive variables, were also examined.ResultsCompared to controls, the schizophrenia patients generated fewer counterfactual thoughts when faced with a simulated scenario. The pattern of response when assessing the causality effect of the order was also different between the groups, with the patients being more frequently unable to attribute any ordering of events than the control subjects. Additionally, the schizophrenia patients showed more difficulties when deriving normative counterfactual inferences from hypothetical social situations. None of the counterfactual reasoning measures was associated to any of the cognitive functions or clinical and socio-demographic variables assessed.ConclusionsA global impairment in counterfactual thinking characterizes schizophrenia patients. Because of the potential impact of such deficits on psychosocial functioning, targeting counterfactual reasoning for improvement might be considered in future treatment approaches.

Symptomatic Remission and Counterfactual Reasoning in Schizophrenia

“…Consistent with previous results reported by our group (Contreras et al, 2016), this tendency to disregard the negative outcome of a social event might be related to negative symptomatology such as blunted affect or emotional withdrawal. This diminished reaction might also be associated with poor psychosocial and vocational functioning among these patients.…”

“…Moreover, and as observed in the general population (Wells et al, 1987), both groups tend to choose the first event as being the most determinant. Contradicting previous findings in a smaller sample of schizophrenia patients who did not meet criteria for symptomatic remission (Contreras et al, 2016), the present results might be cause for optimism since they indicate a normative pattern of causality attribution in schizophrenia.…”

“…However, it should be noted that the total score of 2/4 found in healthy controls is not consistent with the normative pattern (i.e., a total score of 4/4) originally proposed by Hooker et al (2000). In fact, previous studies by our group also failed to observe a score of 4/4 among controls, with these subjects tending to score 2 or 3 instead (Albacete et al, 2016b; Contreras et al, 2016). Thus, given that the pattern of response differs significantly between studies not only on total score but also for each scenario, further research is required to elucidate the role of CFT in the generation of cognitive inferences.…”

“…As a result of these studies, a general counterfactual reasoning disruption has been described in schizophrenia, including deficits in these patients' ability to generate counterfactual thoughts, in their causality attributing pattern, and in their ability to make counterfactual-derived inferences (Hooker et al, 2000; Contreras et al, 2016). In addition, and alongside other non-social (Sitskoorn et al, 2004; Snitz et al, 2006) and social (Lavoie et al, 2013; Albacete et al, 2016a) cognitive deficits that are shared by first-degree relatives of psychotic patients, difficulties in the generation of counterfactual thoughts have also been observed among non-psychotic first-degree relatives of people with schizophrenia (Albacete et al, 2016b), suggesting that CFT impairment might be a promising candidate cognitive endophenotype for this disorder.…”

How women with intimate partner violence (IPV) reason about other's intentions: effect of IPV on counterfactual inferences among healthy high socioeconomic level women from Turkey

“…Counterfactual inference is a part of CFT. There are many studies that had been linked counterfactual thinking problems and defects in counterfactual inference ability with psychopathologies including depression [10][11][12][13] , schizophrenia 14,15 , gambling behavior 13,16 , posttraumatic stress disorder-other trauma-related conditions 9,13,17 and obsessive-compulsive disorder 18 , which are also related to corticalsubcortical region dysfunctions. On the other hand, research on the problems which are subclinical but could have an effect on cognition and CFT are still scarce.…”