Symptomatic Remission and Counterfactual Reasoning in Schizophrenia

Abstract

Counterfactual thinking (CFT) is a type of conditional reasoning involving mental representations of alternatives to past factual events that previous preliminary research has suggested to be impaired in schizophrenia. However, despite the potential impact of these deficits on the functional outcome of these patients, studies examining the role of CFT in this disorder are still few in number. The present study aimed to extent previous results by evaluating CFT in the largest sample to date of schizophrenia patients in symptomatic remission and healthy controls. The relationship with symptomatology, illness duration, and sociodemographic characteristics was also explored.Methods: Seventy-eight schizophrenia patients and 84 healthy controls completed a series of tests that examined the generation of counterfactual thoughts, the influence of the “causal order effect,” and the ability to counterfactually derive inferences by using de Counterfactual Inference Test.Results: Compared with controls, patients generated fewer counterfactual thoughts when faced with a simulated scenario. This deficit was negatively related to scores on all dimensions of the Positive and Negative Syndrome Scale-PANNS, as well as to longer illness duration. The results also showed that schizophrenia patients deviated significantly from the normative pattern when generating inferences from CFT.Conclusions: These findings reveal CFT impairment to be present in schizophrenia even when patients are in symptomatic remission. However, symptomatology and illness duration may have a negative influence on these patients' ability to generate counterfactual thoughts. The results might support the relevance of targeting CFT in future treatment approaches, although further research is needed to better describe the relationship between CFT and both symptomatology and functional outcome.

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

“…The relatively small size of the group, the use of only a survey and self-reported scale for data collection, cross-sectional study design so could not determinate the effects of abuse processes on CFT (e.g., processes related to early years of marriage or later years) are the important limitations of the study. In addition, it should be noted that the total score of 2.5/4 found in non-victims is not consistent with the normative pattern proposed by Hooker et al and is consistent with the low CIT scores in the healthy group of Albacete et al's study 14,24 . On the other hand, we demonstrated that IPV exposure is also severe in women at the high socioeconomic level and is associated with the decrease in CFT ability, which is a sign of cortical-subcortical functions.…”

“…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.…”

Counterfactual thinking in psychiatric and neurological diseases: A scoping review

“…Twelve studies (41%) probed the generation of counterfactual thoughts related to a negative real-life [ 14 – 16 , 22 – 27 ] or a fictional event [ 9 , 23 , 25 , 28 , 29 ]. Ten studies (34%) administered the Counterfactual Inference Test (CIT) [ 22 ] to investigate the ability to use CFT to make causal inferences in fictional social scenarios [ 12 , 14 – 16 , 22 , 24 , 28 – 31 ]. Six works (21%) used the Counterfactual Thinking for Negative Events Scale [ 32 , 33 ] or similar questionnaires [ 34 – 37 ] investigating the content (e.g., upward/downward) and the affective aspects of CFT.…”

“…Individuals who implement an effective CFT are expected to behave anticipating future regret. Finally, two studies (7%) probed the “causal order effect” [ 41 ], meaning the tendency to choose the first event of a sequence as the most decisive for the final negative outcome [ 9 , 28 ]. Finally, two studies (7%) investigated the influence of CFT on the automatic activation of behavioral intentions using the sequential priming paradigm [ 10 , 30 ].…”

Patients with schizophrenia activate behavioural intentions facilitated by counterfactual reasoning

“…Interestingly, the implementation of corrective behaviours (Step 3) appears to be intact in these patients [ 23 ]. With regard to these findings, however, it should be noted that although deficits in CFT activation (Step 1) have been widely reported not only in patients with schizophrenia [ 24 – 26 ] but in their unaffected first-degree relatives [ 27 ], research into the activation of behavioural intentions (Step 2) is still scarce [ 28 ].…”