T241. Interpersonal Cognitive Rigidity Affects Social Functioning in Psychosis More Than Theory of Mind: A Study With the Repertory Grid Technique

Abstract

BackgroundSocial functioning impairment is one of the core features for schizophrenia diagnosis and are also present in other psychotic spectrum disorders, being determinant for disability. This impairment has multiple domains, which are linked but separate. Previous research has shown that social functioning is multiply determined by neurocognition, social cognition and symptoms, being social cognition the domain that accounts for more of the variance in daily functioning. However, cognitive rigidity in interpersonal perception has received less attention and much variance remains unexplained. The aim of this study was to test the role of interpersonal cognitive rigidity, as measured with the Repertory Grid Technique (RGT) in social functioning in psychosis.MethodsSample of 40 out-patients with a psychotic spectrum diagnosis from the network of mental health services of Parc Sanitari Sant Joan de Déu (Barcelona, Spain). Cross-sectional study, assessment was carried out by a predoctoral researcher (GMH), using a sociodemographic questionnaire, the Social Functioning Scale (SFS), the Hinting Task (Theory of Mind, ToM), the Beck Cognitive Insight Scale (BCIS), and the RGT (to measure interpersonal cognitive rigidity, two indices were selected: Percentage of Variance Accounted for the First Factor, PVAFF, and Polarization). Pearson correlations and multiple regression analysis were performed.ResultsResults showed that social engagement/withdrawal was explained by PVAFF, accounting for 16% of the variance. Independence-competence was explained by polarization, explaining 14.6% of the variance and by sex, which accounted for 11.1% of the variance. Independence-performance was explained by theory of mind, explaining 22.5% of variance. Employment/occupation was explained by years of illness accounting for 21.6% of variance, and by polarization (beta=-0.318, p=0.026) which explained 10% of variance. Finally, the total score of the SFS was explained by polarization, explaining 14.4% of variance, and sex, which accounted for 12.6% of variance. For prosocial activities and interpersonal communication, none of the variables entered for the linear regression analysis.DiscussionDespite ToM and cognitive insight are common variables reported in the research literature, in our study the cognitive rigidity measures of the RGT, based on the patients’ own terms (personal constructs) in rating their significant others, were better predictors of social functioning. These findings support the importance and utility of an idiographic instrument like the RGT to investigate cognitive processes related to social perception and their impact on functioning. Regarding PVAFF, a higher tendency to perceive the interpersonal world from a unidimensional manner predicted a worse outcome in social relationships/withdrawal. Regarding interpersonal polarized thinking, it was the best cognitive predictor of social functioning measures. Our results suggest that a dichotomous thinking style in interpersonal perception might also be relevant for...

Placing Cognitive Rigidity in Interpersonal Context in Psychosis: Relationship With Low Cognitive Reserve and High Self-Certainty

“…People with psychosis exhibit high dichotomous interpersonal thinking as compared with controls (20)(21)(22). This is relevant because high levels of it have been linked to more severity of positive symptoms (23), to more psychopathology in general (20), and to lower social functioning (24).…”

Exploring identity and personal meanings in psychosis using the repertory grid technique: A systematic review

“…Three studies explored interpersonal differentiation, but with inconsistent results, as one study found that patients with psychosis had lower differentiation compared with borderline personality disorder and nonclinical groups (de Bonis et al, ), whereas Martín‐Vázquez () found no differences with a nonclinical group. García‐Mieres et al () found that lower interpersonal differentiation was related to higher social withdrawal.…”

“…Martín‐Vázquez () found that inpatients had higher dichotomous thinking compared with controls, and this was associated with longer hospitalization time and greater symptom severity. García‐Mieres et al () found that higher dichotomous thinking was associated with worse social functioning in outpatients.…”

“…In contrast to intrapersonal differentiation, the indices related to rigidity in interpersonal domains, dichotomous thinking, and cognitive differentiation were less studied and led to more inconsistencies. People with psychosis tended to have higher levels of dichotomous thinking, which was associated with increased disorder severity (Martín‐Vázquez, ) or worse social functioning (García‐Mieres et al, ). In addition, Martín‐Vázquez () found no differences in interpersonal cognitive differentiation between people with psychosis and controls, in contrast to de Bonis et al () and Manojlović and Nikolić‐Popović (), who reported that it was lower in people with psychosis than in controls.…”

“…Most studies used cross‐sectional designs, and only four included at least one control group (de Bonis et al, ; Manojlović & Nikolić‐Popović, ; Martín‐Vázquez, ), making it difficult to disentangle cause and effect. Similarly, few studies reported associations with clinical variables of interest, such as symptoms (Martín‐Vázquez, ), personal recovery (Buckley‐Walker et al, ; Chadwick, ), coping style (Marshall, ), or social functioning (García‐Mieres et al, ). Consequently, longitudinal studies that focus on the evolution and influence of identity and personal meanings would help to clarify their role within psychotic disorders.…”