Theory of mind in schizophrenia: Error types and associations with symptoms

Fretland, Ragnhild Avdem; Andersson, Stein; Sundet, Kjetil; Andreassen, Ole A.; Melle, Ingrid; Vaskinn, Anja

doi:10.1016/j.schres.2015.01.024

Cited by 86 publications

(102 citation statements)

References 48 publications

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“…We acknowledge, however, that they can apply to non-social situations (lack of motivation for enjoyed solitary activities). Also, some studies, including our own, find some overlap between neurocognitive and social cognitive measures (Woodward et al, 2009;Fretland et al, 2015) indicating that they are not completely unrelated, although separate, constructs. These are limitations of our study that should be overcome in later efforts to investigate these associations.…”

Section: Discussionmentioning

confidence: 70%

A social path to functioning in schizophrenia: From social self-efficacy through negative symptoms to social functional capacity

Vaskinn¹,

Ventura²,

Andreassen³

et al. 2015

Psychiatry Research

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Section: Discussionmentioning

confidence: 70%

A social path to functioning in schizophrenia: From social self-efficacy through negative symptoms to social functional capacity

Vaskinn¹,

Ventura²,

Andreassen³

et al. 2015

Psychiatry Research

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“…Contrarily, attributing overly complex mental states to others (Montag et al, 2011; Fretland et al, 2015), or overmentalizing, has been connected to positive symptoms of schizophrenia. Suspiciousness and delusions of persecution were found to be significant predictors of poor social functioning, and poor ToM performance (Hinting Test, Corcoran et al, 1995, Visual Cartoon Test, Corcoran et al, 1997) also plays a role in this relationship (Sullivan et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Cognitive Correlates of Different Mentalizing Abilities in Individuals with High and Low Trait Schizotypy: Findings from an Extreme-Group Design

et al. 2017

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Mentalizing or Theory of Mind (ToM) deficits in schizophrenia have been studied to great extent, but studies involving samples of trait schizotypy yield ambiguous results. Executive functions like cognitive inhibition, cognitive flexibility, and agency are all prerequisites of mentalizing, and it is assumed that the impairment of these functions contributes to ToM deficits in schizophrenia. Whether these impairments influence the ToM performance of people with high trait schizotypy remains unclear. Although impaired self-agency has repeatedly been identified in people with schizotypy, its role in mentalizing is yet to be investigated. The main aim of this study was to explore whether deficits in cognitive and affective ToM can be found in high trait schizotypy, and to identify in what way these deficits are related to the positive and negative dimensions of schizotypy. The secondary aim was to examine whether these deficits correlate with executive functions. Based on the dimensional view of the schizophrenia spectrum, an extreme-group design was applied to non-clinical volunteers demonstrating high (N = 39) and low (N = 47) trait schizotypy. Affective and cognitive ToM were investigated using the Movie for Assessment of Social Cognition, a sensitive and video-based measurement. Cognitive inhibition was assessed using the Stroop Test, and cognitive flexibility was analyzed using the Trail-Making Test. Agency was measured using a computerized self-agency paradigm. Participants in the high-schizotypy group performed significantly worse in the affective ToM task (d = 0.79), and their overall ToM performance was significantly impaired (d = 0.60). No between-group differences were found with regards to cognitive ToM, executive functions, and self-agency. Cognitive flexibility correlated negatively with positive schizotypy, and contributed to a worse overall and affective ToM. Impaired cognitive inhibition contributed to undermentalizing-type errors. It was found that non-clinical participants with high trait (positive) schizotypy – especially those with slight executive-function deficits – may have difficulties in understanding the emotional state of others and consequently in functioning in social situations.

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“…An additional limitation of current ToM paradigms is the fact that they often measure ToM in a wright-orwrong format and thus investigate solely reduced ToM abilities/undermentalizing in patients with psychosis, whereas Abu-Akel [60,61] suggested that patients with delusion rather present problems in overmentalizing / "hypermentalizing" mental states of other persons, defined as Hyper-ToM [58,62]. First studies addressed the question of associations between Hyper-ToM and delusions in children with psychotic experiences and normal controls [63,64] and patients with psychosis [58] and found evidence of an association.…”

Section: Discussionmentioning

confidence: 99%

Theory of mind, emotion recognition, delusions and the quality of the therapeutic relationship in patients with psychosis – a secondary analysis of a randomized-controlled therapy trial

et al. 2020

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Background: Cognitive models of psychosis postulate an important role of Theory of mind (ToM) in the formation and maintenance of delusions, but research on this plausible conjecture has gathered conflicting findings. In addition, it is still an open question whether problems in emotion recognition (ER) are associated with delusions. We examined the association of problems in ToM and ER with different aspects of delusions in a large sample of patients with psychosis enrolled in a therapy trial. This also enabled us to explore the possible impact of ToM and ER on one part of patients' social life: the quality of their therapeutic relationship. Methods: Patients with psychotic disorders and delusions and/or hallucinations (n = 185) and healthy controls (n = 48) completed a ToM picture sequencing task and an ER task. Subsequently, patients were enrolled in a randomized-controlled Cognitive Behavior Therapy (CBT) trial (ISRCTN29242879). Patients and therapists rated the quality of the therapeutic relationship during the first five sessions of therapy.Results: In comparison to controls, patients were impaired in both ToM and ER. Patients with deficits in ER experienced more severe delusional distress, whereas ToM problems were not related to delusions. In addition, deficits in ER predicted a less favorable therapeutic relationship and interactional problems viewed by the therapist. Impaired ER also moderated (increased) the negative influence of delusions on the therapeutic relationship and interactional difficulties viewed by the therapist. Conclusions: Cognitive models on the formation and maintenance of delusions should consider ER as a potential candidate that might be related to the formation and maintenance of delusional distress, whereas problems in ToM might not be directly related to delusions and secondary dimensions of delusions. In addition, problems in ER in patients with psychosis might have an impact on the quality of the therapeutic relationship and patients with problems in ER are more likely to be viewed as problematic by their therapists. Nevertheless, training ER might be a way to improve the quality of the therapeutic relationship and potentially the effectiveness of CBT or other interventions for patients with psychosis.

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Theory of mind in schizophrenia: Error types and associations with symptoms

Cited by 86 publications

References 48 publications

A social path to functioning in schizophrenia: From social self-efficacy through negative symptoms to social functional capacity

A social path to functioning in schizophrenia: From social self-efficacy through negative symptoms to social functional capacity

Cognitive Correlates of Different Mentalizing Abilities in Individuals with High and Low Trait Schizotypy: Findings from an Extreme-Group Design

Theory of mind, emotion recognition, delusions and the quality of the therapeutic relationship in patients with psychosis – a secondary analysis of a randomized-controlled therapy trial

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