Benjamin Buck

The Social Cognition Psychometric Evaluation Study: Results of the Expert Survey and RAND Panel

BACKGROUND In schizophrenia, social cognition is strongly linked to functional outcome and is increasingly seen as a viable treatment target. The goal of the Social Cognition Psychometric Evaluation (SCOPE) study is to identify and improve the best existing measures of social cognition so they can be suitably applied in large-scale treatment studies. Initial phases of this project sought to (1) develop consensus on critical domains of social cognition and (2) identify the best existing measures of social cognition for use in treatment studies. METHODS Experts in social cognition were invited to nominate key domains of social cognition and the best measures of those domains. Nominations for measures were reduced according to set criteria, and all available psychometric information about these measures was summarized and provided to RAND panelists. Panelists rated the quality of each measure on multiple criteria, and diverging ratings were discussed at the in-person meeting to obtain consensus. RESULTS Expert surveys identified 4 core domains of social cognition-emotion processing, social perception, theory of mind/mental state attribution, and attributional style/bias. Using RAND panel consensus ratings, the following measures were selected for further evaluation: Ambiguous Intentions Hostility Questionnaire, Bell Lysaker Emotion Recognition Task, Penn Emotion Recognition Test, Relationships Across Domains, Reading the Mind in the Eyes Test, The Awareness of Social Inferences Test, Hinting Task, and Trustworthiness Task. DISCUSSION While it was possible to establish consensus, only a limited amount of psychometric information is currently available for the candidate measures, which underscores the need for well-validated and standardized measures in this area.

Metacognition and social function in schizophrenia: Associations over a period of five months

Introduction. Deficits in the ability to think about thinking have been widely observed in persons with schizophrenia and linked with concurrent assessments of various forms of function. Less is known though about their links to outcome over time. To address this issue, the current study explores whether Mastery, a domain of metacognition that reflects the ability to use knowledge about ones own mental states and those of others to respond to psychological challenges, is related to the frequency of social contact and persons’ capacity for social relatedness. Methods. Participants were 72 adults with schizophrenia spectrum disorders enrolled in vocational rehabilitation; these patients completed a baseline assessment as well as a follow-up assessment 5 months later. Mastery was assessed using the Metacognitive Assessment Scale and social functioning by the Quality of Life Scale. Results. Using structural equation modelling, the proposed model demonstrated acceptable fit even when a range of possible confounding variables were entered as covariates. Conclusions. Results are consistent with the possibility that certain forms of metacognition affect social function among persons with schizophrenia, both concurrently and over time.

Challenges to assisting with the recovery of personal identity and wellness for persons with serious mental illness: Considerations for mental health professionals

With the expectation that many can recover from schizophrenia, the implications for the roles of practitioners to assist them are critical. Although much has been written about how to empower a recovering person to develop a more positive identity, an important area which seems relatively underdeveloped in the literature pertains to the challenges and suffering borne from the process of recovery itself. The current paper will suggest that there are four related, though independent, challenges associated with the recovery process that practitioners should be prepared to address: (1) the discomfort elicited by the loss of, or threats to, a previous sense of identity, (2) the loss of previous ways of making meaning of the world, (3) awareness of concrete losses in one’s life which have occurred, and (4) accepting oneself as an ordinary, though agentic, person. For each we will review experimental, clinical, and first-person literature and refer to an illustrative vignette. Through recognition of these potentially painful challenges, practitioners may be even more effective in supporting recovery.

Consummatory and anticipatory anhedonia in schizophrenia: Stability, and associations with emotional distress and social function over six months

Recent work has suggested that anhedonia in schizophrenia can be understood as involving two separate constructs: deficits in anticipatory and consummatory pleasure. Little is known about the relative stability of these different constructs and their links with clinical features and social function over time. To examine these questions, 51 participants with a diagnosis of schizophrenia or schizoaffective disorder in a non-acute phase of illness were administered the Temporal Experience of Pleasure Scale, the Positive and Negative Syndrome Scale, and Quality of Life Scale at two time points six months apart. Results revealed that baseline scores of both anticipatory and consummatory pleasure were significantly correlated with follow-up scores six months later, suggesting each construct is stable in the short term. The association of anticipatory pleasure at baseline and six months was significantly higher than the relationship between consummatory pleasure at baseline and at six months. Anticipatory pleasure predicted concurrent and prospective levels of positive symptoms, emotional discomfort, and interpersonal function, but not emotion recognition. Consummatory pleasure predicted only concurrent positive symptoms. The link of baseline anticipatory pleasure with emotional discomfort at six months persisted even after controlling for baseline emotional discomfort. Implications for the measurement and conceptualization of anhedonia in schizophrenia are discussed.

Metacognitively Focused Psychotherapy for People with Schizophrenia: Eight Core Elements That Define Practice

Across the history of psychotherapy for schizophrenia, multiple approaches have been proposed that might assist people with this condition to recover. In light of emerging literature on the how deficits in metacognition may represent profound barriers to recovery, this chapter will explore an integrative model of psychotherapy centered around the possibility that a key to facilitating recovery may involve assisting patients to recapture metacognitive capacity. Specifically, we explore eight overarching elements from a range of different theoretical perspectives and discuss how they may guide psychotherapy to assist patients to develop more complex representations of themselves and others. A method for assessing adherence to these elements is offered.

Social cognition in schizophrenia: factor structure, clinical and functional correlates

Abstract Background: Social cognition is consistently impaired in people with schizophrenia, separable from general neurocognition, predictive of real-world functioning and amenable to psychosocial treatment. Few studies have empirically examined its underlying factor structure. Aims: This study (1) examines the factor structure of social cognition in both a sample of individuals with schizophrenia-spectrum disorders and non-clinical controls and (2) explores relationships of factors to neurocognition, symptoms and functioning. Method: A factor analysis was conducted on social cognition measures in a sample of 65 individuals with schizophrenia or schizoaffective disorder, and 50 control participants. The resulting factors were examined for their relationships to symptoms and functioning. Results: Results suggested a two-factor structure in the schizophrenia sample (social cognition skill and hostile attributional style) and a three-factor structure in the non-clinical sample (hostile attributional style, higher-level inferential processing and lower-level cue detection). In the schizophrenia sample, the social cognition skill factor was significantly related to negative symptoms and social functioning, whereas hostile attributional style predicted positive and general psychopathology symptoms. Conclusions: The factor structure of social cognition in schizophrenia separates hostile attributional style and social cognition skill, and each show differential relationships to relevant clinical variables in schizophrenia.

How is the Beads Task related to intolerance of uncertainty in anxiety disorders

Intolerance of uncertainty (IU) is a cognitive bias associated with anxiety disorders that has only been reliably measured using self-report instruments. The current study investigated relationships between a probabilistic inference task - the Beads Task - and self-report IU. Individuals with anxiety disorders (ANX) and non-anxious controls (NAC) completed self-report measures as well as the Beads Task at three levels of difficulty. The Beads Task successfully induced task-related uncertainty as the decision became more difficult. While the two groups did not differ on the observable performance related measures, the ANX group was significantly more distressed during the task than were the NACs. Moreover, among the ANX group, self-reported IU was correlated with draws to decision and distress during the task. The Beads Task appears to provoke distress associated with uncertainty for anxious individuals, rather than altering their behavioral responses; thus, clinical implications and avenues for future research are discussed.

Lexical analysis in schizophrenia: How emotion and social word use informs our understanding of clinical presentation

BACKGROUND The words people use convey important information about internal states, feelings, and views of the world around them. Lexical analysis is a fast, reliable method of assessing word use that has shown promise for linking speech content, particularly in emotion and social categories, with psychopathological symptoms. However, few studies have utilized lexical analysis instruments to assess speech in schizophrenia. In this exploratory study, we investigated whether positive emotion, negative emotion, and social word use was associated with schizophrenia symptoms, metacognition, and general functioning in a schizophrenia cohort. METHODS Forty-six participants generated speech during a semi-structured interview, and word use categories were assessed using a validated lexical analysis measure. Trained research staff completed symptom, metacognition, and functioning ratings using semi-structured interviews. RESULTS Word use categories significantly predicted all variables of interest, accounting for 28% of the variance in symptoms and 16% of the variance in metacognition and general functioning. Anger words, a subcategory of negative emotion, significantly predicted greater symptoms and lower functioning. Social words significantly predicted greater metacognition. CONCLUSIONS These findings indicate that lexical analysis instruments have the potential to play a vital role in psychosocial assessments of schizophrenia. Future research should replicate these findings and examine the relationship between word use and additional clinical variables across the schizophrenia-spectrum.

Social cognition in schizophrenia: Factor structure of emotion processing and theory of mind

Factor analytic studies examining social cognition in schizophrenia have yielded inconsistent results most likely due to the varying number and quality of measures. With the recent conclusion of Phase 3 of the Social Cognition Psychometric Evaluation (SCOPE) Study, the most psychometrically sound measures of social cognition have been identified. Therefore, the aims of the present study were to: 1) examine the factor structure of social cognition in schizophrenia through the utilization of psychometrically sound measures, 2) examine the stability of the factor structure across two study visits, 3) compare the factor structure of social cognition in schizophrenia to that in healthy controls, and 4) examine the relationship between the factors and relevant outcome measures including social functioning and symptoms. Results supported a one-factor model for the patient and healthy control samples at both visits. This single factor was significantly associated with negative symptoms in the schizophrenia sample and with social functioning in both groups at both study visits.

Schizophrenia and alterations in the experience of self and agency: Comparisons of dialogical and phenomenological views

Contemporary researchers have tended to present dysfunction in schizophrenia as the result of biological and social forces. While this has greatly advanced our knowledge, we are still without a full account of the illness’s first-person dimensions. A richer first-person account explains that schizophrenia is a disorder that interrupts the lives of people who must continue to struggle to find and create security and meaning. A range of literature has explored in many directions how schizophrenia is linked to profound changes in self-experience; however, there have not been systematic explorations of the ways in which these views converge and diverge. In response we will explore two different models of the processes which underlie a particular self-experience linked with schizophrenia: experiences of diminished agency. We will present a dialogical model of disturbances in agency and then compare and contrast it with another prominent philosophically based model, one from phenomenology.