Impairments of spontaneous and deliberative mentalizing co‐occur, yet dissociate, in schizophrenia

Abstract

Findings People with schizophrenia were less likely than controls to spontaneously attribute causal mental states when viewing dynamic signals of emotionally driven and goal-driven behaviours. These impairments were even more pronounced when participants were instructed to think of the stimuli as people, suggesting that perceiving others in social roles does not prompt people with schizophrenia to anthropomorphize about others as agents motivated by their own inner worlds. Impairments of spontaneous mentalizing were found to co-occur independently with explicit mentalizing deficits in schizophrenia, consistent with the claim that humans can access two distinct systems for understanding others' minds. Findings suggest that interventions to improve conscious deliberative mentalizing in schizophrenia may not be enough; we also need to target implicit mentalizing processes. Limitations The patient sample was chronic and only mildly symptomatic. As such, findings cannot be generalized to other stages and phases of the illness. All patients were also medicated, allowing for the possibility that automatic responses to socially salient stimuli may have been pharmacologically attenuated. Future research may examine whether unmedicated young people at ultra-high risk of psychosis show a similar profile of mentalizing impairment. Future work may also examine whether impairments of deliberative and spontaneous mentalizing associate differentially with social functioning and different cognitive domains in schizophrenia.

The Importance of Social Cognition in Improving Functional Outcomes in Schizophrenia

“…Individuals with first-episode psychosis and chronic schizophrenia have been shown to have impaired ToM ability, compared with healthy controls and first-degree relatives [ 63 – 66 ]. Moreover, symptoms of schizophrenia have been shown to predict worse ToM ability [ 63 ], and impaired ToM ability has been shown to predict worse social and global functioning [ 63 , 65 ], and to correlate with negative symptoms [ 65 ].…”

Persons With Schizophrenia Misread Hemingway: A New Approach to Study Theory of Mind in Schizophrenia

“…Other investigations-which used animated geometric forms stimuli-found deficient spontaneous ToM skills characterized with incorrect social inferences in schizophrenia (8,10,11,23). Other studies with animated geometric forms reported fewer patient generated mental-state terms (7,24,25). The reduced unprompted mention of mental states reflected a relative insensitivity to salience of mental state information.…”

“…The implicit ToM is present in the early life, possibly from birth (5,6). Explicit ToM, in contrast, is relatively slow, relying on verbal processing, more controlled and conscious, deliberative, and inferential (4,7). Compared to implicit ToM, explicit ToM develops later, and closely tied to language acquisition and executive function development (5).…”

“…It can be conceived as a lower level and early phase ToM processing with an emphasis on mental state decoding (4). Usually the spontaneous ToM activity is tested with animated geometric forms stimuli, and measured by multiple choice questions (8,10,11), or with question not directly asking the subject to reflect upon mental states (7). These types of ToM tasks are also used as indirect measures of verbal mental state attribution indexed by the spontaneous use of mental-state language (7) (e.g.…”

“…feels, thinks, wonders, furious, anxious, etc.) in tasks when the participants are not cued (unlike in explicit ToM tasks), and responses are spontaneous (1,7).…”