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ABSTRACT: Background: Metacognition has been described as the knowledge of our own cognitive processes. Metacognitive deficits are common in schizophrenia, but little is known about metacognition before the onset of full-blown psychosis. Aims: This study aimed to longitudinally characterize metacognition in a sample of individuals at clinical high risk (CHR) for psychosis, and to determine if metacognition was related to later conversion to psychosis. Method: Participants (153 CHR individuals; 68 help seeking controls, HSC) were part of the large multi-site PREDICT study, which sought to determine predictors of conversion to psychosis. They were tested at baseline and 6 months using the Meta-Cognitions Questionnaire (MCQ) that has five sub-scales assessing different domains of metacognition. Results: Results of the mixed-effect models demonstrated significantly poorer scores at baseline for the CHR group compared to the HSC group in Negative beliefs about uncontrollability, Negative beliefs and the overall MCQ score. At the 6-month assessment, no difference was observed in metacognition between the two groups, but both groups showed improvement in metacognition over time. Those who later converted to psychosis had poorer performance on metacognitive beliefs at baseline. Conclusions: A poorer performance in metacognition can be seen as a marker of developing a full blown psychotic illness and confirms the potential value of assessing metacognitive beliefs in individuals vulnerable for psychosis.
Behavioural and Cognitive Psychotherapy 03/2013; · 1.69 Impact Factor
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ABSTRACT: Introduction. Persons with nonclinical paranoia show many of the same biases as those with clinical paranoia, suggesting that paranoia exists on a continuum. However, little is known about the various social cognitive processes found in paranoia and how these relate to social functioning and social behaviours in general. This study will examine performance on emotion perception and attributional style measures and their relationship to social functioning, social problem solving, and social skill. A key element in this study will be the incorporation of ambiguity in the perception of emotional expressions and the assignment of attributional blame, which appears to be an important, yet neglected, construct in paranoia. Methods. Twenty-six persons with high levels of nonclinical paranoia and 31 persons with low levels of paranoia completed measures of emotion perception, attributional style, social functioning, and social problem solving. Salient and subtle emotional expressions were used to examine how ambiguity impacts emotion perception in paranoia. Results. The group high in nonclinical paranoia showed reduced accuracy for subtle negative emotional expressions and showed more perceived hostility and blame for ambiguous social situations as compared to the group low in nonclinical paranoia. Also, the high nonclinical paranoia group reported less social engagement, fewer social contacts, and more problems in social perception and social skill than the group low in nonclinical paranoia. Conclusions. Social cognitive and social functioning biases are found in persons with high levels of nonclinical paranoia. Possible mechanisms of these biases and relevance for treatment approaches are discussed.
Cognitive Neuropsychiatry 02/2013;
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ABSTRACT: Objectives: Persons with non-clinical paranoia show many of the same biases as those with
clinical paranoia, suggesting that paranoia exists on a continuum. However, little is known about
the various social cognitive processes found in paranoia and how these relate to social
functioning and social behaviors in general. This study will examine performance on emotion
perception and attributional style measures and their relationship to social functioning, social
problem solving, and social skill. A key element in this study will be the incorporation of
ambiguity in the perception of emotional expressions and the assignment of attributional blame,
which appears to be an important, yet neglected, construct in paranoia.
Methods: Twenty-six persons with high levels of non-clinical paranoia and thirty-one persons
with low levels of paranoia completed measures of emotion perception, attributional style, social
functioning, and social problem-solving. Salient and subtle emotional expressions were used to
examine how ambiguity impacts emotion perception in paranoia.
Results: The group high in non-clinical paranoia showed reduced accuracy for subtle negative
emotional expressions and showed more perceived hostility and blame for ambiguous social
situations as compared to the group low in non-clinical paranoia. Also, the high non-clinical
paranoia group reported less social engagement, fewer social contacts, and more problems in
social perception and social skill than the group low in non-clinical paranoia.
Conclusions: Social cognitive and social functioning biases are found in persons with high
levels of non-clinical paranoia. Possible mechanisms of these biases and relevance for treatment
approaches are discussed.
Cognitive Neuropsychiatry 02/2013; in press.
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ABSTRACT: In this chapter, we provide an overview of social cognition in schizophrenia. Unlike nonsocial cognition (or neurocognition), which has enjoyed a long history of investigation in schizophrenia, social cognition has only recently come to the forefront of interest, motivated in part by two factors. First, there is growing evidence of a neural network--composed of the prefrontal cortex, fusiform gyrus, superior temporal sulcus, and amygdala--specialized for the processing of social information. Second, it is increasingly realized that nonsocial cognition, although significantly associated with social functioning, still cannot explain approximately 40%-80% in functioning (Penn et al. 1997, 2001; Pinkham et al. 2003; Silverstein 1997) and may in fact exert an influence on social functioning via social cognition (Green et al. 2000). There is evidence, from work in clinical populations, for the relative independence of social cognition from other aspects of cognition. In the ensuing sections, we review three major domains of social cognition in schizophrenia: 1) theory of mind, 2) attributional style, and 3) facial affect perception, with particular emphasis on the salient issues relevant to each domain (e.g., whether facial affect perception impairments in schizophrenia are caused by a specific or generalized performance deficit). We conclude the chapter with a discussion of future research directions in this area. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
10/2012;
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ABSTRACT: The purpose of this chapter is to propose methods for reducing stigmatization of mental illness in adolescents. It begins with a brief summary of community attitudes toward persons with mental illness, including a discussion of a recent nationwide survey of young people. We argue that addressing stigma in adolescence is important for two primary reasons. First, stigma appears to have an adverse effect on the course of mental illness once the person has been diagnosed with a disorder. Second, concerns about stigma may delay the seeking of and continuing in treatment. This section is followed by a discussion of factors that contribute to stigma and methods for reducing it. We conclude by recommending strategies for addressing mental illness stigma in adolescents. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
10/2012;
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ABSTRACT: In this study, the paths between 2 prejudicial attitudes (authoritarianism and benevolence) and a proxy measure of behavioral discrimination (social distance) were examined in a sample drawn from the general public. Moreover, the effects of 2 person variables (familiarity with mental illness and ethnicity) on prejudice were examined in the path analysis. 151 research participants (mean age 37.9 yrs) completed measures of prejudice toward, social distance from, and familiarity with mental illness. Goodness-of-fit indexes from path analyses supported the hypotheses: social distance was influenced by both kinds of prejudice: authoritarianism (the belief that persons with mental illness cannot care for themselves, so a paternalistic health system must do so) and benevolence (the belief that persons with mental illness are innocent and childlike). These forms of prejudice, in turn, were influenced by the believers' familiarity with mental illness and their ethnicity. The authors also discuss how these findings might contribute to a fuller understanding of mental illness stigma. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Schizophrenia Bulletin 10/2012; 27(2):219-225. · 8.80 Impact Factor
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ABSTRACT: Individuals with schizophrenia demonstrate stable deficits in affect recognition. Similar deficits in affect recognition have been observed in those who are at clinical high risk (CHR) of developing psychosis. The current project aimed to longitudinally examine affect processing in CHR individuals, to determine if affect processing predicted later conversion to psychosis and if affect processing deficits were unique to those who met established criteria for prodromal syndromes. The sample consisted of 172 CHR and 100 help-seeking individuals (HS) who were followed for up to 24 months. All CHR individuals met the Criteria of Prodromal Syndromes (COPS) based on the Structured Interview for Prodromal Symptoms (SIPS). The SIPS was used to determine conversion to psychosis. Affect recognition was assessed using two facial affect recognition tasks and a measure of affective prosody. In comparison to previously published data from non-psychiatric controls, both CHR and HS groups demonstrated deficits in affect recognition. By 2 years 25 CHR participants converted to psychosis. Interestingly, there were no differences between converters and non-converters on any affect recognition tasks. This is one of the first studies to longitudinally examine affect processing and its relationship to later conversion to psychosis in individuals at-risk for psychosis. While poorer affect recognition may be associated with vulnerability for psychosis, the current results suggest that it may not be a marker of developing a psychotic illness.
Biological Psychiatry 07/2012; 140(1-3):87-92. · 8.28 Impact Factor
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ABSTRACT: The Journal of Positive Psychology: Dedicated to furthering research and promoting good practice Publication details, including instructions for authors and subscription information: (2012): Positive living: A pilot study of group positive psychotherapy for people with schizophrenia, The Journal of Positive Psychology: Dedicated to furthering research and promoting good practice, 7:3, 239-248page/terms-and-conditions This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae, and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand, or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.
The Journal of Positive Psychology 05/2012; 7(3):239-248. · 1.67 Impact Factor
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ABSTRACT: A growing body of research has demonstrated the potential for comprehensive, phase-specific care to improve clinical and functional outcomes in early psychosis. However, there have been no evaluations of such treatment models in the United States (US). This study is a naturalistic, prospective 1-year follow-up of an early psychosis cohort treated in one of the first US-based multi-element treatment centers.
Participants were 163 individuals treated at the Outreach and Support Intervention Services (OASIS) clinic, a multi-element treatment center for early psychosis. Data were collected as part of routine care at 6-month intervals. Primary outcomes included role functioning and involvement in work or school.
Over the course of 1 year of treatment, individuals experienced significant improvements in positive and negative symptoms, role functioning, and global functioning. The proportion of individuals meeting symptom remission and functional remission criteria increased significantly from baseline to 1 year, as did the proportion of individuals attending school. There were also trend-level reductions in substance abuse.
This study provides preliminary support for the efficacy of comprehensive early intervention services in the US.
Social Psychiatry 01/2012; 47(10):1607-15. · 2.05 Impact Factor
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Biological Psychiatry 12/2011; 135(1-3):196-7. · 8.28 Impact Factor
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ABSTRACT: Oxytocin has numerous prosocial and antipsychotic-like effects in animals. Prosocial effects of acute intranasal oxytocin administration have also been reported in human subjects. We conducted a randomized, placebo-controlled trial testing the effects of twice daily intranasal oxytocin treatment for 14 days on psychotic symptoms and social cognition in patients with schizophrenia. PANSS scores declined significantly and several social cognition measures improved significantly or nearly significantly in oxytocin (N=11) but not placebo (N=9) recipients. Our results suggest that, in addition to reducing classic psychotic symptoms, oxytocin may diminish certain social cognition deficits that are not improved by current antipsychotic medications.
Biological Psychiatry 08/2011; 132(1):50-3. · 8.28 Impact Factor
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Biological Psychiatry 05/2011; 128(1-3):177-8. · 8.28 Impact Factor
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ABSTRACT: Deficits in emotion perception are common in people with schizophrenia and current research has focused on improving these deficits. In our previous research, we demonstrated that directing attention to salient facial features via attention shaping can improve these deficits among inpatients. In this study, we examined the efficacy of an enhanced attention shaping program that contains 192 emotional expressions from which 25 are randomly presented for training. We extended our previous work by using repeated administrations of the shaping intervention and testing its effect in outpatients with schizophrenia and impaired controls. Fifteen participants with schizophrenia and fourteen college student controls with emotion perception deficits were randomly assigned to 1, 3 or 5 sessions of attention shaping. Participants completed 2 outcome measures of emotion perception, the FEIT and BLERT, not presented during the training, and underwent eye tracking at pre and post-tests. All conditions and groups improved, but the largest improvements on the BLERT and FEIT were found for persons assigned to the 5 session condition. Performance on the shaping program was positively correlated with the two outcome measures of emotion perception. There was less support for changes in visual scanning of faces as there was a relative reduction in total scanning time from pre-test to post-test. Results are interpreted in terms of the efficacy of attention shaping as a means to improve emotion perception deficits.
Biological Psychiatry 04/2011; 127(1-3):151-6. · 8.28 Impact Factor
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ABSTRACT: This pilot study examined loving-kindness meditation (LKM) with 18 participants with schizophrenia-spectrum disorders and significant negative symptoms. Findings indicate that the intervention was feasible and associated with decreased negative symptoms and increased positive emotions and psychological recovery.
Biological Psychiatry 03/2011; 129(2-3):137-40. · 8.28 Impact Factor
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ABSTRACT: The Graduated Recovery Intervention Program (GRIP) is a new individual cognitive-behavioral therapy program designed to facilitate functional recovery in people who have experienced an initial episode of psychosis. The purposes of this study were to evaluate the feasibility and tolerability of the GRIP intervention, and to compare the effectiveness of GRIP versus treatment as usual (TAU) for improving specific clinical and psychosocial outcomes. Forty-six individuals with first episode psychosis were randomized to GRIP+TAU or TAU alone. Primary outcomes focused on social and role functioning, and quality of life. Secondary outcomes included psychotic symptoms, depression, substance use, social support, attitudes toward medications, well-being, and hospitalizations. The results indicate that GRIP was well-tolerated, as evidenced by good attendance and low drop-out rates, and well-received (based on positive feedback from participants). Although the majority of mixed model analyses were not statistically significant, examination of within-group changes and effect sizes suggests an advantage for GRIP over TAU in improving functional outcomes. These advantages and the fact that the GRIP intervention demonstrated feasibility and tolerability suggest that this intervention is worthy of further investigation.
Biological Psychiatry 02/2011; 125(2-3):247-56. · 8.28 Impact Factor
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ABSTRACT: This study piloted a role play assessment of conversational skills for adolescents and young adults with high-functioning autism/Asperger syndrome (HFA/AS). Participants completed two semi-structured role plays, in which social context was manipulated by changing the confederate's level of interest in the conversation. Participants' social behavior was rated via a behavioral coding system, and performance was compared across contexts and groups. An interaction effect was found for several items, whereby control participants showed significant change across context, while participants with HFA/AS showed little or no change. Total change across contexts was significantly correlated with related social constructs and significantly predicted ASD. The findings are discussed in terms of the potential utility of the CASS in the evaluation of social skill.
Journal of Autism and Childhood Schizophrenia 12/2010; 41(9):1277-86. · 3.06 Impact Factor
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ABSTRACT: Adolescents at genetic high risk (GHR) for schizophrenia have shown social skill impairments and there is some evidence to suggest they have Theory of Mind (ToM) deficits; however no research has used a standardized, performance-based behavioral measure to assess social functioning in this population nor evaluated ToM with a well-validated measure. We evaluated the psychometric properties of a new, theoretically-derived assessment of social functioning in GHR adolescents: the "High-Risk Social Challenge" task (HiSoC). The second aim was to explore whether GHR adolescents would show social skill and ToM deficits as compared to a non-psychiatric control (NPC) group. The present study evaluated social functioning with the HiSoC and ToM with the Eyes Test in 23 GHR adolescents and 31 NPCs. The HiSoC demonstrated high levels of reliability and validity. The GHR adolescents showed social skill impairments, but not ToM deficits. The results suggest that the HiSoC is a potentially useful new measure of social functioning in GHR adolescents. Furthermore, the findings add to the current body of literature that indicates that social skill impairments are related to schizophrenia vulnerability.
Biological Psychiatry 09/2010; 122(1-3):179-84. · 8.28 Impact Factor
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ABSTRACT: Recent scholarship suggests that virtual environments can serve as effective proxies in battling implicit stereotypes. However, existing experimental research has rarely examined the effectiveness of virtual simulations of mental illnesses in inducing empathy to combat stereotypical responses. We report results from a 4-condition, between subjects experiment (N = 112), wherein participants were exposed to either a virtual simulation of schizophrenia, a written empathy-set induction of schizophrenia, a combination of both the simulation and written empathy conditions, or a control condition. The results indicated that the virtual simulation + empathy condition induced greater empathy and more positive perceptions toward people suffering from schizophrenia than the control or written empathy-set condition. Interestingly, the simulation-only condition resulted in the greatest desire for social distance whereas not significantly differing on empathy and attitude measures from either the written empathy or simulation + empathy conditions. We discuss the implications of the findings and recommend directions for future research.
The Journal of nervous and mental disease 06/2010; 198(6):437-43. · 1.77 Impact Factor
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ABSTRACT: Psychological well-being is a subjective component of quality of life (QOL) that has been previously unexplored in individuals recovering from an initial psychotic episode. This study examined predictors of psychological well-being among individuals with first-episode psychosis (FEP) and compared it to a non-clinical college-aged comparison group.
The Scales of Psychological Well-Being (SPWB) Environmental Mastery and Purpose in Life subscales were administered to both clinical (n = 41) and control (n = 39) participants. Clinical participants were also assessed on symptom measures and QOL, and all participants completed a measure of perceived social support. Multiple regression analyses were carried out to determine predictors of well-being in the FEP sample.
SPWB scores were significantly lower for the FEP group in comparison to the control group. Additionally, greater perceived social support and lower levels of depression were found to be significant predictors of psychological well-being in the clinical sample, whereas gender and negative symptoms were not significant predictors.
These results suggest that the development of a psychotic episode is associated with decreased subjective well-being, and that depression and social support may play an important role in this aspect of an individual's recovery. Additionally, the SPWB appear to be tapping into an important construct that has been relatively unexamined in first-episode research and may have potential utility in clinical practice and future treatment development.
Early Intervention in Psychiatry 05/2010; 4(2):174-81. · 0.92 Impact Factor
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ABSTRACT: This review integrates Fredrickson's broaden-and-build theory of positive emotions with advances in affective neuroscience regarding plasticity in the neural circuitry of emotions to inform the treatment of emotion deficits within psychopathology. We first present a body of research showing that positive emotions broaden cognition and behavioral repertoires, and in so doing, build durable biopsychosocial resources that support coping and flourishing mental health. Next, by explicating the processes through which momentary experiences of emotions may accrue into self-perpetuating emotional systems, the current review proposes an underlying architecture of state-trait interactions that engenders lasting affective dispositions. This theoretical framework is then used to elucidate the cognitive-emotional mechanisms underpinning three disorders of affect regulation: depression, anxiety, and schizophrenia. In turn, two mind training interventions, mindfulness and loving-kindness meditation, are highlighted as means of generating positive emotions that may counter the negative affective processes implicated in these disorders. We conclude with the proposition that positive emotions may exert a countervailing force on the dysphoric, fearful, or anhedonic states characteristic of psychopathologies typified by emotional dysfunctions.
Clinical psychology review 03/2010; 30(7):849-64. · 4.90 Impact Factor
