Effort awareness and sense of volition in schizophrenia

The impact of the degree of action voluntariness on sense of agency in saccades

Experiencing a sense of agency (SoA), the feeling of being in control over one's actions and their outcomes, typically requires intentional and voluntary actions. Prior research has compared the association of voluntary versus completely involuntary actions with the SoA. Here, we leveraged unique characteristics of oculomotor actions to partially manipulate the degree of action voluntariness. Participants performed either highly automatized prosaccades or highly controlled (voluntary) anti-saccades, triggering a gaze-contingent visual action effect. We assessed explicit SoA ratings and temporal action and effect binding as an implicit SoA measure. Anti-saccades were associated with stronger action binding compared to prosaccades, demonstrating a robust association between higher action voluntariness and a stronger implicit sense of action agency. We conclude that our manipulation of action voluntariness may have impacted the implicit phenomenological feeling of bodily agency, but it did not affect the SoA over effect outcomes or explicit agency perception.

Assessment of body Schema distortions in early-onset schizophrenia

Distorted body representations play a major role in the onset and maintenance of Schizophrenia. However, these distortions are difficult to assess because explicit assessments can provoke intense fears about the body and require a good insight. We proposed an implicit motor imagery task to a 14-year-old girl with Early-Onset Schizophrenia. The test consisted of presenting different openings varying in width. For each aperture, the young girl has to say if she could pass through without turning her shoulders. A critical aperture is determined as the first aperture for which she considered she could no longer pass, compared to her shoulders' width. The girl perceived herself as 51 % wider than she was, indicating a significant oversized body schema. The implicit assessments of body schema generate less anxiety and does not require a great level of insight; moreover, those are promising tools for early detection of disease in prodromal phases of Schizophrenia and assistance with differential diagnosis.

Enhancing Agency in Individuals with Depressive Symptoms: The Roles of Effort, Outcome Valence, and Its Underlying Cognitive Mechanisms and Neural Basis

Background

Agency, a sense of control over one's actions and outcomes, is crucial for recovery from depressive symptoms. However, the mechanisms that enhance agency in individuals with depressive symptoms remain poorly understood. This study endeavors to elucidate these fundamental processes.

Materials and Methods

We recruited 52 participants exhibiting depressive symptoms to participate in a novel Judgment of Agency (JoA) task. This task was structured with a 3 (effort: high load, medium load, low load) × 2 (outcome: win, miss) within-subject design to assess the impact of effort and outcome valence on agency. Throughout the task, we utilized functional near-infrared spectroscopy (fNIRS) to explore the neural mechanisms underlying agency. Furthermore, we conducted a randomized, sham-controlled, pre-post-test trial involving intermittent theta-burst stimulation (iTBS) targeted at the left dorsolateral prefrontal cortex (DLPFC) to investigate its potential to enhance agency. Participants were randomly allocated to either an active iTBS group or a sham group, with each receiving a single session of stimulation (600 pulses). The JoA task was conducted both before and after the stimulation.

Results

Effort significantly influenced agency in individuals with depressive symptoms, with this effect being moderated by the outcomes' valences. Agency was positively correlated with self-efficacy (r = 0.28, P < 0.05) when goals were achieved with effort, and with anxiety severity (r = 0.29, P < 0.05) when goals were not achieved. Additionally, it was associated with the activation of several frontal brain regions (all P values < 0.01), including the left DLPFC, right premotor and supplementary motor areas, and the left inferior frontal gyrus (IFG). Application of iTBS over the left DLPFC significantly enhanced self-attributed agency, particularly when the outcomes were achieved under conditions of low-load effort.

Conclusions

Our study highlights the critical role of effort in enhancing agency for individuals with depressive symptoms, with iTBS applied to the left DLPFC showing potential to enhance agency postgoal achievement. Moreover, the activation of the left IFG and the presence of anxiety are associated with maladaptive self-attributed agency, offering potential targets for therapeutic intervention.

Accuracy of Force Generation and Preparatory Prefrontal Oxygenation in Ballistic Hand Power and Precision Grips

It remains unclear whether accurate motor performance and cortical activation differ among grasping forms across several force levels. In the present study, a ballistic target force matching task (20%, 40%, 60%, and 80% of maximum voluntary force) with power grip, side pinch, and pulp pinch was utilized to explore the accuracy of the forces generated as well as the muscular activity of intrinsic and extrinsic hand muscles. By using near-infrared spectroscopy, we also examined bilateral dorsolateral prefrontal cortex (DLPFC) activation during the preparatory phase (initial 10 s) of the task. The accuracy of the power grip and pulp pinch was relatively higher than that of the side pinch, and the electromyographic activity of intrinsic hand muscles exhibited a similar trend for power grip and side pinch, while the opposite muscle recruitment pattern was observed for pulp pinch. The increment of DLPFC oxygenation across force levels differed among grasping forms, with greater activity at relatively higher levels in the power grip and side pinch, and at relatively lower levels in the pulp pinch. Taken together, the differential contribution of the DLPFC may be responsible for force generation depending on different grasping forms and force levels.

Theories of consciousness and psychiatric disorders - A comparative analysis

Disorders of consciousness represent an efficient way to test theories of consciousness' (ToCs) predictions. So far, ToCs have mostly focused on disorders of quantitative awareness such as coma, vegetative state, spatial neglect and hemianopia. Psychiatric disorders, by contrast, have received little attention, leaving their contribution to consciousness research almost unexplored. Therefore, this paper aims to assess the relation between ToCs and psychiatric disorders - that is, the extent to which current ToCs can account for psychiatric symptomatology. First, I review direct and indirect evidence linking each ToC to psychiatry disorders. Next, I differentiate ToCs based on their theoretical and methodological ground, highlighting how they distinctively address neural, cognitive, and phenomenological aspects of conscious experience and, in turn, psychiatric symptoms. Finally, I refer to one specific symptom to directly compare ToCs' explanatory power. Overall, Temporospatial Theory of Consciousness (TTC) appears to provide a more comprehensive account of psychiatric disorders, suggesting that a novel dimension of consciousness (i.e., form of consciousness) may be needed to address more qualitative alterations in conscious experience.

The Neurobiology of Pathological Fatigue: New Models, New Questions

The last decade has seen the emergence of new theoretical frameworks to explain pathological fatigue, a much neglected, yet highly significant symptom across a wide range of diseases. While the new models of fatigue provide new hypotheses to test, they also raise a number of questions. The primary purpose of this essay is to examine the predictions of three recently proposed models of fatigue, the overlap and differences between them, and the evidence from diseases that may lend support to the models of fatigue. I also present expansions for the sensory attenuation model of fatigue. Further questions examined here are the following: What are the neural substrates of fatigue? How can sensory attenuation, which underpins agency also explain fatigue? Are fatigue and agency related?

Investigation of motor self-monitoring deficits in schizophrenia with passivity experiences using a novel modified joint position matching paradigm

Numerous studies have identified deficits in the self-monitoring system that are associated with schizophrenia. However, the tasks used in the few previous studies generally involved complex cognitive processes and rarely compared between patients with and without passivity experiences (PE). Here, we examined the deficits in internal motor predictive representation in patients with and without PE, and in healthy controls using a novel paradigm which involved minimal cognitive processes. All participants completed a modified joint position matching (mJPM) task, in which they were required to replicate a voluntary, a passive verbally-cued, and a passive tactile-cued movement under blinded conditions. The absolute difference between the target spot and replicated spot was measured and compared. We hypothesised that if there was a failure in the internal motor predictive representation, patients with PEs would replicate less accurately in the voluntary condition, relative to passive conditions while the healthy controls would be more accurate, and, therefore, significant interactions between groups and conditions would be revealed. Both healthy controls and patients without PEs replicated more accurately in the voluntary condition compared with the passive conditions. The patients with PEs were less accurate in the voluntary condition compared with the passive tactile condition. A significant interaction was observed between patients with vs. without PEs × voluntary vs. passive tactile conditions. The findings suggested the relationship between deficits in motor self-monitoring in the prediction process and PEs, thus showing the need to highlight the link between motor performance and PEs.

Physical load reduces synchrony effects on agency and ownership in the virtual hand illusion

We used the virtual hand illusion paradigm to investigate the effect of physical load on perceived agency and body ownership. Participants pulled a resistance band that required exerting a force of 1 N, 10 N, or 20 N while operating a virtual hand that moved in synchronous or out of sync with their own hand. Explicit agency and ownership ratings were obtained, in addition to intentional binding and skin conductance as implicit measures of agency and ownership. Physical load increased perceived subjective load but showed no main effect, while synchrony effects were found on all agency and ownership measures. Interestingly, load did interact with synchrony in implicit agency and explicit ownership, by reducing and eliminating synchrony effects as movement synchrony was reduced with higher physical load. Furthermore, consistent with previous claims, implicit agency increased with perceived effort associated with higher physical load.

Exploring the relationship between effort perception and poststroke fatigue

OBJECTIVE

To test the hypothesis that poststroke fatigue, a chronic, pathologic fatigue condition, is driven by altered effort perception.

METHODS

Fifty-eight nondepressed, mildly impaired stroke survivors with varying severity of fatigue completed the study. Self-reported fatigue (trait and state), perceived effort (PE; explicit and implicit), and motor performance were measured in a handgrip task. Trait fatigue was measured with the Fatigue Severity Scale-7 and Neurologic Fatigue Index. State fatigue was measured with a visual analog scale (VAS). Length of hold at target force, overshoot above target force, and force variability in handgrip task were measures of motor performance. PE was measured with a VAS (explicit PE) and line length estimation, a novel implicit measure of PE.

RESULTS

Regression analysis showed that 11.6% of variance in trait fatigue was explained by implicit PE (R = 0.34; p = 0.012). Greater fatigue was related to longer length of hold at target force (R = 0.421, p < 0.001). A backward regression showed that length of hold explained explicit PE in the 20% force condition (R = 0.306, p = 0.021) and length of hold and overshoot above target force explained explicit PE in the 40% (R = 0.399, p = 0.014 and 0.004) force condition. In the 60% force condition, greater explicit PE was explained by higher force variability (R = 0.315, p = 0.017). None of the correlations were significant for state fatigue.

CONCLUSION

Trait fatigue, but not state fatigue, correlating with measures of PE and motor performance, may suggest that altered perception may lead to high fatigue mediated by changes in motor performance. This finding furthers our mechanistic understanding of poststroke fatigue.

The effect of cognitive effort on the sense of agency

While we are performing a demanding cognitive task, not only do we have a sense of cognitive effort, we are also subjectively aware that we are initiating, executing and controlling our thoughts and actions (i.e., sense of agency). Previous studies have shown that cognitive effort can be both detrimental and facilitative for the experienced sense of agency. We hypothesized that the reason for these contradictory findings might lie in the use of differential time windows in which cognitive effort operates. The current study therefore examined the effect of cognitive effort exerted on the current trial, on the previous trial or across a block of trials on sense of agency, using implicit (Experiment 1) and explicit (Experiment 2) measures of sense of agency. We showed that the exertion of more cognitive control on current trials led to a higher explicit sense of agency. This surprising result was contrasted to previous studies to establish potential reasons for this surprising finding and to formulate recommendations for future studies.

Influence of preceding muscle activity on perceptually guided force production during superimposed ballistic contraction

Current study attempted to clarify whether preceding muscle activity influences the perceptually guided force production during superimposed ballistic contractions using isometric abduction of index finger. Subjects were verbally asked to produce ballistic force at requested percentages of their MVC with and without preceding muscle activity at 10% and 20%MVC. Our results showed that the ballistic force and EMG activity were increased significantly with preceding muscle activity at 20%MVC, but no change for 10%MVC. These results suggest that preceding muscle activity at sufficient intensity facilitates spinal motoneuron excitability, which could alter the relationship between the produced force and sense of effort.

A Proposal for a Scientifically-Informed and Instrumentalist Account of Free Will and Voluntary Action

The ability to choose freely is captured under the umbrella concept of “free will,” which designates an ability that plays a crucial role in most understandings of autonomy and responsibility and, thus, bears significance for moral practice and moral theory. Some claim that neuroscience research challenges the existence of free will/voluntary action while some who adopt stronger eliminativist stances have gone as far as describing free will as an illusion. Contrary to that, those relying on realist stances have restated the foundational value and role of folk psychological concepts of voluntary action and free will in, for example, the domains of ethics and law. An emerging body of research in cognitive science and social psychology has generated results suggesting that the phenomena captured by the concepts describing free will and voluntary action are dynamic and responsive to priming and framing effects. We propose that this body of research suggests the existence of dynamic and consequential properties of free will better captured following pragmatist theory and instrumentalist epistemology. This contrasts the simpler static concept of free will and the related metaphysics that was at the basis of earlier debates and structured around the poles of realism and eliminativism. This paper contextualizes ontological and epistemological debates about free will, describes a scientifically-informed and instrumentalist account of the concept of free will and voluntary action consistent with recent research in cognitive science, and discusses its implications for research (e.g., theoretical assumptions of research paradigms, interdisciplinary research) and practice (e.g., impact on self-image and social behavior).

Physical and mental effort disrupts the implicit sense of agency

We investigated the effect of effort on implicit agency ascription for actions performed under varying levels of physical effort or cognitive load. People are able to estimate the interval between two events accurately, but they underestimate the interval between their own actions and their outcomes. This effect is known as 'intentional binding', and may provide feedback regarding the consequences of our actions. Concurrently with the interval reproduction task, our participants pulled sports resistance bands at high and low resistance levels (Experiments 1 and 2), or performed a working memory task with high and low set-sizes (Experiment 3). Intentional binding was greater under low than high effort. When the effort was task-related (Experiment 1), this effect depended on the individual's explicit appraisal of exertion, while the effect of effort was evident at the group level when the effort was task-unrelated (physical, Experiment 2; mental, Experiment 3). These findings imply that the process of intentional binding is compromised when cognitive resources are depleted, either through physical or mental strain. We discuss this notion in relation to the integration of direct sensorimotor feedback with signals of agency and other instances of cognitive resource depletion and action control during strain.

Strength of Intentional Effort Enhances the Sense of Agency

Sense of agency (SoA) refers to the feeling of controlling one’s own actions, and the experience of controlling external events with one’s actions. The present study examined the effect of strength of intentional effort on SoA. We manipulated the strength of intentional effort using three types of buttons that differed in the amount of force required to depress them. We used a self-attribution task as an explicit measure of SoA. The results indicate that strength of intentional effort enhanced self-attribution when action-effect congruency was unreliable. We concluded that intentional effort importantly affects the integration of multiple cues affecting explicit judgments of agency when the causal relationship action and effect was unreliable.

Individuals with pronounced schizotypal traits are particularly successful in tickling themselves

We assessed self-tickling sensations in a group of participants high in schizotypal traits (n=27) and group of participants low in schizotypal traits (n=27). The groups were formed by screening a pool of 397 students for extreme scores in the French version of the Schizotypal Personality Questionnaire. As observed in a previous study involving psychiatric people with auditory hallucinations and/or passivity experiences our results showed that self-applied tactile stimulations are felt to be more ticklish by healthy individuals high in schizotypal traits. In contrast, there were no significant intergroup differences in the mean tickle rating in the externally-produced tickling condition. Furthermore, more successful self-tickling was associated with more frequent self-reports of unusual perceptual experiences (such as supernatural experiences) and passivity experiences in particular (such as a feeling of being under the control of an outside force or power).

Feeling of control of an action after supra and subliminal haptic distortions

Here we question the mechanisms underlying the emergence of the feeling of control that can be modulated even when the feeling of being the author of one's own action is intact. With a haptic robot, participants made series of vertical pointing actions on a virtual surface, which was sometimes postponed by a small temporal delay (15 or 65 ms). Subjects then evaluated their subjective feeling of control. Results showed that after temporal distortions, the hand-trajectories were adapted effectively but that the feeling of control decreased significantly. This was observed even in the case of subliminal distortions for which subjects did not consciously detect the presence of a distortion. Our findings suggest that both supraliminal and subliminal temporal distortions that occur within a healthy perceptual-motor system impact the conscious experience of the feeling of control of self-initiated motor actions.

From Theory to PrACTice: A Cognitive Remediation Program Based on a Neuropsychological Model of Schizophrenia

Cognitive dysfunction is one of the hallmark deficits of schizophrenia. A wide range of studies illustrate how it is strongly interconnected to clinical presentation and daily life functioning [see Ref. (1, 2)]. Hence, cognition is an important treatment target in schizophrenia. To address the challenge of cognitive enhancement in schizophrenia, a large number of cognitive remediation programs have been developed and evaluated over the past several decades. First, an overview of these programs is presented highlighting their specificity to cognitive deficit in schizophrenia using an integrated method. In this case, cognitive training focuses on enhancing several elementary cognitive functions considered as a prerequisite to social skills or vocational training modules. These programs are based on the neurodevelopmental hypothesis of schizophrenia. However, moderate improvement for patients who benefit from these therapies has been observed as described in Wykes et al. review (3). Next, neuropsychological models of schizophrenia are then presented. They highlight the critical role of the internally generated intentions in appropriate willful actions. The cognitive control mechanism deals with this ability. Interestingly, available cognitive remediation programs have not been influenced by these models. Hence, we propose another alternative to set up a specific cognitive remediation program for schizophrenia patients by targeting the cognitive control mechanism. We describe the PrACTice program that is in the process of being validated.

Cortical substrates of the effects of caffeine and time-on-task on perception of effort

Caffeine intake results in a decrease in perception of effort, but the cortical substrates of this perceptual effect of caffeine are unknown. The aim of this randomized counterbalanced double-blind crossover study was to investigate the effect of caffeine on the motor-related cortical potential (MRCP) and its relationship with rating of perceived effort (RPE). We also investigated whether MRCP is associated with the increase in RPE occurring over time during submaximal exercise. Twelve healthy female volunteers performed 100 intermittent isometric knee extensions at 61 ± 5% of their maximal torque 1.5 h after either caffeine (6 mg/kg) or placebo ingestion, while RPE, vastus lateralis electromyogram (EMG), and MRCP were recorded. RPE and MRCP amplitude at the vertex during the first contraction epoch (0–1 s) were significantly lower after caffeine ingestion compared with placebo ( P < 0.05) and were significantly higher during the second half of the submaximal intermittent isometric knee-extension protocol compared with the first half ( P < 0.05). No significant effects of caffeine and time-on-task were found for EMG amplitude and submaximal force output variables. The covariation between MRCP and RPE across both caffeine and time-on-task ( r10 = −0.335, P < 0.05) provides evidence in favor of the theory that perception of effort arises from neurocognitive processing of corollary discharges from premotor and motor areas of the cortex. Caffeine seems to reduce perception of effort through a reduction in the activity of cortical premotor and motor areas necessary to produce a submaximal force, and time-on-task has the opposite effect.

Post-stroke fatigue: a deficit in corticomotor excitability?

The pathophysiology of post-stroke fatigue is poorly understood although it is thought to be a consequence of central nervous system pathophysiology. In this study we investigate the relationship between corticomotor excitability and self-reported non-exercise related fatigue in chronic stroke population. Seventy first-time non-depressed stroke survivors (60.36 ± 12.4 years, 20 females, 56.81 ± 63 months post-stroke) with minimal motor and cognitive impairment were included in the cross-sectional observational study. Fatigue was measured using two validated questionnaires: Fatigue Severity Scale 7 and Neurological Fatigue Index - Stroke. Perception of effort was measured using a 0-10 numerical rating scale in an isometric biceps hold-task and was used as a secondary measure of fatigue. Neurophysiological measures of corticomotor excitability were performed using transcranial magnetic stimulation. Corticospinal excitability was quantified using resting and active motor thresholds and stimulus-response curves of the first dorsal interosseous muscle. Intracortical M1 excitability was measured using paired pulse paradigms: short and long interval intracortical inhibition in the same hand muscle as above. Excitability of cortical and subcortical inputs that drive M1 output was measured in the biceps muscle using a modified twitch interpolation technique to provide an index of central activation failure. Stepwise regression was performed to determine the explanatory variables that significantly accounted for variance in the fatigue and perception scores. Resting motor threshold (R = 0.384; 95% confidence interval = 0.071; P = 0.036) accounted for 14.7% (R(2)) of the variation in Fatigue Severity Scale 7. Central activation failure (R = 0.416; 95% confidence interval = -1.618; P = 0.003) accounted for 17.3% (R(2)) of the variation in perceived effort score. Thus chronic stroke survivors with high fatigue exhibit high motor thresholds and those who perceive high effort have low excitability of inputs that drive motor cortex output. We suggest that low excitability of both corticospinal output and its facilitatory synaptic inputs from cortical and sub-cortical sites contribute to high levels of fatigue after stroke.

Volitional components of consciousness vary across wakefulness, dreaming and lucid dreaming

Consciousness is a multifaceted concept; its different aspects vary across species, vigilance states, or health conditions. While basal aspects of consciousness like perceptions and emotions are present in many states and species, higher-order aspects like reflective or volitional capabilities seem to be most pronounced in awake humans. Here we assess the experience of volition across different states of consciousness: 10 frequent lucid dreamers rated different aspects of volition according to the Volitional Components Questionnaire for phases of normal dreaming, lucid dreaming, and wakefulness. Overall, experienced volition was comparable for lucid dreaming and wakefulness, and rated significantly higher for both states compared to non-lucid dreaming. However, three subscales showed specific differences across states of consciousness: planning ability was most pronounced during wakefulness, intention enactment most pronounced during lucid dreaming, and self-determination most pronounced during both wakefulness and lucid dreaming. Our data confirm the multifaceted nature of consciousness: different higher-order aspects of consciousness are differentially expressed across different conscious states.

Musical agency reduces perceived exertion during strenuous physical performance

Music is known to be capable of reducing perceived exertion during strenuous physical activity. The current interpretation of this modulating effect of music is that music may be perceived as a diversion from unpleasant proprioceptive sensations that go along with exhaustion. Here we investigated the effects of music on perceived exertion during a physically strenuous task, varying musical agency, a task that relies on the experience of body proprioception, rather than simply diverting from it. For this we measured psychologically indicated exertion during physical workout with and without musical agency while simultaneously acquiring metabolic values with spirometry. Results showed that musical agency significantly decreased perceived exertion during workout, indicating that musical agency may actually facilitate physically strenuous activities. This indicates that the positive effect of music on perceived exertion cannot always be explained by an effect of diversion from proprioceptive feedback. Furthermore, this finding suggests that the down-modulating effect of musical agency on perceived exertion may be a previously unacknowledged driving force for the development of music in humans: making music makes strenuous physical activities less exhausting.

Power to the will: how exerting physical effort boosts the sense of agency

The sense of agency refers to the experience of being in control of one's actions and their consequences. The 19th century French philosopher Maine de Biran proposed that the sensation of effort might provide an internal cue for distinguishing self-caused from other changes in the environment. The present study is the first to empirically test the philosophical idea that effort promotes self-agency. We used intentional binding, which refers to the subjective temporal attraction between an action and its sensory consequences, as an implicit measure of the sense of agency. Effort was manipulated independent of the primary task by requiring participants to pull stretch bands of varying resistance levels. We found that intentional binding was enhanced under conditions of increased effort. This suggests not only that the experience of effort directly contributes to the sense of agency, but also that the integration of effort as an agency cue is non-specific to the effort requirement of the action itself.

The neurophysiology of central and peripheral fatigue during sub-maximal lower limb isometric contractions

Fatigue has been defined as an exercise-induced decline in force generation capacity because of changes at both the peripheral and central levels. Movement is preceded and accompanied by brain activities related to the preparation and execution of movement (movement related cortical potentials, MRCP), which have been correlated with the perception of effort (RPE). We combined force measurements, surface electromyography (sEMG), peripheral electrical stimulation (maximal twitch, MT) and MRCP analysis to further our understanding of the neural correlates of peripheral and central changes during a fatiguing task involving the lower limbs. Eighteen healthy volunteers performed 4 blocks of isometric knee extensions at 40% of the maximal voluntary contraction (MVC) for a total of 240 2-s contractions. At the baseline and after each block, we measured RPE, MT and MVC. We simultaneously recorded the force of the knee extensor muscles, root mean square (RMS) of the sEMG of the vastus lateralis muscle, and electroencephalography (EEG) from 64 channels. The MRCPs were extracted from the EEG recordings and averaged in the early (Block 1-2) and late (Block 3-4) blocks. Two cohorts were obtained by cluster analysis based on the RPE (i.e., perception of effort) and MT (i.e., peripheral fatigue). We observed a significant decline in both the MVC (-13%) and RMS (-25%) of the sEMG signal over the course of the task; thus, muscle fatigue had occurred in all of the participants regardless of the cohort. The MRCP amplitude was larger in the fatigued than the non-fatigued MT cohort in the supplementary and premotor areas, whereas the MRCP amplitude was larger in the fatigued than the non-fatigued RPE cohort in the aforementioned areas, and also in the primary motor and prefrontal cortices (PFC). The increase in the positive activity of the PFC, along with the perception of effort, represents a novel result, suggesting that it is modulated more by the perception of effort than peripheral fatigue.

Dream experience and a revisionist account of delusions of misidentification

Standard accounts of delusion explain them as responses to experience. Cognitive models of feature binding in the face recognition systems explain how experiences of mismatch between feelings of "familiarity" and faces can arise. Similar mismatches arise in phenomena such as déjà and jamais vu in which places and scenes are mismatched to feelings of familiarity. These cognitive models also explain similarities between the phenomenology of these delusions and some dream states which involve mismatch between faces, feelings of familiarity and identities. Given these similarities it makes sense to retain that aspect of the standard account in the face of revisionist arguments that feature binding anomalies which lead to delusions of misidentification are not consciously experienced.

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 one's 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.

Increased overlap between the brain areas involved in self-other distinction in schizophrenia

Self-awareness impairments are frequently mentioned as being responsible for the positive symptoms of schizophrenia spectrum disorders. However, the neural correlates of self-other distinction in this pathology are still poorly understood. In the present study, we developed an fMRI procedure in order to examine self-other distinction during speech exchange situations. Fifteen subjects with schizophrenia were compared to 15 matched controls. The results revealed an increased overlap between the self and non-self cortical maps in schizophrenia, in the medial frontal and medial parietal cortices, as well as in the right middle temporal cortex and the right inferior parietal lobule. Moreover, these neural structures showed less BOLD amplitude differences between the self and non-self conditions in the patients. These activation patterns were judged to be independent of mirror-like properties, familiarity or body-ownership processing. Significantly, the increase in the right IPL signal was found to correlate positively with the severity of first-rank symptoms, and thus could be considered a “state-marker” of schizophrenia, whereas temporal and medial parieto-frontal differences appear to be “trait-markers” of the disease. Such an increased overlap between self and non-self cortical maps might be considered a neuro-physiological signature of the well established self-awareness impairment in people suffering from schizophrenia.

Metacognition in schizophrenia: the relationship of mastery to coping, insight, self-esteem, social anxiety, and various facets of neurocognition

OBJECTIVES. Deficits in metacognition, or the ability to think about thinking, are common in schizophrenia and associated with functional impairment. Unknown are what elements of function are affected by what aspects of metacognition. DESIGN. This study explored whether participants with differing capacities for Mastery, a domain of metacognition that reflects the ability to use knowledge about mental states to respond to psychological challenges, had difficulties in different elements of daily function. METHODS. Participants were 98 adults with schizophrenia or schizoaffective disorder in a non-acute phase, classified into three groups on the basis of ratings of their capacity for metacognitive Mastery using the Metacognitive Assessment Scale: low Mastery (those unable to plausibly represent psychological challenges), Intermediate Mastery (those able to plausibly represent psychological problems but cope primarily through passive measures or avoidance), and high Mastery (those able to cope with plausible problems through cognitive means). Participants completed assessments of coping preference, insight, self-esteem, and anxiety. RESULTS. Multivariate Analysis of Variance (MANOVA) and Analysis of Variance (ANOVA) revealed that the high-Mastery group had a greater preference for coping with stressors by thinking and talking about them, and greater insight than all other groups, and higher levels of feeling accepted by peers than the intermediate-Mastery group. The intermediate-Mastery group reported higher levels of resignation when facing stressors and more social phobia than the other two groups. These findings of Mastery group differences in self-esteem and anxiety persisted when neurocognition was controlled for in an Analysis of Covariance (ANCOVA). CONCLUSIONS. Mastery appears linked to coping preference, insight, self-esteem, and anxiety in a generally non-linear manner.

Psychotherapy of Schizophrenia: A Brief History and the Potential to Promote Recovery

With growing awareness of the likelihood of recovery from schizophrenia, interest has arisen about the potential role of psychotherapy within emerging treatment regimens. Could psychotherapy uniquely promote recovery by addressing symptoms, the achievement of psychosocial milestones, and/or helping to enhance the extent to which persons diagnosed with schizophrenia experience themselves as meaningful agents in the world? As an introduction to a set of case studies of how psychotherapy can promote recovery this article briefly reviews the history of the psychotherapy of schizophrenia. In particular the appearance and course of psychoanalytically oriented treatments, as well as cognitively and interpersonally based treatments are detailed. Evidence supporting these approaches and remaining questions for research are discussed.