The subjective-objective deficit paradox in schizotypy extends to emotion regulation and awareness

Empathic accuracy in individuals with schizotypal personality traits

Empirical research using the Empathic Accuracy Task (EAT) has suggested that schizophrenia patients and people with schizotypal personality disorder exhibit lower empathic accuracy than healthy people. However, empathic accuracy in a subclinical sample with high levels of schizotypy has seldom been studied. Our study aimed to investigate empathy in a subclinical sample using the Chinese version of the EAT and a self-report empathy measure. Forty participants with high levels of schizotypy (HS participants) and 40 with low levels of schizotypy (LS participants), as measured by the Schizotypal Personality Questionnaire (SPQ), were recruited. All participants completed the Chinese version of the EAT and the self-report Questionnaire of Cognitive and Affective Empathy. Empathic accuracy (EA) scores and the intra-individual variability of EA scores were calculated. Independent samples t tests and Pearson correlation analyses were performed to examine group differences in empathy and the relationship between empathy and schizotypy respectively. HS participants exhibited reduced EA for both positive and negative videos, and larger intra-individual variability of EA for negative videos than LS participants. However, HS and LS participants did not differ in self-report cognitive empathy. Moreover, the interpersonal dimension of the SPQ was negatively correlated with EAT performance and self-report cognitive empathy in LS participants. Individuals with HS show poorer performance-based EA but relatively intact self-report cognitive empathy. This study provides empirical evidence for the ontogeny of empathy deficits in subclinical populations at risk of developing schizophrenia, supporting early interventions for social cognitive deficits.

Abnormalities in emotion regulation are associated with negative, but not positive or disorganized schizotypy: An experience sampling study

BACKGROUND

Schizotypy, a multidimensional construct with positive, negative, and disorganized dimensions, represents a vulnerability marker for the development of schizophrenia. Although there has been increasing evidence linking schizotypy to emotion regulation (ER) deficits, the specific association between different schizotypal dimensions and alterations in ER strategy use in daily life remains poorly understood.

METHODS

Using the experience sampling method (ESM), the present study examined the associations between positive, negative, and disorganized schizotypy and ER strategy use in daily life in a nonclinical young adult sample (N = 258). Participants were instructed to report their ER strategy use 5 times a day for 14 days. Four adaptive ER strategies (reflection, reappraisal, social sharing, and distraction) and two maladaptive ER strategies (suppression and rumination) were included.

RESULTS

Multilevel modeling analyses showed that positive schizotypal traits predicted greater use of adaptive ER strategies, while negative schizotypal traits predicted less use of adaptive ER strategies and more frequent use of emotional suppression in daily life. No associations between disorganized schizotypal traits and any ER strategy use were found.

CONCLUSION

Schizotypy dimensions are differentiated by preferences for different ER strategies in daily life. The findings suggest a strong association between negative schizotypy and notable dysfunctions in ER, emphasizing the significance of negative schizotypy as a vulnerability factor for psychosis.

I don't understand how I feel: mediating role of impaired self-mentalizing in the relationship between childhood adversity and psychosis spectrum experiences

Introduction

Childhood adversity is associated with the severity of multiple dimensions of psychosis, but the mechanisms underpinning the close link between the two constructs is unclear. Mentalization may underlie this relationship, as impaired mentalizing is found in various stages of the psychosis continuum. Nonetheless, the differential roles of self- and other-mentalizing in psychosis are not well understood.

Methods

Parallel multiple mediation was conducted for the relationship between a diverse range of childhood adversity types, including intentional and nonintentional harm, and schizotypy (positive, negative, disorganized), psychotic-like experiences (PLE) and paranoia via self-mentalizing (attention to emotions and emotional clarity) and other-mentalizing in n = 1,156 nonclinically ascertained young adults.

Results

Significant parallel multiple mediation models were found for all psychotic outcomes except negative schizotypy. The associations between intentionally harmful childhood adversity and psychotic outcomes were significantly mediated by increased attention to emotions for most models and decreased emotional clarity for some models. No significant mediation was found for parental loss. Paternal abuse was only mediated by attention to emotions whereas the effects of maternal abuse were mediated by attention to emotions and emotional clarity. Other-mentalizing only showed mediating effects on one of thirty models tested.

Conclusion

Results highlight the mediating role of impaired self-mentalizing in the association between childhood adversity and psychosis. This is consistent with disturbances of self-concept and self-boundary characterizing, in particular, the positive dimension of psychosis. Maternal versus paternal figures may contribute differentially to the development of mentalizing. These results could inform future preventative interventions, focusing on the development and maintenance of self-mentalizing.

Negative schizotypal traits predict the reduction of reward motivation in effort-reward imbalance

The schizotypy construct is useful for studying the effects of environmental stress on development of subclinical negative symptoms. The relationship among self-report motivation, effort-reward imbalance (ERI), and schizotypal features has seldom been studied. We aimed to examine the possible moderation effect of schizotypal traits on ERI and reward motivation. Eight-hundred-and-forty-three college students were recruited online to complete a set of self-reported measures capturing schizotypal traits, effort-reward imbalance and reward motivation, namely the Schizotypal Personality Questionnaire (SPQ), the Effort-Reward Imbalance-School Version Questionnaire (C-ERI-S) and the Motivation and Pleasure Scale-Self Report (MAP-SR). We conducted multiple linear regression to construct models to investigate the moderating effects of schizotypal traits on the relationship between ERI and reward motivation. Stressful ERI situation predicted the reduction of reward motivation. Negative schizotypal traits showed a significant negative moderating effect on the relationship between ERI and reward motivation, while positive and disorganized schizotypal traits had significant positive moderating effects. Schizotypal traits subtypes differently moderate the relationship between ERI and reward motivation. Only negative schizotypal traits and stressful ERI situation together have negative impact on reward motivation.

Shared and unique affective abnormalities in schizotypy dimensions

Attention to affect is theoretically a precursor to one's ideal affect (i.e., preference for feeling low- and high-arousal positive and negative affect) and emotion regulation (ER). In schizotypy, there have been mixed findings regarding abnormalities in attention to affect. At the same time, little is known about ideal affect in schizotypy or whether differences in ideal affect or ER difficulties in schizotypy are driven by attention to affect. Thus, this study aimed to identify shared and unique abnormalities in attention to affect, ideal affect, and ER difficulties in schizotypy, and to test whether attention to affect underlies differences in ideal affect and ER difficulties. Using groups of individuals with either extreme levels of social anhedonia (SocAnh; n = 181), extreme levels of perceptual aberrations/magical ideation (PerMag; n = 105), or individuals low on both (i.e., controls; n = 531), we tested group differences in attention to affect, ideal affect, and ER difficulties. Our findings suggest both shared and unique affective abnormalities; compared to controls, the SocAnh group paid the least attention to positive affect. Only PerMag had heightened attention to negative affect compared to controls. Additionally, we found unique abnormalities relating to ideal affect but mostly shared difficulties in ER in schizotypy. Abnormalities in ideal affect and ER remain largely consistent after accounting for attention to affect for PerMag, suggesting that attention to affect is not the primary mechanism driving these abnormalities. However, we found evidence that attention to affect underlies some SocAnh-control group differences in ideal affect and ER difficulties. Our work helps to clarify prior work and contributes to the understanding of shared and unique affective abnormalities in schizotypy. Future research may consider longitudinal approaches to test causal mechanisms of affective abnormalities in schizotypy.

Shame in Response to Affective Expression and Its Relation to Social Anhedonia and Schizotypy Traits

ABSTRACT

Schizotypy is marked by negative symptoms including blunted affect, social isolation, and social anhedonia. Contemporary personality theory suggests that maladaptive shame regulation may disrupt interpersonal function across personality disorders. We hypothesized that "affect shame"-a conditioned response of shame evoked by openly expressing emotions would co-occur with interpersonal deficits in schizotypy. As hypothesized, affect shame was associated with interpersonal deficits (r = 0.17, p < 0.001), physical anhedonia (r = 0.13, p = 0.001), and social anhedonia (r = 0.17, p = 0.001). The observed findings were upheld in analyses controlling for demographic characteristics, depression symptom severity, and neuroticism and were maintained consistently across sensitivity analyses. Findings suggest that shame related to emotional expression is related to interpersonal deficits in schizotypy and have implications for our understanding of the etiology and treatment of this disorder.

Measuring Emotional Awareness in Patients With Schizophrenia and Schizoaffective Disorders

The ability to mentalize (i.e., to form representations of mental states and processes of oneself and others) is often impaired in people with schizophrenia spectrum disorders. Emotional awareness (EA) represents one aspect of affective mentalizing and can be assessed with the Levels of Emotional Awareness Scale (LEAS), but findings regarding individuals with schizophrenia spectrum disorders are inconsistent. The present study aimed at examining the usability and convergent validity of the LEAS in a sample of N = 130 stabilized outpatients with schizophrenia or schizoaffective disorders. An adequacy rating was added to the conventional LEAS rating to account for distortions of content due to, for example, delusional thinking. Scores of the patient group were compared with those of a matched healthy control sample. Correlation with symptom clusters, a self-report measure of EA, a measure of synthetic metacognition (MAS-A-G), and an expert rating capturing EA from the psychodynamic perspective of psychic structure (OPD-LSIA) were examined. Regarding self-related emotional awareness, patients did not score lower than controls neither in terms of conventional LEAS nor in terms of adequacy. Regarding other-related emotional awareness, however, patients showed a reduced level of adequacy compared to controls whereas no such difference was found for conventional LEAS scores. Higher conventional LEAS scores were associated with fewer negative symptoms, and higher structural integration of self-perceptions measured by the OPD-LSIA. Higher adequacy of responses correlated with fewer symptoms of disorganization as well as excitement, higher scores of self-reflection on the MAS-A-G as well as self- and object-perception and internal and external communication as measured by the subscales of the OPD-LSIA. Findings suggest that the LEAS might not be sensitive enough to detect differences between mildly symptomatic patients with schizophrenia or schizoaffective disorders and healthy controls. However, LEAS ratings are still suitable to track intraindividual changes in EA over time. Observing the adequacy of patients’ responses when using the LEAS may be a promising way to increase diagnostical utility and to identify patterns of formal and content-related alterations of mentalizing in this patient group. Methodological indications for future studies are discussed.

Personalized lifestyle advice alters affective reactivity to negative events in anhedonic young adults

BACKGROUND

Anhedonia is a common symptom of several disorders, but cost-effective treatments that focus on anhedonia specifically have been lacking. Therefore, personalized lifestyle advice has recently been investigated as a suitable means of enhancing pleasure and positive affect (PA) in young adults with anhedonia. This intervention provided individuals with a personalized lifestyle advice which was based on observed individual patterns of lifestyle behaviors and experienced pleasure in daily life. The present study extends this previous work by examining a potential mechanism of treatment success, affective reactivity.

METHODS

We explored changes in affective reactivity to events in daily life from pre- to post-intervention in a subclinical sample of young adults with anhedonia (N = 69). Using the Experience Sampling Method (ESM), participants answered questions on their activities, their pleasure levels, PA and negative affect (NA) before and after the intervention.

RESULTS

Multilevel analysis revealed that participants did not experience an altered affective reactivity to positive events after the intervention. The affective reactivity to negative events depended on the level of improvement in mean-PA after the lifestyle advice intervention.

LIMITATIONS

The present study used a subclinical sample with the majority of participants being female which limited the generalizability of the findings.

CONCLUSION

This study suggests that an altered affective reactivity to negative events is an underlying mechanism of the effectiveness of a personalized lifestyle advice.

Self-perceived cognitive lapses and psychological well-being in schizotypy: Generalized and domain-specific associations

A critical link between schizotypy and schizophrenia is impoverished cognitive functioning. In the majority of studies, though: (1) cognition is examined with standard neuropsychological tasks; and (2) high-schizotypal individuals are defined according to criteria applied in the respective study sample. Taking these considerations into account, the aims of the present study were to examine: (1) differences between four pre-defined, according to normative criteria, schizotypal (paranoid, negative, disorganized and cognitive-perceptual) and one control groups in self-perceived cognitive lapses; and (2) associations between schizotypal dimensions, self-perceived cognitive lapses and psychological well-being. Two hundred and sixty-one participants were administered the Schizotypal Personality Questionnaire, the Cognitive Failures Questionnaire (CFQ) and the Flourishing Scale, which assesses psychological well-being. Negative schizotypals reported higher scores in almost all CFQ measures compared with the control group (all p values < 0.01) along with poorer psychological well-being compared with the control and the cognitive-perceptual groups (both p values < 0.001). The disorganized group had higher scores in distractibility, blunders and total CFQ scores compared with the control group (all p values < 0.001). High psychological well-being was significantly associated with low negative schizotypy and CFQ blunders along with high cognitive-perceptual schizotypy (all p values < 0.05). To summarize, negative schizotypy is associated with a profile of "generalized" self-perceived cognitive lapses while disorganized schizotypy is characterized by self-perceived cognitive slips that have previously been shown to be mediated by a fronto-parietal network. Although psychological well-being is negatively associated with social-context specific cognitive failures and negative schizotypy, it is positively associated with cognitive-perceptual schizotypy.

Resting frontal EEG asymmetry and schizotypal traits: a test-retest study

Introduction: Increase in right relative to left frontal electroencephalography (EEG) activity has been observed in patients with schizophrenia, both in cognitive tasks and during rest; and this lateralisation may be related to the severity of schizotypal traits. Methods: We used the Schizotypal Personality Questionnaire (SPQ) to assess schizotypal traits, and examined the correlation between these traits and resting EEG frontal asymmetry (left-right) in 52 college students, as well as the reliability of this correlation over a three-month interval. Results: A higher total score on the SPQ was correlated with reduced asymmetry in different frequency bands: gamma and beta2 frequency bands at baseline, and delta and alpha frequency bands three months later. Additionally, the reduced left relative to right frontal gamma and beta2 asymmetry was correlated with the participants' verbal fluency ability. However, this correlation was no longer statistically significant after the total SPQ score was controlled. Conclusions: These findings suggest that resting frontal EEG asymmetry is correlated with powers in different frequency bands, and may be an endophenotype for schizophrenia spectrum disorders.

Frontal alpha asymmetry in schizotypy: electrophysiological evidence for motivational dysfunction

Introduction: Schizotypy is defined as personality traits reflecting an underlying risk for schizophrenia-spectrum disorders. As yet, there is a dearth of suitable objective markers for measuring schizotypy. Frontal alpha asymmetry, characterised by reduced left versus right frontal region activity, reflects trait-like diminished approach-related systems and has been found in schizophrenia. Methods: The present study used electroencephalography (EEG) recorded on a consumer-grade mobile headset to examine asymmetric resting-state frontal alpha, beta, and gamma power within the multidimensional schizotypy (e.g. positive, negative, disorganised) during a three-minute "eyes closed" resting period in college undergraduates (n=49). Results: Findings suggest that schizotypy was exclusively related to reduced left versus right-lateralised power in the alpha frequency (8.1-12.9 Hz., R²= .16). Follow-up analysis suggested that positive schizotypy was uniquely associated with increased right alpha activity, indicating increased withdrawal motivation. Conclusions: Frontal asymmetry is a possible ecologically valid objective marker for schizotypy that may be detectable using easily accessible, consumer-grade technology.

Implicit emotion regulation deficits in individuals with high schizotypal traits: an ERP study

Schizotypy is associated with poor emotion regulation that is thought to contribute to the development of psychotic symptoms and to indicate a predisposition to schizophrenia. Having focused primarily on the relationship between schizotypy and explicit emotion regulation, existing studies have, until now, neglected to acknowledge the potentially important role of implicit emotion regulation. Our aim in the current study was to investigate implicit emotion regulation deficits in schizotypy. To this end, we used a newly developed Priming-Identification (PI) ERP paradigm, consisting of a priming phase and an emotion identification phase, to test 30 individuals with schizotypy and 30 healthy controls while also acquiring EEG data. During the priming phase, we aimed to manipulate emotion regulation goals (i.e., to bring about an intended emotional state) by presenting a category of words related to emotion regulation alongside a category of control words. Associated brain responses occurring during the subsequent stage were indexed according to three ERP components: N170, early posterior negativity (EPN) and late positive potential (LPP). Results showed that, in the control group, priming words associated with emotion regulation led to enhancements in the early N170 amplitude and the middle EPN during expression identification. The same pattern was not observed in the schizotypy group. In summary, our results suggest the presence of deficits in the early and middle stages of the implicit emotion regulation process among individuals with high schizotypal traits.

Introspective accuracy for social competence in psychometric schizotypy

Introduction: Deficits in social competence have been identified in schizotypy; however, most studies rely on self-reports of these skills. Deficits in introspective accuracy (IA) have been identified within schizophrenia, and recent work suggests IA is impaired in schizotypy as well. Thus, the perception of poorer social competence among individuals high in schizotypy may be due to inaccurate self-assessments rather than actual skill deficits.Method: This study examined the relationship between schizotypy, perceived social competence, and observed social competence in 137 undergraduate students.Results: Differences in self-reported social competence were found such that individuals high in schizotypy reported greater deficits than individuals low in schizotypy. However, the groups performed comparably on an objective assessment of social competence. Within groups, individuals high in schizotypy underestimated their social competence, whereas controls overestimated their social competence. Thus, both groups demonstrated impairments in IA.Conclusions: These findings demonstrate that individuals high in schizotypal traits perceive that they have poor social competence despite displaying skills that are on par with their peers. Such perceptions may lead to avoidance of social interactions or employment opportunities and could contribute to deficits in social functioning.

Stress and cognitive biases in schizotypy: A two-site study of bias against disconfirmatory evidence and jumping to conclusions

The dysfunctional cognitive and reasoning biases which underpin psychotic symptoms are likely to present prior to the onset of a diagnosable disorder and should therefore be detectable along the psychosis continuum in individuals with schizotypal traits. Two reasoning biases, Bias Against Disconfirmatory Evidence (BADE) and Jumping to Conclusions (JTC), describe how information is selected and weighed under conditions of uncertainty during decision making. It is likely that states such as elevated stress exacerbates JTC and BADE in individuals with high schizotypal traits vulnerable to displaying these information gathering styles. Therefore, we evaluated whether stress and schizotypy interacted to predict these reasoning biases using separate samples from the US (JTC) and England (BADE). Generally speaking, schizotypal traits and stress were not independently associated with dysfunctional reasoning biases. However, across both studies, the interaction between schizotypy traits and stress significantly predicted reasoning biases such that increased stress was associated with increased reasoning biases, but only for individuals low in schizotypal traits. These patterns were observed for positive schizotypal traits (in both samples), for negative traits (in the England sample only), but not for disorganization traits. For both samples, our findings suggest that the presence of states such as stress is associated with, though not necessarily dysfunctional, reasoning biases in individuals with low schizotypy. These reasoning biases seemed, in some ways, relatively immutable to stress in individuals endorsing high levels of positive schizotypal traits.

Explicit and Implicit Affect and Judgment in Schizotypy

Although emotion deficits in schizotypy have been reported, the exact nature of these deficits is now well understood. Specifically, for social anhedonia (SocAnh), there are questions about whether any decrease in positive affect only reflects an explicit bias not observed in other measures (e.g., implicit affect measure). At the same time, for individuals with elevated levels of perceptual aberrations or magical ideation (PerMag), there is some evidence of an increased influence of affect on judgment. It is also possible that the influence of implicit affect on judgment might be especially pronounced in PerMag; however, this has not been previously examined. The current study involved people with elevated levels of SocAnh (n = 95), elevated levels of PerMag (n = 62), and people with average or lower levels of both (n = 246). We found that SocAnh was associated with decreases in both explicit and implicit positive affect. We also found that PerMag was related to stronger relationships between implicit affect, both positive and negative, and a judgment task. These results suggest that decreased positive affect is a core feature of SocAnh and that a heightened influence of affect could be related to the development of peculiar beliefs/experiences associated with PerMag.

A Transdiagnostic Perspective on Social Anhedonia

Humans are highly social beings, yet people with social anhedonia experience reduced interest in or reward from social situations. Social anhedonia is a key facet of schizotypal personality, an important symptom of schizophrenia, and increasingly recognized as an important feature in a range of other psychological disorders. However, to date, there has been little examination of the similarities and differences in social anhedonia across diagnostic borders. Here, our goal was to conduct a selective review of social anhedonia in different psychological and life course contexts, including the psychosis continuum, depressive disorder, posttraumatic stress disorder, eating disorders, and autism spectrum disorders, along with developmental and neurobiological factors. Current evidence suggests that the nature and expression of social anhedonia vary across psychological disorders with some groups showing deficient learning about, enjoyment from, and anticipation of the pleasurable aspects of social interactions, while for others, some of these components appear to remain intact. However, study designs and methodologies are diverse, the roles of developmental and neurobiological factors are not routinely considered, and direct comparisons between diagnostic groups are rare-which prevents a more nuanced understanding of the underlying mechanisms involved. Future studies, parsing the wanting, liking, and learning components of social reward, will help to fill gaps in the current knowledge base. Consistent across disorders is diminished pleasure from social situations, subsequent withdrawal, and poorer social functioning in those who express social anhedonia. Nonetheless, feelings of loneliness often remain, which suggests the need for social connection is not entirely absent. Adolescence is a particularly important period of social and neural development and may provide a valuable window on the developmental origins of social anhedonia. Adaptive social functioning is key to recovery from mental health disorders; therefore, understanding the intricacies of social anhedonia will help to inform treatment and prevention strategies for a range of diagnostic categories.