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BMC Psychiatry
Published in: BMC Psychiatry 1/2020

01-12-2020 | Schizophrenia | Research article

Theory of mind, emotion recognition, delusions and the quality of the therapeutic relationship in patients with psychosis – a secondary analysis of a randomized-controlled therapy trial

Authors: Stephanie Mehl, Klaus Hesse, Anna-Christine Schmidt, Martin W. Landsberg, Daniel Soll, Andreas Bechdolf, Jutta Herrlich, Tilo Kircher, Stefan Klingberg, Bernhard W. Müller, Georg Wiedemann, Andreas Wittorf, Wolfgang Wölwer, Michael Wagner

Published in: BMC Psychiatry | Issue 1/2020

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Abstract

Background

Cognitive models of psychosis postulate an important role of Theory of mind (ToM) in the formation and maintenance of delusions, but research on this plausible conjecture has gathered conflicting findings. In addition, it is still an open question whether problems in emotion recognition (ER) are associated with delusions. We examined the association of problems in ToM and ER with different aspects of delusions in a large sample of patients with psychosis enrolled in a therapy trial. This also enabled us to explore the possible impact of ToM and ER on one part of patients’ social life: the quality of their therapeutic relationship.

Methods

Patients with psychotic disorders and delusions and/or hallucinations (n = 185) and healthy controls (n = 48) completed a ToM picture sequencing task and an ER task. Subsequently, patients were enrolled in a randomized-controlled Cognitive Behavior Therapy (CBT) trial (ISRCTN29242879). Patients and therapists rated the quality of the therapeutic relationship during the first five sessions of therapy.

Results

In comparison to controls, patients were impaired in both ToM and ER. Patients with deficits in ER experienced more severe delusional distress, whereas ToM problems were not related to delusions. In addition, deficits in ER predicted a less favorable therapeutic relationship and interactional problems viewed by the therapist. Impaired ER also moderated (increased) the negative influence of delusions on the therapeutic relationship and interactional difficulties viewed by the therapist.

Conclusions

Cognitive models on the formation and maintenance of delusions should consider ER as a potential candidate that might be related to the formation and maintenance of delusional distress, whereas problems in ToM might not be directly related to delusions and secondary dimensions of delusions. In addition, problems in ER in patients with psychosis might have an impact on the quality of the therapeutic relationship and patients with problems in ER are more likely to be viewed as problematic by their therapists. Nevertheless, training ER might be a way to improve the quality of the therapeutic relationship and potentially the effectiveness of CBT or other interventions for patients with psychosis.
Literature
1.
Premack D, Woodruff G. Does the chimpanzee have a ‘theory of mind’? Behav Brain Sci. 1978;4:515–26.CrossRef
2.
3.
4.
Frith CD. The cognitive neuropsychology of schizophrenia. Hove: Lawrence Erlbaum Associates; 1992.
5.
Bora E, Yucel M, Pantelis C. Theory of mind impairment in schizophrenia: meta-analysis. Schizophr Res. 2009;109(1–3):1–9.PubMedCrossRef
6.
Bora E, Pantelis C. Theory of mind impairments in first-episode psychosis, individuals at ultra-high risk for psychosis and in first-degree relatives of schizophrenia: systematic review and meta-analysis. Schizophr Res. 2013;144(1):31–6.PubMedCrossRef
7.
Harrington L, Langdon R, Siegert R, Mc CJ. Schizophrenia, theory of mind, and persecutory delusions. Cogn Neuropsychiatry. 2005;10:87–104.PubMedCrossRef
8.
Greig T, Bryson GJ, Bell MD. Theory of mind performance in schizophrenia: diagnostic, symptom and neuropsychological correlates. J Nerv Ment Dis. 2004;192:12–8.PubMedCrossRef
9.
Bentall RP, de Sousa P, Varese F, Wickham S, Sitko K, Haarmans M, et al. From adversity to psychosis: pathways and mechanisms from specific adversities to specific symptoms. Soc Psychiatry Psychiatr Epidemiol. 2014;49(7):1011–22.PubMedCrossRef
10.
11.
Garety P, Bebbington P, Fowler D, Freeman D, Kuipers E. Implications for neurobiological research of cognitive models of psychosis: a theoretical paper. Psychol Med. 2007;37(10):1377–91.PubMedCrossRef
12.
13.
Garety P, Freeman D. The past and future of delusion research: from the inexplicable to the treatable. Br J Psychiatry. 2013;203:327–33.PubMedCrossRef
14.
Ventura J, Wood RC, Hellemann GS. Symptom domains and neurocognitive functioning can help differentiate social cognitive processes in schizophrenia: a meta-analysis. Schizophr Bull. 2013;39(1):102–11.PubMedCrossRef
15.
Mitchell RLC, Phillips LH. The overlapping relationship between emotion perception and theory of mind. Neuropsychologia. 2015;70:1–10.PubMedCrossRef
16.
Kohler CG, Walker JB, Martin EA, Healey KM, Moberg PJ. Facial emotion perception in schizophrenia: a meta-analytic review. Schizphrenia Bulletin. 2010;36(5):1009–19.CrossRef
17.
Chan RC, Li H, Cheung EF, Gong QY. Impaired facial emotion perception in schizophrenia: a meta-analysis. Psychiatry Res. 2010;178(2):381–90.PubMedCrossRef
18.
Ventura J, Wood RC, Jimenez AM, Hellemann GS. Neurocognition and symptoms identify links between emotion recognition and emotion processing in schizophrenia: meta-analytic findings. Schizophr Res. 2013;151(0):78–84.PubMedPubMedCentralCrossRef
19.
Gaweda L, Staszkiewicz M, Balzan R. The relationship between cognitive biases and psychological dimensions of delusions: the importance of jumping to conclusions. J Behav Ther Exp Psychiatry. 2017;56:51–6.PubMedCrossRef
20.
Mehl S, Rief W, Mink K, Lüllmann E, Lincoln TM. Social performance is more closely associated with theory of mind and autobiographical memory than with psychopathological symptoms in clinically stable patients with schizophrenia-spectrum disorders. Psychiatry Res. 2010;178(2):276–83.PubMedCrossRef
21.
Gur RE, Kohler CG, Ragland JD. Flat affect in schizophrenia: relation to emotion processing and neurocognitive measures. Schizophr Bull. 2006;32:279–87.PubMedPubMedCentralCrossRef
22.
Riehle M, Mehl S, Lincoln TM. The specific social costs of expressive negative symptoms in schizophrenia; reduced smiling predicts interactional outcome. Acta Psychiatr Scand. 2018;138(2):133–44.PubMedCrossRef
23.
Fett AK, Viechtbauer W, Dominguez MD, Penn DL, van Os J, Krabbendam L. The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: a meta-analysis. Neurosci Biobehav Rev. 2011;35(3):573–88.PubMedCrossRef
24.
Ventura J, Hellemann GS, Thames AD, Koellner V, Nuechterlein KH. Symptoms as mediators of the relationship between neurocognition and functional outcome in schizophrenia: a meta-analysis. Schizophr Res. 2009;113(2–3):189–99.PubMedPubMedCentralCrossRef
25.
Martin DJ, Garske JP, Davis MK. Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. J Consult Clin Psychol. 2000;68(3):438–50.PubMedCrossRef
26.
Horvath AO, Del Re AC, Flückinger C, Symonds D. Alliance in individual psychotherapy. In: Norcross JC, editor. Psychotherapy relationships that work evidence-based responsiveness. 2nd ed. Oxford: University Press; 2011. p. 25–69.CrossRef
27.
Flückinger C, Del Re AC, Wampold BE, Symonds D, Horvath AO. How central is the alliance in psychotherapy? A multilevel longitudinal meta-analysis. J Couns Psychol. 2012;59:1–17.CrossRef
28.
Shattock L, Berry K, Degnan A, Edge D. Therapeutic alliance in psychological therapy for schizophrenia and related psychosis: a systematic review. Clin Psychol Psychother. 2017;25:60–85.CrossRef
29.
Jung E, Wiesjahn M, Lincoln TM. Negative, not positive symptoms predict the early therapeutic alliance in cognitive behavioral therapy for psychosis. Psychother Res. 2013;24(2):171–83.PubMedCrossRef
30.
Wittorf A, Jakobi-Malterre UE, Bechdolf A, Mueller BW, Sartory G, Wagner M, et al. The influence of baseline symptoms and insight on the therapeutic alliance early in the treatment of schizophrenia. Eur Psychiatry. 2009;24:259–67.PubMedCrossRef
31.
Phalen PL, Dimaggio G, Popolo R, Lysaker P. Aspects of theory of mind that attenuate the relationship between persecutory delusions and social functioning in schizophrenia spectrum disorders. J Behav Ther Exp Psychiatry. 2017;65:65–70.CrossRef
32.
Klingberg S, Wittorf A, Meisner C, Wölwer W, Wiedemann G, Herrlich J, et al. Cognitive behavioural therapy versus supportive therapy for persistent positive symptoms in psychotic disorders: the POSITIVE study, a multicenter, prospective, single-blind, randomised controlled clinical trial. Trials. 2010;11:123.PubMedPubMedCentralCrossRef
33.
Wittchen HU, Wunderlich U, Gruschwitz S, Zaudig M. Strukturiertes Klinisches Interview fuer DSM-VI (SKID). Göttingen: Hogrefe; 1997.
34.
Kay SR, Opler LA, Fiszbein A. Positive and negative syndrome scale (PANSS). New York: Multi Health Systems Inc.; 1992.
35.
Lehrl S. Mehrfachwahl-Wortschatz-Intelligenztest MWT-B. Fünfte unveränderte Auflage. Spitta Verlag: Balingen; 2005.
36.
Walter H, Adenzato M, Ciaramidaro A, Enrici I, Pia L, Bara BG. Understanding intentions in social interaction: the role of the anterior paracingulate cortex. J Cogn Neurosci. 2004;16(10):1854–63.PubMedCrossRef
37.
Walter H, Ciaramidaro A, Adenzato M, Vasic N, Ardito RB, Erk S, et al. Dysfunction of the social brain in schizophrenia is modulated by intention type: an fMRI study. Soc Cogn Affect Neurosci. 2009;4(2):166–76.PubMedPubMedCentralCrossRef
38.
Monke S, Erk S, Schnell K, Schütz C, Romanczuk-Seiferth N, Grimm O, et al. Further evidence for the impact of a genome-wide-supported psychosis risk variant in ZNF804A on the theory of mind network. Neuropsychopharmacology. 2014;39(5):1196–205.CrossRef
39.
Ekman P, Friesen WV. Pictures of facial affect. Palo Alto: Consulting Psychologist Press; 1976.
40.
Woelwer W, Frommann N, Halfmann S, Piaszek A, Streit M, Gaebel W. Remediation of impairments in facial affect recognition in schizophrenia: efficacy and specificity of a new training program. Schizophr Res. 2005;80:295–303.CrossRef
41.
Frommann N, Streit M, Woelwer W. Remediation of facial affect recognition impairments in patients with schizophrenia: a new training program. Psychiatry Res. 2003;117:281–4.PubMedCrossRef
42.
Haddock G, McCarron J, Tarrier N, Faragher EB. Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS). Psychol Med. 1999;29(4):879–89.PubMedCrossRef
43.
Woodward TS, Jung K, Hwang H, Yin J, Taylor L, Menon M, et al. Symptom dimensions of the psychotic rating scales in psychosis: a multisite study. Schizophr Bull. 2014;40(4):265–74.CrossRef
44.
Flückiger C, Regli D, Zwahlen D, Hostettler S, Caspar F. Der Berner Patienten- und Therapeutenstundenbogen 2000. Z Klin Psychol Psychother. 2010;39(2):71–9.CrossRef
45.
Uttl B. Measurement of individual differences: lessons from memory assessment in research and clinical practice. Psychol Sci. 2005;16(6):460–7.PubMed
46.
Berres M, Zehnder A, Bläsi S, Monsch AU. Evaluation of diagnostic scores with adjustment for covariates. Stat Med. 2008;27(10):1777–90.PubMedCrossRef
47.
Hayes AF, Preacher KJ. Statistical mediation analysis with a multicategorical independent variable. Br J Math Stat Psychol. 2014;67:451–70.PubMedCrossRef
48.
Bauer DJ, Curran PJ. Probing interactions in fixed and multilevel regression: inferential and graphical techniques. Multivar Behav Res. 2005;40(3):373–400.CrossRef
49.
Köther U, Lincoln TM. Moritz S. Psychiatry Research: Emotion perception and overconfidence in errors under stress in psychosis; 2018.
50.
Lincoln TM, Reumann R, Moritz S. Is there a functional way of responding to paranoid intrusions? Development of the reactions to paranoid thoughts scale. Cogn Neuropsychiatr. 2010;15(4):377–96.CrossRef
51.
Freeman D, Stahl D, McManus S, Meltzer H, Brugha T, Wiles N, et al. Insomnia, worry, anxiety and depression as predictors of the occurrence and persistence of paranoid thinking. Soc Psychiatry Psychiatr Epidemiol. 2012;47(8):1195–203.PubMedCrossRef
52.
Langdon R, Coltheart M, Ward P. Empathetic perspective-taking is impaired in schizophrenia: evidence from a study of emotion attribution and theory of mind. Cogn Neuropsychiatr. 2006;11(2):133–55.CrossRef
53.
Langdon R, Coltheart M, Ward PB, Catts SV. Mentalising, executive planning and disengagement in schizophrenia. Cogn Neuropsychiatr. 2001;6(2):81–108.CrossRef
54.
Corcoran R, Mercer M, Frith C. Schizophrenia, symptomatology and social inference: investigating theory of mind in people with schizophrenia. Schizophr Res. 1995;17:5–13.PubMedCrossRef
55.
Frith CD, Corcoran R. Exploring ‘theory of mind’ in people with schizophrenia. Psychol Med. 1996;26:521–30.PubMedCrossRef
56.
Sprong M, Schothorst P, Vos E, Hox J, van Engeland H. Theory of mind in schizophrenia. Br J Psychiatry. 2007;191:8–13.CrossRef
57.
58.
Montag C, Dziobek I, Richter IS, Neuhaus K, Lehmann A, Sylla R, et al. Different aspects of theory of mind in paranoid schizophrenia: evidence from a video-based assessment. Psychiatry Res. 2011;186(2–3):203–9.PubMedCrossRef
59.
Mehl S, Rief W, Lüllmann E, Ziegler M, Kesting ML, Lincoln TM. Are theory of mind deficits in understanding intentions of others associated with persecutory delusions? J Nerv Ment Dis. 2010;198(7):516–9.PubMedCrossRef
60.
Abu-Akel A, Bailey A. The possibility of different forms of theory of mind impairment in psychiatric and developmental disorders. Psychol Med. 2000;30(3):735–8.PubMedCrossRef
61.
Abu-Akel A. Impaired theory of mind in schizophrenia. Pragmat Cogn. 1999;7(2):247–82.CrossRef
62.
Fretland A, Andersson S, Sundet K, Andreassen OA, Melle I, Vaskinn A. Theory of mind in schizophrenia: error types and associations with symptoms. Schizophr Res. 2015;162(1–3):42–6.PubMedCrossRef
63.
Clemmensen L, van Os J, Skovgaard AM, Væver M, Blijd-Hoogewys EM, Bartels-Velthuis AA, Jeppesen P. Hyper-theory-of-mind in children with psychotic experiences. Plos one. 2014;9(11).PubMedPubMedCentralCrossRef
64.
Clemmensen L, van Os J, Drukker M, Munkholm A, Rimvall MK, Vaever M, et al. Psychotic experiences and hyper theory-of-mind in preadolescence - a birth cohort study. Psychol Med. 2016;46(1):87–101.PubMedCrossRef
65.
Canty AL, Neumann DL, Fleming J, Shum DHK. Evaluation of a newly developed measure of theory of mind: the virtual assessment of mentalising ability. Neuropsychol Rehabil. 2015;27(5):834–70.PubMedCrossRef
66.
67.
Shrout PE, Rodgers JL. Psychology, science, and knowledge construction: broadening perspectives from the replication crisis. Annu Rev Psychol. 2018;69:487–510.PubMedCrossRef
68.
Schaub D, Brüne M, Jaspen E. G. PF, Bierhoff HW, Juckel G. the illness and everyday living: close interplay of psychopathological syndromes and psychosocial funtioning in chronic schizophrenia. Eur Arch Psychiatry Clin Neurosci. 2011;261(2):85–93.PubMedCrossRef
69.
Dickson JM, Barsky J, Kinderman P, King D, Taylor PJ. Early relationship and paranoia: qualitative investigation of childhood experiences associated with the development of persecutory delusions. Psychiatry Res. 2016;238:40–5.PubMedCrossRef
70.
Hesse K, Kriston L, Mehl S, Wittorf A, Wiedemann W, Wölwer W, et al. The vicious cycle of family atmosphere, interpersonal self-concepts, and paranoia in schizophrenia—a longitudinal study. Schizophr Bull. 2015;41(6):1403–12.PubMedPubMedCentralCrossRef
71.
Meltzer H, Bebbington P, Dennis MS, Jenkins R, McManus S, Brugha TS. Feelings of loneliness among adults with mental disorder. Soc Psychiatry Psychiatr Epidemiol. 2013;48(1):5–13.PubMedCrossRef
72.
Kimhy D, Delespaul P, Corcoran C, Ahn H, Yale S, Malaspina D. Computerized experience sampling method (ESMc): assessing feasibility and validity among individuals with schizophrenia. J Psychiatr Res. 2006;40(3):221–30.PubMedCrossRef
73.
Sündermann O, Onwumere J, Kane F, Morgan C, Kuipers E. Social networks and support in first-episode psychosis: exploring the role of loneliness and anxiety. Soc Psychiatry Psychiatr Epidemiol. 2014;49(3):359–66.PubMedCrossRef
74.
Giacco D, Palumbo C, Strappelli N, Catapano F, Priebe S. Social contacts and loneliness in people with psychosis. Compr Psychiatry. 2016;70:190–9.CrossRef
75.
Frank AF, Gunderson JG. The role of the therapeutic alliance in the treatment of schizophrenia. Relationship to course and outcome. Arch Gen Psychiatry. 1990;47:228–36.PubMedCrossRef
76.
Priebe S, Richardson M, Cooney M, Adedeji O, Mc CR. Does the therapeutic relationship predict outcomes of psychiatric treatment in patients with psychosis? A systematic review. Psychother Psychosom. 2011;80:70–7.PubMedCrossRef
77.
Lincoln TM, Rief W, Westermann S, Ziegler M, Kesting ML, Heibach E, et al. Who stays, who benefits? Predicting dropout and change in cognitive behaviour therapy for psychosis. Psychiatry Res. 2014;216(2):198–205.PubMedCrossRef
78.
Flavell JH. Metacognition and cognitive monitoring: a new area of cognitive-development inquiry. Am Psychol. 1979;34(10):906–11.CrossRef
79.
Pinkham AE, Penn DL, Green MF, Buck B, Healey K, Harvey PD. The social cognition psychometric evaluation study: results of the expert survey and RAND panel. Schizophr Bull. 2014;40:813–23.PubMedCrossRef
80.
Lysaker P, Vohs J, Minor KS, Irrazaval L, Leonhardt B, Hamm JA, et al. Metacognitive deficits in schizophrenia: presence and association with psychosocial outcome. J Nerv Ment Dis. 2015;203:530–6.PubMedCrossRef
81.
Davies LW, Eicher AC, Lysaker P. Metacognition as a predictor of the therapeutic alliance over 26 weeks of psychotherapy in schizophrenia. Schizophr Res. 2011;129:85–90.CrossRef
82.
Tas C, Brown EC, Esen-Danaci A, Lysaker P, Bruene M. Intrinsic motivation and metacognition as predictors of learning potential in patients with remitted schizophrenia. J Psychiatr Res. 2012;46:1086–92.PubMedCrossRef
83.
Beck JS. Cognitive behavior therapy: basics and beyond. New York: Guilford; 2011.
84.
Ross RM, Mc Kay R, Coltheart M, Langdon R. Jumping to conclusions about the beads task? A meta-analysis of delusional ideation and data-gathering. Schizophr Bull. 2015;41(5):1183–91.PubMedPubMedCentralCrossRef
85.
Lysaker P, Shea AM, Buck KD, Dimmagio G, Procacci M, Salvatore G, et al. Metacognition as a mediator of the effects of impairment in neurocognition on social functioning in schizophrenia spectrum disorders. Acta Psychologica Scandinavica. 2010;122:405–13.CrossRef
86.
Wykes T, Huddy V, Cellard C, McGurk SR, Czobor P. A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. Am J Psychiatr. 2011;168(5):472–85.PubMedCrossRef
87.
Combs DR, Adams SD, Penn DL, Roberts D, Tiegreen J, Stem P. Social cognition and interaction training (SCIT) for inpatients with schizophrenia spectrum disorders: preliminary findings. Schizophr Res. 2007;91(1–3):112–6.PubMedCrossRef
88.
Moritz S, Woodward TS. Metacognitive training in schizophrenia: from basic research to knowledge translation and intervention. Curr Opin Psychiatry. 2007;20(6):619–25.PubMedCrossRef
89.
Kowalski J, Pankowski D, Lew-Starowicz M, Gawęda L. Do specific metacognitive training modules lead to specific cognitive changes among patients diagnosed with schizophrenia? A single module effectiveness pilot study. Psychosis. 2017;9(3):254–9.CrossRef
90.
Grant N, Lawrence M, Preti A, Wykes T, Cella M. Social cognition interventions for people with schizophrenia: a systematic review focussing on methodological quality and intervention modality. Clin Pschol Rev. 2017;56:55–64.CrossRef
91.
Vaskinn A, Lovgren A, Egeland MK, Feyer FK, Ostefjells T, Andreassen OA, et al. A randomized controlled trial of training of affect recognition (TAR) in schizophrenia showing lasting effects for theory of mind. 2019.
92.
Kurtz MM, Richardson CL. Social cognitive training for schizophrenia: a meta-analytic investigation of controlled research. Schizophr Bull. 2012;38(5):1092–104.PubMedCrossRef
93.
Kurtz MM, Gagen E, Rocha NBF, Machado S, Penn DL. Comprehensive treatments for social cognitive deficits in schizophrenia: a critical review and effect-size analysis of controlled studies. Clin Psychol Rev. 2016;43:80–9.PubMedCrossRef
94.
Cohen D. Statistical power for the social sciences. Hillsdale: Erlbaum; 1992.
95.
Evans-Jones C, Peters E, Barker C. The therapeutic relationship in CBT for psychosis: client, therapist and therapy factors. Behav Cogn Psychother. 2009;37(5):527–40.PubMedCrossRef
96.
Jung E, Wiesjahn M, Rief W, Lincoln TM. Perceived therapist genuineness predicts therapeutic alliance in cognitive behavioural therapy for psychosis. Br J Clin Psychol. 2015;54:34–48.PubMedCrossRef
Metadata
Title
Theory of mind, emotion recognition, delusions and the quality of the therapeutic relationship in patients with psychosis – a secondary analysis of a randomized-controlled therapy trial
Authors
Stephanie Mehl
Klaus Hesse
Anna-Christine Schmidt
Martin W. Landsberg
Daniel Soll
Andreas Bechdolf
Jutta Herrlich
Tilo Kircher
Stefan Klingberg
Bernhard W. Müller
Georg Wiedemann
Andreas Wittorf
Wolfgang Wölwer
Michael Wagner
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Schizophrenia
Published in
BMC Psychiatry / Issue 1/2020
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-020-2482-z

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