Metacognitive self-reflectivity moderates the relationship between distress tolerance and empathy in schizophrenia

Deficits in empathy seen in schizophrenia are thought to play a major role in the social dysfunction seen in the disorder. However, little work has investigated potential determinants of empathic deficits. This study aimed to fill that gap by examining the effects of two variables on empathy – distress tolerance and metacognitive self-reflectivity. Fifty-four people with schizophrenia-spectrum disorders receiving services at an urban VA or community mental health center were assessed for empathy, metacognition, and distress tolerance. Bivariate correlations and moderation methods were used to ascertain associations amongst these variables and examine interactions. Results revealed that, against hypotheses, empathy was not related at the bivariate level to either distress tolerance or metacognitive self-reflectivity. However, consistent with hypotheses, moderation analyses revealed that participants with higher self-reflectivity showed no relationship between distress tolerance and empathy, while those with lower self-reflectivity showed a relationship such that reduced ability to tolerate distress predicted reduced empathy. Taken together, results of this study suggest that lack of distress tolerance can negatively affect empathy in people with schizophrenia with lesser capacity for metacognitive self-reflection; thus, fostering self-reflectivity may help overcome that negative impact. Future work is needed investigating the impact of metacognitively-tailored interventions on empathy in this population

The roles of emotion regulation and metacognition in performance based-empathy

Indiana University-Purdue University Indianapolis (IUPUI)Background: People with schizophrenia experience significant deficits in empathic skills, which are important for effective interpersonal relationships. Researchers have speculated about the roles of personal distress, emotion regulation, and metacognition in empathic interaction, but the impact of these constructs on empathy has yet to be empirically investigated. This study examines the relationships among these constructs in a sample of people with schizophrenia receiving community-based treatment (N = 58). It was hypothesized that better emotion regulation and metacognition, as well as reduced personal distress, would predict empathy. Further, emotion regulation was expected to mediate the relationship between personal distress and empathy, and metacognition was expected to moderate the relationship between personal distress and empathy. Method: Participants with schizophrenia or schizoaffective disorder completed self-report questionnaires of emotion regulation and personal distress, a performance-based measure of empathy, and an observer-rated interview to assess metacognition. Results: Metacognition, but not emotion regulation or personal distress, significantly predicted cognitive empathy performance, with a trend-level association for affective empathy performance. Mediation analyses revealed that emotion regulation mediates the relationship between personal distress and affective empathy performance, and moderation analyses revealed that metacognition moderates the same relationship. Moderation results suggest the relationship between personal distress and affective empathy performance is significant for those with low metacognition, but that the relationship is the opposite of hypotheses – increased personal distress is associated with better performance. Conclusions: This study is the first of its kind to examine performance-based empathy with personal distress, emotion regulation, and metacognition. Results suggest interventions targeted to improve metacognition may be useful in enhancing empathic skills. Future work is needed to improve existing measures of empathy and personal distress, and to parse apart the intricacies of the relationships among personal distress, emotion regulation, and empathy

Factors impacting work success in Veterans with mental health disorders: A Veteran-focused mixed methods pilot study

BACKGROUND: Veterans with mental illness often have poor employment outcomes. OBJECTIVE: This mixed-methods study sought to understand and describe Veteran perspectives of factors that impact their work success. METHODS: A sample of 40 employed and unemployed Veterans with post-traumatic stress disorder (PTSD) or other severe mental illness (SMI) completed a survey of factors that impact vocational functioning and provided narrative accounts of their most successful and challenging work experiences. RESULTS: Personal motivation, self-efficacy, work skills, interpersonal issues, health, and cognitive problems were rated as most impactful on work. There were no significant differences on ratings of work factors based on employment status. Veterans with PTSD reported significantly more barriers to work success compared with Veterans with SMI, notably, cognitive problems, physical health, and psychological stress. Veterans with SMI were more likely to receive VA vocational services and rated this assistance as beneficial to work success. Narrative findings corroborated the survey results, and yielded additional factors, including economic factors, person/job fit, and Veteran-specific issues. CONCLUSIONS: Several factors substantially impact work success in Veterans with mental illness. Veterans with PTSD and SMI experience a distinct set of barriers and facilitators, suggesting the need for tailoring clinical and rehabilitative services

Is Cognitive Performance Affecting Your Social Life? Cognitive Performance and its Relation to Social Functioning in Psychometric Schizotypy

poster abstractInterpreting cues and appropriately performing in social situations are two skills that are crucial for an individual to function in a modern society. Assessing social functioning and social cognition are used to measure these abilities in first-episode and schizophrenia research. The current study addresses the relationship between social cognition, neurocognition, and social functioning in participants with psychometric schizotypy; a cluster of traits thought to denote increased risk of developing psychosis. Undergraduate students pre-screened for schizotypy were tested for social cognitive and neurocognitive deficits, and lower social functioning. Significant positive correlations were observed between sub-tests of neurocognition and the social cognition measures. The current study shows that there are some subareas of neurocognition that are more closely related to social cognition than others. Independent T-tests reveal that individuals with psychometric schizotypy exhibit lower social functioning. Also, within the schizotypy group, participants report lower social functioning, including in their ability to create and maintain romantic relationships. Future research on this topic could try to find further explanations for social functioning deficits, as they do not appear to be explained by problems with social cognition

Essential Components of Early Intervention Programs for Psychosis: Available Intervention Services in the United States

Programs providing interventions for early psychosis are becoming commonplace in the United States (U.S.); however, the characteristics of existing services remain undocumented. We examined program characteristics, clinical services, and program eligibility criteria for outpatient early intervention programs across the U.S. using a semi-structured telephone interview. Content analysis was used to identify the presence or absence of program components, based in part on a recent list of essential evidence-based components recommended for early intervention programs (Addington, MacKenzie, Norman, Wang and Bond, 2013) as well as program characteristics, including eligibility criteria. A total of 34 eligible programs were identified; 31 (91.2%) program representatives agreed to be interviewed. Of the examined components, the most prevalent were individual psychoeducation and outcomes tracking; the least prevalent were outreach services and communication with inpatient units. The populations served by US programs were most frequently defined by restrictions on the duration of psychosis and age. This study provides critical feedback on services for the early psychosis population and identifies research to practice gaps and areas for future improvement

Correlates of Attendance in Psychiatric Services: A Critical Review

poster abstractAttendance and dropout are concerning problems in the mental health field. With dropout rates averaging around 50%, mental health agencies lose money and resources invested in missed appointments and under-attended groups, providers lose valuable time, and consumers do not receive recommended levels of services. While there is research on consumer, provider, and agency factors that affect attendance, it has not been integrated and reviewed in the context of community services for those with psychotic disorders. The authors conducted a critical review of literature examining correlates of attendance in community services provided to samples with psychotic disorders as the most prominent diagnostic category. Twenty-two studies were identified that met inclusion criteria. Over 100 unique correlates of attendance were tested; the authors categorized these into eight content areas: demographics, current functioning, history (psychiatric/functional), neurocognitive functioning, services/treatment, social functioning, self-stigma/insight, and symptoms/psychopathology. Correlates were also sorted according to how often they were examined and how many times they were found to be significantly related to consumer attendance. The category containing the most unique correlates was symptoms/psychopathology. Demographic correlates were researched the most, with three unique correlates examined in over ten studies (age, sex, and living situation). Of these demographic correlates, all but two were found significant 25% of the time or less, and none exceeded 40%. Alternatively, some correlates have been investigated few times, but with promising results and theoretical connections to attendance, such as baseline illness severity, which has been found significant in 75% of analyses. There is evidence that researchers are examining correlates for which there is little empirical evidence of a connection to attendance. This may lead to missed opportunities to maximize attendance, use of services, and resources. Implications for future research in the area are discussed

Metacognitive function and fragmentation in schizophrenia: Relationship to cognition, self-experience and developing treatments

Bleuler suggested that fragmentation of thought, emotion and volition were the unifying feature of the disorders he termed schizophrenia. In this paper we review research seeking to measure some of the aspects of fragmentation related to the experience of the self and others described by Bleuler. We focus on work which uses the concept of metacognition to characterize and quantify alterations or decrements in the processes by which fragments or pieces of information are integrated into a coherent sense of self and others. We describe the rationale and support for one method for quantifying metacognition and its potential to study the fragmentation of a person\u27s sense of themselves, others and the relative place of themselves and others in the larger human community. We summarize research using that method which suggests that deficits in metacognition commonly occur in schizophrenia and are related to basic neurobiological indices of brain functioning. We also present findings indicating that the capacity for metacognition in schizophrenia is positively related to a broad range of aspects of psychological and social functioning when measured concurrently and prospectively. Finally, we discuss the evolution and study of one therapy that targets metacognitive capacity, Metacognitive Reflection and Insight Therapy (MERIT) and its potential to treat fragmentation and promote recovery

Sexuality and intimacy among people living with serious mental illnesses: Factors contributing to sexual activity

OBJECTIVE: Limited research has focused on sexuality for those diagnosed with a severe mental illness. We aimed to extend existing work by exploring relationships between mastery (perception of control of one's life and future), sexual self-esteem (perceptions of one's capacity to engage in healthy sexual behavior), sexual attitudes (permissive ideas about sexuality), and perceived importance of relationships/sexuality and number of sexual partners. METHOD: A secondary analysis of survey data from adult participants living with a severe mental illness (N = 401) in the Indiana Mental Health Services and HIV-Risk Study (Perry & Wright, 2006) was conducted. Analysis of covariance (controlling for marital status) compared those with 0 partners, 1 partner, or multiple partners over the past 3 months on the dependent variables of mastery, sexual self-esteem, sexual attitudes, and perceived importance. RESULTS: Participants with more permissive attitudes, greater perceived importance, and higher mastery were more likely to be sexually active with multiple partners. Self-esteem did not differentiate groups. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Given the key role of sexual satisfaction in quality of life and the high rates of sexual risk behavior in this population, it is important that clinicians systematically assess mastery, perceived importance, and attitudes about sexuality when working with consumers diagnosed with a severe mental illness. Individually tailoring existing interventions on the basis of consumers' levels of mastery, related to self-efficacy for implementing changes in life, could improve long-term outcomes for these programs. Future research should examine other constructs that may account for more variance in sexual activity, such as perceptions of risk, intentions for sexual safety, or romantic relationship functioning

Schizotypy in an online sample: Associations with functioning, wellbeing, and stigma toward psychological treatment

poster abstractBackground: Social functioning and positive attitudes toward treatment have been strongly linked with recovery in people with schizophrenia, yet less is known for schizotypy – traits that are associated with risk for schizophrenia. Previous studies of schizotypy have used primarily undergraduate or small community samples. The aim of the current study was to investigate correlates of schizotypy in a large online sample. We hypothesized that people with schizotypy traits would report lower functioning, well-being, and greater stigmatizing attitudes regarding treatment. Methods: In a sample (N=856) recruited using Amazon’s Mechanical Turk (MTurk), participants were dichotomized into non-schizotypy or schizotypy groups based on their endorsement of schizotypal traits on the Schizotypal Personality Questionnaire – Brief Revised (SPQ-BR; schizotypy group n=101; non-schizotypy group n=431). Participants completed a demographic survey and several measures related to functioning, well-being, and stigma, including the Romantic Relationship Functioning Scale (RRFS), the Social Adjustment Scale – Self-Report: Screener (SAS-SR: Screener), the SPQ-BR, the Short Form-12 Health Survey (SF-12), and the Stigma Scale for Receiving Psychological Help (SSRPH). Independent-samples t-tests were conducted to compare schizotypy groups on these variables. Results: Those who reported high levels of schizotypy reported significantly poorer social functioning, t(122.74)=-10.66, p<.001; poorer romantic relationship functioning, t(129.01)=12.00, p<.001; poorer mental wellbeing ,t(132.58)=13.42, p=.001; and greater stigma toward receiving psychological treatment, t(137.06)=-3.89, p=.037. There was no significant difference in physical wellbeing. Discussion: These findings support the use of online samples and suggest schizotypy is associated with poorer functioning and wellbeing and increased stigma toward seeking treatment. Results support the emergence of deficits in key social domains among those at risk for developing greater psychosis symptoms. Given the links between these deficits and attitudes and poorer functioning in clinical samples, these findings suggest social functioning and help-seeking attitudes may be important targets of early intervention services

Levels of distress tolerance in schizophrenia appear equivalent to those found in borderline personality disorder

Objective: Distress tolerance is an important but understudied construct for those with schizophrenia-spectrum disorders. This study compared levels of distress tolerance between people diagnosed with schizophrenia and borderline personality disorder (BPD) to better characterize distress tolerance in schizophrenia-spectrum disorders. Method: Using cross-sectional data, we examined group differences in distress tolerance in people with schizophrenia-spectrum disorders (n = 55) and BPD (n = 32) through mean comparison and equivalence analyses. Results: Our results indicate that, in our data, distress tolerance did not differ between those with schizophrenia and those with BPD, and was in fact statistically equivalent between groups. In contrast, those with BPD tended to report more difficulty on some aspects of emotion regulation. Conclusion: Findings from this study suggest that increased focus on distress tolerance is called for in research on schizophrenia. Furthermore, people with schizophrenia-spectrum disorders may benefit from interventions targeting distress tolerance