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Item 16.3 Are Visual Motion Perception and Detection of Animacy Critical to Higher-Order Social Cognitive Function in Schizophrenia?(Oxford University Press, 2019-04) Johannesen, Jason; Lysaker, Paul; James, Alison; Kenney, Joshua; Bell, Morris; Medicine, School of MedicineBackground The observation that individuals with schizophrenia tend to misinterpret subtle social cues is often attributed to deficit in Theory of Mind (ToM). While ToM is commonly assessed using videos portraying interaction between actors, recent work in vision science shows that stimuli with no innate animate features can also convey similar social information through motion alone. These simplified stimuli are advantageous for experimental purposes and may provide further insights into perceptual mechanisms supporting social cognitive function. The Social Attribution Task-Multiple Choice (SAT-MC), based on the classic Hieder and Simmel (1944) stimuli, tells a story using three geometric shapes moving about a centrally fixed figure, followed by questions about what the viewer observed. Although there are no explicit social cues, viewers typically detect actions suggestive of relationships between objects, their intentions, and emotions. This talk will present findings from three studies examining psychometric, functional, and neurophysiological aspects on SAT -MC performance in schizophrenia. Methods Study 1 examined psychometric properties of two forms of the SAT-MC in comparison to video-based social cognitive tests using human actors in 32 schizophrenia (SZ) and 30 substance use disorder (SUD) participants. Study 2 examined functional relationships of the SAT-MC and affect recognition (BLERT) performance across neurocognitive, metacognitive, ToM, and symptom domains in 72 adults with SZ. Study 3 is an in-progress investigation of neurophysiological mechanisms of social cognition using test versions adapted for EEG recording. Chronic SZ, clinical high-risk (CHR), and healthy age-matched community samples are being collected. Results SZ scored significantly lower than SUD on two versions of the SAT-MC, each classifying ~60% of SZ as impaired, compared with ~30% of SUD. The two SAT-MC forms demonstrated good test-retest and parallel form reliability, minimal practice effect, high internal consistency, similar patterns of correlation with social cognitive test performance, and compared favorably to social cognitive tests across psychometric features. When examining functional correlates of SAT -MC performance, impairment is found to co-occur with deficits in affect recognition in the majority of cases but relates uniquely to reductions in verbal memory and emotional intelligence measures. Finally, a preliminary analysis (n=8 SZ, n=2 CHR) of EEG collected during SAT-MC video presentation finds significant correlations (r=.66-.72) between occipito-parietal gamma desynchronization and task performance. Additional analyses find task-related EEG during SAT to be predictive of affect recognition (BLERT) and ToM (TASIT) performance, with correlates including alpha desynchronization in frontal, occipital, and temporal regions, and synchronization of temporal theta and occipital gamma (all r > .5). Conclusions SAT-MC performance is found to be reliable using different stimuli, related to affect recognition and ToM in three independent samples, and shows high diagnostic specificity in classifying SZ against a SUD sample. Functional correlates also involve encoding and emotional intelligence abilities tested outside the visual modality. Analysis of neural oscillatory activity related SAT-MC performance to visual and attention processes, as well as engagement of a broader social cognitive network applied to affect recognition and ToM tasks. Impairment in visual motion processing appears integral to schizophrenia pathophysiology and a critical factor influencing social cognitive abilities attributed to higher-order ToM ability.Item Addressing Formal Thought Disorder in Psychosis through Novel Assessment and Targeted Intervention(2020-08) Marggraf, Matthew P.; Minor, Kyle; Salyers, Michelle; Lysaker, Paul; Stewart, JesseFormal thought disorder (FTD) is a debilitating symptom of psychosis. It is linked to functional deficits and generally demonstrates poor response to interventions. Metacognition has emerged as a potential therapeutic target that may be effective in reducing FTD, as metacognitive deficits and FTD both arise from disruptions in associative thought processes. This study’s primary aim was to determine whether FTD could be reduced with metacognitive therapy. Pre-post changes in FTD severity were assessed using clinician-rated and automated measures in 20 individuals with psychotic disorders who received 12 sessions of evidence-based metacognitive therapy. We also examined whether reductions in FTD were larger when assessed with automated instruments versus clinician-rated measures. Aim two compared associations between FTD and three outcome variables (social functioning, role functioning, metacognition) across FTD-measurement approach. Results indicated that automated FTD, but not clinician-rated FTD, was significantly reduced post-intervention. This effect was more robust within a subsample exhibiting greater levels of FTD. Strength of associations between FTD and outcome variables did not differ across FTD measurement approach. These findings provide initial evidence that a targeted metacognitive intervention can reduce FTD. Effects were strongest for automated instruments, which may be more sensitive to detecting change; however, differences in measurement type did not extend to associations with selected outcome variables. This study provides preliminary support for future efforts to reduce FTD. Large-scale studies with longer intervention periods may further our understanding of the effectiveness of metacognitive intervention on FTD.Item Evaluating the Impact of Metacognitive Reflection and Insight Therapy on Social Functioning in Schizophrenia(2021-12) Mickens, Jessica L.; Minor, Kyle S.; Salyers, Michelle; Lysaker, PaulObjective: Social functioning encompasses interactions with people across situations of varying complexity. Given the frequency of observed social impairments in individuals with schizophrenia, there is a need to identify mechanisms that influence social functioning impairments. One proposed mechanism is metacognition, a mental process that enables the integration and interpretation of mental states and experiences. Impaired metacognition can inhibit one’s ability to engage and navigate through our social world. In individuals with schizophrenia, both social functioning and metacognitive deficits are profound. This study examined three hypotheses. Following Metacognitive Reflection and Insight Therapy (MERIT), (1) individuals will show improvements in social functioning; (2) individuals will show improvements in metacognitive abilities; and (3) improvements in social functioning will be associated with improved metacognitive abilities. Method: Using secondary data from a MERIT therapy feasibility study, data collected from the active condition groups (e.g., individuals with schizophrenia, n =16) at pre-and post-assessment were analyzed using paired samples t-tests for primary outcomes and hierarchical linear regressions to assess metacognition as an underlying mechanism of change. Results: Paired samples t-tests found no significant improvement in social functioning or metacognition. In contrast to the hypothesis, metacognitive abilities significantly declined. When subscales were examined, two subscales (self-reflectivity and awareness of others) significantly decreased. The post-hoc analysis found significant improvements in overall symptoms and disorganization. Lastly, metacognition did not significantly predict post-intervention social functioning. Conclusions: Measurement modality and the length of intervention may help explain the null findings observed in this study. The improvement in overall and disorganized symptoms could indicate that symptom reductions precede social functioning and metacognition changes. Given that the results from this trial were not aligned with previous studies, further research is needed to determine the effectiveness of MERIT on social functioning and metacognition in schizophrenia.Item F105. Measuring Empathy in Schizophrenia: The Empathic Accuracy Task and Its Correlation With Other Empathy Measures(Oxford University Press, 2018-04) Donkersgoed, Rozanne van; Sportel, Bouwina; De Jong, Steven; aan het Rot, Marije; Wunderink, Alexander; Lysaker, Paul; Hasson-Ohayon, Ilanit; Aleman, Andre; Pijnenborg, Marieke (Gerdina); Psychiatry, School of MedicineBackground Empathy is a complex interpersonal process thought to be impaired in individuals with schizophrenia spectrum disorders. Past studies have mainly used questionnaires or performance-based tasks with static cues to measure cognitive and affective empathy. In contrast, we used an Empathic Accuracy Task (EAT) designed to capture the more dynamic aspects of empathy by using video clips in which perceivers continuously judge emotionally charged stories of various targets. We compared individuals with schizophrenia to healthy controls on the EAT and assessed correlations among the EAT and three other commonly used empathy tasks. Methods Patients (n=92) and healthy controls (n=42) matched for age and education, completed the EAT, the Interpersonal Reactivity Index, the Questionnaire of Cognitive and Affective Empathy and the Faux Pas task. Differences between groups were analyzed and correlations were calculated between empathy measurement instruments. Results The groups differed in EAT performance, with controls outperforming patients. A moderating effect was found for the emotional expressivity of the target: while both patients and controls scored low when judging targets with low expressivity, controls performed better than patients with more expressive targets. Though there were also group differences on the cognitive and affective empathy questionnaires (with lower scores for patients in comparison to controls), EAT performance did not correlate with questionnaire scores. Reduced empathy performance did not seem to be part of a generalized cognitive deficit, as differences between patients and controls on general cognition was not significant. Discussion Individuals with schizophrenia benefit less from the emotional expressivity of other people than controls, which contributes to their impaired empathic accuracy. The lack of correlation between the EAT and the questionnaires suggests a distinction between self-report empathy and actual empathy performance. To explore empathic difficulties in real life, it is important to use instruments that take the interpersonal perspective into account.Item F247. Internalized Stigma Has a Stronger Relationship with Intrinsic Motivation Compared to Amotivation in Early Phase and Prolonged Schizophrenia(Oxford University Press, 2018-04) Firmin, Ruth; Luther, Lauren; Lysaker, Paul; Vohs, Jennifer; Psychiatry, School of MedicineBackground Motivation deficits predict decreased functioning in schizophrenia. Recent work suggests deficits reflect challenges in separate domains: intrinsic motivation (one’s internal drive to engage in a behavior out of enjoyment or interest) and amotivation (one’s broader decrease in motivated behavior linked to avolition and anhedonia). Internalized stigma is another determinant of functioning for people with schizophrenia that may impact motivation. However, little is known about these relationships, including which aspects of motivation it may impact nor when these links emerge. Identifying the link between these constructs may help to identify whether internalized stigma may be a novel treatment target to facilitate improvements in motivation. Methods Forty adults with early phase schizophrenia and 66 adults with prolonged schizophrenia completed measures of internalized stigma, intrinsic motivation, and amotivation. Pearson’s correlations were examined followed by Fischer’s r-to-z transformations to compare differences in the magnitude of associations between internalized stigma and intrinsic motivation and internalized stigma and amotivation among the first episode and prolonged samples. Next, we conducted stepwise regressions to examine whether internalized stigma was associated with intrinsic motivation above and beyond associations with amotivation in each sample. Results In the early phase sample, the association between internalized stigma was greater with intrinsic motivation (r=-0.48, p=.00) compared to amotivation (r=0.27, p=0.10). Associations with internalized stigma in the prolonged sample were also greater with intrinsic motivation (r=-0.30, p=0.02) versus amotivation (r=0.19, p=0.12). The magnitude of the associations between internalized stigma and intrinsic motivation (z=1.03, p=0.15) and between internalized stigma and amotivation (z=0.41, p = 0.34) did not significantly differ when comparing phase of illness. Regression analyses indicated that, controlling for amotivation, internalized stigma predicted intrinsic motivation in both the prolonged sample (R2=0.09, F(1,64) =6.18, p=0.02) and the early phase schizophrenia sample (R2=0.23, F(1,37)=10.98, p=.00). Discussion Results suggest internalized stigma has a stronger relationship with intrinsic motivation separate from, and above and beyond, its association with amotivation. Findings support models of intrinsic and amotivation being distinct domains. Links between internalized stigma and motivation appear to emerge and persist from the early stages of schizophrenia, suggesting that targeting stigma in early intervention services may help to improve intrinsic motivation in people with schizophrenia.Item Intersections of occupational participation and borderline personality disorder: A grounded theory approach(Taylor and Francis, 2020-01) Wasmuth, Sally; Mokol, Emily; Szymaszek, Karolina; Gaerke, Kyra-Jo; Manspeaker, Trevor; Lysaker, Paul; Tommasi, Marco; Occupational Therapy, School of Health and Human SciencesBorderline personality disorder (BPD) is characterized by intense emotions, self-harm, unstable self-image, and risky behaviors, which impede wellness and interfere with occupational participation. However, literature on occupational participation of people with BPD is scarce and has mostly focused on women. This study explores and elucidates intersections of occupational participation and BPD in a sample of mostly male veterans in order to identify potential ways occupational therapists and other health professionals can support wellbeing for this population. Grounded theory analysis was conducted on data collected using the Indiana Psychiatric Illness Interview (IPII), a semi-structured interview designed to elicit illness personal narratives. Analysis yielded three main themes—influencing environment, internal experience, and occupation—and several subthemes including being abused, arising problems, feeling neglected, feeling victimized, escape, self-segregating, positive change, participating/engaging, and substance abuse. Occupations both influenced and were influenced by the environment and internal experiences. Environments appeared to influence internal experience, but internal experiences did not influence environments directly. Rather, internal experiences impacted a person’s occupations which, in turn, impacted their environments. Participants’ occupational lives revealed, as expected, several subthemes depicting negative and/or isolating experiences. However, participants’ occupations directly impacted both their environmental contexts and internal experiences, suggesting occupational performance may be a powerful mechanism of change for this population. Findings offer promise that occupational therapists could facilitate health-promoting occupational participation which, in turn, may result in more positive and health-promoting environments and internal experiences.Item Interventions targeting mental health self-stigma: A review and comparison(American Psychological Association, 2015-06) Yanos, Philip T.; Lucksted, Alicia; Drapalski, Amy L.; Roe, David; Lysaker, Paul; Department of Psychiatry, IU School of MedicineOBJECTIVE: With growing awareness of the impact of mental illness self-stigma, interest has arisen in the development of interventions to combat it. The present article briefly reviews and compares interventions targeting self-stigma to clarify the similarities and important differences between the interventions. METHOD: We conducted a narrative review of published literature on interventions targeting self-stigma. RESULTS: Six intervention approaches (Healthy Self-Concept, Self-Stigma Reduction Program, Ending Self-Stigma, Narrative Enhancement and Cognitive Therapy, Coming Out Proud, and Anti-Stigma Photo-Voice Intervention) were identified and are discussed, and data is reviewed on format, group-leader backgrounds, languages, number of sessions, primary mechanisms of action, and the current state of data on their efficacy. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: We conclude with a discussion of common elements and important distinctions between the interventions and a consideration of which interventions might be best suited to particular populations or settings.Item Meaning-Making Processes Across the Lifespan: An Investigation of Metacognitive Capacity and Autobiographical Reasoning(2020-08) Davis, Beshaun J.; Minor, Kyle S.; Salyers, Michelle P.; Lysaker, Paul; Pietri, EvavaDeficits in metacognitive capacity (i.e., the ability to integrate knowledge of oneself and others into a cohesive whole) have been shown to lead to poor functional outcome in psychosis. However, there is a gap in the literature concerning the role of metacognition in typically developing populations, which makes it difficult to define what level of metacognition is normative. Evidence from other models of self-experience such as autobiographical reasoning indicate that self-reflection increases across the lifespan, suggesting that the same may be true for metacognitive capacity. Thus, the current study expands knowledge of the self-concept by establishing a connection between metacognitive capacity and autobiographical reasoning and exploring the developmental course of metacognition in healthy populations. To that end, the following aims were evaluated: 1) Determining the developmental trajectory of metacognitive capacity; 2) Elucidating the relationship between metacognitive capacity and autobiographical reasoning; and 3) Exploring the potential moderating effect of autobiographical reasoning on the proposed relationship between age and metacognitive capacity. Our findings suggest that overall metacognitive capacity is consistent across the lifespan; however, awareness of the experiences of others increases with age. We also found that metacognitive capacity and autobiographical reasoning are separate constructs, with only a trend level negative association between autobiographical reasoning and decentration. This novel study elucidates the role of aging on metacognition and suggests that self-reflectivity is generally intact in the absence of severe psychopathology.Item Promoting Meaning and Recovery for Psychosis: Comparison of Metacognitively-Oriented Psychotherapists and Clinicians in Psychiatric Rehabilitation(Dove Press, 2023-10-18) Faith, Laura; Wiesepape, Courtney; Kukla, Marina; Lysaker, Paul; Psychiatry, School of MedicineIntroduction: Recovery from psychosis is an expected and desired outcome in psychiatric rehabilitation that may involve subjective outcomes related to personal recovery. While a considerable amount of qualitative research has examined patients' experience of recovery oriented approaches, there are less studies examining clinicians' perspectives. Examining the clinician point of view is important for both supporting clinicians within recovery-oriented practice, as well as for understanding underlying therapeutic processes. The aims of this study were to explore clinician experience of offering different psychiatric rehabilitation treatments for individuals with psychosis, and to understand similarities and differences of clinicians whose work differed in its recovery emphasis. Methods: Open-ended interviews were conducted with 10 psychotherapists providing Metacognitive Reflection and Insight Therapy (MERIT), a recovery oriented form of integrative psychotherapy focused on subjective aspects of recovery, and 10 clinicians providing standard psychiatric rehabilitation services. Results: Thematic analysis revealed important similarities and differences between these two groups of providers. There were seven themes found for MERIT therapists: Comfort with uncertainty, Emphasis on collaboration, Being part of therapeutic change, Connecting with clients, Emphasis on patient autonomy, Experiencing growth, and Therapist use of self-awareness. There were four themes found for psychiatric rehabilitation clinicians: Value of a structured approach, Focus on a strengths-based approach, Witnessing behavioral change, and Building rapport to support the work. Discussion: As expected, both similarities and differences arose between clinician groups. Results indicated that both groups focused on the therapeutic relationship and monitoring progress and outcomes. Unexpectedly, MERIT therapists reported growth as well as comfort with uncertainty. These findings suggest that MERIT is a a psychotherapy that offers unique opportunities for creative and flexible exploration of meaning and agency that is both challenging and rewarding for clinicians. Implications for supporting healthy clinician practice and the development of services are discussed.Item Psychosocial Stress, Epileptic-Like Symptoms and Psychotic Experiences(Frontiers Media, 2022-04-14) Bob, Petr; Touskova, Tereza Petraskova; Pec, Ondrej; Raboch, Jiri; Boutros, Nash; Lysaker, Paul; Psychiatry, School of MedicineBackground: Current research suggests that stressful life experiences and situations create a substantive effect in the development of the initial manifestations of psychotic disorders and may influence temporo-limbic epileptic-like activity manifesting as cognitive and affective seizure-like symptoms in non-epileptic conditions. Methods: The current study assessed trauma history, hair cortisol levels, epileptic-like manifestations and other psychopathological symptoms in 56 drug naive adult young women experiencing their initial occurrence of psychosis. Results: Hair cortisol levels among patients experiencing their initial episode of psychosis, were significantly correlated with stress symptoms measured by Trauma Symptom Checklist-40 (r = - 0.48, p < 0.01), and complex partial seizure-like symptoms measured by the Complex Partial Seizure-Like Symptoms Inventory (r = - 0.33, p < 0.05) and LSCL-33 (r = - 0.33, p < 0.05). Hair cortisol levels were not found to be significantly correlated with symptoms of anxiety and depression measured by Beck depression Inventory and Zung Anxiety Scale. Conclusion: These findings suggest a significant relationship between epileptic-like symptoms and stress responses demonstrated by patients in their first psychotic episode. These findings may suggest the potential for research to explore usefulness of anticonvulsant treatment in patients who do not respond to usual psychotropic medication.