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Item Affective Empathy in Schizophrenia: A Meta-Analysis(Elsevier, 2016-08) Bonfils, Kelsey A.; Lysaker, Paul H.; Minor, Kyle S.; Salyers, Michelle P.; Department of Psychiatry, IU School of MedicineBackground Affective empathy, or the emotional response one has to the experiences or emotional states of others, contributes to relationship-maintaining behaviors and is key in fostering social connections, yet no work has synthesized the body of literature for people with schizophrenia. The aim of the present meta-analysis was to determine the extent to which those diagnosed with schizophrenia experience deficits in affective empathy. Methods A literature search was conducted of studies examining empathy. Data were analyzed using a random effects meta-analytic model with Hedges' g standardized mean difference effect size. Results Individuals with schizophrenia exhibited significant, medium deficits in affective empathy (k = 37). Measurement type moderated the affective empathy deficit such that performance-based measures showed larger schizophrenia group deficits than self-report measures. Conclusion Consistent, significant deficits in affective empathy were found comparing people with schizophrenia to healthy controls, especially when using performance-based assessments. The medium effect suggests an important role for empathy in the realm of social cognitive research, and points to the need for further investigation of measurement techniques and associations with functional outcomes.Item Conceptual Disorganization Weakens Links in Cognitive Pathways: Disentangling Neurocognition, Social Cognition, and Metacognition in Schizophrenia(Elsevier, 2015-12) Minor, Kyle S.; Marggraf, Matthew P.; Davis, Beshaun J.; Luther, Lauren; Vohs, Jenifer L.; Buck, Kelly D.; Lysaker, Paul H.; Department of Psychology, School of ScienceDisentangling links between neurocognition, social cognition, and metacognition offers the potential to improve interventions for these cognitive processes. Disorganized symptoms have shown promise for explaining the limiting relationship that neurocognition holds with both social cognition and metacognition. In this study, primary aims included: 1) testing whether conceptual disorganization, a specific disorganized symptom, moderated relationships between cognitive processes, and 2) examining the level of conceptual disorganization necessary for links between cognitive processes to break down. To accomplish these aims, comprehensive assessments of conceptual disorganization, neurocognition, social cognition, and metacognition were administered to 67 people with schizophrenia-spectrum disorders. We found that conceptual disorganization significantly moderated the relationship between neurocognition and metacognition, with links between cognitive processes weakening when conceptual disorganization is present even at minimal levels of severity. There was no evidence that conceptual disorganization—or any other specific disorganized symptom—drove the limiting relationship of neurocognition on social cognition. Based on our findings, conceptual disorganization appears to be a critical piece of the puzzle when disentangling the relationship between neurocognition and metacognition. Roles of specific disorganized symptoms in the neurocognition – social cognition relationship were less clear. Findings from this study suggest that disorganized symptoms are an important treatment consideration when aiming to improve cognitive impairments.Item The four-factor conceptualization of empathy in schizophrenia: A meta-analysis(Elsevier, 2016-03) Bonfils, Kelsey A.; Lysaker, Paul H.; Minor, Kyle S.; Salyers, Michelle P.; Department of Psychology, School of ScienceEmpathy is a complex construct, thought to contain multiple components. One popular measurement paradigm, the Interpersonal Reactivity Index (IRI), has been used extensively to measure empathic tendencies in schizophrenia research across four domains: empathic concern, perspective-taking, personal distress, and fantasy. However, no recent meta-analysis has been conducted for all four factors of this scale. The goal of this meta-analysis was to examine self-reported empathic tendencies for each factor of the IRI in people with schizophrenia as compared to healthy controls. A literature search revealed 32 eligible schizophrenia studies. The Hedges’ g standardized difference effect size was calculated for each component using a random effects meta-analytic model. Compared to healthy controls, schizophrenia samples reported significantly reduced tendencies for empathic concern, perspective-taking, and fantasy, but significantly greater tendencies for personal distress. Duration of illness significantly moderated the results for perspective-taking such that those with a longer duration exhibited greater deficits; percent female significantly moderated the results for personal distress such that samples with more females exhibited reduced effect sizes. Future work is needed to examine the impact of heightened personal distress on the empathic tendencies and abilities of those with schizophrenia, including the possible role of emotion regulation.Item Measures of Cancer-related Loneliness and Negative Social Expectations: Development and Preliminary Validation(2016-01-21) Adams, Rebecca N.; Kroenke, Kurt; Mosher, Catherine Esther; Hirsh, Adam Todd; Rand, Kevin L.; Grahame, Nicholas J.Loneliness is a known risk factor for poor mental and physical health outcomes in the general population, and preliminary research suggests that loneliness is linked to poorer health in cancer patients as well. Various aspects of the cancer experience (e.g., heightened existential concerns) lend themselves to making patients feel alone and misunderstood. Furthermore, loneliness theory suggests that negative social expectations, which may specifically relate to the cancer experience, precipitate and sustain loneliness. Thus, loneliness interventions in cancer should be tailored to address illness-related social conditions and negative social expectations. Prior to the development of loneliness interventions for cancer populations, cancer-specific tools are needed to assess: (1) loneliness attributed to cancer (i.e., cancer-related loneliness), and (2) negative social expectations related to cancer. In the current project I developed measures of cancer-related loneliness and cancer-related negative social expectations for use in future theory-based loneliness research. A mixed-methods study design was employed. First, I developed items for the measure of cancer-related loneliness (i.e., the Cancer Loneliness Scale) based on theory, prior research, and expert feedback. Second, I conducted a clinic-based qualitative study (n=15) to: (1) obtain cancer patient feedback on the Cancer Loneliness Scale items, and (2) inform development of the item pool for the measure of negative social expectations (i.e., the Cancer-related Negative Social Expectations Scale). Interviews were audiotaped, transcribed verbatim, and then transferred to Atlas.ti for analysis. Content analysis was used to analyze data regarding patient feedback and theoretical thematic analysis was used to analyze data regarding negative social expectations. Overall, patients said they liked the Cancer Loneliness Scale and no changes were made to the items based on patient feedback. Based on results, I also created five content domains of negative social expectations that were represented in the item pool for the Cancer-related Negative Social Expectations Scale. Third, I conducted a telephone and mail-based quantitative study (n=186) to assess psychometric properties of the two new measures. Dimensionality was determined using confirmatory factor analysis. Reliability was assessed by examining internal consistency coefficients and construct validity was assessed by examining theoretical relationships between the Cancer Loneliness Scale, the Cancer-related Negative Social Expectations Scale, and existing reliable and valid measures of health and social well-being. The final products of the project included a 7-item unidimensional Cancer Loneliness Scale and 5-item unidimensional Cancer-related Negative Social Expectations Scale. Excellent evidence for reliability and validity was found for both measures. The resulting measures have both clinical and research utility.Item Metacognition in schizophrenia disorders: Comparisons with community controls and bipolar disorder: Replication with a Spanish language Chilean sample(Elsevier, 2018-09) Lysaker, Paul H.; Irarrázaval, Leonor; Gagen, Emily C.; Armijo, Ivan; Ballerini, Massimo; Mancini, Milena; Stanghellini, Giovanni; Psychiatry, School of MedicineMetacognition refers to the activities which allow for the availability of a sense of oneself and others in the moment. Research mostly in North America with English-speaking samples has suggested that metacognitive deficits are present in schizophrenia and are closely tied to negative symptoms. Thus, replication is needed in other cultures and groups. The present study accordingly sought to replicate these findings in a Spanish speaking sample from Chile. Metacognition and symptoms were assessed among 26 patients with schizophrenia, 26 with bipolar disorder and 36 community members without serious mental illness. ANCOVA controlling for age and education revealed that the schizophrenia group had greater levels of metacognitive deficits than the bipolar disorder and community control groups. Differences in metacognition between the clinical groups persisted after controlling for symptom levels. Spearman correlations revealed a unique pattern of associations of metacognition with negative and cognitive symptoms. Results largely support previous findings and provide added evidence of the metacognitive deficits present in schizophrenia and the link to outcome cross culturally. Implications for developing metacognitively oriented interventions are discussed.Item Metacognitive self-reflectivity moderates the relationship between distress tolerance and empathy in schizophrenia(Elsevier, 2018) Bonfils, Kelsey A.; Minor, Kyle S.; Leonhardt, Bethany L.; Lysaker, Paul H.; Psychiatry, School of MedicineDeficits 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.Item The roles of emotion regulation and metacognition in performance based-empathy(2017-05) Bonfils, Kelsey A.; Salyers, Michelle P.; Lysaker, Paul H.; Minor, Kyle S.; Zapolski, Tamika C.B.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.