Effective connectivity gateways to the Theory of Mind network in processing communicative intention.

An Intention Processing Network (IPN), involving the medial prefrontal cortex, precuneus, bilateral posterior superior temporal sulcus, and temporoparietal junctions, plays a fundamental role in comprehending intentions underlying action goals. In a previous fMRI study, we showed that, depending on the linguistic or extralinguistic (gestural) modality used to convey the intention, the IPN is complemented by activation of additional brain areas, reflecting distinct modality-specific input gateways to the IPN. These areas involve, for the linguistic modality, the left inferior frontal gyrus (LIFG), and for the extralinguistic modality, the right inferior frontal gyrus (RIFG). Here, we tested the modality-specific gateway hypothesis, by using DCM to measure inter-regional functional integration dynamics between the IPN and LIFG/RIFG gateways. We found strong evidence of a well-defined effective connectivity architecture mediating the functional integration between the IPN and the inferior frontal cortices. The connectivity dynamics indicate a modality-specific propagation of stimulus information from LIFG to IPN for the linguistic modality, and from RIFG to IPN for the extralinguistic modality. Thus, we suggest a functional model in which the modality-specific gateways mediate the structural and semantic decoding of the stimuli, and allow for the modality-specific communicative information to be integrated in Theory of Mind inferences elaborated through the IPN.

Cognitive Pragmatic Rehabilitation Program in Schizophrenia: A Single Case fMRI Study.

Introduction. The present study was intended to evaluate the effects of a rehabilitative training, the Cognitive Pragmatic Treatment (CPT), aimed at improving communicative-pragmatic abilities and the related cognitive components, on the cerebral modifications of a single case patient diagnosed with schizophrenia. Methods. The patient underwent two functional magnetic resonance imaging (fMRI) sessions, before and after the treatment. In order to assess brain changes, we calculated the Amplitude of Low Frequency Fluctuation (ALFF) index of the resting-state fMRI signal, which is interpreted as reflecting the intensity of the spontaneous regional activity of the brain. Behavioural measures of the patient's communicative performance were also gathered before and after training and at follow-up. Results. The patient improved his communicative performance in almost all tests. Posttraining stronger ALFF signal emerged in the superior, inferior, and medial frontal gyri, as well as the superior temporal gyri. Conclusions. Even if based on a single case study, these preliminary results show functional changes at the cerebral level that seem to support the patient's behavioural improvements.

Cognitive Pragmatic Treatment: A Rehabilitative Program for Traumatic Brain Injury Individuals.

OBJECTIVE: To verify the efficacy of Cognitive Pragmatic Treatment (CPT), a new rehabilitation training program for improving communicative-pragmatic abilities. DESIGN: The CPT program consists of 24 group sessions, concerned with improving several communication modalities, theory of mind (ToM), and cognitive components that can affect pragmatic performance, such as awareness and executive functions. PARTICIPANTS: A sample of 15 adults with severe traumatic brain injury. MAIN MEASURES: Improvements were evaluated before and after training, using the equivalent forms of the Assessment Battery for Communication (ABaCo), a tool for evaluating comprehension and production of a wide range of pragmatic phenomena. A neuropsychological and ToM assessment was also conducted. RESULTS: The patients' performance improved after training, in terms of both comprehension and production, in all the communication modalities assessed by the ABaCo, that is, linguistic, extralinguistic, paralinguistic, and social appropriateness abilities. The follow-up showed that the improvement of patients persists after 3 months from the end of the training. CONCLUSIONS: The results suggest that the CPT program is efficacious in improving communicative-pragmatic abilities in individuals with TBI, and that improvements at this level are still detectable even in chronic patients years after the injury.

Explaining pragmatic performance in traumatic brain injury: a process perspective on communicative errors.

BACKGROUND: The purpose of this study is to investigate the pragmatic abilities of individuals with traumatic brain injury (TBI). Several studies in the literature have previously reported communicative deficits in individuals with TBI, however such research has focused principally on communicative deficits in general, without providing an analysis of the errors committed in understanding and expressing communicative acts. Within the theoretical framework of Cognitive Pragmatics theory and Cooperative principle we focused on intermediate communicative errors that occur in both the comprehension and the production of various pragmatic phenomena, expressed through both linguistic and extralinguistic communicative modalities. AIMS: To investigate the pragmatic abilities of individuals with TBI. METHODS & PROCEDURES: A group of 30 individuals with TBI and a matched control group took part in the experiment. They were presented with a series of videotaped vignettes depicting everyday communicative exchanges, and were tested on the comprehension and production of various kinds of communicative acts (standard communicative act, deceit and irony). The participants' answers were evaluated as correct or incorrect. Incorrect answers were then further evaluated with regard to the presence of different intermediate errors. OUTCOMES & RESULTS: Individuals with TBI performed worse than control participants on all the tasks investigated when considering correct versus incorrect answers. Furthermore, a series of logistic regression analyses showed that group membership (TBI versus controls) significantly predicted the occurrence of intermediate errors. This result holds in both the comprehension and production tasks, and in both linguistic and extralinguistic modalities. CONCLUSIONS & IMPLICATIONS: Participants with TBI tend to have difficulty in managing different types of communicative acts, and they make more intermediate errors than the control participants. Intermediate errors concern the comprehension and production of the expression act, the comprehension of the actors' meaning, as well as the respect of the Cooperative principle.

Communicative abilities in children: an assessment through different phenomena and expressive means.

Previous studies on children's pragmatic abilities have tended to focus on just one pragmatic phenomenon and one expressive means at a time, mainly concentrating on comprehension, and overlooking the production side. We assessed both comprehension and production in relation to several pragmatic phenomena (simple and complex standard communication acts, irony, and deceit) and several expressive means (linguistic, extralinguistic, paralinguistic). Our study involved 390 Italian-speaking children divided into three age groups: 5;0-5;6, 6;6-7;0, and 8;0-8;6. Children's performance on all tasks improved with their age. Within each age group, children responded more accurately to tasks involving standard communication than to those involving deceit and irony, across all expressive means and for both comprehension and production. Within each pragmatic phenomenon, children responded more accurately to simple acts than to complex ones, regardless of age group and expressive means, i.e., linguistic or extralinguistic. Overall results fit well with the Cognitive Pragmatics theory (Bara, 2010).

Assessment battery for communication (ABaCo): normative data.

The Assessment Battery for Communication (ABaCo) was introduced to evaluate pragmatic abilities in patients with cerebral lesions. The battery is organized into five evaluation scales focusing on separate components of pragmatic competence. In the present study, we present normative data for individuals 15-75 years of age (N = 300). The sample was stratified by age, sex, and years of education, according to Italian National Institute of Statistics indications in order to be representative of the general national population. Since performance on the ABaCo decreases with age and lower years of education, the norms were stratified for both age and education. The ABaCo is a valuable tool in clinical practice; the normative data provided here will enable clinicians to determine different kinds and specific levels of communicative impairments more precisely.

Intention processing in communication: a common brain network for language and gestures.

Human communicative competence is based on the ability to process a specific class of mental states, namely, communicative intention. The present fMRI study aims to analyze whether intention processing in communication is affected by the expressive means through which a communicative intention is conveyed, that is, the linguistic or extralinguistic gestural means. Combined factorial and conjunction analyses were used to test two sets of predictions: first, that a common brain network is recruited for the comprehension of communicative intentions independently of the modality through which they are conveyed; second, that additional brain areas are specifically recruited depending on the communicative modality used, reflecting distinct sensorimotor gateways. Our results clearly showed that a common neural network is engaged in communicative intention processing independently of the modality used. This network includes the precuneus, the left and right posterior STS and TPJ, and the medial pFC. Additional brain areas outside those involved in intention processing are specifically engaged by the particular communicative modality, that is, a peri-sylvian language network for the linguistic modality and a sensorimotor network for the extralinguistic modality. Thus, common representation of communicative intention may be accessed by modality-specific gateways, which are distinct for linguistic versus extralinguistic expressive means. Taken together, our results indicate that the information acquired by different communicative modalities is equivalent from a mental processing standpoint, in particular, at the point at which the actor's communicative intention has to be reconstructed.

Inferring intentions from biological motion: a stimulus set of point-light communicative interactions.

We present the first database of communicative interactions reproduced through point-light displays (Communicative Interaction Database). The database contains 20 communicative interactions performed by male and by female couples. For each action, we provide movie files from four different viewpoints, as well as text files with the 3-D spatial coordinates of the point lights, allowing researchers to construct customized versions. By including various types of actions performed with different social motives, the database contains a diverse sample of nonconventional communicative gestures. Normative data collected to assess the recognizability of the stimuli suggest that, for most action stimuli, information in point-light displays is sufficient for clear recognition of the action as communicative, as well as for identification of the specific communicative gesture performed by the actor. The full set of stimuli may be downloaded from http://brm.psychonomic-journals.org/content/supplemental and from http://ppw.kuleuven.be/labexppsy/lepSite/resources/CID.rar.

Does the intention to communicate affect action kinematics?

The aim of the present study was to investigate the effects of communicative intention on action. In Experiment 1 participants were requested to reach towards an object, grasp it, and either simply lift it (individual condition) or lift it with the intent to communicate a meaning to a partner (communicative condition). Movement kinematics were recorded using a three-dimensional motion analysis system. The results indicate that kinematics was sensitive to communicative intention. Although the to-be-grasped object remained the same, movements performed for the 'communicative' condition were characterized by a kinematic pattern which differed from those obtained for the 'individual' condition. These findings were confirmed in a subsequent experiment in which the communicative condition was compared to a control condition, in which the communicative exchange was prevented. Results are discussed in terms of cognitive pragmatics and current knowledge on how social behavior shapes action kinematics.

Neuropragmatics: Extralinguistic pragmatic ability is better preserved in left-hemisphere-damaged patients than in right-hemisphere-damaged patients.

The aim of the present study is to compare the pragmatic ability of right- and left-hemisphere-damaged patients excluding the possible interference of linguistic deficits. To this aim, we study extralinguistic communication, that is communication performed only through gestures. The Cognitive Pragmatics Theory provides the theoretical framework: it predicts a gradient of difficulty in the comprehension of different pragmatic phenomena, that should be valid independently of the use of language or gestures as communicative means. An experiment involving 10 healthy individuals, 10 right- and 9 left-hemisphere-damaged patients, shows that pragmatic performance is better preserved in left-hemisphere-damaged (LHD) patients than in right-hemisphere-damaged (RHD) patients.

Group Membership Modulates the Neural Circuitry Underlying Third Party Punishment.

This research aims to explore the neural correlates involved in altruistic punishment, parochial altruism and anti-social punishment, using the Third-Party Punishment (TPP) game. In particular, this study considered these punishment behaviors in in-group vs. out-group game settings, to compare how people behave with members of their own national group and with members of another national group. The results showed that participants act altruistically to protect in-group members. This study indicates that norm violation in in-group (but not in out-group) settings results in increased activity in the medial prefrontal cortex and temporo-parietal junction, brain regions involved in the mentalizing network, as the third-party attempts to understand or justify in-group members' behavior. Finally, exploratory analysis during anti-social punishment behavior showed brain activation recruitment of the ventromedial prefrontal cortex, an area associated with altered regulation of emotions.

Mental Fitness for patients with acute coronary syndrome: A randomized clinical trial.

OBJECTIVES: The aim of this study was to verify the efficacy of a manualized, cognitively oriented psychological intervention, called Mental Fitness, in improving the mental and physical health of patients with acute coronary syndrome (ACS). Mental Fitness is a small-group four-session treatment aimed at increasing awareness of one's own bodily perceptions, emotions, and thoughts and is overall tailored on participants' perception of control over their health. DESIGN: Prospective randomized controlled single-blind trial. METHODS: Patients with ACS were recruited within a week from their acute cardiac event. Patients in the intervention group underwent one of two variants of Mental Fitness, depending on their perceived (internal or external) control over their health. Patients in the control group underwent standard treatment. All the patients were submitted to a clinical and psychological follow-up for 8 months. RESULTS: The patients who underwent the Mental Fitness intervention (N = 31) showed, compared to the control patients (N = 34), increased quality of life in its physical, psychological, social and environmental domains, more functional emotional and problem-centred coping strategies, and higher emotional awareness. They also showed improved high-density lipoprotein cholesterol, triglycerides, heart rate, and left ventricular ejection fraction compared to the controls. In addition, they were more successful in maintaining physical exercise. CONCLUSIONS: This study demonstrates the efficacy of Mental Fitness in modifying specific psychological and physical variables conditioning cardiological patients' prognosis. It also confirms the importance of differentiating psychological interventions based on the psychological characteristics of the patients. Statement of contribution What is already known on this subject? Traditional symptom-based interventions in heart disease are aimed at diagnosing and reducing psychological symptomatology (e.g., depression), but recent work has shown the usefulness of orienting psychological interventions to patients' representations of themselves and of the world and to how such representations influence their thoughts, feelings, and behaviours (e.g., Chiavarino et al., ). What does this study add? Mental Fitness, by working on awareness of bodily perceptions, emotions, and thoughts, leads to positive changes in physical and psychological health. Mental Fitness is a cost-effective psychological intervention that adds significantly to the effectiveness of standard medical care.

Rehabilitation of Communicative Abilities in Patients with a History of TBI: Behavioral Improvements and Cerebral Changes in Resting-State Activity.

A targeted training program for the rehabilitation of communicative abilities-Cognitive Pragmatic Treatment (CPT)-has been developed and previously tested on a sample of patients with traumatic brain injury (TBI), whose performance was found to have improved. Since cortical plasticity has been recognized as the main mechanism of functional recovery, we investigated whether and how behavioral improvements following the training program are accompanied by brain modifications. Eight TBI patients took part in the training program and were behaviorally assessed pre- and post-treatment; six of these patients were also evaluated with pre- and post-treatment resting state (rs) functional magnetic resonance imaging (fMRI). At the end of the rehabilitation program patients showed improvement in overall communicative performance, in both comprehension and production tasks. A follow-up retest revealed the stability of these results 3 months after completing the training program. At the brain level, we found significant increases in the amplitude of low frequency fluctuation (ALFF) index in the bilateral precentral gyrus, in the right middle and superior temporal gyri, in the right cingulate gyrus, and in the left inferior parietal lobule. We discuss these differences of brain activity in terms of their possible contribution to promoting recovery.

Theory of mind deficit in adult patients with congenital heart disease.

This article provides the first assessment of theory of mind, that is, the ability to reason about mental states, in adult patients with congenital heart disease. Patients with congenital heart disease and matched healthy controls were administered classical theory of mind tasks and a semi-structured interview which provides a multidimensional evaluation of theory of mind (Theory of Mind Assessment Scale). The patients with congenital heart disease performed worse than the controls on the Theory of Mind Assessment Scale, whereas they did as well as the control group on the classical theory-of-mind tasks. These findings provide the first evidence that adults with congenital heart disease may display specific impairments in theory of mind.

Schizophrenia and autism as contrasting minds: neural evidence for the hypo-hyper-intentionality hypothesis.

Both schizophrenia (SCZ) and autism spectrum disorder (ASD) are characterized by mentalizing problems and associated neural dysfunction of the social brain. However, the deficits in mental state attribution are somehow opposed: Whereas patients with SCZ tend to over-attribute intentions to agents and physical events ("hyper-intentionality"), patients with autism treat people as devoid of intentions ("hypo-intentionality"). Here we aimed to investigate whether this hypo-hyper-intentionality hypothesis can be supported by neural evidence during a mentalizing task. Using functional magnetic resonance imaging (fMRI), we investigated the neural responses and functional connectivity during reading others intention. Scanning was performed in 23 individuals with ASD, 18 with paranoid SCZ and 23 gender and IQ matched control subjects. Both clinical groups showed reduced brain activation compared to controls for the contrast intentional vs physical information processing in left posterior superior temporal sulcus (pSTS) and ventral medial prefrontal cortex (vMPFC) for SCZ, and right pSTS in ASD. As predicted, these effects were caused in a group specific way: Relative increased activation for physical information processing in SCZ that was also correlated with positive PANNS score and relative decreased activation for intentional information processing in ASD. Additionally, we could demonstrate opposed connectivity patterns between the right pSTS and vMPFC in the clinical groups, ie, increased for SCZ, decreased for ASD. These findings represent opposed neural signatures in key regions of the social brain as predicted by the hyper-hypo-intentionality hypothesis.

Do you mean me? Communicative intentions recruit the mirror and the mentalizing system.

Being able to comprehend communicative intentions and to recognize whether such intentions are directed toward us or not is extremely important in social interaction. Two brain systems, the mentalizing and the mirror neuron system, have been proposed to underlie intention recognition. However, little is still known about how the systems cooperate within the process of communicative intention understanding and to what degree they respond to self-directed and other-directed stimuli. To investigate the role of the mentalizing and the mirror neuron system, we used functional magnetic resonance imaging with four types of action sequence: communicative and private intentions as well as other-directed and self-directed intentions. Categorical and functional connectivity analyses showed that both systems contribute to the encoding of communicative intentions and that both systems are significantly stronger activated and more strongly coupled in self-directed communicative actions.

Understanding the communicative impairments in schizophrenia: a preliminary study.

UNLABELLED: The aim of the present study was to evaluate the pragmatic abilities of patients with schizophrenia in a variety of pragmatic phenomena expressed through different communicative means (language, gestures, and paralinguistic modality). For this purpose we used the Assessment Battery of Communication (ABaCo; Sacco et al., 2008). The ABaCo is a validated clinical tool for assessing pragmatic skills, which comprises five evaluation scales-linguistic, extralinguistic, paralinguistic, context, and conversational-investigating both comprehension and production of the main pragmatic phenomena involved in a communicative exchange, such as direct and indirect speech acts, irony, deceit, the violation of Grice's maxims, topic management, and turn-taking. The battery was administered to a group of seventeen patients with schizophrenia, and matched healthy controls. We expected the clinical group to perform widely worse than the control group in the different pragmatic dimensions investigated. Results showed that patients with schizophrenia performed significantly worse than controls on all the five scales of the battery, both in comprehension and production tasks. Moreover, the results within each scale showed a differentiated performance in the clinical group among the pragmatic phenomena, with irony assessed as the most difficult task. The implications of these results for research and treatment in schizophrenia are discussed. LEARNING OUTCOMES: After reading this article, the reader will be able to: (1) summarize thepreliminary assessment of pragmatic impairments in patients with schizophrenia; (2) describea variegated communicative profile regarding different pragmatic phenomena; and (3) discuss the planning and evaluating specific rehabilitation programs.

Recognition and repair of communicative failures: the interaction between Theory of Mind and cognitive complexity in schizophrenic patients.

UNLABELLED: The aim of the present research is to perform a detailed and empirical investigation of schizophrenia patients' deficits in recognizing and recovering a communicative failure. In particular, this paper investigates the role of Theory of Mind (ToM) and of the complexity of the mental representations involved in explaining patients' deficits in recognizing and recovering different kinds of communicative failures, i.e. failure of the expressive act, failure of communicative meaning and failure of the communicative effect. Twenty-two patients with schizophrenia and an equal number of healthy controls took part in the experiment. The experimental protocol consisted of videotaped stories in which two agents interact, showing a communicative failure; the participants were asked to recognize and repair the observed failure. Some classical ToM tests (Sally and Ann, Modified Smarties and a selection of six Strange Stories) were also administered. Our results revealed a deficit in patients, when compared with healthy controls, in recognizing and recovering communicative failures. Furthermore, focusing on schizophrenia patients' performance per se, we observed a trend with regard to the increasing difficulty of understanding and recognizing different kinds of communicative failures, i.e. failure of expression act, failure of communicative meaning, and failure of the communicative effect. LEARNING OUTCOMES: The reader becomes aware that schizophrenic patients perform less well than healthy controls in recognizing and recovering different kinds of communicative failures, and of the role played by Theory of Mind, and representational complexity involved in such different kinds of failures, in explaining patients' performance.

Assessment Battery for Communication: development of two equivalent forms.

UNLABELLED: The aim of this paper was to develop and test two equivalent forms of the Assessment Battery for Communication (ABaCo), a tool for evaluating pragmatic abilities in patients with neuropsychological and psychiatric disorders. The equivalent forms were created using the data from a sample of 390 children, then tested in a sample of 30 patients with traumatic brain injury. Equivalent forms of the same test are useful in clinical practice and intervention research, when performance needs to be tested on two separate occasions, for example before and after a rehabilitation program. The present results provide additional evidence on the psychometric functioning of the equivalent forms of the ABaCo and their usability in a clinical context. LEARNING OUTCOMES: The reader will be able to discuss the evidence of the psychometric propriety of the equivalent forms of the ABaCo and describe its potential usefulness.

Emotional coping is a better predictor of cardiac prognosis than depression and anxiety.

OBJECTIVE: We compared, in a prospective study on patients with acute coronary syndrome, the predictive effect of a depression or anxiety diagnosis and of emotion-focused, problem-focused and dysfunctional coping strategies, as detected early after an acute event, on patients' left ventricular ejection fraction (LVEF), a reliable prognostic index of disease severity, at a three-month follow up. METHODS: Ninety consecutive patients following an acute coronary syndrome event (83.3% men; mean age 56.9 ± 8.9 years) were included in the study. Demographic and clinical characteristics, presence of depression and anxiety disorders (MINI), and active use of emotion-focused, problem-focused and dysfunctional coping strategies (Brief Cope) were assessed at the time of enrolment. LVEF at a three-month follow up was used as the outcome measure. RESULTS: The medical predictors of LVEF accounted for 10.6% of the variance of LVEF at follow up. Emotion-focused coping strategies significantly contributed for an additional 6.1%, while the presence of a depression and/or anxiety disorder was not a significant predictor of LVEF at follow up, nor were dysfunctional and problem-focused coping strategies. CONCLUSION: Emotion-focused coping strategies at the time of the cardiac event were the only reliable psychological predictor of disease severity at a three-month follow up. These findings hint to the possibility that variables such as emotional coping may be a fruitful target for psychological treatments directed at cardiac patients in primary care settings.