The functional significance of cognitive empathy and theory of mind in early and chronic schizophrenia.

Theoretical models suggest that it is the interplay between social cognitive processes that result in adaptive social functioning in schizophrenia. This study explored the relative contributions of, and interplay between, cognitive empathy, affective theory of mind (ToM), neurocognition, and severity of clinical symptoms, in predicting the social functioning of individuals with schizophrenia. Clinical participants (early schizophrenia n = 26, chronic schizophrenia n = 32) were administered an ecologically valid measure of ToM (viz., the Virtual Assessment of Mentalising Ability or VAMA) and the Empathy Quotient (EQ) as part of a larger neuropsychological and social functioning assessment battery. Results indicated that individuals with early schizophrenia reported significantly better cognitive empathy than individuals with chronic schizophrenia. ToM was found to have added value in predicting both community functioning and functional capacity that was beyond that accounted for by cognitive empathy, clinical symptoms, and neurocognition for both clinical groups. Further, our results indicated that the capacity to demonstrate empathic understanding of another's situation (i.e., cognitive empathy) mediates the relationship between ToM and social functioning. Together, our findings highlight the intricate and compounding nature of social cognition constructs, and their effect on social functioning for individuals with schizophrenia.

An assessment of age differences in theory of mind using the virtual assessment of mentalizing ability.

Prior research has shown that older adults perform more poorly than young on tasks that assess theory of mind (ToM). However, these studies have used tasks that are performed "offline" (i.e., requiring a second-person perspective) as opposed to "online" (i.e., requiring a first-person perspective). Therefore, the present study was designed to establish whether age-related ToM difficulties are also evident when an "online" measure of ToM is used. Forty younger and 40 older adults completed the Virtual Assessment of Mentalizing Ability (VAMA) along with two conventional ToM tasks. No age differences were evident on the conventional measures, but older adults had lower accuracy on the VAMA relative to their younger counterparts. The overall pattern of errors did not differ between the groups. These data provide no evidence that age effects are reduced when stimuli are used that are more likely to engage the mentalizing processes elicited in real life social interactions.

Using virtual reality to assess theory of mind subprocesses and error types in early and chronic schizophrenia.

Individuals with schizophrenia often demonstrate theory of mind (ToM) impairment relative to healthy adults. However, the exact nature of this impairment (first- vs. second-order ToM and cognitive vs. affective ToM) and the extent to which ToM abilities deteriorate with illness chronicity is unclear. Furthermore, little is known about the relationships between clinical symptoms and ToM error types (overmentalising, reduced mentalising and no ToM) in early and chronic schizophrenia. This study examined the nature and types of ToM impairment in individuals with early (n = 26) and chronic schizophrenia (n = 32) using a novel virtual reality task. Clinical participants and demographically-matched controls were administered the Virtual Assessment of Mentalising Ability, which provides indices of first- and second-order cognitive and affective ToM, and quantifies three different types of mentalising errors (viz., overmentalising, reduced mentalising, and no ToM). Individuals with early schizophrenia performed significantly poorer than healthy controls on first-order affective and second-order cognitive and affective ToM, but significantly higher than individuals with chronic schizophrenia on all ToM subscales. Whereas a lack of mental state concept was associated with negative symptoms, overmentalising was associated with positive symptoms. These findings suggest that ToM abilities selectively deteriorate with illness chronicity and error types are related to these individuals' presenting symptomology. An implication of the findings is that social-cognitive interventions for schizophrenia need to consider the nature, time course and symptomatology of the presenting patient.

Evaluation of a newly developed measure of theory of mind: The virtual assessment of mentalising ability.

This study examined the reliability and validity of the Virtual Assessment of Mentalising Ability (VAMA). The VAMA consists of 12 video clips depicting a social drama imposed within an interactive virtual environment with questions assessing the mental states of virtual friends. Response options capture the continuum of ability (i.e., impaired, reduced, accurate, and hypermentalising) within first- and second-order cognitive and affective theory of mind (ToM). Sixty-two healthy participants were administered the VAMA, three other ToM measures, and additional measures of neurocognitive abilities and social functioning. The VAMA had sound internal consistency and high test-retest reliability. Significant correlations between performance on the VAMA and other ToM measures provided preliminary evidence of convergent validity. Small to moderate correlations were observed between performance on the VAMA and neurocognitive tasks. Further, the VAMA was found to correlate significantly with indices of social functioning and was rated as more immersive, more reflective of everyday ToM processes, and was afforded a higher recommendation than an existing computer-based ToM task. These results provide potential evidence that the VAMA is an ecologically valid tool that is sensitive to the spread of ability that can occur in ToM subprocesses and may be a valuable addition to existing ToM measures. Future research should explore the validity and utility of the VAMA in larger, more diverse samples of healthy adult and clinical populations.

Evaluation of a virtual reality prospective memory task for use with individuals with severe traumatic brain injury.

The current study aimed to evaluate the sensitivity, convergent validity and ecological validity of a newly developed virtual reality prospective memory (PM) task (i.e., the Virtual Reality Shopping Task; VRST) for use with individuals with traumatic brain injury (TBI). Thirty individuals with severe TBI and 24 uninjured adults matched on age, gender and education level were administered the VRST, a lexical decision PM task (LDPMT), an index of task-friendliness and a cognitive assessment battery. Significant others rated disruptions in the TBI participants' occupational activities, interpersonal relationships and independent living skills. The performance of the TBI group was significantly poorer than that of controls on event-based PM as measured by the LDPMT, and on time- and event-based PM as measured by the VRST. Performance on the VRST significantly predicted significant others' ratings of patients' occupational activities and independent living skills. The VRST was rated as significantly more reflective of an everyday activity, interesting and was afforded a higher recommendation than the LDPMT. For the TBI group, event and total PM performance on the VRST significantly correlated with performance on measures of mental flexibility and verbal fluency, and total PM performance correlated with verbal memory. These results provide preliminary but promising evidence of the sensitivity, as well as the convergent and ecological validity of the VRST.