Metacognition, Personal Distress, and Performance-Based Empathy in Schizophrenia.

Background: People with schizophrenia experience significant deficits in the kinds of empathic skills that are the foundation for interpersonal relationships. Researchers have speculated that deficits in empathic skills in schizophrenia may be related to disturbances in metacognition and heightened levels of personal distress. To explore this issue, this study examined whether better metacognition and reduced personal distress would be associated with improved performance on cognitive and affective empathy tasks. Further, we tested whether metacognition moderated the relationship between personal distress and empathy. Method: Fifty-eight participants with schizophrenia-spectrum disorders receiving community-based treatment completed a self-report questionnaire of personal distress, a performance-based measure of empathy, and an observer-rated interview to assess metacognitive capacity. Results: Correlation analyses revealed that metacognitive capacity, but not personal distress, was significantly associated with cognitive and affective empathy performance. Moderation results suggest the relationship between personal distress and affective empathy performance was significant for those with low metacognition, but that the relationship was the opposite of hypotheses-increased personal distress predicted better performance. This relationship changed at higher levels of metacognition, when increased personal distress became associated with reduced performance. Conclusions: This study is the first of its kind to examine performance-based empathy with metacognition and personal distress. Results suggest interventions targeted to improve metacognition may be useful in enhancing empathic skills.

Metacognition in schizophrenia disorders: Comparisons with community controls and bipolar disorder: Replication with a Spanish language Chilean sample.

Metacognition 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.

La relación entre el estigma y los síntomas positivos y de malestar emocional en la esquizofrenia / Associations of stigma with positive and emotional discomfort symptoms in schizophrenia

La investigación sugiere que el estigma se comporta como una barrera para la autoestima y el logro de un funcionamiento psicosocial adecuado en las personas con esquizofrenia. Es menos claro cómo las experiencias estigmatizadoras se asocian con los síntomas tanto en forma concurrente como prospectiva. Para evaluar este aspecto se valoraron los síntomas positivos y de malestar emocional mediante la escala para el síndrome positivo y negativo (Positive and Negative Syndrome Scale), y la experiencia estigmatizadora mediante la escala del estigma internalizado de la enfermedad mental (Internalized Stigma of Mental Illness Scale), en 75 personas con esquizofrenia en dos momentos separados por 5 meses. Los mayores niveles de estigma se asociaron con mayores niveles de síntomas positivos y de malestar emocional, tanto en forma concurrente como prospectiva. Los síntomas también se asociaron prospectivamente con el grado de estigma. Los resultados de la replicación de hallazgos previos indican que existe una relación estrecha entre la experiencia estigmatizadora y los síntomas. Ambos pueden exacerbarse recíprocamente dando lugar a un círculo vicioso.