Running head: COMPLEX SOCIAL JUDGMENT IN SCHIZOPHRENIA
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Social Trait Judgment and Affect Recognition from Static Faces and
Video Vignettes in Schizophrenia
Lindsey Gilling McIntosh
Thesis completed in partial fulfillment of the requirements of the
Honors Program in Psychological Sciences
Under the direction of Professor Sohee Park
Vanderbilt University
May, 2011
Approved by
_________________________________________
Date
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COMPLEX SOCIAL JUDGMENT IN SCHIZOPHRENIA
Acknowledgements
I would like to acknowledge and extend my heartfelt gratitude my mentor, Dr. Sohee
Park, for introducing me to the world of schizophrenia research, and for her vital support and
guidance throughout this project. I am also grateful to Heathman Nichols, Katy Thakkar, and
Joel Peterman for their assistance in conducting the clinical interviews and making the data
analysis considerably less stressful.
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Abstract
Previous research has shown impairment in affect recognition in individuals with
schizophrenia. Poor affect recognition has been associated with more severe clinical symptoms
and poor social functioning. The current body of literature has not properly addressed more
complex social judgments made by schizophrenics. The present study combined an affect
recognition task with a social trait judgment task, using a combination of emotional faces and
short video vignettes. Patients showed a general impairment in affect recognition. However, as a
group, schizophrenic patients did not make significantly different judgments of trustworthiness,
approachability, attractiveness, and intelligence, from either stimulus, relative to the control
group. We found evidence for a positive bias in trait attribution to static faces in patients with
more severe positive symptoms, particularly delusions. These findings suggest that the ability to
integrate nonverbal cues for trait judgment is largely intact, but when there are few nonverbal
cues to draw from in judgment formation, a positive bias in more symptomatic patients is shown
for some types of judgments.
Keywords: affect recognition, social judgment, social cognition, nonverbal behavior
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Introduction
We unintentionally send salient nonverbal social cues from socially rich channels such as
voice, facial expression, body posture, and gestures. These cues are often automatically decoded
by others, and integrated in the formation of complex social judgments. We update these
judgments as new cues become available, and use them to organize our own displayed behavior
during social interaction (Funder, 1995). Healthy people are very good at this process, and it
seems to result in mostly successful social interactions. However, research on people with
schizophrenia generally suggests that patients are impaired in both the encoding and decoding of
nonverbal social cues and that these social cognition deficits may contribute to poor social
functioning (Mandal, Pandey & Prasad, 1998).
Affect recognition impairment by schizophrenics is one of the most studied topics of
social cognition in schizophrenia. Most of these studies have found that people with
schizophrenia are impaired in judging the emotional state of others (Hooker & Park, 2002;
Kohler et al., 2010). However, it takes much more than correctly identifying the emotion your
social partner is displaying in order to successfully interact with them, and research on more
complex judgments in schizophrenia is relatively underdeveloped. How do schizophrenic
patients judge social traits such as trustworthiness, approachability, and intelligence of others
relative to healthy people? If their judgments are abnormal, do these misjudgments contribute to
the patient’s social dysfunction? Such questions have not been systematically addressed by the
current body of literature on schizophrenia. The goal of this project was to address such gaps in
the literature with the hope of gaining a better picture of the social judgment process in
schizophrenia.
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Schizophrenia has a worldwide prevalence rate of about 1 to 2% and is characterized by
positive symptoms such as delusions, hallucinations, and bizarre behavior, as well as negative
symptoms such as anhedonia, alogia, and blunted affect (van Os & Kapur, 2009). In addition to
these symptoms, schizophrenia patients exhibit cognitive deficits such as those of executive
function and working memory (Gold & Harvey, 1993; Lee & Park, 2005). Although the etiology
of schizophrenia is far from clear, research suggests a complex combination of genetic
vulnerability, prenatal insult, and environmental factors may be the source.
Poor social functioning is common among people with schizophrenia (Bellack et al.,
1990), and even though schizophrenia is a debilitating and often isolating disorder, this social
dysfunction usually predates the diagnosis, and as such is characteristic of the nonpsychotic
prodrome (Jones et al., 1993; Yung & McGorry, 1996; Zigler & Phillips, 1960). Antipsychotic
medication, the standard primary treatment for schizophrenia, does little to improve social
dysfunction (Patterson & Leeuwenkamp, 2008). Social dysfunction often leads to social
isolation, which could have more adverse effects on the patient than any of the symptoms on
their own (Morrison & Bellack, 1987). Identifying the primary contributors to social dysfunction
is thus the focus of much current research.
An impairment in affect recognition has been found to be related with poor social
functioning (Hooker & Park, 2002), and has been extensively researched in schizophrenia.
Patients have been found to be impaired in both the identification and discrimination of affect
from facial expressions (Kohler et al., 2010). In addition to a general impairment, studies have
found evidence for specific impairment, particularly in the recognition of negative emotions such
as anger and fear (Bigelow et al., 2006; Kohler et al., 2003; van’t Wout et al., 2007). Studies
point to a failure to attend to salient face regions like the eyes by schizophrenics as a possible
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explanation for these impairments, or a more basic perceptual impairment in face processing
(Doop & Park, 2009; Loughland, Williams & Gordon, 2002). However, beyond deficits in
detecting emotion from faces, schizophrenic patients are also impaired in gleaning emotion from
social scenes, gestures, and postures, so it seems that errors in the basic perception of faces
cannot fully account for affect recognition impairment (Bigelow, et al., 2006; Toomey et al.,
2002).
The nonverbal cues integrated and used in making judgments of affect can also be used in
making more complex social judgments such as that of social traits. These judgments are
considered more complex because the traits themselves are often descriptions of a behavior
pattern or prediction (e.g. trustworthy, honest). In other words, social trait judgments move
beyond a term that captures the mental state of another, to behavioral consequences. Research in
healthy populations suggests that we have a normative ability to make surprisingly accurate
interpersonal judgments from very few nonverbal cues (Ambady & Rosenthal, 1992; 1993).
These judgments are quick and automatic social assessments of personality and physical traits
(Zebrowitz & Collins, 1997). We constantly make these judgments during natural social
interaction (think: first impressions), but they can be studied under laboratory conditions using
the presentation of ‘thin slices’ of nonverbal behavior (faces, content-filtered voices, video clips)
from one second to five minutes of recorded, expressive nonverbal behavior (Ambady &
Rosenthal, 1992). Within this range, studies have shown that the judgments are surprisingly
accurate at as little as one second and further exposure length serves mainly to increase
confidence in the judgments made at zero acquaintance (Ambady & Rosenthal, 1992).
This fascinating research on thin slice judgments provides insight into how we form first
impressions and a basis for social interaction. In the past decade, this research has begun to
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transfer into the schizophrenia population, with an eye to understanding its potential role in
social dysfunction. Many of these studies have used trustworthiness ratings of unfamiliar, neutral
faces to index the ability for patients to make these more complex social judgments (Baas,
Aleman et al., 2008; Baas, van’t Wout et al., 2008; Couture et al., 2008; 2010; Hall et al., 2004;
Haut & MacDonald, 2010; Hooker et al., 2011; Pinkham et al., 2008). These studies have
generally found evidence for no group difference or a positive bias in the attribution of
trustworthiness. However, recent studies by Hooker et al., Haut and MacDonald, and Pinkham et
al. have found that this relationship may be influenced by the symptom profile of the patient.
These findings still do not provide a complete account of the complex social judgment
process in schizophrenia. Only Haut and MacDonald (2010) and Hall et al. (2004) used traits
other than trustworthiness, including attractiveness, approachability, distinctiveness, and
intelligence, to assess social judgment processing. Hall et al. approached the study of complex
social judgment by measuring accuracy of these trait attributions, and found that patients were
less accurate. However, the results lacked a description of what kinds of mistakes patients were
making. The same study also combined emotion recognition and trait judgment to show that the
same patients were impaired on both tasks, but separating these social cognition tasks precludes
the investigation of how trait judgment is influenced by the displayed emotion in the stimulus.
These studies solely used pictures of faces for their stimuli, as the majority of studies on affect
recognition have done. Researchers should also explore the use of more ecologically valid
stimuli such as short video clips, which would present more nonverbal cues. Finally, studies on
complex social judgment have not properly discussed implications for social functioning. If trait
judgment is indeed spared in schizophrenia, then this could potentially be used in social
cognition training.
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The present study attempted to take many of these concerns into account. In addition to
picture stimuli this study used short video clips. By combining the affect recognition and social
trait judgment tasks into one, the present study was also designed to answer the question of how
perceived affect influences these trait judgments. We hypothesized that patients would be
impaired in affect recognition relative to controls, and would particularly struggle with the more
numerous but subtle emotional cues in the video stimuli. While we predicted that patients would
not make abnormal trait judgments, we expected symptom presentation to play an important role
in the types of judgments made, so special attention was paid to this during data analysis.
Method
Participants
Twenty-one schizophrenia outpatients (SZ) who met the DSM-IV diagnostic criteria for
schizophrenia were recruited from a psychiatric facility in Nashville, TN. All of the patients were
taking antipsychotic medication at the time of testing with a mean chlorpromazine (CPZ)
equivalent dose of approximately 375 mg (S.D. 277). Symptoms were assessed with the Brief
Psychiatric Rating Scale (BPRS; Overall & Gorham, 1962), the Scale for the Assessment of
Positive Symptoms (SAPS; Andreasen, 1984a), and the Scale for the Assessment of Negative
Symptoms (SANS; Andreasen, 1984b). Twenty healthy control participants (HC) were recruited
by advertisements in the community. Exclusion criteria were neurological disorders, current or
history of substance abuse, history of severe head injury, or age over 60 years for both SZ and
HC. Controls were excluded for Axis I disorder or a family history of schizophrenia. Patients
were excluded for comorbid Axis I disorder. Intelligence was estimated using the National Adult
Reading Test (NART; Nelson, 1982). All subjects reported having normal or corrected-to-
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normal vision. After providing a description of the experiment to the participants, written
informed consent, approved by the Vanderbilt Institutional Review Board, was obtained.
Participants were paid for paid for their time. SZ and HC were matched for age, sex, and race.
Although HC had a higher estimated IQ and more years of education, both groups were well
within the normal IQ range, and on average SZ participants had completed one year of college.
IQ and education were controlled for in between-group analyses, as described below.
Demographic characteristics for the two groups are outlined in Table 1.
In addition, a younger group of healthy participants comprising of 17 healthy students
(STU) enrolled at Vanderbilt University were recruited. The student group had 2 males and 15
females. The mean age was 19.6 (S.D. 1.9). The students were mostly Caucasian (12 Caucasian,
3 African-American, 2 other). Students were given course credit for their participation.
Design and Procedure
All participants completed a computerized social judgment task comprised of questions
designed to assess basic face perception, facial affect recognition, and social trait judgment
abilities. The experiment was run using PsyScope (http://psy.ck.sissa.it/) on a Macintosh
computer. The task was divided into two parts, which differed by type of stimuli used (picture or
video), and were counterbalanced across subjects. Social questionnaires were also given and are
described below.
Stimuli. All stimuli used were taken from the Karolinska Directed Emotional Faces
database (KDEF; Lundqvist & Litton, 1998) and The Awareness of Social Inference Test
(TASIT; McDonald et al., 2002). Both KDEF and TASIT provide standardized stimuli designed
depict six emotions and neutral. TASIT was designed to assess social perception in individuals
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with traumatic brain injury but has been used in schizophrenic populations to assess aspects of
social cognition (Horan et al., 2009; Kern et al., 2009).
Fifty-four color images from KDEF were used, and there were a total of six actors (three
male, three female). Forty-two of these images depicted six emotions (happy, surprised, sad,
angry, disgusted, afraid) and neutral, and were oriented straight to the camera. Twelve additional
images were used for the face recognition task, and were from the same six actors displaying
neutral emotion oriented at a 45 degree angle away from the camera left or right. All 54 images
are of Caucasian faces.
Thirty-five 15s-long color video clips were adapted from Part 1 of TASIT versions A and
B. Part 1 is an emotional evaluation section, and both versions have 28 scenes (between 15 and
40s long) in which a total of nine actors perform scenes depicting six emotions (happy, surprised,
sad, angry, revolted, anxious) and neutral. All scenes in Part 1 of TASIT involve either one or
two actors. Two-person scenes comprise the minority of total scenes, and always have a principal
actor on which the scene focuses. Scenes were selected for use in the present study by choosing
an equal number of scenes per emotion category while minimizing the number of actors selected.
The final stimuli included a total of five principal actors (two men, three women) in the seven
emotion conditions. In all of the video scenes used, the actors were Caucasian. The most scenes
included in the social judgment task in which an actor was the principal actor was eight, and the
least was five. One two-person scene was included for each emotion type.
TASIT had been previously converted to DVD (AVI format). Using a video editing
software (TrakAxPC; http://www.trakax.com/software/pc/), the selected scenes were edited
down to 15s, and converted to MOV files. A 15s block was randomly selected from the middle
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of each full-length scene. The audio from each scene was removed during editing, in order to
control for the verbal content. To align the use of the two types of stimuli and to avoid confusing
the participant, the emotion label “revolted” from the TASIT was relabeled “disgusted” in the
social judgment task. “Anxious” remained as the label and answer choice for fear-related videos,
and “afraid” for face stimuli. This will be addressed further in the discussion section. Twelve
screenshots of just the actors’ faces during neutral scenes were used in the face recognition task.
Social Judgment Task. For the pictures part of the task, subjects viewed 42 colored
frontal photographic images of emotional and neutral faces, presented for 1s on a computer
screen and made judgments about each individual face. The subjects were prompted by the
computer to make a seven-forced-choice answer by mouse-click to identify the emotion. Then
the subjects were asked to make social trait judgments on attractiveness, trustworthiness,
approachability, and intelligence of the actor by choosing between four choices ranging from
very negative to very positive (for example: “very unattractive”, “somewhat unattractive”,
“somewhat attractive”, “very attractive”) again by mouse-click. The trait judgments selected for
the present study were drawn from those used in the Hall et al. (2004) study.
Next, subjects completed six face recognition trials in which they were instructed to
choose the face from the bottom row that was the same as the face in the top row, but rotated.
There was a trial for each actor of the face stimuli. The test faces were always of neutral
emotion, and oriented facing center. The distractors and target images, also of neutral emotion,
were oriented 45 degrees to the left or right of center. The two distractor images on each trial
were the remaining two actors of the same gender used in the face stimuli. Afterward, the
subjects were instructed to rate the same six neutral faces for age by choosing one of the answers
on the screen (19 or younger, 20-29, 30-39, 40-49, 50-59, 60 or older).
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For the videos portion, subjects viewed 35 colored video-clips presented on the computer
screen for their duration, 15s, and made the same judgments as above for the principal actor in
each clip. Afterward, they completed a face recognition task similar to the one described above.
The test and target images came from a different scene, with the target image being the actor’s
face angled roughly 45 degrees to the left or right of center. Because there were only two male
principal actors in the video stimuli, distractor images of a secondary actor were added. Next, the
subject indicated age of the video actors shown with neutral faces in the same manner as
described above for the pictures task.
Affect recognition accuracy was assessed for each subject by stimulus type and emotion
condition. Face recognition accuracy was assessed for each subject by stimulus type. A subject
was excluded from analyses if he or she scored 0% on the picture or video face recognition
stimuli, signaling a complete inability to perceive basic facial features. Two schizophrenia
patients and one healthy control were excluded. Their results and demographic information are
not included in the reported results. Perceived age of each picture and video stimulus was
averaged for each participant group, and not judged by accuracy.
Questionnaires. Participants in the three groups completed the Peters et al. Delusions
Inventory (Peters et al., 2004) to measure delusional ideation. The STU and HC groups also
completed the Schizotypal Personality Questionnaire to index psychosis proneness (Raine,
1991). Additionally, the SZ and HC groups completed a social functioning interview using the
SFS (Birchwood et al., 1990). Average SPQ and PDI are reported in Table 1. In the STU group,
mean total SPQ was 16 (S.D. 9.8) and total PDI was 55.5 (S.D. 46.4).
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Results
Data Analysis
Accuracy for the facial recognition control tasks was averaged for the two stimulus
conditions (pictures/videos) to produce an average accuracy for face recognition. Age judgment
was averaged for the two stimulus conditions. Mean accuracy for affect recognition was recorded
for each participant by stimulus type and affect condition. After coding trait judgment responses
from 1-4 where 1 is least positive and 4 is most positive, mean judgment rating for traits was
calculated by stimulus type, trait, and affect condition. Statistical analyses were performed using
SPSS after checking for data entry errors.
Control Tasks
T-tests were performed to measure group differences on face recognition and age
judgment. There was no significant group difference for face recognition accuracy (t(39)=1.52,
p>0.1). Age judgment was likewise not significant, although there was a trend toward significant
group differences (t(39)=1.79, p>0.05). Patients did not judge age significantly different than
healthy controls. The results from these control measures suggest that the participant groups did
not differ in their ability to process facial features.
Affect Recognition
Repeated measures ANOVA was used to compare groups on mean accuracies for affect,
with stimulus type (pictures/videos) as the within-subjects variable and diagnostic group the
between-subjects variable. IQ and education were entered as covariates. There was significant
effect of group (F(1,37)=21.4, p<0.001), whereby the SZ group performed more poorly than HC
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(Figure 1). Average accuracy was lower in the video stimulus condition for both groups but there
was no significant main effect of stimulus type (F(1,37)=1.67, p>0.05). This was probably
because the HC group still performed well on the videos task, and was reflected by a significant
interaction between group and stimulus type (F(1, 37)=4.8, p<0.05).
Contrast analyses (t-tests) identified specific affect recognition impairments (Figure 2). In
the pictures task, patients were significantly impaired in recognizing neutral (t(39)=2.3, p<0.05)
and afraid (t(39)=2.7, p=0.01). In the videos task, patients were impaired in recognizing sad
(t(39)=2.8, p<0.01), angry (t(39)=3.1, p<0.01), disgusted (t(39)=3.0, p<0.01) and anxious
(t(39)=3.9, p<0.001). There were no main effects of IQ or education on affect recognition
performance. Individual performance on the pictures and videos task was correlated in the SZ
group (r=0.53, p<0.05), but not in either the HC or STU groups.
Finally, we investigated the relationship between affect recognition performance and
symptom severity in the patients. We found that alogia (poverty of speech) from the SANS is
negatively correlated with affect recognition performance in both the pictures task (rs=-0.57,
p<0.01) and videos task (rs=-0.47, p<0.05).
Trait Judgment
A repeated measures ANOVA was used to compare mean trait judgment ratings, with
stimulus type, trait, and affect condition as the within-subjects variables, and group as the
between-subjects variable. As for affect recognition analysis, IQ and education were entered as
covariates. There was a main effect of stimulus condition (F(1, 37)=6.0, p<0.05) and no stimulus
by group interaction; both SZ and HC judging traits more favorably in the videos condition.
There was no main effect of trait (F(3, 35)=1.9, p>0.1), and no significant trait by group
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interaction, though it was trending (F(3, 35)=2.7, p=0.06). Importantly, there was no main effect
of group on trait judgments (F(1, 37)= 1.9, p >0.1), unlike affect recognition performance. There
were no main effects of IQ or education on trait judgment.
Subsequent pairwise comparisons using Bonferroni correction showed that
trustworthiness and approachability ratings were not significantly different from one another
(p>0.1), which was likely responsible for the lack of a main effect of trait. Intelligence was the
highest rated trait across conditions, then trustworthiness and approachability. Attractiveness was
rated the lowest. There was a significant main effect of emotion condition for ratings made
(F(2.02, 74.75)=4.6, p<.05), with less favorable trait ratings made during negative affect
stimulus conditions, on average.
Relationship to clinical symptoms: In the pictures task, attractiveness (rs=0.51, p<0.05),
trustworthiness (rs=.47, p<0.05), and approachability (rs=0.68, p<0.001), but not intelligence
(rs=0.2, p >0.1) ratings were positively correlated with patients’ positive symptoms indexed by
total SAPS (Figure 3). The delusions subscore of SAPS was likewise correlated with
trustworthiness (rs=0.48, p<0.05) and approachability (rs=0.46, p<0.05), so it is likely that the
delusions score played a significant role in driving the larger SAPS correlations. No significant
correlations were found with symptoms ratings and trait judgments made in the videos condition.
Relationship to social measures: Attractiveness ratings in pictures (rs= -0.56, p<0.01) and
videos (rs= -0.48, p<0.05) conditions were negatively correlated with the independence
performance subscale of the SFS. No other correlations were found with social functioning.
Relationship to psychosis proneness: No relationship was found with total SPQ or its
subscales in the HC. However, total SPQ scores in this group were very low. In the STU group,
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which had a higher mean SPQ, approachability ratings from pictures (rs=0.74, p<0.001) and
videos (rs=0.49, p<0.05), trustworthiness ratings from pictures (rs=0.6, p<0.01) and intelligence
ratings from pictures (rs=0.6, p<0.05) were correlated with self-reported experience of unusual
perceptual events (Figure 4). Additionally, total SPQ was significantly correlated with
approachability ratings of picture stimuli (rs=0.524, p<0.05) but not videos.
Delusional ideation: In healthy controls, total PDI was negatively correlated with
trustworthiness ratings from pictures (rs=-0.56, p<0.05) (Figure 5a). This was the opposite
relationship found between the same variables in the patients (rs=0.46, p<0.05) (Figure 5b). No
significant correlations were found in the STU group with delusional ideation.
Affect recognition and trait judgment relationship: To investigate how the affect
recognition and trait judgment tasks were related, we performed a median split on the affect
recognition performances in pictures and videos for each participant in all three participant
groups, and compared the average trait judgments for low and high performers. The only
significant difference found was in the SZ group, where low performers on the video affect
recognition task rated approachability in the videos task more favorably relative to the high
performers (F(1,16)=6.2, p<0.05).
Discussion
The results from the affect recognition task are generally in line with much of the
previous research in that schizophrenics exhibited both general and specific negative
impairments (Bigelow et al., 2006; Kohler et al., 2010; van’t Wout et al., 2007). The impairment
in affect recognition from the video stimuli adds to the relatively sparse literature on affect
recognition beyond simple face stimuli. However, it is not clear if the worse performance by
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schizophrenic participants in the videos task relative to the pictures task was the result of
increased number of social cues, stimulus duration, decreased affective intensity, or some
combination of these factors. Importantly, since the videos task is arguably closer to real world
interpersonal situations than the pictures task, it seems likely that the performance on the video
task may better reflect the patients’ performance in the outside world. Future studies should
investigate this by manipulating specific stimulus parameters and measuring the gains or losses
in affect recognition performance.
The display of the affective cues in the videos condition seemed to be considerably less
intense than in the pictures condition. It can be argued that this is a natural and necessary step
toward more ecologically valid stimuli. However, the perception of “anxious” and “afraid” may
differ by more than just expression intensity, but due to restraints posed by the chosen stimuli,
these conditions were matched during analyses as theoretically similar affect conditions. As a
precaution, a more conservative analysis without the anxious/afraid affect conditions was
performed and did not yield different results of main effects, so it is unlikely that this
significantly impacted the findings in this paper.
The important finding of no group difference in the overall judgment of social traits is
also in line with previous research (Baas, Aleman, et al., 2008; Couture et al., 2008; 2010; Haut
& MacDonald, 2010; Hooker et al., 2011). Schizophrenic patients made similar complex social
judgments as controls, across two types of stimuli, seven emotion conditions, and four traits. Few
studies in schizophrenia and especially those focusing on social cognition find evidence for a
spared cognitive process so this is an exciting finding. These findings point toward a dissociation
in social judgments, where patients are impaired in judging affect but not social traits from the
same stimuli. Functional imaging studies have found that the two processes rely on partially
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nonoverlapping brain circuits (Heberlein et al., 2004), with emotion recognition activating
somatosensory cortex and personality judgments activating frontal operculum (Heberlein &
Saxe, 2005). Other imaging studies have implicated the amygdala in both processes (Adolphs,
2001).
This study is the first to have an experimental paradigm designed to properly investigate
this relationship in a behavioral task. Future studies, particularly those focusing on improving
social cognition through training, should parse this relationship further. While both processes use
nonverbal cues from the face regions, judgments of social traits, particularly physical traits such
as attractiveness, are based more on size and spacing of facial features as well as skin
complexion (Paunonen et al., 1999). Judgments of affect often focus within individual regions
such as the shape of the mouth, lips, or eyebrows (Loughland, Williams & Gordon, 2002).
Patients could potentially be retrained to form affect judgments from trait judgment-related facial
cues, and improve their ability to recognize facial affect.
The findings from the face recognition and age judgment control tasks lead us to
conclude that basic perceptual processing of faces was not impaired in patients. While the group
difference in the age judgment task approached significance, this is probably reflective of the
task difficulty and not abnormal perceptual processing. In previous studies which used age
judgment as a control, participants are typically asked to make a dichotomous forced-choice
between “young” and “old” or “above 30” or “below 30” (Hall et al, 2004; Pinkham et al., 2008).
In the present study, participants had to choose between six response options, making the task
considerably more difficult. Furthermore, the finding of no group difference in the trait judgment
of trustworthiness, approachability, attractiveness, and intelligence, suggests that basic
perceptual processing was indeed intact.
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While there was no group difference in trait judgment in the patient group, we found an
important and possibly mediating relationship with positive symptoms. Patients with severe
positive symptoms made more favorable ratings of attractiveness, trustworthiness, and
approachability. A similar positive bias in trustworthiness judgment has been found for an entire
patient group (Baas, van’t Wout et al., 2008) and in a subset of patients with higher disorganized
symptoms (Hooker et al., 2011). This positive correlation with symptoms and trait judgment
carries over to delusional ideation and trait judgment. Schizophrenics with higher delusional
ideation were more favorable in their approachability judgments, whereas healthy controls with
high delusional ideation tended to be more cautious in these judgments. Interestingly, healthy
young people who report unusual perceptual experiences on a psychosis-proneness measure
show a similar positive bias. This suggests perhaps that this bias is related more toward the
disorder and vulnerability for the disorder than the presence of delusions and delusional ideation.
Research in schizophrenia beyond social trait judgment has also found a similar positive
bias. People with schizophrenia report higher preference ratings for everyday things, including
hedonic judgment of food (Folley & Park, 2010) and smell (Cumming, Matthews & Park, in
press; Doop & Park, 2006). However, this positive bias does not necessarily benefit the patient.
For instance, more positively biased social traits of others during negative interpersonal
situations misinform and perhaps underprepare the patient for adverse social interaction. This
could increase the amount of objectively unsuccessful social interactions, where there are
negative social consequences. Additionally, a positive bias in judging people seemingly sets high
expectations for a given social interaction. These expectations, of course, will not always be met
and in fact will not be met at a higher rate than someone who has lower expectations. This could
lead to more subjectively unsuccessful social interactions. In this sense, a positive bias may
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contribute to poor social functioning. However, the present study only found such a negative
relationship with attractiveness ratings. Future studies should investigate this relationship in
greater detail.
Correlations between symptoms and delusional ideation in the pictures task were not also
present in the videos task. That is, the patients with more severe positive symptoms did not show
a positive bias in the videos condition. In the pictures condition, the same small number of
nonverbal cues was presented briefly to the subject. In the videos condition, more nonverbal cues
were presented to the participant, and new cues appeared as the video continued. Perhaps a
positive bias in social trait judgment is most apparent when there are few social cues to draw
upon in making these judgments, and as more and more cues are presented, the positive bias is
masked by a normal ability to integrate these cues into trait judgments. This would explain why
the patients with severe positive symptoms made normal judgments in the videos condition, but
future studies could test this by having patients updating these trait judgments as more nonverbal
cues are presented in a dynamic stimulus. This finding underlies the importance of using more
ecologically valid stimuli to measure social cognition, and suggests that simple paradigms using
just static faces are less useful in describing the judgment process during real-life interaction.
By combining two processes of social judgment, expanding the stimuli used in order to
approach similarity to real-life conditions, and exploring attribution of multiple traits, this study
provides an intriguing way to understand the social judgment process in schizophrenia. The
finding of a dissociation of affect recognition and social trait judgment could be useful in social
cognition training efforts, and evidence for a positive bias in more positively symptomatic
patients sheds light on this social trait judgment process in schizophrenia as well as a potential
line of future research.
20
COMPLEX SOCIAL JUDGMENT IN SCHIZOPHRENIA
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COMPLEX SOCIAL JUDGMENT IN SCHIZOPHRENIA
Table 1: Participant demographics
Figure 1: Performance on pictures and videos task in HC (gray) and SZ (black), with standard
deviation bars. Significant group differences found in both tasks. Patients performed worse on
videos task than pictures.
Figure 2: (a) Performance on the pictures task by emotion condition in HC (gray) and SZ (black),
with standard deviation bars. Specific group differences in neutral and afraid conditions. (b)
Performance on the videos task by emotion condition in HC (gray) and SZ (black), with standard
deviation bars. Specific group differences in sad, angry, anxious, and disgusted conditions.
Figure 3: Positive correlations between increasing total SAPS score on x-axis and increasing
favorability of trait judgment on y-axis. (a) Attractiveness ratings vs. total SAPS score (rs= 0.51,
p<0.05). (b) Approachability ratings vs. total SAPS score (rs=0.68, p<0.001). (c) Trustworthiness
ratings vs. total SAPS score (rs=0.47, p<0.05).
Figure 4: Trait judgments made by STU vs. unusual perceptual experiences score of SPQ. (a)
Approachability ratings from pictures (rs=0.74, p<0.001). (b) Approachability ratings from
videos (rs=0.49, p<0.05). (c) Trustworthiness ratings from pictures (rs=0.6, p<0.01). (d)
Intelligence ratings from pictures (rs=0.6, p<0.01).
Figure 5: Trustworthiness judgment and delusional ideation. (a) Trustworthiness ratings from
pictures vs. HC total PDI (rs=0.56, p<0.05) (b) Trustworthiness ratings from pictures vs. SZ total
PDI (rs=0.46, p<0.05).
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COMPLEX SOCIAL JUDGMENT IN SCHIZOPHRENIA
Table 1
Schizophrenia patients
Mean (S.D.)
Healthy controls
Mean (S.D.)
N
21
20
--
Sex (Male/Female)
13/8
10/10
x2= 0.6, p> 0.1
Age (years)
40.6 (8.1)
38 (8.7)
t= 1.0, p> 0.1
Education (years)
13.7 (2.6)
15.5 (2.3)
t= 2.41, p= 0.02
NART IQ
101.1 (10.4)
107.2 (7.5)
t= 2.12, p= 0.04
6
13
0
1
1
11
7
1
1
0
BPRS
SAPS
SANS
13.1 (7.4)
15.7 (8.6)
22.0 (15.5)
--
--
Total PDI
104.3 (77.6)
37.4 (30.9)
t= 3.59, p< 0.01
Total SPQ
--
8.7 (8.3)
--
Significance
Ethnicity
Caucasian
African American
Hispanic
Asian
Multi-race
x2= 6.0, p> 0.1
Clinical Symptoms
26
COMPLEX SOCIAL JUDGMENT IN SCHIZOPHRENIA
Figure 1
27
COMPLEX SOCIAL JUDGMENT IN SCHIZOPHRENIA
Figure 2
28
COMPLEX SOCIAL JUDGMENT IN SCHIZOPHRENIA
Figure 3
(a)
(b)
(c)
29
COMPLEX SOCIAL JUDGMENT IN SCHIZOPHRENIA
Figure 4
(a)
(c)
(b)
(d)
30
COMPLEX SOCIAL JUDGMENT IN SCHIZOPHRENIA
Figure 5
(a)
(b)
31