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Empathy in schizophrenia: impaired resonance

European Archives of Psychiatry and Clinical Neuroscience volume 259, pages 352–361 (2009)Cite this article

Abstract

Resonance is the phenomenon of one person unconsciously mirroring the motor actions as basis of emotional expressions of another person. This shared representation serves as a basis for sharing physiological and emotional states of others and is an important component of empathy. Contagious laughing and contagious yawning are examples of resonance. In the interpersonal contact with individuals with schizophrenia we can often experience impaired empathic resonance. The aim of this study is to determine differences in empathic resonance—in terms of contagion by yawning and laughing—in individuals with schizophrenia and healthy controls in the context of psychopathology and social functioning. We presented video sequences of yawning, laughing or neutral faces to 43 schizophrenia outpatients and 45 sex- and age-matched healthy controls. Participants were video-taped during the stimulation and rated regarding contagion by yawning and laughing. In addition, we assessed self-rated empathic abilities (Interpersonal Reactivity Index), psychopathology (Positive and Negative Syndrome Scale in the schizophrenia group resp. Schizotypal Personality Questionnaire in the control group), social dysfunction (Social Dysfunction Index) and executive functions (Stroop, Fluency). Individuals with schizophrenia showed lower contagion rates for yawning and laughing. Self-rated empathic concern showed no group difference and did not correlate with contagion. Low rate of contagion by laughing correlated with the schizophrenia negative syndrome and with social dysfunction. We conclude that impaired resonance is a handicap for individuals with schizophrenia in social life. Blunted observable resonance does not necessarily reflect reduced subjective empathic concern.

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Abbreviations

cL:

Contagious laughing

CPZe:

Chlorpromazine equivalents

cY:

Contagious yawning

IRI:

Interpersonal Reactivity Index

IRI_EC:

Empathic concern subscale of the IRI

IRI_FS:

Fantasy subscale of the IRI

IRI_PD:

Personal distress subscale of the IRI

IRI_PT:

Perspective taking subscale of the IRI

MNS:

Mirror neuron system

PANSS:

Positive and Negative Syndrome Scale

SDI:

Social Dysfunction Index

siL:

Stimulus incongruent laughing

siY:

Stimulus incongruent yawning

SPQ:

Schizotypal Personality Questionnaire

ToM:

Theory of Mind

References

  1. Anderson JR, Myowa-Yamakoshi M, Matsuzawa T (2004) Contagious yawning in chimpanzees. Proc Biol Sci 271(Suppl 6):S468–S470

    PubMed  Article  Google Scholar 

  2. Arbib MA (2007) Other faces in the mirror: a perspective on schizophrenia. World Psychiatry 6:11–14

    Google Scholar 

  3. Azevedo MH, Soares MJ, Coelho I, Dourado A, Valente J, Macedo A, Pato M, Pato C (1999) Using consensus OPCRIT diagnoses. An efficient procedure for best-estimate lifetime diagnoses. Br J Psychiatry 175:154–157

    PubMed  Article  CAS  Google Scholar 

  4. Blair RJR (2005) Responding to the emotions of others: dissociating forms of empathy through the study of typical and psychiatric populations. Conscious Cogn 14:698–718

    PubMed  Article  CAS  Google Scholar 

  5. Brune M (2005) Emotion recognition, ‘theory of mind’, and social behavior in schizophrenia. Psychiatry Res 133:135–147

    PubMed  Article  Google Scholar 

  6. Brune M (2005) “Theory of mind” in schizophrenia: a review of the literature. Schizophr Bull 31:21–42

    PubMed  Article  Google Scholar 

  7. Brune M, Abdel-Hamid M, Lehmkamper C, Sonntag C (2007) Mental state attribution, neurocognitive functioning, and psychopathology: what predicts poor social competence in schizophrenia best? Schizophr Res 92:151–159

    PubMed  Article  Google Scholar 

  8. Chartrand TL, Bargh JA (1999) The chameleon effect: the perception-behavior link and social interaction. J Pers Soc Psychol 76:893–910

    PubMed  Article  CAS  Google Scholar 

  9. Daprati E, Franck N, Georgieff N, Proust J, Pacherie E, Dalery J, Jeannerod M (1997) Looking for the agent: an investigation into consciousness of action and self-consciousness in schizophrenic patients. Cognition 65:71–86

    PubMed  Article  CAS  Google Scholar 

  10. Davis MH (1980) A multidimensional approach to individual differences in empathy. Cat Sel Doc Psychol 10:85–100

    Google Scholar 

  11. de Vignemont F, Fourneret P (2004) The sense of agency: a philosophical and empirical review of the “Who” system. Conscious Cogn 13:1–19

    PubMed  Article  Google Scholar 

  12. de Vignemont F, Singer T (2006) The empathic brain: how, when and why? Trends Cogn Sci 10:435–441

    PubMed  Article  Google Scholar 

  13. Decety J, Jackson PL (2004) The functional architecture of human empathy. Behav Cogn Neurosci Rev 3:71–100

    PubMed  Article  Google Scholar 

  14. Decety J, Lamm C (2006) Human empathy through the lens of social neuroscience. Scientific WorldJournal 6:1146–1163

    Google Scholar 

  15. Franck N, Farrer C, Georgieff N, Marie-Cardine M, Dalery J, d’Amato T, Jeannerod M (2001) Defective recognition of one’s own actions in patients with schizophrenia. Am J Psychiatry 158:454–459

    PubMed  Article  CAS  Google Scholar 

  16. Frith CD (2004) Schizophrenia and theory of mind. Psychol Med 34:385–389

    PubMed  Article  CAS  Google Scholar 

  17. Gaebel W, Zaske H, Baumann AE (2006) The relationship between mental illness severity and stigma. Acta Psychiatr Scand Suppl:41–45

  18. Gallese V (2007) Before and below ‘theory of mind’: embodied simulation and the neural correlates of social cognition. Philos Trans R Soc Lond B Biol Sci 362:659–669

    PubMed  Article  Google Scholar 

  19. Gallese V (2003) The roots of empathy: the shared manifold hypothesis and the neural basis of intersubjectivity. Psychopathology 36:171–180

    PubMed  Article  Google Scholar 

  20. Georgieff N, Jeannerod M (1998) Beyond consciousness of external reality: a “who” system for consciousness of action and self-consciousness. Conscious Cogn 7:465–477

    PubMed  Article  CAS  Google Scholar 

  21. Grube M (2006) Towards an empirically based validation of intuitive diagnostic: Rümke’s ‘Praecox Feeling’ across the schizophrenia spectrum: preliminary results. Psychopathology 39:209–217

    PubMed  Article  Google Scholar 

  22. Jackson PL, Decety J (2004) Motor cognition: a new paradigm to study self-other interactions. Curr Opin Neurobiol 14:259–263

    PubMed  Article  CAS  Google Scholar 

  23. Jaspers K (1913) Allgemeine Psychopathologie. Springer, Berlin

    Google Scholar 

  24. Joly-Mascheroni RM, Senju A, Shepherd AJ (2008) Dogs catch human yawns. Biol Lett 4:446–448

    PubMed  Article  Google Scholar 

  25. Kay SR, Fiszbein A, Opler LA (1987) The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 13:261–276

    PubMed  CAS  Google Scholar 

  26. Keysers C, Gazzola V (2007) Integrating simulation and theory of mind: from self to social cognition. Trends Cogn Sci 11:194–196

    PubMed  Article  Google Scholar 

  27. Kircher TT, Leube DT (2003) Self-consciousness, self-agency, and schizophrenia. Conscious Cogn 12:656–669

    PubMed  Article  Google Scholar 

  28. Klein C, Andresen B, Jahn T (1997) Erfassung der schizotypen Persönlichkeit nach DSM-III-R. Psychometrische Eigenschaften einer autorisierten deutschsprachigen Übersetzung des “Schizotypal Personality Questionnaire” (SPQ) von Raine. Diagnostica 4:347–369

    Google Scholar 

  29. Kring AM, Kerr SL, Smith DA, Neale JM (1993) Flat affect in schizophrenia does not reflect diminished subjective experience of emotion. J Abnorm Psychol 102:507–517

    PubMed  Article  CAS  Google Scholar 

  30. Kring AM, Moran EK (2008) Emotional response deficits in schizophrenia: insights from affective science. Schizophr Bull 34:819–834

    PubMed  Article  Google Scholar 

  31. Lauber C, Keller C, Eichenberger A, Rossler W (2005) Family burden during exacerbation of schizophrenia: quantification and determinants of additional costs. Int J Soc Psychiatry 51:259–264

    PubMed  Article  Google Scholar 

  32. Lawrence EJ, Shaw P, Giampietro VP, Surguladze S, Brammer MJ, David AS (2005) The role of ‘shared representations’ in social perception and empathy: an fMRI study. Neuroimage 29:1173–1184

    PubMed  Article  Google Scholar 

  33. Lehmann HE (1979) Yawning: a homeostatic reflex and its psychological significance. Bull Menninger Clin 43:123–136

    PubMed  CAS  Google Scholar 

  34. Leslie KR, Johnson-Frey SH, Grafton ST (2004) Functional imaging of face and hand imitation: towards a motor theory of empathy. Neuroimage 21:601–607

    PubMed  Article  Google Scholar 

  35. Lysaker PH, Tsai J, Maulucci AM, Stanghellini G (2008) Narrative accounts of illness in schizophrenia: association of different forms of awareness with neurocognition and social function over time. Conscious Cogn 17:1143–1151

    PubMed  Article  Google Scholar 

  36. Montag C, Heinz A, Kunz D, Gallinat J (2007) Self-reported empathic abilities in schizophrenia. Schizophr Res 92:85–89

    PubMed  Article  CAS  Google Scholar 

  37. Motlova L (2007) Schizophrenia and family. Neuro Endocrinol Lett 28(Suppl 1):147–159

    PubMed  Google Scholar 

  38. Munroe-Blum H, Collins E, McCleary L, Nuttall S (1996) The social dysfunction index (SDI) for patients with schizophrenia and related disorders. Schizophr Res 20:211–219

    PubMed  Article  CAS  Google Scholar 

  39. Perret E (1974) The left frontal lobe of man and the suppression of habitual responses in verbal categorical behaviour. Neuropsychologia 12:323–330

    PubMed  Article  CAS  Google Scholar 

  40. Platek SM, Critton SR, Myers TE, Gallup GG (2003) Contagious yawning: the role of self-awareness and mental state attribution. Brain Res Cogn Brain Res 17:223–227

    PubMed  Article  Google Scholar 

  41. Platek SM, Mohamed FB, Gallup GG Jr (2005) Contagious yawning and the brain. Brain Res Cogn Brain Res 23:448–452

    PubMed  Article  Google Scholar 

  42. Preston SD, de Waal FB (2002) Empathy: Its ultimate and proximate bases. Behav Brain Sci 25:1–20

    PubMed  Google Scholar 

  43. Provine RR (2005) Yawning. Am Sci 93:532–539

    Google Scholar 

  44. Raine A (1992) Sex differences in schizotypal personality in a nonclinical population. J Abnorm Psychol 101:361–364

    PubMed  Article  CAS  Google Scholar 

  45. Raine A (1991) The SPQ: a scale for the assessment of schizotypal personality based on DSM-III-R criteria. Schizophr Bull 17:555–564

    PubMed  CAS  Google Scholar 

  46. Regard M, Strauss E, Knapp P (1982) Children’s production on verbal and non-verbal fluency tasks. Percept Mot Skills 55:839–844

    PubMed  CAS  Google Scholar 

  47. Rizzolatti G, Craighero L (2004) The mirror neuron system. Annu Rev Neurosci 27:169–192

    PubMed  Article  CAS  Google Scholar 

  48. Roncone R, Falloon IR, Mazza M, De Risio A, Pollice R, Necozione S, Morosini P, Casacchia M (2002) Is theory of mind in schizophrenia more strongly associated with clinical and social functioning than with neurocognitive deficits? Psychopathology 35:280–288

    PubMed  Article  Google Scholar 

  49. Rossler W, Riecher-Rossler A, Angst J, Murray R, Gamma A, Eich D, van Os J, Gross VA (2007) Psychotic experiences in the general population: a twenty-year prospective community study. Schizophr Res 92:1–14

    PubMed  Article  Google Scholar 

  50. Rümke HC (1941) Das Kernsyndrom der Schizophrenie und das “Praecox-Gefühl”. Zent Gesamte Neurol Psychiatrie 102:168–169

    Google Scholar 

  51. Salvatore G, Dimaggio G, Lysaker PH (2007) An intersubjective perspective on negative symptoms of schizophrenia: implications of simulation theory. Cogn Neuropsychiatry 12:144–164

    PubMed  Article  Google Scholar 

  52. Sass LA, Parnas J (2003) Schizophrenia, consciousness, and the self. Schizophr Bull 29:427–444

    PubMed  Google Scholar 

  53. Schurmann M, Hesse MD, Stephan KE, Saarela M, Zilles K, Hari R, Fink GR (2005) Yearning to yawn: the neural basis of contagious yawning. Neuroimage 24:1260–1264

    PubMed  Article  Google Scholar 

  54. Schurmann M, Jarvelainen J, Avikainen S, Cannon TD, Lonnqvist J, Huttunen M, Hari R (2007) Manifest disease and motor cortex reactivity in twins discordant for schizophrenia. Br J Psychiatry 191:178–179

    PubMed  Article  Google Scholar 

  55. Senju A, Maeda M, Kikuchi Y, Hasegawa T, Tojo Y, Osanai H (2007) Absence of contagious yawning in children with autism spectrum disorder. Biol Lett 3:706–708

    PubMed  Article  Google Scholar 

  56. Shamay-Tsoory SG, Shur S, Harari H, Levkovitz Y (2007) Neurocognitive basis of impaired empathy in schizophrenia. Neuropsychology 21:431–438

    PubMed  Article  Google Scholar 

  57. Spreen S (2006) A compendium of neuropsychological tests. Oxford University Press, Oxford

    Google Scholar 

  58. Sprong M, Schothorst P, Vos E, Hox J, Van Engeland H (2007) Theory of mind in schizophrenia: meta-analysis. Br J Psychiatry 191:5–13

    PubMed  Article  Google Scholar 

  59. Stroop JR (1935) Studies of interference in serial verbal reaction. J Exp Psychol 18:643–662

    Article  Google Scholar 

  60. Turken AU, Vuilleumier P, Mathalon DH, Swick D, Ford JM (2003) Are impairments of action monitoring and executive control true dissociative dysfunctions in patients with schizophrenia? Am J Psychiatry 160:1881–1883

    PubMed  Article  Google Scholar 

  61. Uddin LQ, Iacoboni M, Lange C, Keenan JP (2007) The self and social cognition: the role of cortical midline structures and mirror neurons. Trends Cogn Sci 11:153–157

    PubMed  Article  Google Scholar 

  62. Villagrán J (2003) Consciousness disorders in schizophrenia: a forgotten land for psychopathology. Int J Psychol Psychol Ther 3:209–234

    Google Scholar 

  63. Woods SW (2003) Chlorpromazine equivalent doses for the newer atypical antipsychotics. J Clin Psychiatry 64:663–667

    PubMed  CAS  Article  Google Scholar 

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Acknowledgments

We thank Martina Scherrer for her assistance in data acquisition and Vladeta Ajdacic-Gross for his assistance in data analysis.

Conflict of interest statement

This research was supported by an unconditional grant of the Swiss Network Schizophrenia Foundation (“Stiftung Netzwerk Schizophrenie”).

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Authors and Affiliations

  1. Department of General and Social Psychiatry, Psychiatric University Hospital of Zurich, Militärstrasse 8, POB 1930, 8021, Zurich, Switzerland

    Helene Haker & Wulf Rössler

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  1. Helene Haker
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  2. Wulf Rössler
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Correspondence to Helene Haker.

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Haker, H., Rössler, W. Empathy in schizophrenia: impaired resonance. Eur Arch Psychiatry Clin Neurosci 259, 352–361 (2009). https://doi.org/10.1007/s00406-009-0007-3

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Keywords

  • Contagion
  • Imitation
  • Laughing
  • Social cognition
  • Yawning