Self-experience In Schizophrenia Research Articles

Interactions between the cortical midline structures and sensorimotor network track maladaptive self-beliefs in clinical high risk for psychosis

Individuals at clinical high risk for psychosis (CHR) report a maladaptive self-concept—with more negative and less positive self-beliefs—linked to clinical symptoms and functional impairment. Alterations have also been reported in brain networks associated with intrinsic (cortical midline structures, CMS) and extrinsic (sensorimotor network, SMN) self-processing. Theoretical accounts of multiple levels of self-experience in schizophrenia suggest that interactions between these networks would be relevant for self-beliefs. This study tested whether self-beliefs related to resting-state functional connectivity within and between the CMS and SMN. Participants were 56 individuals meeting CHR criteria and 59 matched healthy community participants (HC). Pearson correlations examined potential mediators and outcomes. The CHR group reported more negative and less positive self-beliefs. Greater resting-state functional connectivity between the posterior CMS (posterior cingulate cortex) and the SMN was associated with less positive self-beliefs in CHR, but more positive self-beliefs in HC. Attenuated negative symptoms and poorer social functioning were associated with CMS-SMN connectivity (trend level after FDR-correction) and self-beliefs. Reduced connectivity between the left and right PCC was associated with lower positive self-beliefs in CHR, although this effect was specific to very low levels of positive self-beliefs. Left-right PCC connectivity did not correlate with outcomes. Dynamic interactions between intrinsic and extrinsic self-processing supported positive self-beliefs in typically developing youth while undermining positive self-beliefs in CHR youth. Implications are discussed for basic self-fragmentation, narrative self-related metacognition, and global belief updating. Interventions for self-processing may be beneficial in the CHR syndrome.

The Psychotherapeutic Treatment of Schizophrenia: Psychoanalytical Explorations of the Metacognitive Movement

Metacognition refers to the set of activities which allow persons to have a sense of oneself and of others available to them within the flow of daily experience. These activities range from awareness of discrete aspects of experience to their synthesis into larger, more complex ideas. Following research documenting the existence and influence of metacognitive deficits in schizophrenia, psychotherapeutic frameworks have emerged aiming to improve metacognition in this group. Metacognitive Reflection and Insight Therapy (MERIT) is one such integrative psychotherapy framework. Therapeutic targets and principles of MERIT are intended to be integrative but share common characteristics with psychoanalytical tradition in the treatment of schizophrenia. This paper accordingly explores how psychoanalytic theory can help explain how the effects of MERIT upon metacognition and self-experience in schizophrenia may reflect its effects on repairing the collapse of the boundary/connection between self and the world, mental fragmentation, and the lack of symbolization.

S68. SYMPTOMS, NEUROCOGNITION, SOCIAL COGNITION AND METACOGNITION IN SCHIZOPHRENIA: A NETWORK ANALYSIS

BackgroundSchizophrenia is associated with broad range of phenomena which affect function and represent significant barriers to recovery. These include semi-independent forms of psychopathology, disturbances in neurocognition, social cognition and metacognition. The current study explores the paths through which these constructs affect each other and whether some of these phenomena play a relatively more or less central role than others as they interact. Answers to these questions seem essential to choosing which of a dizzying array of problems should be targeted by treatment.MethodsData was collected from 81 adult outpatients with schizophrenia or schizoaffective disorder, recruited at a Veterans’ Affairs Medical Center and a community mental health center in Indiana, USA. Network analysis which explored the relative relationships of five groups of symptoms (positive, negative, disorganization, hostility and emotional discomfort), six domains of neurocognition, four domains of social cognition and four domains of metacognition with one another was conducted. The analysis produces the following centrality measures: 1) strength of items within a network according to their sum weighted connections; 2) closeness between items that reflect the distance from a particular item to all others; 3) betweenness which reflect the number of times that an item appears on the shortest path between two other items.ResultsA clear differentiation between metacognition, social cognition, neurocognition and symptoms was observed. The only outliers were social cognition attribution, which was close to the symptoms area, and the cognitive symptoms factor that was found close to the neuro-cognition area. The social cognition was found in an “intermediate” area between the metacognition and neurocognition. Metacognition variables were the closest to the symptoms variables. The strongest nodes are: metacognition-self reflectivity, theory of mind measures of social cognition and visual memory. The nodes with the highest closeness measure were self-reflectivity sub-scale of metacognition and theory of mind of social cognition. The node with the highest betweenness measure was metacognition self-reflectivity.DiscussionThe centrality of the self-experience in schizophrenia is emphasized in phenomenological, theoretical as well as empirical literature and can be traced back to earlier writing on schizophrenia. Accordingly, a sense of barren or diminished self, problems in self-reflection and self-clarity as well as difficulties in agency and ownership over one’s thoughts, feelings and sensations which is necessary for creating meaning were reported and discussed. The current study adds to this body of literature the finding that in a network which includes symptoms, social cognition, neuro cognition and metacognition variables, self-reflection is standing out as being a central connector that has the strongest relationship with other variables. As such it impacts all the network, and interventions targeting metacognitive self-reflection are expected to have secondary effects on additional constructs in the network- i.e additional elements of metacognition, social cognition, neurocognition and symptoms.

Functional abnormalities of the right posterior insula are related to the altered self-experience in schizophrenia

The insula is involved in detecting the salience of internal and external stimuli, and it plays a critical role in psychosis. Previous studies have demonstrated the structural and functional alterations of the insula in schizophrenia. To acquire a full picture of the functional alterations of the insula in schizophrenia, the resting-state fMRI data of 46 patients with schizophrenia and 46 healthy control subjects were collected. We used clustering analysis to divide the insula into three subregions: the dorsal anterior insula (dAI), ventral anterior insula (vAI) and posterior insula (PI). Then, whole-brain functional connectivity analysis was conducted based on these subregions. The results showed that the right dAI and PI in patients exhibited altered functional connections with the primary sensorimotor area. In addition, the right PI of the patients exhibited increased functional correlations with the thalamus. More importantly, the altered functional properties of the right PI were significantly correlated with the severity of the delusion and poor insight in schizophrenia. The results suggested that the right PI might play an important role in self-experience processing in schizophrenia. Accordingly, the right PI should be considered very important in the pathological mechanism of schizophrenia.

Psychoanalytic phenomenology of schizophrenia: Synthetic metacognition as a construct for guiding investigation.

A review of psychoanalytic writings reveals a vibrant but overlooked history of descriptions of the phenomenology of schizophrenia. In this paper we suggest that neglect of these important psychoanalytic contributions to the understanding of alterations of self-experience in schizophrenia is at least partially due to an absence of sufficient operational definitions by which to study these constructs. We then detail an emergent line of research from the neurosciences investigating processes, referred to as metacognition, by which persons develop, evolve, and reflect upon mental representations of self and others. The findings from this growing line of research are convergent with psychoanalytic descriptions of self-experience in schizophrenia, and may provide a method to guide investigation of concepts found in psychoanalytic literature. This convergence presents a number of implications for both contemporary understandings of schizophrenia, future research, as well as psychoanalytically and nonpsychoanalytically informed treatments of schizophrenia.

Individual Psychotherapy and Changes in Self-Experience in Schizophrenia: A Qualitative Comparison of Patients in Metacognitively Focused and Supportive Psychotherapy

Objective: Deficits in metacognition, or the ability to form complex ideas about self and others, may be a root cause of dysfunction in schizophrenia. Accordingly, forms of psychotherapy have been proposed to address metacognitive deficits. This study explored whether metacognitively focused individual psychotherapy can affect self-experience by conducting narrative interviews of patients with a schizophrenia spectrum disorder enrolled in either metacognitively oriented psychotherapy (n = 12) or supportive psychotherapy (n = 13) in a naturalistic setting. Method: Participants in both groups completed a narrative interview consisting of questions that focused on perceptions and process of psychotherapy and its impact on outcomes. Interviews were audiotaped, transcribed, and coded using an inductive process informed by grounded theory. Results: Qualitative analyses revealed all participants reported psychotherapy led to improvements in self-esteem and the ability to think more clearly and set meaningful goals. The group receiving metacognitively oriented therapy, in contrast to those receiving supportive therapy, reported being able to integrate their current experiences into the larger narratives of their lives and an increased experience of sense of agency and the ability to understand and manage pain. Conclusions: Results provide evidence that metacognitively oriented psychotherapy may promote subjective forms of recovery.

Self-Experience in Schizophrenia: Metacognition as a Construct to Advance Understanding

Self-Experience in Schizophrenia: Metacognition as a Construct to Advance Understanding

Disordered self in the schizophrenia spectrum: a clinical and research perspective.

Learning ObjectivesAfter participating in this activity, learners should be better able to:1. Assess anomalous self-experience as a core feature of schizophrenia spectrum disorders.2. Evaluate current and historical research regarding disorders of self-experience in schizophrenia.This article explores the phenomenological and empirical rediscovery of anomalous self-experience as a core feature of the schizophrenia spectrum disorders and presents the current status of research in this field. Historically, a disordered self was considered to be a constitutive phenotype of schizophrenia. Although the notion of a disordered self has continued to appear occasionally over the years—mainly in the phenomenologically or psychodynamically oriented literature—this notion was usually considered as a theoretical construct rather than as referring to concretely lived anomalous experiences. Empirical research on the disorders of self-experience in schizophrenia can be traced back to the US-Denmark psychopathological collaboration in the well-known adoption and high-risk studies, which aimed at identifying trait or phenotypic vulnerability features. This research was later followed by clinical work with first-admission schizophrenia patients. We offer clinical descriptions of anomalous self-experience and outline the phenomenological structures of subjectivity that are needed for grasping the nature of these anomalous experiential phenomena. What appears to underlie these experiences is an instability of the first-person perspective that threatens the basic experience of being a self-coinciding, embodied, demarcated, and persisting subject of awareness. We summarize a series of empirical studies targeting self-experience in schizophrenia performed prior to and after the construction of a phenomenologically oriented psychometric instrument for assessing anomalies of self-experience, the Examination of Anomalous Self-Experience (EASE). These empirical studies support the classic clinical intuition that anomalous self-experiences form a central phenotype of schizophrenia. Implications for diagnosis and research are briefly discussed.

Anomalous self-experience in depersonalization and schizophrenia: A comparative investigation

Various forms of anomalous self-experience can be seen as central to schizophrenia and other psychiatric disorders. We examined similarities and differences between anomalous self-experiences common in schizophrenia-spectrum disorders, as listed in the EASE (Examination of Anomalous Self Experiences), and those described in published accounts of severe depersonalization. Our aims were to consider anomalous self-experience in schizophrenia in a comparative context, to refine and enlarge upon existing descriptions of experiential disturbances in depersonalization, and to explore hypotheses concerning a possible core process in schizophrenia (diminished self-affection, an aspect of "ipseity" or minimal self). Numerous affinities between depersonalization and schizophrenia-spectrum experience were found: these demonstrate that rather pure forms of diminished self-affection (depersonalization) can involve many experiences that resemble those of schizophrenia. Important discrepancies also emerged, suggesting that more automatic or deficiency-like factors--probably involving self/world or self/other confusion and erosion of first-person perspective--are more distinctive of schizophrenia-spectrum disorders.

CS02-02 Recent phenomenological developments in psychopathology of schizophrenia

Nancy Andreasen (2007) published a bleak assessment of the consequences of introducing operational criteria for psychiatric diagnosis (DSM-III and subsequent editions). She lists a widespread ignorance of features that are not themselves criteria, dehumanisation of psychiatric praxis, and unquestioned belief in reified rigidly conceived diagnostic categories with poor validity.Moreover, we could add that subjectivity-aversive stance has had a negative consequence for etiological, preventive and therapeutic efforts in schizophrenia. As an example of phenomenological approach, integrated with empirical design, a series of studies of disorders of self-experience in schizophrenia is presented.

Associations of symptoms, psychosocial function and hope with qualities of self-experience in schizophrenia: Comparisons of objective and subjective indicators of health

While changes in self-experience have been suggested to be an important element of recovery from severe mental illness, little is known about how qualities of self-experience are linked with other indicators of health including objective measures such as symptoms profiles and subjective measures such as hope. To examine these issues the narratives of self and illness of 65 persons with schizophrenia spectrum disorder were obtained prior to entry into rehabilitation and rated using the Scale to Assess Narrative Development (STAND). STAND scores were then compared with concurrent assessments of hope assessed with the Beck Hopelessness Scale (BHS), psychosocial function using the Quality of Life Scale (QOLS) and symptom profile defined categorically using the Positive and Negative Syndrome Scale (PANSS). Results suggest that higher ratings of the STAND were associated with greater expectations of perseverance on the BHS and higher levels of psychosocial function on the QOL. Lower symptom profiles were similarly linked with higher STAND scores. Results suggest qualities of self-experience expressed within personal narratives are linked to symptom profiles and subjective assessments of health. Theoretical and clinical implications are discussed.

Anhedonia, Self-Experience in Schizophrenia, and Implications for Treatment

Anhedonia - the inability to experience pleasure - is a symptom of several psychiatric disorders such as depression, drug and alcohol dependence, but also schizophrenia. The concept of anhedonia played a major role in psychiatric and psychoanalytic explanations of psychotic behavior. The relationship between notions of anhedonia and of mental evolution and regression (in the work of Myerson and Bleuler) is discussed. The non-evolutionist views of Rado and Meehl are described. Then the concept of anhedonia is discussed in relationship to the phenomenological approach of Sass and Parnas, who view anhedonia as one manifestation of a self-disturbance or self-disorder that is fundamental in schizophrenia. Concerning treatment of anhedonia, it was often hypothesized that anhedonia is associated with a dysfunction of the mesolimbic dopaminergic reward system. However, studies in humans and non-human animal models indicate that dysfunction of central dopaminergic neurotransmission interferes with the process of motivation rather than with the ability to experience pleasure; the latter may be more mediated by the opioidergic and serotonergic neurotransmission. Understanding the neurobiological correlates of motivation and pleasure may provide new options to treat anhedonia in patients with schizophrenia.

Phenomenology, context, and self-experience in schizophrenia

AbstractImpairments in cognitive coordination in schizophrenia are supported by phenomenological data that suggest deficits in the processing of visual context. Although the target article is sympathetic to such a phenomenological perspective, we argue that the relevance of phenomenological data for a wider understanding of consciousness in schizophrenia is not sufficiently addressed by the authors.

Narrative Structure in Psychosis

There is nearly universal acceptance that persons with schizo-phrenia often experience a profound disruption in their basic sense of self. But what does this disruption in sense of self reflect? Is this the result of an internal catastrophe? If so, where and in what manner did this catastrophe occur? To address these issues this paper will review various perspectives on disruptions of self-experience in schizophrenia as well as literature regarding how sense of self among people in general normally develops out of dialogues both within the individual and between the self and others. Following this we will theorize that the subjective experience of personal incoherence in schizophrenia may reflect a collapse of the ability to maintain ongoing dialogue within the self, specifically arguing that as internal dialogues evaporate, self-experience and personal narrative can devolve into one of three forms: (a) a barren and empty self-organization; (b) internal cacophony; or (c) self constructions dominated by rigid, non-evolving monologues. Lastly, implications for treatment and recovery will be discussed, including the potential usefulness of a focus on interventions that might revitalize clients' internal and external dialogue.