Measurement invariance and change of affective and cognitive Theory of Mind in mental health patients

Knopp, Magdalena (2024): Measurement invariance and change of affective and cognitive Theory of Mind in mental health patients. Dissertation, LMU München: Fakultät für Psychologie und Pädagogik

Abstract

Theory of Mind (ToM) is one of the most investigated aspects of social cognition and refers to a range of mental processes that allow humans to interpret, perceive, and respond to social cues, while accounting for a specific situation. ToM is the cognitive ability to ascribe mental states such as desires, beliefs, intentions and emotions to oneself and others (Apperly, 2012). It allows humans to predict and explain behavior. ToM can also be construed as a part of empathy, in this case ToM is equated to one aspect of empathy termed cognitive empathy. The second aspect of empathy is affective empathy, which refers to affective contagion (i.e., sharing the emotional experiences of others). The two systems of empathy rely on separate but interacting brain networks (Shamay-Tsoory, 2011). ToM is not a monolithic ability; it includes two different facets, affective and cognitive ToM (Maleki et al., 2020; Shamay-Tsoory et al., 2007; Zabihzadeh et al., 2017). Cognitive ToM involves representing thoughts, intentions, or beliefs by making inferences about mental states through interpretation or prediction of others’ behaviors (i.e., understanding the intentions of others). Affective ToM involves representing emotions and feelings by decoding and discriminating the mental states of others based on available environmental information. The importance of ToM is exemplified by the finding that ToM deficits have been reliably associated to mental disorders. For instance, individuals with alcohol use disorder (AUD) show medium to strong ToM impairments (Bora & Zorlu, 2017; Hanegraaf et al., 2021; Onuoha et al., 2016; Sanvicente-Vieira et al., 2017). ToM impairments are also common in patients with borderline personality disorder (BPD; Bora, 2021; Hanegraaf et al., 2021; Németh et al., 2018; Richman & Unoka, 2015). The ToM deficits shown by these groups are likely contributing to the interpersonal difficulties frequently seen among BPD and AUD patients (Hanegraaf et al., 2021). Further, both disorders are frequently comorbid. At the same time the two groups are marked by uniquely different socio-demographic characteristics. Even though both are marked by ToM deficits, the two disorders have been linked to different types of ToM deficits. People can show exceeding ToM, less ToM, or no ToM. Exceeding ToM implies over-interpretating others’ behaviors. Reduced ToM and no ToM imply a limited tendency to ascribe mental states to others, which is often marked by literal understanding (Vegni et al., 2021). By examining these two distinct clinical samples, which show characteristic symptoms, socio-demographic characteristics, and ToM deficits, a more comprehensive understanding of ToM abilities can be achieved. Studies on socio-demographic characteristics such as sex or age have shown inconsistent results. There is some evidence that men outperform women (Russell et al., 2007), while in other studies sex differences are largely absent (Barrett et al., 1998; Derntl et al., 2010). Given the inconsistent results, further research is crucial to clarify sex influences on ToM. Studies about age indicate a decline in ToM in older adults (Bailey et al., 2008; Henry et al., 2013; Krych-Appelbaum et al., 2007). Hence, ToM development across the entire lifespan is relevant. ToM research is plagued by the presence of a multitude of measures (Olderbak & Wilhelm, 2020; Quesque & Rossetti, 2020). According to Quesque and Rossetti (2020), ToM measures need to require test takers to represent others' mental states and to distinguish these from one’s own. These two criteria are fulfilled by the Movie for the Assessment of Social Cognition (MASC). The MACS is consistently employed across all three studies presented in this dissertation. While many ToM measures have been criticized for lacking validity (Pabst et al.,2022), the MASC (Dziobek et al., 2006) is considered both valid and reliable (Benito-Ruiz et al., 2022; Fossati et al., 2018). Nevertheless, it has created inconsistent findings. To enhance the understanding of the MASC’s psychometric properties, individual and situational factors that influence affective and cognitive ToM should be investigated to improve the understanding of ToM measurements in the clinical context. This dissertation presents findings from three articles. Article 1 tested invariance of the MASC over the duration of the test and depending on sex and age. Article 2 explored the impact of the interaction partner’s gender per item within the ToM measure. Article 3 presents findings on changes of ToM during inpatient treatment. Article 1 explored ToM in a large clinical sample, including patients with AUD and Personality Disorders (PD). The study assessed the changes in cognitive and affective ToM within the MASC over the course of a test session. Results indicated a decrease in cognitive ToM and an improvement in affective ToM performance as the test progressed. This effect was moderated by age, older participants showed a more pronounced trend in affective ToM than younger. Sex differences were also observed, with women displaying higher affective ToM skills. Furthermore, individuals with PD generally showed better ToM abilities than those with AUD. These findings underscore the importance of considering individual (e.g., age, sex), and situational (test duration) variables when measuring ToM abilities, offering insight into potential reasons for inconsistent results in prior studies. Article 2 examined ToM assessments by exploring how the gender of the interaction partners and the congruence of their perspective affect ToM measurement. Based on previous research, it was hypothesized that ToM scores vary with the social groups of the interaction partners. ToM performance is enhanced when the target and the perceiver share similar social groups and perspectives. Conversely, ToM performance is diminished when interaction partners have identical social groups but possess differing perspectives (Simpson & Todd, 2017). Article 2 assessed ToM in a large clinical sample, including individuals with AUD, and PD, and healthy controls (HC). A consistent pattern emerged, items with the same gender of interaction partners resulted in lower ToM abilities compared to items with different gender of interaction partners, within both clinical samples and HC. Within clinical samples, items with male targets resulted in better ToM performance compared to items with female targets, the smaller HC did not replicate this effect. The findings indicate that the gender of interaction partners serves as a significant moderator of ToM performance. However, the findings of this article need to be further investigated with studies in which the gender within items is systematically manipulated. Article 3 focused on the effect inpatient psychotherapeutic treatment has on affective and cognitive ToM and related outcomes (like alcohol use and psychological symptoms) in individuals with AUD. This longitudinal study used the MASC to track changes in affective and cognitive ToM between admission and discharge. This longitudinal study was carried out within a naturalistic environment to increase the degree of clinical representativeness and the external validity of clinical care routine. All variables were assessed at admission and discharge of the inpatient stay. Article 3 investigated affective and cognitive ToM in a longitudinal study within individuals with AUD for the first time. It contributes to the expanding body of literature by demonstrating that only cognitive ToM improved following an eclectic abstinence-oriented inpatient treatment. It might be that more specific interventions are required to yield improvements in affective ToM. Moreover, the results of Article 3 reveal that initial ToM abilities positively correlated with a decrease in symptoms of depression and somatization, suggesting ToM's potential as a treatment target to improve psychological health not only in patients with BPD (Kvarstein et al., 2020), but also in those with AUD. These findings highlight the need for further research on ToM's relationship with psychological symptoms in AUD, emphasizing the value of incorporating ToM training into treatment programs. This fits with the current literature highlighting ToM’s vital role in the recovery process (Rupp et al., 2017) and the alleviation of comorbid symptoms in other mental disorders (Sondermann et al., 2020). In conclusion, this dissertation explored the interactions of multiple individual and situational factors that influence ToM measurement. The studies showed that ToM measurements would be more consistent if age is accounted for. Future, ToM measures could balance the number of male and female items. The studies help to understand the heterogeneity in the previous findings. By differentiating between these two ToM facets within sizable clinical samples, while always relying on the MASC, this research enriches our understanding of the subject. Previous findings highlight the significance of ToM across a spectrum of mental disorders, McLaren et al. (2022) provided a comprehensive examination of ToM exceeding in many mental disorders. Moreover, a systematic review by Cotter et al. (2018) emphasized the role of social cognitive processes as transdiagnostic clinical indicators across various clinical presentations, underscoring their importance in discerning disease progression, and treatment efficacy. Previous findings have led to the conclusion that ToM should be considered as a transdiagnostic factor essential for conceptualizing mental health. This was for instance recognized within the Research Domain Criteria (RDoC) framework (National Institute of Mental Health, 2020). This framework assesses dysfunctions across broad psychological and biological matrices and tries to overcome the limitations of categorical diagnostic models. Especially the last article highlighted the potential relevance of ToM for therapeutic processes. To effectively integrate social cognition training within psychotherapeutic treatment programs, a more comprehensive understanding of ToM in clinical adult samples is necessary. Evidence supports that such integrative therapies can improve outcomes across various psychiatric disorders (Peyroux & Franck, 2014). This offers valuable insights for identifying and prioritizing therapeutic interventions in patients within clinical samples, specifically among patients with AUD and PD.

• Dokumententyp: Dissertationen (Dissertation, LMU München)
• Themengebiete: 100 Philosophie und Psychologie ; 100 Philosophie und Psychologie > 150 Psychologie
• Fakultäten: Fakultät für Psychologie und Pädagogik
• Sprache der Hochschulschrift: Englisch
• Datum der mündlichen Prüfung: 25. April 2024
• 1. Bericht­erstatter:in: Sprung, Manuel