Mental state references in psychosis: A pilot study of prompted implicit mentalising during dialogue and its relationship with social functioning

Abstract

Introduction. Few studies of psychosis have examined dialogue-based implicit mentalising even though this is likely to reflect the skills required in everyday life better than more typical mentalising tasks. Using a semistructured dialogue task, we predicted that a psychosis sample would be impaired in “prompted” online mentalising (i.e., the frequency and variety of mental and emotional state words as well as references to own mental state) and that performance would relate to social functioning.

Methods. Eighteen adults with psychosis and nine healthy adults were each recorded during four semistructured dialogues, which were transcribed, coded, scored, and quantitatively analysed. The patients also completed a measure of social functioning.

Results. Compared to controls, the psychosis participants referred to others’ mental and emotional states significantly less and with a lower variety of words. These findings were all large effects with sufficient observed power. There was no significant difference in references to own mental state. The relationships between mentalising and social functioning were mostly modest.

Conclusions. Although prompted implicit mentalising is impoverished in psychosis, self-knowledge appears to be intact. Simulation-based mentalising may be spared in the context of impoverished theory-based mentalising. Also, implicit mentalising contributes to social functioning, corroborating the results of previous work.

Keywords:

• Dialogue
• Mentalising
• Psychosis
• Schizophrenia
• Social functioning
• Theory of mind

Acknowledgements

The first author would like to thank Universities UK for providing an Overseas Research Studentship.