همدردی عاطفی و شناختی و اجتماعی کیفیت زندگی در اسکیزوفرنی: مقایسه بین مدل فرایند موازی و یک مدل یکپارچه مدیتیشن

Two alternative models of impaired cognitive and affective processing that may underlie reduced social quality of life (SQoL) of persons with schizophrenia, were examined. According to the parallel process model, impaired cognitive empathy and affective empathy make relatively independent contributions to the symptoms of schizophrenia and to the consequent reduction in SQoL. According to the integrative mediation model, the symptoms of schizophrenia and the reduction in SQoL associated with these symptoms are the products of a process by which impairments of cognitive empathy are contingent on impairments of affective empathy. 90 persons with schizophrenia were assessed for SQoL, symptoms and cognitive and affective empathy. Results support the integrative mediation model only for cognitive empathy and negative psychiatric symptoms. Only the negative links between cognitive empathy and negative symptoms served to mediate the positive relation between affective empathy and SQoL. Positive symptoms had a limited negative impact on SQoL and did not play a role in the paths that linked affective empathy to SQoL. Age had a statistically significant and negative indirect relationship to SQoL. Results are consistent with recent approach that distinguish between cognitive and affective empathy and specify how these two processes are integrated.

Schizophrenia is a clinical syndrome that interferes with intrapersonal and interpersonal functioning and, as a consequence, reduces social quality of life (SQoL) (Addington and Addington, 2000). The disruptive impact of these social difficulties can be even more debilitating than the psychotic symptoms (Carson et al., 2000). Accordingly, various researchers view schizophrenia as an interpersonal disturbance characterized by problems in understanding the social environment and the individual׳s place within it (Penn et al., 1997 and Stanghellini, 2001). The present study investigated two alternative models of the impaired cognitive and affective processing that may underlie the decline in SQoL of persons with schizophrenia. One of these models is termed the parallel process model. According to this model, impaired empathic cognitive and affective processes make relatively independent contributions to the initiation and maintenance of positive and negative symptoms of schizophrenia and to the consequent reduction in SQoL. The other model is termed the integrative mediation model. According to this model, the positive and negative symptoms of schizophrenia and the reduction in SQoL associated with these symptoms are the products of a process by which impairments of cognitive empathy and the positive and negative symptoms of schizophrenia are contingent on impairments of affective empathy. Both models stem from a conceptualization of empathy as a set of distinct processes by which one person attends to the inner experiences of another person (Zaki and Ochsner, 2012), and concern a major dichotomy that over the last decade has become the focus of theoretical and empirical research on empathy. This dichotomy distinguishes between affective empathy with its emphasis on phylogenetically early emotional contagion systems and cognitive empathy with its emphasis on phylogenetically advanced perspective taking and theory of mind (TOM) processes (Singer, 2006 and Zaki and Ochsner, 2012). These two kinds of empathy are also thought to be sub-served by different neural systems (Shamay-Tsoory et al., 2008). The parallel process model is partially based on Frith, 1992 and Frith, 2004 meta-representation explanation of the etiology of the positive and negative symptoms associated with schizophrenia. Central assumptions of Frith׳s meta-representation account of the positive and negative symptoms of schizophrenia (Frith, 1992) are that the ability to develop and to make use of ToM processes are derived from the capacity to meta-represent the personal and social environment and that psychiatric symptoms of schizophrenia are the consequence of an impaired ability to meta-represent. Accordingly, impairment of cognitive processes plays a primary role in the etiology of the psychiatric symptoms of schizophrenia. However, this theory does not specify the extent to which and the manner in which affective empathy processes might contribute to the development and maintenance of the negative and positive symptoms of schizophrenia. To test these claims, the proposed present study׳s parallel process model was based on the assumption that cognitive and affective empathic processes have a relatively independent influence on psychiatric symptoms and SQoL. However, in keeping with Frith׳s meta-representation theory, the impact of impaired cognitive empathic processes on SQoL was hypothesized as being mediated by the psychiatric symptoms of schizophrenia. The impact of impaired affective empathic processes was hypothesized as having a direct impact on the SQoL. The integrative mediation model was influenced by the theories of Hobson, 1990 and Hobson, 2007 and Gallese, 2001 and Gallese, 2007. According to this model, the reduction in SQoL associated with schizophrenia is principally due to a disturbance of affective empathy. One of the indices of this disturbance is difficulty in identifying the emotions associated with facial expressions (Goldman and Sripada, 2005 and Blair, 2005). According to the integrative mediation model, ToM capacity and the resulting attainment and maintenance of SQoL are based upon the ability to identify interpersonal emotional experiences by means of the affective content of the physical expressions of others. Therefore, impaired affect processing was hypothesized as a precursor of the impairment of ToM processes. This impairment, in turn, was expected to produce the positive and negative symptoms of schizophrenia that then limit interpersonal functioning and reduce SQoL. Depending upon which of the above models of the relations between SQoL and affective and cognitive empathy are shown to be valid, persons with schizophrenia could experience different sets of interpersonal problems. The parallel process model implies that the latter persons may experience the negative and positive symptoms of schizophrenia when, for example, they do not fully grasp the goals, intentions, and beliefs of such significant others as their wives׳ or husbands׳. These symptoms then may interfere with their attempts to carry-out the interpersonal activities required for the attainment of SQoL. In addition, the quality of these persons׳ intimate relationships may deteriorate due to their failure to respond spontaneously and appropriately to their wives׳ or husbands׳ moods. However, according to the integrative mediation model, the interpersonal problems of persons with schizophrenia emerge because their perception of other persons׳ emotions does not lead to attributing the appropriate goals, intentions, and beliefs to these persons. To compare the above two models, the following structural hypotheses were derived from each of the above models. In keeping with the parallel process model, the negative and positive symptoms of schizophrenia were hypothesized as mediating the negative relations between ToM processes and SQoL whereas emotion recognition was hypothesized as directly and positively related to SQoL. In keeping with the integrative mediation model, the relation between emotion recognition and SQoL was hypothesized as being mediated by ToM processes and the negative and positive symptoms of schizophrenia.