As a group, patients reported lower Cognitive Empathy but higher Affective Empathy than controls. For Cognitive Empathy, patients had lower scores on both the Perspective Taking and Online Simulation subscales, consistent with Michaels et al. (2014). The subscale label, “Online Simulation,” is potentially confusing because the term “simulation” is often used to describe automatic mirroring processes associated with affective empathy (e.g., Preston and deWaal, 2002). In contrast, this subscale refers to making efforts to understand others’ emotions and partly overlap with items on the IRI Perspective Taking scale, which is consistently decreased in schizophrenia. A benefit of the QCAE Cognitive Empathy subscales is that they focus more on understanding and mentally representing others’ emotions than the IRI, which more broadly assesses perspective taking in non-emotional contexts. Beyond self-report measures, the current findings also converge with impairments consistently seen in schizophrenia on behavioral and neuroimaging cognitive empathy tasks see (Derntl et al., 2009; Derntl et al., 2012; Langdon et al., 2006; Smith et al., 2015).
In contrast to the patients’ diminished QCAE Cognitive Empathy, they reported higher overall Affective Empathy than controls, a pattern that replicates that found by Michaels et al. The patients’ elevated Emotional Contagion scores may seem surprising in light of impaired performance in schizophrenia on tasks that assess this construct, such as spontaneous mimicry of others’ observable expressions or behaviors (e.g., yawning) (Haker and Rossler, 2009; Sestito et al., 2013; Varcin et al., 2010). This apparent discrepancy, however, reflects differences in the processes that these measures assess. The QCAE Emotional Contagion subscale actually focuses on the extent to which one’s internal emotional experience (particularly for unpleasant emotions) matches the emotions of those around him/her, whereas behavioral measures focus on the degree of congruence of outward expressions among people. The current findings, therefore, suggest that some aspects of affective empathy are not diminished in schizophrenia (also see Horan et al., 2014a; Horan et al., 2014b).
The patients’ normal Proximal Responsivity (emotional responses to close personal contacts) and elevated Emotional contagion (emotional response to others in one’s general social environment) could be interpreted to suggest that Affective Empathy is an area of relatively preserved function and a social cognitive strength in schizophrenia. Alternatively, patients’ sensitivity to others’ emotions could contribute to social difficulties, particularly if patients become overwhelmed by negative emotions that are not appropriately modulated. Such a hyper-responsivity interpretation would be consistent with evidence that patients report heightened negative emotions to unpleasant and neutral stimuli (Cohen and Minor, 2008), often report elevated scores on the IRI Personal Distress scale (Achim et al., 2011; Corbera et al., 2013; Smith et al., 2012), and show hyper-responsive mirror neuron system activity in certain conditions (McCormick et al., 2012). Furthermore, schizophrenia is associated with impaired emotion regulation (Henry et al., 2008; Horan et al., 2013), as well as self-other distinction (Ebisch et al., in press; Liepelt et al., 2012). If patients are sensitive to others emotions, yet unable to down-regulate or distinguish their own emotions from others’, this could contribute to overwhelming
emotions that impede adaptive empathic behavior.
To educate those who were all too willing to misjudge me on this subject, and therefore punish me when I had not done wrong.