Schizophrenia Research 122 (2010) 164–171

Contents lists available at ScienceDirect

Schizophrenia Research
j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / s c h r e s

Social attribution test — multiple choice (SAT-MC) in schizophrenia:
Comparison with community sample and relationship to neurocognitive,
social cognitive and symptom measures
Morris D. Bell a,b,⁎, Joanna M. Fiszdon a,b, Tamasine C. Greig b, Bruce E. Wexler b
a
b

VA Connecticut Healthcare System, Rehabilitation Research and Development Service, West Haven, CT 06517, USA
Yale University School of Medicine, Department of Psychiatry, New Haven, CT 06511, USA

a r t i c l e

i n f o

Article history:
Received 20 January 2010
Received in revised form 14 March 2010
Accepted 16 March 2010
Available online 18 April 2010

Keywords:
Social attribution
Theory of Mind
Mentalizing
Social cognition
Schizophrenia
Neuropsychology

a b s t r a c t
This is the first report on the use of the Social Attribution Task — Multiple Choice (SAT-MC) to
assess social cognitive impairments in schizophrenia. The SAT-MC was originally developed for
autism research, and consists of a 64-second animation showing geometric figures enacting a
social drama, with 19 multiple choice questions about the interactions. Responses from 85
community-dwelling participants and 66 participants with SCID confirmed schizophrenia or
schizoaffective disorders (Scz) revealed highly significant group differences. When the two
samples were combined, SAT-MC scores were significantly correlated with other social cognitive
measures, including measures of affect recognition, theory of mind, self-report of egocentricity
and the Social Cognition Index from the MATRICS battery. Using a cut-off score, 53% of Scz were
significantly impaired on SAT-MC compared with 9% of the community sample. Most Scz
participants with impairment on SAT-MC also had impairment on affect recognition. Significant
correlations were also found with neurocognitive measures but with less dependence on verbal
processes than other social cognitive measures. Logistic regression using SAT-MC scores correctly
classified 75% of both samples. Results suggest that this measure may have promise, but
alternative versions will be needed before it can be used in pre–post or longitudinal designs.
Published by Elsevier B.V.

1. Introduction
Social functioning deficits are among the most prominent
features of schizophrenia and play a large role in the individual's level of disability and the likelihood of relapse. Social
cognition, or how an individual processes, interprets, and
responds to social information, has repeatedly been shown to
be impaired in schizophrenia (Bora et al., 2009; Brune and
Brune, 2005; Corcoran et al., 1995a; Edwards et al., 2002;
Fiszdon et al., 2009; Penn et al., 2008; Silverstein, 1997) and to
be associated with various components of functioning (Cohen
et al., 2009; Couture et al., 2006; Hooker and Park, 2002;

⁎ Corresponding author. Psychology Service 116B, VA Connecticut, Healthcare
System, West Haven CT 06516, USA. Tel.: +203 932 5711x2281; fax: +203 937
4883.
E-mail address: morris.bell@yale.edu (M.D. Bell).
0920-9964/$ – see front matter. Published by Elsevier B.V.
doi:10.1016/j.schres.2010.03.024

Mueser et al., 1996; Penn et al., 1996; Pinkham and Penn, 2006).
While some studies suggest that social cognition may mediate
the relationship between other variables (e.g. neurocognition)
and functional outcomes, other studies indicate that social
cognition may also account for a unique portion of the variance
in predicting functional outcomes (Addington et al., 2006; Bell
et al., 2009; Brekke et al., 2005; Brekke et al., 2007; Dickinson
et al., 2007; Kee et al., 2003; Meyer and Kurtz, 2009; Vauth et al.,
2004). The interrelationship between social cognition and
functional outcomes has led researchers to suggest that social
cognition may be a good proximal treatment target for interventions aimed at improving functional outcomes in schizophrenia (Horan et al., 2008).
A number of laboratory measures have been developed to
assess social cognitive function. Most of these measures have
focused on narrowly defined social cognitive processes such
as ability to recognize affect, identify interrelationships and

While the majority of affect recognition measures have focused on an individual's ability to recognize or differentiate emotions from photograph stills. draw inferences about the causes of events.. particularly with verbal memory tasks. we wished to determine its discriminant validity by comparing scores from 165 an urban community mental health center (CMHC) sample with those of an urban community-dwelling sample. . The stimulus for the SAT is based on a 1944 Heider and Simmel (Heider and Simmel. Based on these study aims. and scoring issues reduce their usefulness in capturing impairments in understanding spontaneous complex social situations (Klin.. make guesses about how characters may be feeling or what they may be thinking.. 1995. such as whether specific skills are actually employed in social situations. Participants Participants were 66 adult outpatients with Diagnostic and Statistical Manual of Mental Disorders. 2008). since real-world situations require a combination of different social cognitive processes as well as allow for informational redundancies occurring through multiple sources of information and multiple modes of presentation (Bazin et al. We also wished to determine its degree of convergent validity with other measures of social cognition. Methods 2. Klin created a multiple choice version of the task (SAT-MC). The participants were recruited from an urban community mental health center for an on-going study of cognitive training and supported employment (Clinical Trials. 2) SAT-MC performance of our schizophrenia sample would correlate with other social cognitive measures but have only a moderate degree of shared variance. 2000). we speculated that because the task does not require the examinee to remember verbal content. 1996. Specifically. Yager et al. verbal IQ. emergency room visits. and. 2009. Finally. homelessness or substance abuse in the past 30 days) and have an interest in returning to work. This may limit their ecological validity. whether the individual is able to focus on relevant aspects of social situations. gauge social rules and expectations... it might make performance less dependent upon verbal ability. something which we have identified as a problem with other social cognitive measures we have used such as the Hinting Task (Greig et al. This task has since been adapted by Klin. To determine whether this task could be useful for schizophrenia research. other social cognitive measures most frequently rely on written or videotaped vignettes of social situations. Klin. Although we expected that neurocognitive processes would have some association with this new social cognitive measure as they have with other social cognitive measures used in schizophrenia research. 1944) silent cartoon animation showing moving geometric figures. Participants were required to meet criteria for clinical stability (no hospitalizations. Based on these results. and whether the individual is capable of assimilating various pieces of social information (D'Zurilla and Maydeu-Olivares. 2006). existing social cognitive measures have also been critiqued for how narrowly they target specific social cognitive skills.1. When originally developed and tested. Recently experts concluded that most measures of social cognition have poor or unknown psychometric properties (Green et al. where the examinee is asked to make guesses about the relationship of characters to each other. Klin et al. It has also been suggested that many of the existing social cognitive tasks fail to measure some variables that do in fact affect reallife performance. who created a scoring procedure for narratives made to this animation.. The multiple choice version was selected over the narrative approach because it eliminates rating error and allows for easier use across studies.gov #NCT00339170). 2009). 2008). which has been shown sensitive to social cognitive deficits in adolescents and adults with Asperger's Syndrome and high functioning autism (Klin. 1994) diagnosis of schizophrenia or schizoaffective disorder. we hypothesized that: 1) our schizophrenia sample would perform significantly worse than our comparison group on the SAT-MC. Demographic and illness characteristics of these 66 participants are presented in Table 1. and classification accuracy could be increased by using a combination of SAT-MC scores with other social cognitive measures. or metalinguistic skill. 4th revision (DSM-IV) (American Psychiatric Association and Task Force on DSM-IV. brain injury or developmental disability. 3) SAT-MC scores for our schizophrenia sample would have modest relationships with neurocognitive measures. as confirmed by the Structured Clinical Interview (SCID) (First et al. These four subjects plus 1 subject with uncollected symptom data are not included in the symptom analyses (n = 61). Finally.M. Bellack et al..D. it has been suggested that variables such as dependence on verbal ability (for example having to read short stories and answer questions about them).. We also wanted to determine its divergent validity from neurocognitive measures. or identify the intentions. 1996). 2006). Other exclusion criteria included evidence of current neurological disease. This is the first study using SAT-MC in adults with schizophrenia. dispositions and mental states of other people (Green et al. which may offer a purer characterization of social cognitive deficits separate from linguistic skill or verbal memory. English proficiency was also required. 2000. These deficits were unrelated to age. the explicit nature of tasks. Bell et al. or make guesses about what caused specific events. Because the task is a silent cartoon. 2004). it was noted that nearly every subject experienced the cartoon figures as animate beings enacting a social drama. / Schizophrenia Research 122 (2010) 164–171 clues in social situations. 2. while perhaps capturing features of the illness that have here-tofore not been measured.. we wished to determine the classification accuracy of this new measure in being able to categorically distinguish our schizophrenia sample from the community comparison group alone and in combination with other social cognitive measures. and particularly the Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT) (Wexler et al. 4) schizophrenia and community samples could be accurately classified based on SAT-MC scores alone. it does not reply on verbal ability. Four subjects were not included in analyses of neurocognition (n = 62) because they were recruited from an earlier version of the parent study that used somewhat different measures. 2000). The Social Attribution Task (SAT) is a measure of social inference that has been proposed to overcome some of the weaknesses of social cognitive assessments noted above. which further reduced the task's dependence on verbal ability. exploring the extent to which it may share variance with these measures.

4) Schizophrenia diagnosis Disorganized 2 Paranoid 28 Residual 11 Undifferentiated 8 Schizoaffective 16 Psychosis Disorder NOS 1 (3. they were somewhat younger than our schizophrenia sample (mean age = 31. they differed in having a higher percentage of women (88%).. Unexpectedly. after being shown a short segment. This is comprised of scores from the Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT) (Mayer et al.7) (12.2) Negative Cognitive Hostility Emotional Discomfort SANS Total SAPS Total 8. and who after reading a description of the study that explained that we were collecting data to represent a non-psychiatric comparison sample.6) 42. / Schizophrenia Research 122 (2010) 164–171 Table 1 SAT-MC participant characteristics.”). It wants to lock the door. 1987) (r = 0.43.94 (15.73 (10.0) (42. and the examinee is asked to decide what emotion the actor is portraying.. Following approval by our local Institutional Review Board (IRB) we recruited participants who were students in two urban community college classes.9) Lifetime number of hospitalizations 16. we sought to recruit participants who were not identified as having a psychiatric illness and who would be similar to our schizophrenia participants in being an ethnically diverse sample of urban dwellers of similar age.g.42. p b 0. This is a self-report measure with 90 true/false items assessing 4 dimensions of object relations and 3 dimensions of reality testing.20 (6. 2006): Index scores for Speed of Processing.6) Female 26 (39.1) (7.2. Developed by Klin (Klin. education and socio-economic status. and the examinee is asked what was meant by the hint. At the end of the scenario one of the characters drops an obvious hint (e.” The Bell-Lysaker Emotion Recognition Task (BLERT) (Bell et al. 2. 2009). 19 questions are asked with 4 possible responses to each. small triangle and small circle enact a social drama (Interested readers can find the original on YouTube “Heider and Simmel Movie.4) 12.0) 8.58)). The Hinting Task (Corcoran et al. Measures Social cognitive measures included: The Social Attribution Task — Multiple Choice version (SATMC). 2006) this task is comprised of a 64-second animation created by Heider and Simmel (Heider and Simmel. Relevant to this report.1) (24.. “Jane. The animation is shown twice and then short segments are presented followed by multiple choice questions about the actions depicted. It wants to help the little circle.. .6) (n = 65) Mean (SD) Mean (SD) PANSS Total Positive Age 64. Of relevance to this report.58 (2.50)) and similar in ethnic composition (42% Caucasian). We revised the original Hinting Task to American English. The tasks require respondents to evaluate how effective different actions would be in achieving an outcome involving other people (e.4) (16. 2002) Emotion Management Task (Section D) and Social Management Task (Section H).000) and with the cognitive component of the Positive and Negative Syndrome Scale (Kay et al. this is an unscreened representative community sample.72 (8. Thus. I'd love to wear that blue shirt. For example.75 (3.42. p b 0. felt that they qualified.45 (9. 1987) Logical Memory I.. It wants to help the big triangle.5) Ethnicity African American Caucasian Hispanic Other Medications Atypical Conventional Both None n (%) 40 (60. MATRICS Social Cognition Index.g. Others frequently try to humiliate me (True). has been linked with performance measures of social cognition (Bell et al.166 M. and it is likely that had individual screening been performed some of these participants might have been excluded. p b 0..D.5) (1. 2009). there was no individual screening for psychopathology. 2000. 1995b). 4.18 (19. A total correct score of 1–14 is categorized as indicating impairment and 15– 21 as unimpaired. Bell Object Relations Reality Testing Inventory (BORRTI) (Bell.000. 2004). how effective would calling friends or eating healthy be in making someone feel better).63 to both Emotion Management and Social Management (Wexler et al. r = 0.2) (1. This affect perception task consists of 21 short video clips in which an actor displays one of seven emotions with three neutral monologues.8 (1.000) (Greig et al. (n = 66) n (%) Gender Male 40 (60. we found the Hinting Task to be significantly correlated with story memory (Wechsler Memory Scale (Wechsler. Bell et al. Neurocognitive and symptom measures included: MATRICS Consensus Cognitive Battery (MCCB) (Nuechterlein and Green. People are never honest with each other (true).7) 35.52 (4.4) (1. As a group. Klin et al. with Logical Memory I scores correlating r = 0. This is a Theory of Mind measure consisting of 10 brief scenarios that describe an interaction between two people. the respondent is presented with the question: “What is the little triangle trying to do?” and given these choices: “1. 2. Neurocognitive measures were selected to provide both broad information about separate cognitive domains and overall neurocognitive function as well as provide more specific information about verbal memory function.. in particular. It was developed initially for schizophrenia research and has been found to have strong psychometric properties in a wide variety of applications and to have crosscultural validity (Li and Bell.69 (3.0) In selecting a comparison group. 3. 1997).8) 6. r = 0. Therefore.5) 29.6) 24 1 1 (36.6) (13. but it's very wrinkled”). 1995).6) 23. but were similar in education (mean = 13. we have found that there is a large verbal ability contribution to these scores. 1944) in which a large triangle.37 (5. 2008).11 (19. Logical Memory II.5) 44 8 5 9 (66.1) Age at 1st hospitalization 16.63 (10.7) (12. It wants to play with the little circle and with the big triangle.4) Education 15. The egocentricity scale. Examples of items on this scale include: I believe a good mother should always please her children (True). In all..

. Digit Span. SAT-MC correct score distributions for community sample (CS) and schizophrenia sample (Scz). Matrix Reasoning. Results 3. the covariates in the model were not 2.36. Wisconsin Card Sorting Task (WCST) (Heaton. schizophrenia participants were individually administered all measures over several assessment sessions. Measures included the Positive and Negative Syndrome Scale (PANSS) (Kay et al. Working Memory.147)= 1. correcting for group membership. 3. Block Design. and each student had a copy of the answer sheet. Group differences were statistically significant (F(1. Symptom evaluations and social cognitive measures were generally performed on different assessment days.11).M. Wechsler Adult Intelligence Scale-III (WAIS-III) (Wechsler. ANCOVA did not reveal a significant difference on SAT-MC scores by gender (F(1.D. These distributions and a receiver operating characteristic (ROC) curve analysis were used to determine the best SAT-MC cut-off score for sensitivity and specificity to the schizophrenia sample. For the SAT-MC. Categorical agreement between BLERT impaired/unimpaired and SAT-MC impaired/unimpaired was determined using chi-square. Demographic differences were not significant for education. Wechsler Memory Scale.13. Age was also not significantly correlated with SAT-MC performance (r = −0. education and gender as covariates. Symptom assessments were performed at intake by Ph. Men had a slightly higher mean score (mean = 14. 1997): Scaled scores for Vocabulary. 1994) and the Schedule for the Assessment of Positive Symptoms (SAPS) (Andreasen. controlling for age. a large TV monitor placed at the front of the 40-person classroom displayed the task. Hinting Task. educa- Fig. but the community comparison sample had a significantly higher proportion of women (88% versus 39%) and were significantly younger (32 versus 43 years of age). Cronbach's Alpha for item to scale consistency was 0.. 167 tion and gender. 1987): Scaled Scores for Logical Memory I. Community participants were not administered any neurocognitive or symptom measures.93). Correct scores for the schizophrenia sample are normally distributed with a mean.. Data analysis Internal consistency of items on the SAT-MC was assessed using Cronbach's alpha and Spearman–Brown coefficient for split-half reliability. 2. As expected. education and gender to SAT-MC scores. p = 0.26. Relationship of convergent and divergent validity measures to SAT-MC scores was determined using bivariate correlations. Group administration of the SAT-MC. median and mode of 15. and Egocentricity). revised (Wechsler. Discriminant validity Following written informed consent. not all items scored false). and Conceptual Level. Reasoning.05. p = 0.25). Visual Learning. All forms were reviewed to determine that they had been filled out correctly and with sincere intent (e. Because of the exploratory nature of this study. Kappa and Eta.75. were used to determine the relationship of age. Procedures 3. level clinical psychologists who had been trained to high levels of inter-rater agreement (intra class correlation = 0. To be conservative.3. Split-half reliability using Spearman– Brown coefficient was 0. Verbal Learning.D. median and mode of 11. 1.001). Internal consistency SAT-MC items were evaluated for internal consistency for both samples combined.4. / Schizophrenia Research 122 (2010) 164–171 Attention and Vigilance. Distributions of SAT-MC scores were examined separately for the schizophrenia and community samples. Discriminant validity between samples was determined using analysis of covariance (ANCOVA). All tests were two-tailed and alpha was set at 0. BORRTI.g.1. with 6 outliers with scores below 9.144) = 20.13). 1. 1984b) and Schedule for the Assessment of Negative Symptoms (SANS) (Andreasen. Controlling for group membership. and Mental Control. 1981): Scaled scores for Total Errors. correlations were not corrected for multiple comparisons. standard deviation of 3.82 to 0. and Neurocognitive Composite Score (average of Index scores excluding Social Cognition). percent agreement. Bell et al. The SAT-MC was paused at each question and administration did not resume until it was clear that all participants had circled a response. Neurocognitive assessments were usually performed over at least two testing sessions. The community sample was provided with a description of the study by their classroom teacher. Logistic regression was used to determine the classification accuracy of SAT-MC and of SAT-MC combined with the other social cognitive measures (BLERT. The distributions of SAT-MC scores for both samples are presented in Fig. Demographic variables were compared using t-tests and chi-square analyses. Partial correlations. BLERT and Hinting Task was done by study personnel during a single classroom session. Only standardized scores were used in correlational analyses and were assumed to meet parametric assumptions. 1984a).2.83. and a range from 2 to 19. Non-perseverative Errors. between groups analysis of variance was performed with age. p b 0. standard deviation of 4. Perseverative Errors. but additional breaks were taken if there was concern about the participant's fatigue or alertness. Logical Memory II. 1987) with 5 component scoring (Bell et al.0) than women (mean = 13. The community sample has a mean.

A categorical examination of the relationship between impairment on the SAT-MC and BLERT showed 65% agreement (Chi-square (1) = 5. with less pathology on Egocentricity.0 34.24 0.5 6.32 0.32 0. Logical Memory I is significantly correlated. r = −0. p = 0.143.7 36.31 0. 4. BORRTI (Reality Distortion. r = − 0. 3.23.30. indicating that 26% of the between-group variance was explained by SAT-MC performance.28 0.0.09.37. but we felt that specificity was to be preferred over sensitivity. Convergent validity Significant bivariate correlations were found between SAT-MC correct scores for the combined samples with BLERT (r = 0. p = 0.003 ns 0.9.6. r = 0. SAT-MC scores had a weaker but similar pattern of correlations to that of the combined samples.26. / Schizophrenia Research 122 (2010) 164–171 significant.5 34.004 0. A score of 12 also produced good discrimination (61% schizophrenia.10).1 7.7 7.05 WCST Standard Scores (n = 62) Total Errors Perseverative Errors Non-perseverative Errors Conceptual Level 85.D.10.47.16.02 0.001). 14% community sample). r = −0.26 0. Sensitivity = 60. 3.21. which includes Social Cognition is also excluded.3 8.31 0. r = 0.001).0 0.01 *MATRICS T Scores (n = 62) Speed of Processing Attention and Vigilance Working Memory Verbal Learning Visual Learning Reasoning and Problem Solving Neurocognitive Composite 35. the adjusted R squared was 0.3 36.4 8. r = 0.23 0. p b 0. is not.1 41. Discussion This is the first report using the Social Attribution Test in its multiple choice form as a possible measure of social Table 3 Logistic regression using SAT-MC scores to predict group membership (Community sample (CS) vs.08). Correctly Classified = 74.0%.34 ns ns 0.25 0. p = 0.02). SAT-MC scores have modest significant correlations with MATRICS indices of Working Memory and Reasoning and Problem Solving (based on Mazes.4 0.6 3. p b 0.07).34 0. Sensitivity to schizophrenia was 60.05. Emotional Discomfort. For the schizophrenia sample alone. that is. Negative.9 3.2 17. p = 0.7 WMS Scaled Scores (n = 62) Logical Memory I Logical Memory II Mental Control SD *Social Cognition Index is excluded because it is a social cognition measure. BLERT. and 15 (48%) of the 31 who were SAT-MC unimpaired were also BLERT unimpaired. p b 0. which involves delayed recall.003 0.001).3 13.1 8.002).001). p = 0.8 7. Schizophrenia (Scz)).7 3.01 ns 0.1 2. Removing the demographics from the model. which increased classification accuracy slightly to 78%. a non-verbal problem-solving task. However.0 2. which also involves non-verbal problem-solving. there is also a modest relationship to WCST. Therefore.3 10.18 0. 3.04.0 9. and overall classification accuracy was 74. overall composite.5 15.5. Schizophrenia) was highly significant (Chi-square (1) = 44. p b 0.3 12.36 0. .7 16. Cognitive. SANS.4. and Egocentricity scores. Mean r p 3.05.6 86.168 M.8% (Table 3).37. Hostility.37 0.08. p = ns).08.07) or with Egocentricity (r = − 0. also a non-verbal task) and with the Neurocognitive Composite score.29.001) and with Hinting Task (r = 0. r = 0.3 2.38 0. SAT-MC scores were not significantly correlated with the BORRTI subscales Alienation (r = −0.47 0. which suggests that IQ (not specifically measured here) probably affects performance. The strongest correlation is with Matrix Reasoning.0 36. p b 0.7.19 0.5 87. p b 0.6. r = 0.44).37.7 3. They were significantly correlated with BLERT (r = 0. SAT-MC was not significantly correlated with any symptom measures (PANSS Positive. r = 0. Divergent validity For the schizophrenia sample. Bell et al.9 9.22 0. but did not reach significance with Hinting task (r = 0.8 8. they were significantly correlated with Egocentricity (r = −0.6 12. Uncertainty of Perception.29 0.18 0.26 0.007 0.008 WAIS-IV Scaled Scores (n = 62) Vocabulary Digit Span Letter Number Sequencing Symbol Search Digit Symbol Coding Block Design Matrix Reasoning 8.4 14. Eta = 0.3. Kappa = 0.1 0. Hallucinations and Delusions.000 7.4% of the community sample (Chi-square(1) = 34. SAT-MC was also not significantly correlated with reality testing impairments as measured by the Table 2 Correlations between SAT-MC correct scores and neurocognitive measures in the schizophrenia sample.02 ns 0.3 6. r = − 0. Insecure Attachment (r = −0. p = ns) or Social Incompetence (r = −0. This score identified 53% of the schizophrenia sample as having an impairment as compared to 9.1 2. specificity was 77.05. Twenty-eight of the 35 (80%) schizophrenia participants identified as SAT-MC impaired were also BLERT impaired. but Logical Memory II. Specificity = 77.04 0.03 0.001. p b 0. Observed Scz CC Predicted Scz CS Total 40 12 52 26 73 99 66 85 151 Chi-Sq (1) = 44.5 86.07. This analysis was repeated adding Hinting Task.6.10). correlations between SATMC correct scores and neurocognitive variables are presented in Table 2. SAT-MC scores were significantly correlated with the Social Cognition index score on the MATRICS (r = 0.01 ns ns 0. An examination of the distribution of SAT-MC scores and its ROC curve led us to choose the SAT-MC score of 11 as the cut-off for impairment.6%.3 0.8%. Classification accuracy Logistic Regression using SAT-MC scores to predict group membership (Community Comparison sample vs. SAPS. SAT-MC scores are about equally correlated with Vocabulary and Block Design.6 2.07.

and modest relationships to most measures of neurocognition. Other highly significant relationships were also found with our theory of mind task and with the self-report measure of Egocentricity. a highly significant finding. Taken together.g. Peer et al. The SAT-MC had a modest. except that they did not exclude themselves. Future studies should explore differences between schizophrenia and other forms of psychopathology where social cognition is not expected to be impaired (e. social problem-solving. or self-experience. 2007). Thus.. It is also the case that such deficits are related to other disorders such as Asperger's Syndrome. Attention and Vigilance. Corcoran et al. it does appear that the SAT-MC is relatively independent of Speed of Processing. clinically stable sample. it is hoped that a social cognitive measure would be relatively independent from basic cognition.D. Thus. Thus. Thus. who had not been screened for psychopathology. suggesting that the SAT-MC on its own is a powerful predictor of group membership. These findings lend some support to the construct validity of the SAT-MC as a measure of social cognition. particularly affect recognition. The instrument showed strong discriminant validity. and that the total contribution of neurocognition based on the Neurocognitive Composite is relatively modest. working memory.g. The community comparison sample was not ideal. Adding other social cognitive measures to the model did not increase the prediction very much. Additionally. the Social Cognition Index from the MATRICS battery was significantly correlated with SAT-MC scores. metacognitive creation of coherent social narrative. With the more restricted range of scores within the schizophrenia sample.. It is possible that our divergent results may be due to the relatively low level of symptoms in this outpatient. so it may be that some of the community comparison participants with poor SAT-MC scores may have a psychiatric condition that affects social cognition and thus were not strictly speaking “false positives”. Sprong et al. the SAT-MC would appear to have promise as an additional tool for exploring social cognition in schizophrenia. / Schizophrenia Research 122 (2010) 164–171 cognition for schizophrenia research. late onset depression) to further clarify how distinctive this impairment is in schizophrenia. the scores of the SAT-MC are indicating a process that distinguishes many people with schizophrenia from the community comparison group but that is relatively unrelated to symptoms. 2002. 169 The SAT-MC was found to have no significant correlation with any symptom domain measured by the PANSS and by the SANS and SAPS. and Verbal and Visual Learning. These findings are inconsistent with the existing literature linking social cognition to severity of various symptoms such as paranoid delusions (Bentall et al. suggesting that correctly interpreting the actions of the geometric figures in the SAT-MC may share some of the same problem-solving processes required for solving the geometric sequences in Matrix Reasoning. there was a higher proportion of women than men. and although this task does not appear to be sensitive to gender differences. Despite this lack of screening. problem-solving). The robust relationship between SAT-MC scores and schizophrenia was shown in its classification accuracy. Martin and Penn. if there were an affect. 1995b).. Most participants with schizophrenia who were SAT-MC impaired were also BLERT impaired. In addition. This is of particular concern because the Social Cognition Index of the MATRICS and the Hinting Task have both shown highly significant dependence on verbal processes. We found that schizophrenia participants had significantly poorer scores than our community sample.g. although many who were BLERT impaired were not SAT-MC impaired. Interestingly. a cut-off score for impaired functioning on the SAT-MC successfully distinguished our schizophrenia sample from the community sample with more than half the schizophrenia sample designated as having impairment while fewer than 10% of the community sample participants were so designated. it would have been better to have had no gender differences between samples. attention. 2004) as well as negative and/or disorganized symptoms (Garety and Freeman. We did not expect to find social cognitive deficits in all people with schizophrenia and recognize these deficits as a likely and important source of heterogeneity within the disorder. 1999. if anything. the administration format (group versus individual) differed between the schizophrenia and community samples.. shared variance with other social cognitive measures. the greatest amount of shared variance was with our measure of affect recognition. Unpredictably. but the associations are moderate at best. We also do not know very much about the psychiatric status of the community sample. the strongest relationship was with Matrix Reasoning.. Greig et al. about 75% of participants were correctly classified. but significant relationship to Logical Memory I as it did to a number of verbal and non-verbal tasks. and social attribution) that are related to but distinct from affect recognition. a hypothesis supported by literature indicating that social cognitive impairments are still found in remitted patients (Bora et al. We found that the SAT-MC was also not significantly correlated with any dimensions of self-reported deficits in reality testing. 2008. anthropomorphizing. the associations were weaker than for the combined samples but the pattern was similar. . the differences between our samples may be a conservative estimate of the true difference between people with schizophrenia and those without mental illness of any kind.. While this potentially may have affected performance. we would speculate that the individual administration would lead to better performance in the schizophrenia sample and worse performance in the community comparison sample. Bora et al. While it is generally agreed that social cognition relies on some features of neurocognition (e. 2009).. In particular. This may be because the SAT-MC is capturing features of social cognition (e. 2009. 2004. There are a number of important limitations to this study. For those measures that were administered to both the community comparison and the schizophrenia participants.M. these findings offer encouragement for further use of SAT-MC in schizophrenia research. it was relatively independent of story memory as measured by Logical Memory. so it should not be expected that SAT-MC scores would distinguish all schizophrenia participants from the community comparison participants. it would have decreased the true difference in performance of the two samples and makes the differences we did find all the more compelling. Bell et al. 2009. Based on the MATRICS index scores. theory of mind. Convergent validity for the instrument was sought by examining its relationship to other social cognitive measures and to a self-report measure of object relations. Lysaker et al. 2009. particularly story memory (Wexler et al. When SAT-MC scores were used in a logistic regression to predict group membership.

1996. Lindenmayer. Lysaker.F. Kayser.D. The cognitive and affective structure of paranoid delusions: a transdiagnostic investigation of patients with schizophrenia spectrum disorders and depression.M.. Freeman. D. 1944. Schizophrenia Bulletin 33. respectively.. Bell et al. Park. Brune.S. American Psychiatric Association. Social/communication skills.S. 2008.. 535–544. J. Blackwood. D'Zurilla. A.. perceived social discomfort. J. Bell... 21–42. Schizophrenia Bulletin 22.J. Bell. E. Kayahan. Pattison. Bell. weaknesses in metacognition of social narrative.. F. Deficits of socialcognitive and social-perceptual aspects of theory of mind in remitted patients with schizophrenia: effect of residual symptoms.. 1–9.. Dickinson. M. Kay. Version 2... J. D. 2008.M. 261–276. D. S. Garety. Heinssen... Conflict of interest There are no conflicts of interest for any of the authors of this paper. Lee.L. M. cognition.S. R. Kring... Greig. P. W. Fiszdon... Milstein. Carpenter. Behavior Therapy 26. M. FL. W. Jackson.. Brune. 2009. Structured Clinical Interview for DSM-IV Axis I Disorders—Patient Edition (SCID-I/P. T.. we hope to create a second version of the task.F.. Brunet-Gouet. G.S. in the collection... 114–118..F. Washington.. Role of funding source This study was funded by the NIMH grant R01 MH061493-01 awarded to Bell and Wexler.. Biometrics Research Department.. Theory of mind performance in schizophrenia: diagnostic... For the same reason. 2004. Penn. University of Iowa.. Acknowledgements We wish to acknowledge Ami Klin.. Park. Neurocognition. helped plan the study.. E.J. Green.. DC. C. Neither sponsor contributed in the study design. Contributors Dr. 487–497. K. 1996.... 2009..M.S. “Theory of mind” in schizophrenia: a review of the literature. 2009.. Falissard.. which may influence subsequent administrations. Falissard.A.. 1994. H. Bell. Schizophrenia Bulletin 34... 738–747.0).. R.B. 2009. Green. J. Mercer.. awarded to Bell and Fiszdon..F. Andreasen. 40–46. Gur. Western Psychological Services. Bellack.M. S. Schizophrenia Bulletin 35. Greig.L.. 2007. Social cognition in schizophrenia: an NIMH workshop on definitions.. B. P. was the project director. R.. which will extend the SAT-MC's usefulness for longitudinal studies and interventions research.. for his generously providing us with the SAT-MC for this study. Cue availability and affect perception in schizophrenia. Kayser. Biosocial pathways to functional outcome in schizophrenia. Docherty. J. 1211–1220. Green. Dinzeo.C.. Gur. Bora.. Kee. Dr. Archives of General Psychiatry 66. R. 73–82 Nov 14..C. E.. R. Kay...D..S. CA. 2002. Opler. Bell. Is emotion processing a predictor of functional outcome in schizophrenia? Schizophrenia Bulletin 29.M.D. Manual for the Bell Object Relations Reality Testing Inventory.... N. Conceptual and methodological issues in social problem-solving assessment. 1995. M. J.D.. M. H. N.L.. 28–35.. Heinssen. Schizophrenia Bulletin 31. R.. Psychiatry Research 112. Brekke. 213–225.. M. T. Passerieux. Task Force on DSM-IV. Director of the Autism Program. Clinical Psychology Review 22. Bazin. Quantitative assessment of attribution of intentions to others in schizophrenia using an ecological video-based task: a comparison with manic and depressed patients. 409–432. matched for difficulty with the current version. 2005. G.M. Social cognition training for individuals with schizophrenia: emerging evidence.. K. 295–303 Jun 1994. University of Iowa. Bora. Bryson. Addington.. M. N..170 M.P. Tsang. Roberts...R. Once a respondent has answered the 19 questions. Research Career Scientist award and Career Development Award from the VA Rehabilitation Research and Development Service.22(8):1267-85. N. Long. 2002.D. 2006. 2005. Emotion recognition via facial expression and affective prosody in schizophrenia: a methodological review... R.. J.. / Schizophrenia Research 122 (2010) 164–171 A final consideration is that this is not a repeatable instrument. social cognition. N... Journal of Nervous and Mental Disease 196. Bell. S. A. Bellack. Cognitive approaches to delusions: a critical review of theories and evidence. First. 2006. Beam-Goulet. test–retest reliability cannot be easily established. American Psychiatric Association.. An experimental study of apparent behavior.S. M. symptom. 113–154. Lysaker. Gokcen. C.. Blanchard...H. 205–252. S. G. 2008. 2002 Nov. Schizophrenia Research 17.C. Schizophrenia. G. S.. No author has any possible financial gain for the findings presented here. Schizophrenia Bulletin 33. Bell. 2009. 2009. Bentall. Positive and negative affect recognition in schizophrenia: a comparison with substance abuse and normal control subjects. Edwards. Diagnostic and statistical manual of mental disorders : DSM-IV. The functional significance of social cognition in schizophrenia: a review. R.E. S. W..D.D. E. Silverstein. Gibbon.. planned and executed the statistical analysis and wrote the first draft. 1984a.. Psychiatry Research. Bourdet. N. D. 1987. Penn.. R. N. Iowa City. Schizophrenia Bulletin 13....L. Emotion processing and its relationship to social functioning in schizophrenia patients. and neuropsychological correlates.-C. symptomatology and social inference: investigating “theory of mind” in people with schizophrenia. We also hope to learn whether there are certain patterns of errors that can be associated with deficits in anthropomorphizing. Psychopathology 42.. Gold.T. Park. C. A.S.. Nienow. Effects of presentation modality and valence on affect recognition performance in schizophrenia and healthy controls. M. Schizophrenia Bulletin 32 (Suppl 1).. Bryson.B. M. or attribution bias. Penn. Corcoran. Journal of Nervous and Mental Disease 192 (1).C. Gaebel.D... References Addington. Rowse. and collected data. Mercer. Schizophrenia. D. New York State Psychiatric Institute. 142–150. Facial affect recognition: a mediator between cognitive and social functioning in psychosis? Schizophrenia Research 85. Psychiatry Research 170.. 5–13 Sep 1995. M. M. Schizophrenia Research 109. 1995b.. C. A... J. Ph. Bentall.. 1247–1256. T.J. Hardy-Bayle. Kinderman... T. 73 (1–2). Gold.. 789–832 Erratum appears in Clin Psychol Rev. Bellack.. Wexler designed the study and participated in its oversight. D.C. J. Frith. M.S.W. 1213–1220. 2007. 1994. M.. 243–259. collected the community control data. J. The Wisconsin Card Sorting Test Manual. Fiszdon..D. analysis or interpretation of data. A. Dickinson.. All authors contributed to and have approved the final manuscript. American Journal of Psychiatric Rehabilitation 11. R. J. Simmel.C. N. 1995. Brekke. Mintz. Hoe. 2003.. Green. C. R. Green. and research opportunities. M. Scale for the assessment of positive symptoms (SAPS). Yucel. P. Passerieux. particularly by those with Autism spectrum disorders. A. C. Shryane. J. Therefore. M..P.. M. IA. Carpenter. S44–S63.P.A. N.. 95–99.. Fiszdon managed the literature searches. A. Green. Bryson. 41–50. Mueser. S. P. Fiszbein. symptomatology and social inference: investigating “theory of mind” in people with schizophrenia. Frith. How neurocognition and social cognition influence functional change during community-based psychosocial rehabilitation for individuals with schizophrenia.S. Bell designed the study. D.F. Andreasen. IA. Hooker. G. Bentall.M.. In future research. Veznedaroglu. New York. Pantelis. Kring.. 1995a. D.M. Hardy-Bayle. Corcoran. Inc... Corcoran.. Moore. 1997. Iowa City. Penn. Psychiatry Research 52 (3).. Kern.. J. C. K.M. R. Scale for the assessment of negative symptoms (SANS).. assessment.M. American Journal of Psychology 57. 12–18 Jan 2004..J. Gaebel. C. R.F. M.. Williams. . S. Brekke. in the writing of the report. D. Heaton. and vocational outcomes in schizophrenia. Bazin. 1984b. M. Schizophrenia Research 80.M. P.D.R. Horan. T. Cohen.. Greig assisted in planning the study.L.. Brunet-Gouet. M.. Yale Child Study Center. 236–247.. Schizophrenia Research 17 (1).. Howard.. Dr.T. L... A.J. M. or in the decision to submit the paper for publication. Theory of mind impairment in schizophrenia: meta-analysis..D. H.L.. Silverstein.. Saeedi.C. Los Angeles. This may help us better understand whether the types of errors made by people with schizophrenia are similar to or different from those made by people with other disorders. B. 5–13. and vocational functioning in schizophrenia. R.. British Journal of Clinical Psychology 38. Five-component model of schizophrenia: assessing the factorial invariance of the positive and negative syndrome scale.. Attribution biases in schizophrenia: relationship to clinical and functional impairments. Couture..M. R. J. W. it is likely not useful as a pre–post measure in intervention trials aimed at improving social cognition. Maydeu-Olivares. Heider. G. 1999. J. B. Dr. Psychological Assessment Resources. 1981. Bourdet.J.. B. he or she may have acquired some ideas about what has occurred in the animation. and drafted the introduction. Professor of Child Psychology.T. D.. The positive and negative syndrome scale (PANSS) for schizophrenia. Psychiatry Research 167. Odessa. M. W.L.

70155&_dad=portal&_schema=PORTAL.W. Yager. Schizophrenia Research 71... T.S. P. Brain and Cognition 61.E. P. Reed.M. 327–340. Caruso. Greig. 131–141.. J.. A. M. Ontario. 2008. Wirtz. 1987.B. J.H. Corrigan. 1996. Schizophrenia Bulletin 28. Penn. Psychiatry Research 166. M. Klin. . Klin. British Journal of Psychiatry 191.. 2006. Vos. R.. L. Elementary neurocognitive function. Theory of mind in schizophrenia: meta-analysis. Roberts. S.L. D. Martin. Blanchard. 327–335. M.. 2009.. Attributional style in schizophrenia: an investigation in outpatients with and without persecutory delusions. Rusch. 271–275. S... Psychological Corporation..L.. H. J.. Psychiatry 69.. 125–131.. Western Psychological Services.. L.. D...M.S. 1997.A.. J. D.. The relationship of social cognition to ward behavior in chronic schizophrenia.L.. Salovey. 250.. M. Schothorst. Doonan. 173–179. Spaulding. Lysaker.D.. Ehmann.L. A..E. Sprong. Ehmann. Yager. Bell. Neurocognitive and social cognitive predictors of interpersonal skill in schizophrenia. W.. Zito. Psychiatry 60. Wechsler. 2004. 408–411. van Engeland. Penn. Sanna. Multi-Health Systems.[comment]. K.. M. A. Bell. D. Los Angeles. J. Psychiatry Research 143. N. Penrod.com/portal/ page?_pageid=53. E. 2002... B. Information processing.. D.L. W.F. facial affect recognition and social-skills in schizophrenia. P. The Wechsler Memory Scale-Revised. 167–178. Nishith.. Jones. D. social cognition.S.. 2002. Nuechterlein.. D.. and psychiatric rehabilitation in schizophrenia.. W. Silverstein..L.. 2009. D. Toronto. Attributing social and physical meaning to ambiguous visual displays in individuals with higherfunctioning autism spectrum disorders. San Antonio. / Schizophrenia Research 122 (2010) 164–171 Klin. J. Meyer. Wexler. Untangling social function and social cognition: a review of concepts and measurement. Rothmann. Penn. 463–471.J. CA. http://portal. Penn.. Schizophrenia Bulletin 34.. Jones. 2006. 1997. W. 2000.. DeLeon. Kurtz. Large verbal ability contribution to MSCEIT scores of social cognition in schizophrenia [abstract].. Davis. Mayer. T. 831–846. 155–165. Suspiciousness and low self-esteem as predictors of misattributions of anger in schizophrenia spectrum disorders. 2009. R.. Social cognition in schizophrenia: an overview.T... Bellack.. New York. M. Peer. 2006. Spaulding. Schizophrenia Bulletin 35.L. Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT). T. J. Inc. Schizophrenia Research 110. Psychological Corporation.. Mueser.. Emotion recognition and social competence in chronic schizophrenia. Journal of Child Psychology and Psychiatry and Allied Disciplines 41.. Sullivan.D. BORRTI journal articles and annotated bibliography. TX. 2006. T. 2004. Vauth. Hox.A.D. J. Penn.H. D... The Regents of the University of California. Tsai. K.. Attributing social meaning to ambiguous visual stimuli in higherfunctioning autism and Asperger syndrome: the Social Attribution Task... M. Social cognitive bias and neurocognitive deficit in paranoid symptoms: 171 evidence for an interaction effect and changes during treatment.. 1996.. 40–53. P.R.E.A. Wechsler.W. NY.C.. Schizophrenia Research 20. P.D. D..D.wpspublish. Bell et al..D. A. 2007. M.J. Pinkham. W.. R. J. Matrics Consensus Cognitive Battery Manual. 2008. D.. 5–13.M. 47–68.. Li.L. WAIS-III Manual: Wechsler Adult Intelligence Scale-III. Green. A. Penn. Does social cognition influence the relation between neurocognitive deficits and vocational functioning in schizophrenia? Psychiatry Research 128. Journal of Abnormal Psychology 105.