Metacognition, Personal Distress, and Performance-Based Empathy in Schizophrenia

Kelsey A. Bonfils; Paul H. Lysaker; Kyle S. Minor; Michelle P. Salyers


Schizophr Bull. 2019;45(1):19-26. 

In This Article

Abstract and Introduction


Background: People with schizophrenia experience significant deficits in the kinds of empathic skills that are the foundation for interpersonal relationships. Researchers have speculated that deficits in empathic skills in schizophrenia may be related to disturbances in metacognition and heightened levels of personal distress. To explore this issue, this study examined whether better metacognition and reduced personal distress would be associated with improved performance on cognitive and affective empathy tasks. Further, we tested whether metacognition moderated the relationship between personal distress and empathy.

Method: Fifty-eight participants with schizophrenia-spectrum disorders receiving community-based treatment completed a self-report questionnaire of personal distress, a performance-based measure of empathy, and an observer-rated interview to assess metacognitive capacity.

Results: Correlation analyses revealed that metacognitive capacity, but not personal distress, was significantly associated with cognitive and affective empathy performance. Moderation results suggest the relationship between personal distress and affective empathy performance was significant for those with low metacognition, but that the relationship was the opposite of hypotheses–increased personal distress predicted better performance. This relationship changed at higher levels of metacognition, when increased personal distress became associated with reduced performance.

Conclusions: This study is the first of its kind to examine performance-based empathy with metacognition and personal distress. Results suggest interventions targeted to improve metacognition may be useful in enhancing empathic skills.