Theory of Mind - Seminar presentation

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A seminar on Theory of Mind I made as part of Psychiatry residency.

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Theory of Mind - Seminar presentation

  1. 1. Theory Of Mind Dr (Maj) Ashutosh Ratnam Resident Psychiatry 1
  2. 2. OVERVIEW Introduction Definition & Vocabulary Theories of Theory of Mind (ToM) Development of a ToM Tests Evaluating a ToM Neuroanatomy Clinical Implications 2
  3. 3. INTRODUCTION “As humans we assume that others want, think, believe and the like, and thereby infer states that are not directly observable, using these states anticipatorily, to predict the behaviour of others as well as our own. These inferences, which amount to a theory of mind, are to our knowledge, universal in human adults” (Premack, D. G.; Woodruff, G. (1978). "Does the chimpanzee have a theory of mind?". Behavioural and Brain Sciences 1 (4): 515–526. e.g. Chimpanzee shown a video of human encountering problems  Video stopped before solution reached  Chimp consistently chose picture depicting human solving problem  Interpretation : attributed mental state to actor 3
  4. 4. When competing with others for food chimps take into account what the competitor can or cannot see/hear and even what he does/does not know • Conceal own approach to food • No understanding of false beliefs • Performance did not improve despite knowing competitor held a false belief Hare B, et al (2001) Do Chimpanzees know what cospecifics know? Anim. Behav. 61, 139-51 4
  5. 5. INTRODUCTION Definition : The ability to  recognise that all people act on the basis of mental states or propositional attitudes (beliefs, desires, etc)  attribute mental states or attitudes to oneself and to others  understand that others have beliefs, desires and intentions different from one’s own  Premack, D. G.; Woodruff, G. (1978). "Does the chimpanzee have a theory of mind?". Behavioral and Brain Sciences 1 (4): 515–526. “Theory of mind is being able to infer the full range of mental states (beliefs, desires, intentions, emotions etc) that cause action. Having a theory of mind is to be able to reflect on the contents of one’s own and other’s minds” Baron-Cohen S, (2001) “Theory of Mind and Autism: a review”. J of Applied Research in Mental Retardation 5
  6. 6. INTRODUCTION Meta-representation – internal/mental representation of ourselves and others as conscious beings who mentally represent external reality (Firth, 1992) - Ability to represent someone else’s act of representing the world (Josef Pener) Mentalising – the process of deploying a ToM to infer states of minds of others (Langdon,R, Coltheart, M, 2001) Intentional stance – intuitively understanding that the actions of others are goal-directed and arise from particular beliefs or desires (Daniel Dennet, 1990) Reflexive awareness – awareness of ourselves and others as thinking beings 6
  7. 7. Theories of ToM 1. Theory-Theory 2. Simulation Theory a) Direct Matching b) Inverse Modelling c) Response Modelling 7
  8. 8. Theory-Theory ‘Folk’ psychological ability resting upon knowledge of a theory Theory = “large no. of conditional statements, with the conjunction of  explanatory factors as antecedents  explanandum as consequence”  A person who suffers bodily damage will feel pain  A person who is denied food will feel hungry Together, forms an integrated body of knowledge concerning law-like relations between  external circumstances  internal states  overt behaviour Churchland, P. M. (1991). Folk psychology and the explanation of human behavior. In: J. D. Greenwood (Ed.). The future of folk psychology. Cambridge: Cambridge University Press. 51–69. 8
  9. 9. Theory-Theory Use constantly, unaware of laws of which it is composed → implicit/tacit  e.g. Person untrained in science knows just as well about food and hunger Independent of knowledge of one’s own mind human psychology Anyone who knows laws and propositions can form predictions and explanations 9
  10. 10. Theory-Theory acquisition 1. Learned a) By implicit “teaching” through others b) Learning step-by-step by living with/having social interactions with others 2. Innate a) If young children ‘construct’ a theory how do all come to same theory by age four? b) If “learnt from” adults, can it take place w/o explicit ‘teaching’? c) If learnt how can it be invariant across cultures/historical eras? Carruthers, 1996 10
  11. 11. Simulation-Theory Use “resources of our own mind to simulate others” 1. Creation of pretend states to match those of target 2. Processing of ‘pretend states’ by same mechanisms used to understand own mental states 3. Assignment/projection of those states’ interpretations onto target Goldman, A. (2005). Imitation, mind reading, and simulation. In S. Hurley, & N. Chater, Perspectives on Imitation II (pp. 80-81). Cambridge, MA: MIT Press. 11
  12. 12. Mirror Neurons Neuron which fires both when  animal acts  observes the an action being performed by another animal Humans  Premotor Cortex  Primary Somatosensory area  Inf Parietal Cortex  Supplementary Motor Area 12
  13. 13. Mirror Neurons 13 Functions  Empathy  Ant Insula, Ant Cingulate Cortex, Inf Frontal Cortex  Understanding actions & learning new skills by imitation  Simulating observed actions (ToM)  Interpreting intentions of other people  Coupling of perception & action
  14. 14. Simulation-Theory Direct Matching Hypothesis  Mirror Neurons mimic state of target in the observer  Smiling, Anger, etc  Mirroring elicits similar emotion/intention in observer  Implicitly/explicitly projected upon target Inverse Modeling Hypothesis  Mirror Neurons simulate intended goal of action first  Observer then uses conceptual ability to infer intention of action Response Modeling Hypothesis  Mirror Neurons prepare complementary action in response to target  Dynamically couple action observation to action execution 14
  15. 15. Ontogenic aspects 6 months of age: Animate Vs inanimate 12 months: Joint attention 14-18 months: Senses direction of another’s gaze. 18-24 months: Pretense (Decoupling of reality)  3-4 years: False beliefs in others 6-7 years: Jokes, Metaphors, Irony 9-11 years: ‘faux pas’.
  16. 16. Development 1. Imitative Experiences with Other People 2. Understanding Attention in Others 3. Understanding Others’ Knowledge 4. Understanding Others’ Beliefs a) True Beliefs b) False Beliefs 5. Understanding Others’ Intentions Firth, CD (1992) The cognitive neuropsychology of schizophrenia. Hove, UK: Psychology Press 16
  17. 17. Development 17 1. Imitative experiences with others  Precursor of perspective-taking and empathy  Recognition of equivalence between physical and mental states apparent in others and those felt in self  Construction of first-person experience  Map the relation between mental experiences and behaviour (facial gesture)  Infer about experiences of others  On seeing others behave like himself, infer that others have similar mapped mental state Meltzoff, A. N. (2002). Imitation as a mechanism of social cognition: Origins of empathy, theory of mind, and the representation of action. In U. Goswami (Ed.), Handbook of childhood cognitive development (pp. 6-25). Oxford: Blackwell Publishers.
  18. 18. Development 2. Understanding Attention Skill formed at 7-9 months age Understanding that  Seeing can be directed selectively as attention  Viewer assess a seen object as ‘of interest’  Seeing induces beliefs Sharing → Following → Directing attention (Carpenter, Nagell & Tomasello 1998) Attention can be directed and shared by pointing  Taking into account other person’s mental state (Baron-Cohen, S. (1991). Precursors to a theory of mind: Understanding attention in others. In A. Whiten (Ed.), Natural theories of mind: Evolution, development and simulation of everyday mindreading (pp. 233-251). Oxford: Basil Blackwell.) 18
  19. 19. Development 3. Understanding Others’ Knowledge Povinelli & de Blois (1992) 3yrs vs 4yrs old children ‘Hider’ – hid toy in 1 of 4 containers behind screen ‘Knower’ – saw hider placing toy ‘Guesser’ – left before hider placed toy  ‘Knower’ and ‘Guesser’ guided/advised children where toy was 4yr olds always chose correct cups, 3yr olds inconsistent 19
  20. 20. Development 20 O Neill (1996) • Child would watch toy being hidden in cup/box • Parent would/would not be present • When asking parent for help with retrieval • If not present – child significantly more often named toy, named location, gestured location Dunham, Dunham, & O‘Keefe (2000) • if the parent‘s eyes are covered at an irrelevant point in the hiding process (before but not during the hiding), young 2-year-olds treat the parent as ignorant
  21. 21. Development 4. Understanding Others’ Intentions Meltzoff (1995)  18 month old children  E attempted to pull an object away from another to which it is attached, but failed  Infant able to infer what action person tried to perform Call, Tomasello (1998)  2-3 year old child  Able to discriminate when E intentionally vs accidentally marked a box as baited with stickers 21
  22. 22. Development 5. Understanding Others’ Beliefs Begin to explain others’ behaviours based on beliefs at 3yrs age Wellman & Bartsch, 1988 Sam wants to find his puppy. The puppy might be hiding in the garage or under the porch. But Sam thinks the puppy is under the porch. Where will Sam look for the puppy: in the garage or under the porch? Three-year-olds pass this test. 3-year-olds do badly on tests of false beliefs. 22
  23. 23. Neural areas in ToM Temporal Pole Dorsal medial PFC Sup temporal Sulcus
  24. 24. Neuroanatomy – Temporal Pole  aka Association cortex  Prefrontal Cortex (through Uncinate Process)  Basal forebrain  Visual / Auditory / Olfactory areas Functions  Emotional attachment to peers/infants  Decoding/production of social signals  Narrative Coherence  Coding for personal memories  Representing social motives and appropriateness behaviour of others (rTPJ)  Difficulty predicting how even familiar people behave in social/emotional circumstances Kaplan & Sadock, Comprehensive Text book of Psychiatry 9th edition 24
  25. 25. Posterior Sup Temporal Sulcus Perception of biological motion Motion cues express social information (intent)  Gaze shifts, communicative gestures  Heider-Simmel animations  Attribution of mental states even in absence of motion cues (trustworthiness)  ?? Three distinct regions 1. Biological motion 2. Mentalize whether or not motion cues are present  Active vs passive movement 3. Mental states from motion cues  More active when mvt is incongruous  Kaplan & Sadock, Comprehensive Text book of Psychiatry 9th edition 25
  26. 26. Medial Prefrontal Cortex  Anterior-most part of paracingulate cortex 26
  27. 27. Medial Prefrontal Cortex Pain / Tickling / Autobigraphical Memory / Aestheic Judgement ↓  Attending to mental state giving rise to experience  Create a representation of what one thinks/feels  Perspective taking  Perception of Communicative actions  Present and Foreseen Social Interactions  Lesion = Frontal variant of Fronto-temporal dementia  Striking personality changes, empathy impaired, ToM test performance poor  Executive functions preserved Kaplan & Sadock, Comprehensive Text book of Psychiatry 9th edition 27
  28. 28. Neuroanatomy – ToM Rt Temporal Pole Med PFC Post Sup Temp Sulcus – biological motion, attributing cues Distinguishing between False Belief and False-photograph test Saxe, R; Kanwisher, N (2003). "People thinking about thinking peopleThe role of the temporo- parietal junction in "theory of mind"". NeuroImage 19 (4): 1835–42 Saxe, Rebecca; Schulz, Laura E.; Jiang, Yuhong V. (2006). "Reading minds versus following rules: Dissociating theory of mind and executive control in the brain". Social Neuroscience 1 (3– 4): 284–98. 28 Mentalising
  29. 29. FALSE PHOTOGRAPH TEST  Zaitchik (1990): compared out-of-date beliefs to out-of-date photographs (same structure, cognitive demands)  3-year-olds fail this too executive function problems? (difficulty inhibiting the perceptually salient response? – not a problem in tasks using looking measures) from Happé (1994)
  30. 30. Tests of Theory of Mind 1. False Belief Tasks a) First Order b) Second Order c) Third Order 2. ToM Stories 3. Eye Interpretation Tasks 4. Hinting Tasks 5. Heider-Simmel (like) animations 6. Faux pas 30
  31. 31. False Belief Tasks False belief = beliefs about the world which diverge from reality  Understand how knowledge is formed  People’s beliefs and mental states are based on their knowledge  Mental states can differ from reality  Behaviour can be predicted by mental states 1. First Order a) Sally-Anne Test b) Smarties Test 2. Second Order 3. Third Order 31
  32. 32. False Beliefs: Sally-Anne (Maxi) test (Baron-Cohen, Leslie, & Frith, 1985; Wimmer & Perner, 1983) control questions: − Where is the marble really? − Where did Sally put the marble at the beginning of the story?  3-year-olds say box, where it is (fail); 4+-year-olds say basket from Frith (1989)
  33. 33. Development 3. Understanding Others’ Knowledge Povinelli & de Blois (1992) 3yrs vs 4yrs old children ‘Hider’ – hid toy in 1 of 4 containers behind screen ‘Knower’ – saw hider placing toy ‘Guesser’ – left before hider placed toy  ‘Knower’ and ‘Guesser’ guided/advised children where toy was 4yr olds always chose correct cups, 3yr olds inconsistent 33
  34. 34. False Beliefs: Smarties test (Perner, Leekam, & Wimmer, 1987) control questions: − Is that what’s really in here? − What is really in here?  again, 3-year-olds fail (say pencil); 4+-year-old pass (say Smarties) from Frith (1989) ? ?
  35. 35. False Belief Tasks 35 What does the person with the blue shirt believe is in the bag? (false belief) Gift, present, flower, (bug is incorrect) What‘s in the bag? (reality) Wasp, bee, insect, or bug What does the person in blue shirt believe the person in red intends to do? (2nd order false belief) Give him a gift or present What does the person in red assume the person with the blue shirt believes, regarding his (the one in red) intentions? (3rd order false belief) Give him a gift or present
  36. 36. Theory of Mind Stories Misunderstanding (Glove): A burglar who has just robbed a shop is making his getaway. As he is running home, a policeman on his beat sees him drop his glove. He doesn’t know the man is a burglar, he just wants to tell him he dropped his glove. But when the policeman shouts out to the burglar, ‘‘Hey you, Stop!’’, the burglar turns round, sees the policeman and gives himself up. He puts his hands up and admits that he did the break-in at the local shop. 1. Was the policeman surprised by what the burglar did? 2. Why did the burglar do this, when the policeman just wanted to give him back his glove? 36
  37. 37. Theory of Mind Stories Lie (Dentist): John hates going to the dentist because every time he goes to the dentist he needs a filling, and that hurts a lot. But John knows that when he has toothache, his mother always takes him to the dentist. Now John has bad toothache at the moment, but when his mother notices he is looking ill and asks him ‘‘Do you have toothache, John?’’. John says ‘‘No, Mummy’’. 1. Is it true what John says to his mother? 2. Why does John say this? 37
  38. 38. Eye Interpretation Tasks 38 • Pure Theory of Mind Test • No executive function required • Tests recognition of complex mental states • Artificial constraints not present in real life • Limited Choice of options • Unlimited time to study faces • Validation study sample size small
  39. 39. Hinting Tasks Participant infers intentions behind veiled speech act Normal adults perform close to ceiling Example Paul has to go to an interview and he’s running late. While he is cleaning his shoes, he says to his wife, Jane: “I want to wear my blue shirt but it’s very creased.” Question: What does Paul really mean when he says this? (If necessary add: Paul goes on to say: “Its in the ironing basket.” Question: What does Paul want Jane to do?) 39
  40. 40. Faux Pas Test Faux pas = beach of etiquette Recognition calls for a high level of ToM Jill had just moved into a new apartment. Jill went shopping and bought some new curtains for her bed room. When she had just finished decorating the apartment, her best friend, Lisa, came over. Jill gave her a tour of the apartment and asked, “How do you like my bedroom?” “Those curtains are horrible” Lisa said, “I hope you are going to get some new ones!” Questions 1. Did Lisa know the curtains were new? 2. Did some one say something she shouldn’t have said? 40
  41. 41. Spectrum of ToM abnormalities Deficit in TOM ability Application Deficit in TOM Abnormal attributions Normal TOM Impaired Sense of Self-Agency Autism NormalPassivity phenomena +ve Sx Schiz Asperger’s -ve Sx Schiz ?PD (Abu-Akel 1999)
  42. 42. ToM in Autism S Baron Cohen, (1985)  Autistic children consistently fail False-Belief tasks e.g.Sally-Anne (80%)  Down’s Syndrome children did not fail (86%)  Difficulties persisted even when child matched for verbal skill  Deficits persisted on picture story, hinting, when matched for age/language  Inability to assign mental states to others Neuroimaging studies  less activation in  mPFC (Happe (1996),  Frontal regions ( Ring, Baron-Cohen 1999),  mPFC, posterior STS, temporal poles (Castelli 2002)  STS hypo-activation (Pelphrey 2005).  m PFC and right STS (Wang 2007) 42
  43. 43. ToM in Autism Social-affective Justification (Hobson)  ToM deficits are result of distortion in ability to understand & reciprocate to emotions  Devoid of skills (social referencing ability) which later lets them comprehend and react to other people’s feelings (Hobson, R.P. (1995). Autism and the development of mind. Hillsdale, N.J.: Lawrence Erlbaum Associates Ltd.) Developmental Delay  Consistent with varying degrees of impairment (difficulties at various stages of growth)  Early setbacks → Joint attention behaviour ability impaired  Hence unable to form full ToM (Baron-Cohen, S. (1991). Precursors to a theory of mind: Understanding attention in others. In A. Whiten, Ed., Natural theories of mind: Evolution, development, and simulation of everyday mindreading (233-251). Cambridge, MA: Basil Blackwell.) 43
  44. 44. Ontogenic aspects 6 months of age: Animate Vs inanimate 12 months: Joint attention 14-18 months: Senses direction of another’s gaze. 18-24 months: Pretense (Decoupling of reality)  3-4 years: False beliefs in others 6-7 years: Jokes, Metaphors, Irony 9-11 years: ‘faux pas’.
  45. 45. ToM in Schizophrenia  Some symptoms of Schizophrenia are comparable to autism  Social dysfunction / withdrawal / impaired social cognition  ? accountable by ToM deficit ToM deficits accounting for Schizophrenia Symptoms Firth (1992) 45 Inability to perceive own intentions Inability to see behaviour as result of own willed action Disorder of Willed Action (Passivity) Impaired self monitoring Impaired awareness of self-generation of thoughts Delusion of alien control Impaired monitoring of others (impaired awareness of others’ intentions/thoughts) Persecutory delusions Delusions of reference Delusions of misidentification
  46. 46. ToM in Schizophrenia Disorganized, paranoid schizophrenia, (>) negative show ToM deficits. Correlation of ToM deficit with  symptoms severity and remission  social functioning  pragmatic language use ToM deficit is independent of  General intellectual ability  Memory  Executive function (Leigh Harrington , Richard Siegert & John McClure (2005) Theory of mind in schizophrenia: A critical review, Cognitive Neuropsychiatry, 10:4, 249-286,) 46
  47. 47. ToM in Schizophrenia State v/s Trait  5 studies found majority of ToM deficits disappear after acute episode  Severity correlates with severity of illness.  But in a few studies it was noted that,  Chronically ill patients also have ToM deficits  High schizotypal patients had ToM deficits (1 study)  Remitted patients > Family members of Schiz patients > controls: on ToM tasks. (3 studies)  Imaging Findings  Russel et al (2000): eye-reading task on f MRI showed hypo-activity  left middle and inferior frontal regions  middle temporal regions  Brune (2001): picture-story task on PET hypo-activity  right prefrontal cortex  Hempel et al (2003) emotional recognition task  Medial PFC (Leigh Harrington , Richard Siegert & John McClure (2005) Theory of mind in schizophrenia: A critical review, Cognitive Neuropsychiatry, 10:4, 249-286,) 47
  48. 48. Other Conditions with ToM Deficits Bipolar Disorder (Kerr et al 2003, Montag et al 2009) Depression (Wolkenstein et al, 2011) Huntington’s Disease (Brune et al, 2011) Frontotemporal Dementia (Gregory et al, 2002) Callosal Agenesis (Booth et al, 2011) Congenital Deafness Schizoid, Schizotypal Pridmore S (2006) Download of Psychiatry, University of Tasmania Press 48
  49. 49. REFERENCES  Leigh Harrington , Richard Siegert & John McClure (2005) Theory of mind in schizophrenia: A critical review, Cognitive Neuropsychiatry, 10:4, 249-286,  Goldman A.I, (2012) Theory of Mind, Oxford Handbook of Philosophy and Cognitive Science  Pridmore S (2006) Download of Psychiatry, University of Tasmania Press  Call J, Tomasello M., (2008) Does the chimpanzee have a theory of mind? 30 years later. Trends Cogn Sci. May;12(5):187-92.  Flavell JH, (2004) Theory of Mind Development: Retrospect and Prospect Merrill-Palmer Quarterly 50:3, 274-290  Kaplan & Sadock, Comprehensive Text book of Psychiatry 9th edition 49
  50. 50. THANK YOU 50

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