Michael Green presentation at the Schizophrenia Research Forum's live event of February 23, 2016 - www.schizophreniaforum.org.

1. Social Cognition and Social Neuroscience
in Schizophrenia
Michael F. Green
William P. Horan
Junghee Lee
• Department of Psychiatry and Biobehavioral Sciences, UCLA
Geffen School of Medicine
• UCLA Semel Institute for Neuroscience and Human Behavior
• VA Desert Pacific Mental Illness, Research, Education and
Clinical Center (MIRECC)
• VA Research Enhancement Award Program (REAP) on
Enhancing Community Integration for Homeless Veterans
Schizophrenia Research
Forum
Webinar Feb 2016

2. Consultant
AbbVie, ACADIA, DSP, FORUM, Lundbeck,
Luc (scientific board), Takeda
Past and Current Research Support
Amgen, Forum
Officer in non-profit
MATRICS Assessment, Inc. – but receive no
financial compensation
Disclosures For M.F. Green
(2 years)

3. Outline
• Pulling things apart: Systems of the Social Brain
• Social cue perception
• Experience sharing
• Mentalizing
• Experience and regulation of emotion
• Pulling things together: Integration & Implications
• Which systems work and which don’t?
• Integrating systems: e.g., empathy

4. Organizing findings from social cognition and
social neuroscience in schizophrenia
• Work on social cognition in schizophrenia
has exploded
• > 200 cites in PubMed every year from
2011-2015.
• Work on social neuroscience in
schizophrenia is expanding
• Can only conduct an informative review in
last couple of years.

5. Organizing findings from social cognition and
social neuroscience in schizophrenia
What the review intended to do:
• Provide a framework to organize the
findings.
• Help to identify consistencies, failures to
replicate, or patterns across systems.
• Identify what is intact versus impaired in
schizophrenia.
What the review did not intend to do:
• Provide a mechanistic explanation of social
processing dysfunction in schizophrenia.
• Identify new social processing systems.

6. Which social processing systems,
among many, to consider?
1. Consensus among social neuroscientists that
system is partly distinct from others (e.g. non-
social) and important for social processing.
2. Sufficient clinical research of the system to
allow inferences about social processing in
schizophrenia.

7. Faces Voices
Mentalizing
Social cue
perception
Emotion
regulation
Emotion
experience
Experience and
management of
emotion
Experience
sharing
Motor
resonance
Affect
sharing
Impaired Intact Possibly intact
Subprocesses
Processes
Social processing systems in
schizophrenia
For each system:
- psychological processes
- associated neural regions
- findings from schizophrenia.
Green, Horan, Lee, Nature Reviews Neuroscience 2015

8. Social Cue Perception
This system involves accurate identification of
social information conveyed in cues from faces,
voices, body movements / gestures, gait etc.
For the review, we considered:
1. Face emotion perception
2. Prosody (voice) perception
Schizophrenia patients show impairment on both
types of tasks.

9. Superior temporal sulcus and
Inferior frontal gyrus
Social Cue Perception
Key regions: amygdala, fusiform gyrus,
superior temporal sulcus, inferior frontal gyrus
Fusiform gyrus
Amygdala

10. Facial Emotion Recognition in
Schizophrenia (meta-analysis)
Between group differences:
Yellow: Controls > Patients
- Amygdala / hippocampus
- Fusiform
Blue: Patients > Controls
Taylor et al. Biological Psychiatry 2012

11. Experience Sharing
The simple act of observing others’ behaviors leads
us to experience neural activations that correspond
to those that occur when we execute these behaviors
1. Motor resonance -- while observing or executing
motor actions, input is compared with stored
motor representations for actions.
2. Affect sharing -- shared processes are also
engaged during the perception of emotional
behaviors.

12. Inferior parietal lobule;
Premotor cortex
Experience Sharing
Motor Resonance: inferior parietal; premotor cortex
Affect sharing: dorsal anterior cingulate cortex, anterior insula
Affect Sharing
Dorsal ACC
Anterior insula
Motor Resonance

13. Lift
Index
Lift
Middle
2. Execute task
Lift
Index
Lift
Middle
Lift
Index
Lift
Middle
Lift
Index
Lift
Middle
3. Observe task
1. Imitate task
2.5 s
Imitation / Execution / Observation Task
for Motor Resonance

14. • Patients
Finger Tasks- no group differences
24 patients and 24 controls
1. Imitate task 3. Observe task2. Execute task
• Controls
Horan,Iacoboni et al.
NeuroImage Clinical 2014
Voxel threshold z=2.3, corrected
cluster threshold p=0.05

15. Mentalizing
Mentalizing (also called theory of mind or mental
state attribution)
Understanding others requires one to take other
people’s viewpoints into account and to make
inferences about their mental states (including
intentions, beliefs and emotions) based on
available social cues.

16. Temporoparietal junction;
Temporal pole
Mentalizing
Key regions: Temporoparietal junction, temporal pole,
medial prefrontal cortex, precuneus
Precuneus
Medial Prefrontal cortex

17. Mentalizing and fMRI
John told Emily that he had a
Porsche. Actually, his car is a Ford.
Emily doesn’t know anything about
cars though, so she believed John.
When Emily sees John’s car, she
thinks it is:
Porsche Ford
False picture condition
condition
Amy made a painting of a tree house
three years ago when it was blue. That
was before the storm. We built a new
treehouse last summer, but we painted
it red instead.
The treehouse in the painting is:
red blue
In both cases, a false representation leads to a correct answer.
Mentalizing / Theory of Mind: the mental capacity to represent
one’s own mind and others’ mental state (i.e., belief, emotion,
intention). Large pt-control effect sizes in performance (.96).
False belief condition

18. Belief Attribution Task
False belief vs. False photo / picture
Controls
Patients
z value > 1.96 with a corrected cluster probability of p=.05
using Gaussian random field theory.

19. Emotion Experience and Regulation
Emotion Experience in Schizophrenia
is Intact:
 Patients report diminished pleasure on
interview and trait measures
 However, patients report and show normal
responses (self-report and physiological)
when exposed to pleasant stimuli.
 But… might experience greater negative
responses to neutral stimuli.

20. Emotion Regulation
• Emotion regulation -- processes by which
people influence which emotion is experienced,
when it is experienced, and how it is
experienced.
• The most extensively studied regulation strategy
is cognitive reappraisal. That involves
changing one’s interpretations or appraisals of
stimuli to alter an emotional response.

21. Emotion Regulation
Key regions: ventrolateral prefrontal cortex, dorsolateral
prefrontal cortex, amygdala
Ventrolateral and dorsolateral
prefrontal cortex
Amygdala

22. Emotion Regulation in Schizophrenia and
Bipolar Disorder
People with schizophrenia
showed reduced activation
in vlPFC during cognitive
reappraisal; people with
bipolar disorder showed
increased activation.
Morris et al Transl. Psychiat 2012

23. Faces Voices
Mentalizing
Social cue
perception
Emotion
regulation
Emotion
experience
Experience and
management of
emotion
Experience
sharing
Motor
resonance
Affect
sharing
Impaired Intact Possibly intact
Subprocesses
Processes
Social processing systems in
schizophrenia
Green, Horan, Lee, Nature Reviews Neuroscience 2015

24. When Systems Work Together:
Empathy as an Emergent Phenomenon
Empathy-- sharing, understanding, and responding to
the unique emotional experiences of another person. It
depends on multiple components.
• Experience sharing
• Affective empathy
• Mentalizing
• Cognitive empathy
• Other components:
• Emotion regulation (to be less empathic)
• Prosocial motivation (takes resources)
• Social cue perception
• Empathic accuracy

25. Patterns of intact vs impaired activity
across social processing systems
• Social cognition can be divided into reflective and
reflexive social processes.
• Reflective require effortful controlled processing.
These social processes are impaired in
schizophrenia -- perception of face and voice social
cues, mentalizing, emotion regulation.
• Reflexive require less mental effort than the other
social processes. These social processes that are
intact or partially intact in schizophrenia – motor
resonance, affect sharing, and emotion experience.

28. Questions for Discussion
• What are the shared and distinct contributions from social and
non-social processing systems?
• What are the implications of this framework for self-other
processing?
• What are the neural mechanisms for reflective versus reflexive
social processing?
• What is the role of social context on patient – control
differences?
• What is the role of negative emotion in social cognitive
impairment in schizophrenia?
• Where does connectivity break down in schizophrenia: within
regions, between regions, between systems?
• Does this framework apply to social cognitive impairment in
other neuropsychiatric disorders?
• Can interventions be targeted for specific social processing
systems?