Emotional Intelligence in Schizophrenia: Deficits in Schizophrenia

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Doctor of Psychology Carlos Rebolleda explains what emotional intelligence is in schizophrenia, evaluation and deficits in schizophrenia.

Emotional intelligence in schizophrenia: definition

The model of the four branches of emotional intelligence postulated by the researchers J.D. Mayer and P. Salovey in 1997 defines it as a type of intelligence different from the rest, composed of four capacities or “branches” which are specifically called emotional perception, emotional facilitation, emotional understanding and emotional management and which, in turn, are organized into two areas called experiential and strategic.

As indicated by Mayer, Salovey and Caruso (2002), the experiential area refers to the subject’s capacity to perceive, respond to and manipulate emotional information without necessarily implying that he or she understands it. It indicates the precision with which the subject can “read” and express emotions and if he/she is able to compare the emotional information with other types of emotional experiences (for example, colors and sounds). This indicates how the individual functions under the influence of different emotions. This area is integrated by the branches perception and emotional facilitation.

1. Emotional perception

Emotional perception refers to the ability to recognize how an individual feels by being around them. This branch involves the ability to perceive and express feelings, as well as, to pay attention and accurately decode emotional cues from facial expressions, tone of voice and artistic expressions (Mayer et al, 2002).

2.Emotional facilitation

Emotional facilitation focuses on how emotions affect cognition and can be used for reasoning, problem solving, or decision making (Mayer et al., 2002). It is known that some emotions, such as fear, can negatively affect cognition but, as has been proven in multiple investigations, they can also favor cognitive abilities, for example, by making it easier for the subject to establish priorities when paying attention to what is most relevant or by favoring his or her level of concentration when facing a task.

The so-called strategic area would be the subject’s ability to understand and manage emotions without necessarily perceiving or experiencing them correctly. It indicates the precision with which the subject is able to understand the meaning of the emotions and the ability to manage both his own and others’ emotions. The branches understanding and emotional management integrate this area (Mayer et al, 2002).

3. Emotional understanding

As Mayer et al (2002) pointed out, the branch emotional understanding refers to the subject’s capacity to label emotions, that is, to come to recognize that there are groups of terms related to them. The capacity to understand how different emotions originate, how they are combined or change over time, are fundamental components of emotional intelligence, apart from important aspects when it comes to relating with others or improving self-knowledge.

4. Emotional management

Finally, the branch emotional management refers to the ability of the subject to, at appropriate times, not repress his emotions but work with them in a reflective way and use them to make better decisions. A term that has been historically associated with this branch is that of emotional regulation, which has usually been understood as the repression or rationalization of emotions. However, this term really refers to the participation of emotions in thought, not to their minimization or elimination (Mayer et al., 2002).

Emotional Intelligence in Schizophrenia: Evaluation

Emotional intelligence is considered to be an important component of social cognition (Matthews, Zeidner & Roberts, 2007; Mayer & Salovey, 1997) and since the MATRICS committee recommended in 2003 the emotional management branch of the MSCEIT (Mayer et al, 2002) as the only tool for the measurement of social cognition in schizophrenia, there have been several studies that have tried to explore the psychometric characteristics of the test, especially in a population with a diagnosis of schizophrenia.

Emotional intelligence in schizophrenia: test

The Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT; Mayer et al., 2002) is based on the four-branch model and, through 141 items divided into eight tasks, yields a total of seven scores, namely an overall score, another two for the experiential and strategic areas and, finally, another four for each of the branches that make up the model. The name of these tests is as follows:

Emotional perception: Composed of the tasks called Drawings and Faces.
Emotional Facilitation: Integrated by the subtests Facilitation and Sensations.
Emotional Understanding: Composed by Changes and Combinations.
Emotional Management: Integrated by Emotional Management and Emotional Relations.

Reliability was 0.91 for the total score, 0.91 and 0.85 for the experiential and strategic areas respectively, while Crombach’s alpha coefficients for the branches ranged from the lowest, but adequate, coefficient which would be 0.74 in emotional facilitation, to the highest which was 0.89 in the case of emotional perception. (Mayer et al, 2002).

Spanish adaptation of the MSCEIT: Extremera and Fernández-Berrocal (2009)

Extremera and Fernández-Berrocal (2009) carried out the Spanish adaptation of the MSCEIT which, in turn, shows very similar and even higher reliability coefficients than those found in the original test, being 0.95 for the total score, 0.93 and 0.90 for the experiential and strategic areas, 0.93 in perception, 0.76 in facilitation, 0.83 in understanding and 0.85 in emotional management. The Spanish adaptation, like the rest of the MSCEIT adaptations, shows adequate levels of apparent, predictive and content validity.

Emotional Intelligence in Schizophrenia: Deficits in Schizophrenia

Some studies have been able to prove the existence of deficits in emotional intelligence both in patients diagnosed with psychiatric pathologies (Lizeretti, Extremera and Rodriguez, 2012), and in their direct relatives (Sanders and Szymanksi, 2012).

Regarding the study of deficits in emotional intelligence in psychosis, one of the first investigations that used this concept, as it is currently known, was that of Aguirre, Sergi and Levy (2008) in which they found that people who present high levels of schizotypy show deficits in emotional intelligence which, in turn, significantly affect their psychosocial functioning.

But the study of the emotional deficits that accompany a psychotic disorder such as schizophrenia is much earlier, for example, the reduction that these patients manifest in facial emotional expression has been noted in a multitude of research (Andreasen, 1979; Borod et al, 1990; Tremeau et al., 2005; Yecker et al., 1999), a deficit that, according to what has been proven, is present even several years before the person develops the disease (Hafner et al., 2003; Yung and McGorry, 1996), which places it as a strong candidate to become an endophenotypical feature of the disease.

These problems are not limited to facial expression, but patients diagnosed with schizophrenia also show difficulties in identifying and verbalizing their own emotions (Cedro, Kokoszka, Popiel and Narkiewicz-Jodko, 2001; Stanghellini and Rica, 2010; Van’t Wout, Aleman, Bermond and Kahn, 2007; Yu et al, 2011), a deficit known as alexithymia (Sifneos, 1973).

These deficits are compounded by the problems these people show in recognizing emotional expressions in others, especially when these emotions are negative (Edwards et al, 2002; Kohler et al, 2003; Mandal et al, 1998; Scholten, Aleman, Montagne & Kahn, 2005).

Emotional regulation deficits have also been found in this population (Nuechterlein & Green, 2006), with emotional suppression being the self-regulation strategy usually used by these subjects (Kimhy et al, 2012; Van der Meer, Van’t Wout & Aleman, 2009). While, in the only emotional area in which patients diagnosed with schizophrenia seem to show similar functioning to the population without the pathology, it is in the ability to experience emotions (Kring, Barret & Gard, 2003; Kring & Earnst, 1999).

Even so, the aspect on which there is full agreement today has to do with the negative influence that such emotional deficits show on the subject’s psychosocial functioning (Baslet, Termini & Herberner, 2009; Kee, Green, Mintz & Brekke, 2003; Kimhy et al, 2012; Kring & Caponigro, 2010).

Research using MSCEIT as a measure

As for the research that has been carried out using the MSCEIT as a measure, for example, Eack et al (2010) extend the results obtained in three previous researches (Eack et al, 2009; Kee et al, 2009; Neuchterlein et al, 2008), and for this they use a sample of 64 subjects diagnosed with various psychotic disorders, including schizophrenia, to which they apply this test.

These authors find, first of all, that the scores obtained by the subjects are significantly lower than those of the population without a diagnosis of psychosis, although they emphasize the need to carry out rigorous studies that can yield more reliable results about the actual degree to which these differences occur, since some research states that the most affected branch would be that of emotional management (Wojtalik, Eack and Keshavan, 2013), while others find that it is emotional understanding (Dawson et al., 2012; Kee et al., 2009).

Nor do all the studies carried out at this level find affectation in all the branches that make up the test, for example, Kee et al (2009) do not find significant differences in emotional facilitation between the group of patients diagnosed with schizophrenia and the undiagnosed population. This reinforces the need for further research on the actual differences and the extent to which they occur.

At a neurostructural level, Wojtalik et al (2013) find that those patients who present malfunction in the branches of facilitation, comprehension and emotional management, show a significant reduction of gray matter in both the left parahippocampal gyrus and the right posterior cingulate gyrus.

References

References from the article on emotional intelligence in schizophrenia:

Aguirre, F., Sergi, M. J., y Levy, C. A. (2008). Emotional intelligence and social functioning in person with schizotypy. Schizophrenia Research, 104(1), 255-264.
Andreasen, N.C. (1979). Affective flattening and the criteria for schizophrenia. American Journal of Psychiatry, 136(7), 944-947.
Baslet, G., Termini, L., y Herberner, E. (2009). Deficits in emotional awareness in schizophrenia and their relationships with other measures of functioning. Journal of Nervous and Mental Disease, 197(9), 655-660.
Borod, J. C., Welkowitz, J., Alpert, M., Brozgold, A. Z., Martin, C., Peselow, E., y Diller, L. (1990). Parameters of emotional processing in neuropsychiatric disorders: conceptual issues and battery of tests. Journal of Communication Disorders, 23(4), 247-271.
Cedro, A., Kokoszka, A., Popiel, A., y Narkiewicz- Jodko, W. (2001). Alexithymia in schizophrenia: an exploratory study. Psychological Reports, 89(1), 95-98.
Dawson, S., Kettler, L., Burton, C., y Galletly, C. (2012). Do people with schizophrenia lack emotional intelligence? Schizophrenia Research and Treatment. doi:10.1155/2012/495174.
Eack, S. M., Greeno, C. G., Pogue-Geile, M. F., Newhill, C. E., Hogarty, G.E., y Keshavan, M. S. (2010). Assessing social-cognitive deficits in schizophrenia with the Mayer-Salovey-Caruso Emotional Intelligence Test. Schizophrenia Bulletin, 36(2), 370-380.
Eack, S. M., Pogue-Geile, M. F., Greeno, C. G., y Keshavan, M. S. (2009). Evidence of the factorial variance of the Mayer-Salovey-Caruso Emotional Intelligence Test across schizophrenia and normative samples. Schizophrenia Research, 114(1-3), 105-109.
Edwards, J., Jackson, H. J., y Pattison, P. E. (2002). Emotion recognition via facial expression and affective prosody in schizophrenia: a methodological review. Clinical Psychology Review, 22(6), 789-832.
Extremera, N., y Fernández-Berrocal, P. (2009). Test de Inteligencia Emocional Mayer-Salovey- Caruso (MSCEIT): manual. Madrid: TEA Ediciones.
Hafner, H., Maurer, K., Loffler, W., Van der Heiden, W. Hambretch, M., y Schultze- Lutter, F. (2003). Modeling the early course of schizophrenia. Schizophrenia Bulletin, 29(2), 325-340.
Kee, K. S., Green, M. F., Mintz, J., y Brekke, J. S. (2003). Is emotion processing a predictor of functional outcome in schizophrenia? Schizophrenia Bulletin, 29(3), 487-497.
Kee, K. S., Horan, W. P., Salovey, P., Kern, R. S., Sergi, M. J., Fiske, A. P.,… y Green, M. F. (2009). Emotional intelligence in schizophrenia. Schizophrenia Research, 107(1), 61-68.
Kimhy, D., Vakhrusheva, J., Jobson-Ahmed, L., Tarrier, N., Malaspina, D., y Gross, J. J. (2012). Emotion awareness and regulation in individuals with schizophrenia: implications for social functioning. Psychiatry Research, 200(2), 193-201..
Kohler, C. G., Turner, T. H., Bilker, W. B., Brensinger, C., Siegel, S. J., Kanes, S. J.,… y Gur, R. C. (2003). Facial emotion recognition in schizophrenia: intensity effects and error pattern. American Journal of Psychiatry, 160(10), 1768-1774..
Kring, A. M., Barrett, L. F., y Gard, D. E. (2003). On the broad applicability of the affective circumplex: representations of affective knowledge among schizophrenia patients. Psychological Science, 14(3), 207-214.
Kring, A. M., y Caponigro, J. M. (2010). Emotion in schizophrenia: where feeling meets thinking. Current Directions in Psychological Science, 19(4), 225-259.
Kring, A. M., y Earnst, K. S. (1999). Stability of emotional responding in schizophrenia. Behavior Therapy, 30(3), 373-388.
Lizzeretti, N. P., Extremera, N., y Rodríguez, A. (2012). Perceived emotional intelligence and clinical symptoms in mental disorders. Psychiatric Quarterly, 83(4), 407-418.

More references from the article on emotional intelligence in schizophrenia:

Mandal, M. K., Pandey, R., y Prasad, A. B. (1998). Facial expressions of emotion and schizophrenia: a review. Schizophrenia Bulletin, 24(1), 399-412.
Matthews, G., Zeidner, M., y Roberts, R. D. (2007). Emotional intelligence: consensus controversies, and questions. En G. Mathews, M. Zeidner y R.D. Roberts. (Eds). The science of emotional intelligence: knows and unknowns. Series in affective science (pp. 3-46). New York, NY: Oxford University Press.
Mayer, J. D., y Salovey, P. (1997). What is emotional intelligence? En P. Salovey y D. Sluyter (Eds). Emotional development and emotional intelligence: implications for educators (pp 3-31). New York, NY: Basic Books.
Mayer, J. D., Salovey, P., y Caruso, D. R. (2002). Mayer- Salovey- Caruso Emotional Intelligence Test (MSCEIT): USER´s Manual. Toronto, ON: Multi- Health Systems Inc.
Nuechterlein, K. H., y Green, M. F. (2006). MATRICS consensus battery manual. Los Angeles, CA: MATRICS Assessment Inc
Nuechterlein, K. H., Green, M. F., Kern, R. S., Baade, L. E., Barch, D. M., Cohen, J. D.,… y Marder, S. R. (2008). The MATRICS Consensus Cognitive Battery, part 1: test selection, reliability and validity. American Journal of Psychiatry, 165(2), 203- 213
Sanders, A., y Szymanski, K. (2012). Emotional intelligence in siblings of patients diagnosed with a mental disorder. Social Work in Mental Health, 10(4), 331-342.
Scholten, M. R., Aleman, A., Montagne, B., y Kahn, R. S. (2005). Schizophrenia and processing of facial emotions: sex matters. Schizophrenia Research, 78(1), 61-68
Sifneos, P. E. (1973). The prevalence of “alexithymic” characteristics in psychosomatic patients. Psychotherapy and Psychosomatics, 22(2-6), 255-262.
Stanghellini, G., y Ricca, V. (2010). Alexithymia and schizophrenias. Psychopathology, 28(5), 263-272
Tremeau, F., Malaspina, D., Duval, F., Correa, H., Hager-Budny, M., Coin-Bariou, L.,… y Gorman, J. M. (2005).Facial expressiveness in patients with schizophrenia compared to depressed patients and nonpatient comparison subjects. American Journal of Psychiatry, 162(1), 92-101.
Van der Meer, L., Van´t Wout, M., y Aleman, A. (2009). Emotion regulation strategies in patients with schizophrenia. Psychiatry Research, 170(2-3), 108-113.
Van´t Wout, M., Aleman, A., Bermond, B., y Kahn, R. S. (2007). No words for feelings: alexithymia in schizophrenia patients and first-degree relatives. Comprehensive Psychiatry, 48(1), 27-33.
Wojtalik, J. A., Eack, S. M., y Keshavan, M. S. (2013). Structural neurobiological correlates of Mayer-Salovey-Caruso Emotional Intelligence Test in early course schizophrenia. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 40, 207-212.
Yecker, S., Borod, J. C., Brozgold, A., Martin, C., Alpert, M., y Welkowitz, J. (1999). Lateralization of facial emotional expression in schizophrenic and depressed patients. The Journal of Neuropsychiatry and Clinical Neurosciences, 11(3), 370-379
Yu, S., Li, H., Liu, W., Zheng, L., Ma, Y., Chen, Q.,… y Wang, W. (2011). Alexithymia and personality disorder functioning styles in paranoid schizophrenia. Psychopathology, 44(6), 371-388.
Yung, A. R., y McGorry, P. D. (1996). The prodromal phase of first-episode psychosis: past and current conceptualizations. Schizophrenia Bulletin, 22(2), 353-370

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