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Neurocognition, Social Cognition, and Functional Outcome in Schizophrenia and High-Functioning Autism 
Shannon Couture

This dissertation investigated the relationships amongst neurocognition, social cognition, and functional outcome using path models.  I contrasted how the models fit in schizophrenia and high-functioning autism samples, and concluded that the relationship between neurocognition and social cognition appeared to be stronger within the schizophrenia sample.  It also appeared that there was modest support for social cognition serving as a mediator between neurocognition and functional outcome within the schizophrenia sample.

See related publications:

Sasson, N., Hurley, R., Couture, S., Penn, D. L., Piven, J., Tsuchiya, N., & Adolphs, R. (2007). Orienting to Social Stimuli Differentiates Social Cognitive Impairment in Autism and Schizophrenia. Neuropsychologia, 45, 2580-2588.

Couture, S. M., & Penn, D. L.  (2006). The effects of prospective naturalistic contact on the stigma of mental illness. Journal of Community Psychology, 34, 635-645.

Couture, S. M., Roberts, D. L., & Penn, D.L. (2006). The functional significance of social cognition in schizophrenia: A review. Schizophrenia Bulletin, 32 (Suppl. 1), S44-S63.

Couture, S. M., Roberts, D. L., Penn, D.L. , Cather, C., Otto, M., & Goff, D, A. (2006). Do baseline client characteristics predict the therapeutic alliance in the treatment of schizophreniaJournal of Nervous and Mental Disease, 194, 10-14

Couture, S., & Penn, D. L. (2003). Interpersonal contact and the stigma of mental illness: A review of the literature.  Journal of Mental Health, 12, 291-305.

Development and initial evaluation of a psychosocial intervention
for first-episode psychosis

Evan Waldheter

This dissertation involved manual development/standardization and pilot test of a novel cognitive-behavioral intervention for individuals recovering from a first episode of psychosis.  The treatment aims to assist clients in managing their illness more effectively, and places particular
emphasis on facilitating functional recovery (i.e., improved social/occupational functioning).  Pilot data suggested that the intervention was associated with symptomatic and social functioning
improvements, and was well-received by clients and therapists

See related publications: Waldheter, E. J., Penn, D. L, Perkins, D. O., Mueser, K. T., Owens, L. W., & Cook, E. (2008). The graduated recovery intervention program for first episode psychosis: Treatment development and preliminary data. Community Mental Health Journal, 44, 443-455.

Penn, D. L., Uzenoff, S., Perkins, D., Mueser, K. T., Hamer, R., Waldheter, E., Saade, S. & Cook, L. (2011). A pilot investigation of the Graduated Recovery Intervention Program (GRIP) for first episode psychosis. Schizophrenia Research, 125, 247-256

Development and preliminary evaluation of a social cognition intervention for outpatients with schizophrenia spectrum disorders
David Roberts

This was a study of Social Cognition and Interaction Training (SCIT) among individuals with schizophrenia in North Carolina and New York.

See related publications: Penn, D.L., Roberts, D.L., Combs, D., Sterne, A. (2007).  Best practices: The development of the Social Cognition and Interaction Training program for schizophrenia spectrum disordersPsychiatric Services, Apr;58(4), 449-51.

Combs, D. R., Adams, S. D., Penn, D. L., Roberts, D. L., Tiegreen, J., & Stem, P. (2007). Social Cognition and Interaction Training for inpatients with schizophrenia spectrum disorders: Preliminary findingsSchizophrenia Research, 91, 112-116.

Penn, D. L., Roberts, D. L., Munt, E., Silverstein, E., & Sheitman, B. (2006). A pilot study of Social Cognition and Interaction Training (SCIT) for SchizophreniaSchizophrenia Research, 80, 357-359.

Roberts, D., & Penn, D. L. (2009). Social cognition and interaction training (SCIT) for outpatients with schizophrenia: A preliminary studyPsychiatry Research166, 141-147.

Roberts, D. L., Penn, D. L., Corrigan, P. W., Lipkovitch, I., Kinon, B., & Black, R. A. (2010). Antipsychotic medication and social cue recognition in chronic schizophrenia. Psychiatry Research, 178, 46-50.

Roberts, D. L., Penn, D. L., Labate, D., Margolis, S. A., & Sterne, A. (2010). Transportability and feasibility of Social Cognition and Interaction Training (SCIT) in community settings. Behavioral and Cognitive Psychotherapy, 38, 35-47.

Do Similar Neural Profiles Underlie Social Cognitive Deficits in Schizophrenia and High-Functioning Autism?
Amy Pinkham

See related publication: Pinkham, A. E., Hopfinger, J. B., Pelphrey, K. A., Piven, J., & Penn, D. L.. (2008). Neural bases of impaired social cognition in schizophrenia and autism-spectrum disordersSchizophrenia Research, 99, 164-175.

Pinkham, A. E., Hopfinger, J. B., Ruparel, K. & Penn, D. L. (2008). An investigation of the relationship between activation of a social cognitive neural network and social functioning. Schizophrenia Bulletin, 34, 688-697.

Pinkham, A. E., Hopfinger, J., & Penn, D. L. (2012). Context influences social cognitive judgments in paranoid individuals with schizophrenia (letter to the editor). Schizophrenia Research, 135, 196-197.

Prospective Evaluation of Clinically Relevant Risk Factors in Childhood- and Adolescent-Onset Psychotic Disorders
Abigail Judge

Psychotic disorders with an onset in childhood and adolescence are associated with a more severe illness presentation and malignant course than those with an onset in adulthood. Despite this, their longitudinal course has been studied only to a limited extent and often utilizing statistical methods inappropriate for repeated measures data. Accordingly, the current study prospectively evaluated the predictive effects of clinically relevant factors on illness course utilizing a longitudinal database from a grant-supported investigation. Hierarchical linear modeling and multiple regressions were utilized to evaluate the predictive effects of risk factors on level of psychiatric symptoms at 2-5 year follow-up among children and adolescents with well characterized psychotic disorders (i.e., schizophrenia, schizoaffective disorder, major depression with psychosis). Psychotic and general symptoms decreased significantly over time but none of the examined covariates explained significant variance in the observed changes. Supplementary analyses evaluated the effects of two design characteristics (i.e., study effect and rater bias) on the observed changes and found significant rater effects with respect to measures of select psychotic symptoms. General psychiatric symptoms decreased during the follow-up period with a significant interaction to characterize this change, with observed changes in psychotic symptoms appearing to be the artifacts of rater bias. Clinical implications with respect to development effects on symptom presentation and methodological considerations, including the importance of modeling rater effects within clinical research, were discussed.

Loving-kindness meditation to enhance the psychological recovery of individuals with persistent negative symptoms of schizophrenia: A pilot study
David Johnson

The proposed group treatment, loving-kindness meditation (LKM), will be tested for its feasibility and initial efficacy in a pilot sample of 18 participants with schizophrenia-spectrum disorders who have persistent negative symptoms. Consistent with the broaden-and-build theory of positive emotions, LKM is hypothesized to increase the frequency and intensity of positive emotions in participants’ lives. This is expected to broaden participants’ cognitive and behavioral repertoires and in turn lead to increases in personal resources and life satisfaction. These personal resources include psychological well-being and anticipatory pleasure, a key component of the anhedonic deficit in negative symptomatology. This pilot study will not directly test the mechanisms proposed through the theory but will indirectly explore this theory through analyses of outcomes pre- and post-treatment. If results are consistent with theory, LKM could be a promising intervention as there are few effective treatments for negative symptoms.

See related publication: Johnson, D. P., Penn, D. L., Fredrickson, B. L., Kring, A. M., Meyer, P. S. & Brantley, M. (2009). Loving-kindness meditation to enhance recovery from negative symptoms of schizophreniaJournal of Clinical Psychology, 65, 499-599.

Johnson, D.P., Penn, D. L., Fredrickson, B. L., Kring, A. M. Meyer, P. S., Catalino, L., & Brantley, M. (2011). A pilot study of loving kindness meditation for the negative symptoms of schizophrenia. Schizophrenia Research, 129, 137-140.

Web-based cognitive behavioral therapy for auditory hallucinations in persons with psychosis: A pilot study
Katy Harper Romeo

Dissertation research involving a pilot study evaluating feasibility and efficacy of a novel Internet cognitive behavioral therapy program (Coping with Voices program: developed by B. Chiko & J. Gottlieb, Ph.D.) for auditory hallucinations.

See related publication: Gottlieb, J., Harper Romeo, K., Penn, D. L., Mueser, K. T. & Chiko, B. (2013). Web-based cognitive behavioral therapy for auditory hallucinations in persons with psychosis: A pilot study. Schizophrenia Research 145, 82-87.

Evaluation of a multi-element treatment center for early psychosis: Predictors of functional outcome at 1 year
Sarah Uzenoff Mintz

This study is a naturalistic, prospective one-year follow-up of an early psychosis cohort treated in one of the first US-based multi-element treatment centers. Participants were 163 individuals treated at the Outreach and Support Intervention Services (OASIS) clinic, a multi-element treatment center for early psychosis. Data were collected as part of routine care at six-month intervals. Primary outcomes included role functioning, involvement in work or school, and subjective experiences of recovery. In addition, a novel definition of functional remission was proposed. This study provided preliminary support for the efficacy of comprehensive early intervention services in the US.

See related publication: Uzenoff, S.R., Penn, D.L., Graham, K.A., Saade, S., Smith, B. & Perkins, D.O. (2012). Evaluation of a multi-element treatment center for early psychosis in the United States. Social Psychiatry and Psychiatric Epidemiology. DOI 10.1007/s00127-011-0467-4.

A pilot six-week randomized controlled trial of oxytocin on social cognition and social skill in schizophrenia
Clare Gibson

This dissertation was an investigation of the effects of six weeks of daily oxytocin on social cognition, social skill and psychotic symptoms in individuals with schizophrenia. This study was done in collaboration with Cort Pedersen, M.D at UNC-CH, Department of Psychiatry and projected was supported by a grant from the Foundation of Hope for Research and Treatment of Mental Illness (grant awared to Dr. Pedersen). The preliminary findings indicate oxytocin treatment may help improve certain components of functioning in schizophrenia. The dissertation has recently been submitted for publication and is currently under review. See article below for related research (2 week oxytocin trial).

See related publication: Pedersen, C.A., Gibson, C.M., Rau, S.W., Salimi, K., Smedley, K.L., Casey, R.L., Penn, D.L.(2011). Intranasal oxytocin reduces psychotic symptoms and improves theory of mind and social perception in schizophrenia. Schizophrenia Research, 132, 50-53. doi: 10.1016/j.schres.2011.07.027.

Latent profile analysis and conversion to psychosis: Characterizing subgroups to enhance risk prediction
Kristin Healey

Healey, K.M, Penn, D.L, Perkins, D., Woods, S.W., Keefe, R.S.E, and Addington, J. (2017). Latent profile analysis and conversion to psychosis: Characterizing subgroups to enhance risk prediction.  Schizophrenia Bulletin, 44(2), 286-296.

Automatic and controlled components of attribution biases in schizophrenia; Examination of novel measures of intentionality and immorality bias

Benjamin Buck

This dissertation was an examination of automatic (or implicit) biases toward intentionality and immorality in schizophrenia. This study was done in collaboration with colleagues in the social psychology program at UNC, including Drs. Keith Payne and Kurt Gray as well as Neil Hester. Results suggested that individuals with schizophrenia do present with an elevated bias to interpret intentionality in others’ ambiguous actions, and this bias appears modestly related to interpersonal conflict, paranoia, hostile cognition and behavior, though unrelated to positive symptoms. This bias was not, however, just a result of a failure of control, but participants with schizophrenia differed from controls in their reliance on both automatic and controlled processes. The immorality bias, on the other hand, was not elevated in schizophrenia or paranoia, nor was it related to any disorder-related processes.

Buck, B., Hester, N. R., Pinkham, A., Harvey, P. D., Jarskog, L. F., & Penn, D. L. (2018). The bias toward intentionality in schizophrenia: Automaticity, context, and relationships to symptoms and functioning. Journal of Abnormal Psychology, 127(5), 503-512.

The Therapeutic Alliance in Individual Resiliency Training for First Episode Psychosis: Relationship with Treatment Outcomes and Therapy Participation

Julia Browne

This dissertation examined the therapeutic alliance and its relationship to treatment outcomes and therapy participation in first episode psychosis clients who received treatment as part of the Recovery After an Initial Schizophrenia Episode Early Treatment Program Study (RAISE-ETP). Results indicated that a better therapeutic alliance was related to improved mental health recovery, psychological well-being, quality of life, total symptoms, negative symptoms, and disorganized symptoms at the end of treatment. Additionally, the between-therapist effect of the alliance was significantly related to better mental health recovery whereas the within-therapist effect of the alliance was related to better quality of life, total symptoms, and negative symptoms at the end of treatment.

Browne, J., Mueser, K. T., Meyer-Kalos, P., Gottlieb, J. D., Estroff, S. E., & Penn, D. L. (2019). The Therapeutic Alliance in Individual Resiliency Training for First Episode Psychosis: Relationship with Treatment Outcomes and Therapy Participation. Journal of Consulting and Clinical Psychology, 87(8), 734-744.

Further Exploration of the Effectiveness of Coordinated Specialty Care for First Episode Psychosis in the United States

Emily Gagen

This dissertation utilized latent class analysis to identify homogenous groups of individuals with first episode psychosis based on social functioning, which was operationally defined as satisfaction with social relationships and frequency of social interactions. Participants were clients presenting to a coordinated specialty care clinic for treatment for recent-onset psychosis. Results suggested the presence of three groups, representing poor, good, and mixed levels of social functioning. Classes did not differ with regard to demographic variables, but evidenced significant differences in symptom severity. Class membership was not associated with duration of untreated psychosis or with six-month symptom and functional outcomes. These findings extend previous subgroup research based on premorbid adjustment and underline the heterogeneity of individuals with first episode psychosis. They also support the need for specific and targeted treatments to address varying needs with which clients present.



Why is Schizophrenia Worse for Black Americans? Understanding Pathways to Real-world Impairment

Arun Nagendra

A recent meta-analysis of 55 studies revealed that Black Americans are 2.4 times more likely than Whites to be diagnosed with schizophrenia. After diagnosis, Black Americans with schizophrenia experience worse objective functional outcomes (eg, hospitalizations, homelessness) than their White counterparts. However, there is a paucity of systematic research on why this happens. This knowledge is necessary in order to develop effective and targeted interventions. This three-paper dissertation aims to answer some foundational questions about the experiences of Black Americans with schizophrenia after diagnosis. Taken together, the proposed studies endeavor to expand the body of research on racial disparities in schizophrenia from a narrow focus on diagnosis, to a broader exploration of why Black Americans diagnosed with schizophrenia experience damaging real-world outcomes.

Why Loneliness Matters in Psychosis: A Comprehensive and Integrative Approach to Research and Intervention

Kelsey Ludwig

We used an integrative approach to examine the experience and impact of lonely feelings among persons diagnosed with a psychotic disorder.  Study 1 evaluated relationships between loneliness and social cognition and functioning in a large sample of persons with schizophrenia or schizoaffective disorder.  Study 2 assessed the impact of active engagement in an online social media platform specifically designed for individuals with first episode psychosis on loneliness severity and perceived social support.  Study 3 examined which aspects of living with psychosis were associated with perceptions of loneliness, including symptomatology, perceptions of extant social relationships, and disruptions in school or work, among others. Taken together, these studies highlight the importance of cognition as it relates to loneliness.  In particular, lonely feelings may be closely linked to the following cognitive processes: attention, perception, interpretation, attributions, and memory. Issues with measurement also arose as a central theme related to our understanding of loneliness in psychotic disorders. On their own, findings may help researchers identify specific target areas of treatment and inform the development of individualized treatment plans for persons with psychosis experiencing exacerbated lonely feelings.

Ludwig, K., Nye, L., Simmons, G., Jarskog, L., Pinkham, A., Harvey, P., & Penn, D. (2019). Correlates of Loneliness Among Persons with a Psychotic Disorder. Social Psychology and Psychiatric Epidemiology.

Ludwig, K., Browne, J., Nagendra, A., Gleeson, J., D’Alfonso, S., Penn, D., & Alvarez-Jimenez, M. (2020). Horyzons USA: A Moderated Online Social Intervention for First Episode Psychosis. Early Intervention in Psychiatry.


Brief Battery of the Social Cognition Psychometric Evaluation Study (BB-SCOPE): Development and Validation in Schizophrenia Spectrum Disorders

Tate Halverson

Social cognition (SC) encompasses domains related to how individuals think about themselves, others, and understand social situations. Impairment in social cognition in schizophrenia spectrum disorders (SSD) is relatively common and exhibits strong relationships with neurocognition and functional outcomes. However, there is considerable heterogeneity in the assessment of SC in SSD. The aim of the present study was to develop a brief battery of SC in SSD to reduce heterogeneity of SC measurement in research and increase SC assessment in clinical practice. To this end, the present study utilized an Item Response Theory approach to develop brief versions of SC tasks administered to individuals with SSD (n = 387) and individuals without a psychiatric diagnosis (n = 292) during the Social Cognition Psychometric Evaluation (SCOPE) Study to assemble a brief battery of SC in SSD. Psychometric properties for each brief SC measure were evaluated and compared to the original measures. Eight brief measures of SC were developed (i.e., Ambiguous Intentions and Hostility Questionnaire, Bell Lysaker Emotion Recognition Task, Penn Emotion Recognition Task, Reading the Mind in the Eyes Task, Hinting Task, Intentionality Bias Task, Relationships Across Domains Task, and The Awareness of Social Inference Test). Based on psychometric properties and relationships with other measures of SC, neurocognition, and functioning, four brief tasks and one full-length task were recommended for inclusion in a brief battery of SC tasks from the SCOPE Study (BB-SCOPE). The resulting BB-SCOPE is efficient with an estimated administration time of twenty-five minutes, comprehensively assesses three domains of SC (i.e., attribution bias, emotion processing, theory of mind), and is easily-administered across a variety of settings.


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