Mixed signals

Communication problems can be sign of mental health disorder

Human interactions are complex and come with their share of disappointments. This can be the case, for instance, when a loved one doesn’t react to our distress or joy the way we wish they had. Communication accidents happen!

Psychiatry teaches us, however, that if these mishaps occur over and over with the same person, it might not be because the person lacks good intentions. It could be the result of a change in their social cognition.

A growing number of studies are establishing a link between social cognition and different psychiatric conditions. Reactions that are normal for most people, such as showing concern for a person who expresses sadness, may be absent in others.

For some, a situation or interaction that seems very basic might lead to a misinterpretation, which in turn could provoke behaviour that is inappropriate or inadequate. If these kinds of errors happen often, this might be due to impairment of a key cognitive skill: social cognition.

Social cognition is mainly about our ability to decode emotions and understand the beliefs and intentions of people around us. Determining whether this cognitive skill has been affected by a psychiatric illness, or by another disorder, is essential in order for the person to be able to respond appropriately to the problems they encounter, and to limit potential harmful effects.

An emerging field of research
As an assistant professor of psychiatry at McGill University, I conduct research on psychiatric disorders in order to study cognitive impairment, its impact and possible solutions. My work is part of a growing field of research into the relationship between social cognitive disorders and mental health disorders such as depression, bipolar disorder and schizophrenia. Varying degrees of impairment of social cognition have been observed in all these disorders.

The different signs of impaired social cognition must be taken seriously. The problem not only affects an individual’s understanding of the world, but disrupts communication with the people he or she meets every day.

It’s possible to spot these signs when interpreting a real-life situation or a fictional film. Someone suffering from cognitive impairment may be the only one who doesn’t understand the innuendo of the main character in a favourite TV series, or the double meaning of a remark made during a discussion between colleagues.

An impact on everyday life

A literature review I carried out with colleagues a few years ago showed there were connections between impairment of social cognition in people living with bipolar disorder, and how they functioned in everyday life. In other words, the more social cognition is impaired, the less likely the individual will be able to function well in everyday life.

Since then, our work, as well as that of other teams, has shown that social cognition impairments mediate the relationship between cognitive problems (e.g. memory) and clinical symptoms. Indeed, in disorders such as schizophrenia and certain types of bipolar disorder, memory is frequently affected.

These impairments occur early in the course of the disease and are associated with loss of motivation, withdrawal and difficulty expressing emotions. Impairments of social cognition, such as difficulty identifying one’s own emotions and those of others, and in understanding oneself and others, are at the heart of this process. It’s through understanding these that we can propose care solutions.

Improving cognitive skills

Several proposals have been developed to support and improve these skills.

Some interventions, for example, include exercises to improve social cognition and memory. These may involve the patient correctly recognizing emotions expressed by another person, or correctly interpreting the beliefs or intentions of others, which then enables him or her to read more complex situations.

Other interventions allow the patient to become aware of the way he or she thinks, by integrating social cognition. An exercise may present a story in which the characters’ motivations are only gradually revealed.

For example, a young girl offers chocolates to an elderly woman, who thanks her with a smile. Once the girl has left, the lady expresses disgust and throws the box in the garbage can. After a few months, the girl returns with a new box of chocolates. The questions will then focus on the girl’s beliefs and the reaction she could expect from the elderly lady.

This type of exercise, where the complexity increases, can help an individual gradually become aware of his or her difficulties and then find strategies that lead to solutions. Such a program, initially developed for schizophrenia, has proven effective and is now recommended for a number of psychiatric disorders. For schizophrenia, a recent meta-analysis showed sustained improvement over one year in symptoms, self-esteem and functioning.

Most of these programs take place in a care environment in the presence of a therapist. Practical exercises then enable people living with social cognitive disorders to introduce these skills into their daily lives. Indeed, interventions that support social cognition involve rapidly applying the proposed strategies in everyday life, so that they are useful and sustainable over time.

Accessibility to be improved

Numerous efforts are being made to make this type of care available to a wider public, notably through the use of digital tools. For example, since the pandemic, our team has proposed videoconferencing groups for people with severe mental health problems as part of a research project. The people who took part in these remote interventions found them both feasible and satisfying, and their well-being improved as a result.

For the loved ones of a person living with a mental health disorder, a better knowledge and understanding of these processes is also useful. It is important for friends and family to understand that they are not dealing with a malicious person who is deliberately trying to hurt or misinterpret them, but with a person who is suffering.

Schizophrenia is one of the most incomprehensible disorders for families, so programs exist to help improve intra-family communication (e.g., AMI Québec). These programs support the maintenance and quality of relationships, even if they do not specifically target social cognition.

A great deal of research and clinical work is being carried out to understand the mechanisms of social cognition and help people living with a mental health disorder to recover. Although a lot of work remains to be done in adjusting to individual situations, real advances are being made.

(By Delphine Raucher-Chéné, McGill University, The Conversation)