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What Social Neuroscience Reveals About Schizophrenia

Addressing the major challenges of communication and relationship formation.

Margarida CSilva/Unsplash
Margarida CSilva/Unsplash

Emmanuel Olarewaju is a Ph.D. candidate at McGill University, where he studies social neuroscience and what it can do to shed light on schizophrenia.

His latest research shows how social neuroscience is revealing new perspectives about why and how schizophrenia functions, and how researchers can build new tools to help individuals living with the illness recover.

Here is an interview with him about his research.

Sarah An Myers: What can social neuroscience offer for patients with schizophrenia?

Emmanuel Olarewaju: Social neuroscience integrates perspectives from social cognition, which focuses on the mental frameworks guiding our social interactions. One theory, for example, is embodied cognition—a theory that cognitive processes are deeply rooted in the body's interactions with the world. This inclusive approach allows for a more comprehensive understanding of how physical experiences and environments can shape cognitive processes during social interactions. In schizophrenia, disruptions in 'shared intentionality'—the mutual mental frameworks that are thought to govern inter-brain synchronization—may give rise to 'disorganized communication,' a symptom marked by challenges in delivering coherent and contextually appropriate dialogue.

Disturbances in the ability to resonate with others are believed to play a critical role in the social isolation and maladaptive behaviors commonly observed in individuals with schizophrenia. Social neuroscience offers viable treatment strategies, addressing challenges often insufficiently met by traditional therapeutic approaches.

For example, addressing the limitations of traditional therapies for schizophrenia's negative symptoms, social neuroscientists integrate real-time neurofeedback with hyperscanning. Neurofeedback uses real-time electroencephalogram (EEG) data to help subjects consciously control their brain wave patterns. Focused mainly on alpha (8-12 Hz, often associated with a relaxed, alert state), beta (12-30 Hz, commonly linked to active thinking and focus), and theta (4-7 Hz, usually related to drowsiness or meditation) wave patterns, this method aims to improve symptoms. Preliminary findings suggest that this approach can lead to meaningful brain changes, offering a supplementary strategy for alleviating social impairments.

SAM: How do you perceive social integration to be a helpful recovery tool for patients with schizophrenia and psychosis? What do your findings show?

EO: Think of social interactions as a balanced dance: You mirror some actions of your dance partner, while also adding your complementary moves. For people with schizophrenia, this balance is off. Instead of a balanced interplay, they may engage in repetitive, involuntary behaviors. In clinical terms, these are known as echolalia, where the person cannot help but repeat words or phrases, and echopraxia, where they mirror movements they observe. Both conditions are barriers to integrating successfully into social settings and adapting to changing others.

To tackle these challenges, a social neuroscience approach could involve placing individuals with schizophrenia or psychosis in social settings designed to encourage more than simply mirroring behavior. Instead, these environments aim to promote diverse social exchanges, correcting for the imbalanced behavioral patterns often observed in these individuals. In this framework, it is not merely the individual's mental state that is of concern but how this state resonates with the social environment. This presents a paradigm shift away from a purely individualistic approach, which has been the prevailing practice in clinical settings, towards one that is interpersonal or even communal in scope.

My research focuses on how social interactions can be used to treat schizophrenia. Specifically, I focus on two significant challenges that people with schizophrenia often encounter: communication problems and difficulty forming and maintaining social relationships.

For example, when healthy people engage in a conversation, they naturally mirror each other's behaviors—like nodding when agreeing or mirroring the other's facial expressions, which is a natural part of social interaction. I refer to this state as interpersonal resonance—a mutual, dynamic synchronization between people during interactions. The region of the brain controlling these behaviors is called the frontal cortex, the brain's control center for making decisions, controlling our impulses, and regulating how we interact socially.

In people with schizophrenia, however, the natural tendency to mirror another person's actions is not well-regulated. They might copy words or actions repetitively—a condition known as 'echolalia' for repeated words and 'echopraxia' for repeated actions. The problem seems to be related to the brain's internal 'feedback mechanisms,' like built-in guides that help us adapt and respond appropriately in social situations. The malfunction of this social feedback mechanism is implicated in disorganized communication and social difficulties often seen in schizophrenia.

I argue that treatments should include carefully designed social environments to improve the social skills and communication abilities of people with schizophrenia or similar conditions. This can add another layer to existing treatment plans and provide a more well-rounded approach to improving the lives of people affected by these conditions.

SAM: How specifically does social integration help patients with psychosis recover? Is there any evidence shown in neuroimaging work that confirms this hypothesis?

EO: Current research in neuroscience and mental health has demonstrated that having strong social connections changes specific brain pathways that target mental disorders, such as schizophrenia and psychosis (Bolis et al., 2023; Dumas, 2022; Olarewaju, 2023; Schilbach, 2016). Social neuroscientists employ a brain imaging technique known as hyperscanning to explore these brain pathways. Hyperscanning allows researchers to record the brain activity of two or more people simultaneously, making it possible to study how brains interact during social interaction (Czeszumski et al., 2020). One study using a specific type of hyperscanning called functional near-infrared spectroscopy (fNIRS) found that people at high risk for psychosis showed reduced brain activity in an area known as the right inferior frontal cortex.

This area is vital for social skills like understanding other people's emotions and points of view (Wei et al., 2023). The reduced activity in this frontal brain region could contribute to the symptoms of social withdrawal, disorganized speech, and behaviors often seen in psychosis.

Another study summarized the results of multiple fNIRS hyperscanning experiments and found that cooperative activities increase brain activity in essential areas like the frontal cortex and the temporoparietal junction (Czeszumski et al., 2022). The frontal cortex is responsible for higher-level thinking skills, including making decisions and regulating social behavior.

The temporoparietal junction helps us interpret social cues and understand other people's intentions and beliefs. When these brain areas are activated through cooperative activities, it could potentially rewire the brain in beneficial ways, offering a scientific basis for the effectiveness of social integration in treating psychosis.

Building upon existing research, my co-authors and I recently published a review article that explores a new angle. We argue that the communication issues frequently seen in people with schizophrenia are not just due to irregularities in their brain activity. Instead, these issues are also strongly affected by how these individuals interact with the people around them (Olarewaju et al., 2023). This insight complements empirical findings by providing a dual-purpose framework: It serves as both a potential treatment strategy and a lens to understand the complex relationship between neural function and communication impairments in schizophrenia.

References

Bolis, D., Dumas, G., & Schilbach, L. (2023). Interpersonal attunement in social interactions: from collective psychophysiology to inter-personalized psychiatry and beyond. Philosophical Transactions of the Royal Society B: Biological Sciences, 378(1870), 20210365. https://doi.org/doi:10.1098/rstb.2021.0365

Czeszumski, A., Eustergerling, S., Lang, A., Menrath, D., Gerstenberger, M., Schuberth, S., Schreiber, F., Rendon, Z. Z., & König, P. (2020). Hyperscanning: A Valid Method to Study Neural Inter-brain Underpinnings of Social Interaction [Review]. Frontiers in Human Neuroscience, 14. https://doi.org/10.3389/fnhum.2020.00039

Czeszumski, A., Liang, S. H.-Y., Dikker, S., König, P., Lee, C.-P., Koole, S. L., & Kelsen, B. (2022). Cooperative Behavior Evokes Interbrain Synchrony in the Prefrontal and Temporoparietal Cortex: A Systematic Review and Meta-Analysis of fNIRS Hyperscanning Studies. eneuro, 9(2), ENEURO.0268-0221.2022. https://doi.org/10.1523/eneuro.0268-21.2022

Dumas, G. (2022). From inter-brain connectivity to inter-personal psychiatry. World Psychiatry, 21(2), 214-215. https://doi.org/10.1002/wps.20987

Olarewaju, E., Dumas, G., & Palaniyappan, L. (2023). Disorganized communication and social dysfunction in schizophrenia: Emerging concepts and methods. . https://doi.org/https://doi.org/10.31234/osf.io/pr4vx

Schilbach, L. (2016). Towards a second-person neuropsychiatry. Philosophical Transactions of the Royal Society B: Biological Sciences, 371(1686), 20150081. https://doi.org/doi:10.1098/rstb.2015.0081

Wei, Y., Liu, J., Zhang, T., Su, W., Tang, X., Tang, Y., Xu, L., Qian, Z., Zhang, T., Li, X., & Wang, J. (2023). Reduced interpersonal neural synchronization in right inferior frontal gyrus during social interaction in participants with clinical high risk of psychosis: An fNIRS-based hyperscanning study. Prog Neuropsychopharmacol Biol Psychiatry, 120, 110634. https://doi.org/10.1016/j.pnpbp.2022.110634

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