Impaired socio-affective, but intact socio-cognitive skills in patients with treatment-resistant, recurrent depression

Hannah M Kilian; Bastian Schiller; Thomas E Schläpfer; Markus Heinrichs

doi:10.1016/j.jpsychires.2022.07.025

Impaired socio-affective, but intact socio-cognitive skills in patients with treatment-resistant, recurrent depression

J Psychiatr Res. 2022 Sep:153:206-212. doi: 10.1016/j.jpsychires.2022.07.025. Epub 2022 Jul 7.

Authors

Hannah M Kilian¹, Bastian Schiller², Thomas E Schläpfer³, Markus Heinrichs⁴

Affiliations

¹ Division of Interventional Biological Psychiatry, Department of Psychiatry and Psychotherapy Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany. Electronic address: hannah.kilian@szvt.rhap.de.
² Department of Psychology, Laboratory for Biological Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, DE, 79104, Freiburg, Germany. Electronic address: schiller@psychologie.uni-freiburg.de.
³ Division of Interventional Biological Psychiatry, Department of Psychiatry and Psychotherapy Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; Johns Hopkins University, Baltimore, MD, USA.
⁴ Department of Psychology, Laboratory for Biological Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, DE, 79104, Freiburg, Germany.

PMID: 35841816
DOI: 10.1016/j.jpsychires.2022.07.025

Abstract

Background: Social withdrawal is a key symptom of depression. The resulting loss of social reinforcement in turn contributes to chronic, recurrent courses of the disease. However, it is not clear whether depressed patients have less motivation to socially interact, or whether their skills in doing so are impaired. The current study investigates potential skill deficits in patients with treatment-resistant depression (TRD).

Methods: 15 TRD patients and 19 age- and sex-matched healthy controls performed the EmpaToM, a paradigm which includes naturalistic video stimuli of either neutral or emotional valence and which differentiates between socio-affective (affective empathy, compassion) and socio-cognitive (theory of mind) skills.

Results: Controlling for the baseline affective state in neutral situations, TRD patients displayed significantly reduced affective empathy towards emotional situations compared to healthy controls. Furthermore, TRD patients were less compassionate in both neutral and emotional situations. In contrast, socio-cognitive skill performances did not differ between patients and healthy controls.

Limitations: Further studies might explore socio-affective and socio-cognitive skills in TRD patients using socio-affective/-cognitive tasks involving face-to-face social interactions.

Conclusion: Our study revealed a specific socio-affective deficit in TRD patients, while showing intact socio-cognitive skills. Patients were less able to affectively resonate with others (affective empathy) and exhibited generally reduced feelings of compassion. These deficits might interfere with providing and receiving social support. Our study contributes to a better understanding of the underlying causes of social withdrawal and stresses the need to specifically address pervasive socio-affective deficits in psychotherapy of TRD patients.

Keywords: Affective empathy; Compassion; EmpaToM; Social isolation; Theory of mind; Treatment-resistant depression.

MeSH terms

Cognition
Depression*
Depressive Disorder, Treatment-Resistant* / therapy
Empathy
Humans