Being well understood and generating interest during verbal interactions: the role of Theory of Mind and clinical symptoms in people with schizophrenia spectrum disorders

People with schizophrenia spectrum disorders (SSD) present with communication impairments. This study aimed to determine whether individuals with SSD make it less easy or interesting to perform a joint task with them relative to community controls (CO), and to examine the link between clinical symptoms and theory of mind (ToM). Fifty-one outpatients with SSD and 68 CO performed the storytelling in sequence task (STST) with an interaction partner. Four raters subsequently listened to the STST audio recordings and scored how easily they could place the images of the narrated stories in the correct order (Facility ratings), how interesting they found the stories (Interest ratings) and how expressive they found the voice (Expressivity ratings). Symptoms were assessed using the Positive and Negative Syndrome Scale and ToM using the Combined Stories Test. The Facility, Interest and Expressivity ratings were lower in SSD than in CO. In SSD, the Facility ratings were positively associated with ToM and negatively associated with several symptom dimensions. The Interest and Expressivity ratings were strongly linked together and negatively associated with Negative symptoms. ToM deficits in SSD may contribute to difficulties communicating clearly. The strong association between Expressivity and Interesting ratings raises important questions regarding the real-life impacts of reduced expressivity.This article is part of the theme issue 'At the heart of human communication: new views on the complex relationship between pragmatics and Theory of Mind'.