Cognitive empathy contributes to poor social functioning in schizophrenia: Evidence from a new self-report measure of cognitive and affective empathy Tania M. Michaels a , William P. Horan b,c , Emily J. Ginger a , Zoran Martinovich a , Amy E. Pinkham d , Matthew J. Smith a,e,n a Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA b Department of Psychiatry and Biobehavioral Sciences, Geffen School of Medicine at University of California at Los Angeles, USA c VA Greater Los Angeles Healthcare System, VISN22 MIRECC, USA d School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA e Warren Wright Adolescent Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA article info Article history: Received 28 February 2014 Received in revised form 25 August 2014 Accepted 26 August 2014 Available online 4 September 2014 Keywords: Schizophrenia Empathy Social functioning Social cognition QCAE abstract Cognitive empathy impairments have been linked to poor social functioning in schizophrenia. However, prior studies primarily used self-reported empathy measures developed decades ago that are not well- aligned with contemporary models of empathy. We evaluated empathy and its relationship to social functioning in schizophrenia using the recently developed Questionnaire of Cognitive and Affective Empathy (QCAE). Schizophrenia (n ¼52) and healthy comparison (n ¼37) subjects completed the QCAE, Interpersonal Reactivity Index (IRI), and measures of neurocognition, symptoms, and social functioning. Between-group differences on the QCAE, and relationships between QCAE and IRI subscales, neurocog- nition, symptoms, and social functioning were examined. The schizophrenia group reported significantly lower cognitive empathy than comparison subjects, which was driven by low online simulation scores. Cognitive empathy explained significant variance in social functioning after accounting for neurocogni- tion and symptoms. Group differences for affective empathy were variable; the schizophrenia group reported similar proximal responsivity, but elevated emotion contagion relative to comparison subjects. These findings bolster support for the presence and functional significance of impaired cognitive empathy in schizophrenia using a contemporary measure of empathy. Emerging evidence that some aspects of affective empathy may be unimpaired or hyper-responsive in schizophrenia and implications for the assessment and treatment of empathy in schizophrenia are discussed. & 2014 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Empathy, which refers to the ability to understand and share the thoughts and feelings of others, has emerged as an important topic in the field of social neuroscience (Decety and Jackson, 2004). Although empathy has historically been defined in many ways (Batson, 2009), recent social neuroscience research has made considerable progress in identifying key brain-based subcompo- nents of empathy (Fan et al., 2011) and understanding how empathy is impacted in various forms of psychopathology (Decety and Moriguchi, 2007). There is now general agreement that empathy is a multidimensional construct, which includes distinct cognitive and affective processes (Shamay-Tsoory, 2011). Social neuroscience defines cognitive empathy as a set of reflective processes that include taking the ‘perspective’ of others, understanding the emotional state of others, distinguishing another's feelings from one's own, and being able to integrate this information with social knowledge to adaptively guide interper- sonal behavior. Social neuroscience defines affective empathy as a set of relatively automatic processes through which perceived social cues trigger an emotional response in oneself that is shared with an observed person (Decety, 2011; Shamay-Tsoory, 2011; Bernhardt and Singer, 2012). The capacity to accurately and adaptively empathize is believed to involve coordinated interac- tion between these sub-processes (Zaki and Ochsner, 2011). More Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/psychres Psychiatry Research http://dx.doi.org/10.1016/j.psychres.2014.08.054 0165-1781/& 2014 Elsevier Ireland Ltd. All rights reserved. n Corresponding author at: Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Abbott Hall 13th Floor, Chicago, IL 60611. Tel.: þ1 312 503 2542; fax: þ1 312 503 0527. E-mail address: matthewsmith@northwestern.edu (M.J. Smith). Psychiatry Research 220 (2014) 803–810