Brain and Cognition 90 (2014) 8799

Contents lists available at ScienceDirect

Brain and Cognition

journal homepage: www.elsevier.com/locate/b&c

Disturbances of spontaneous empathic processing relate with the

severity of the negative symptoms in patients with schizophrenia:
A behavioural pilot-study using virtual reality technology
Brangre Thirioux a,,1, Louis Tandonnet b,2, Nematollah Jaafari b,c,d,e,f, Alain Berthoz a
a
Laboratoire de Physiologie de la Perception et de lAction, CNRS UMR 7152, Collge de France, 11 Place Marcelin Berthelot, Paris F-75005, France
b
CIC INSERM U 802, CHU de Poitiers, Poitiers F-86022, France
c
INSERM U 1084, Experimental and Clinical Neurosciences Laboratory, Poitiers F-86022, France
d
Universit de Poitiers, Facult de Mdecine, Poitiers F-86022, France
e
Unit de Recherche Clinique intersectorielle en psychiatrie vocation rgionale (URC) du Centre Hospitalier Henri Laborit, Poitiers F-86022, France
f
Groupement de Recherche, CNRS 3557, France

a r t i c l e i n f o a b s t r a c t

Article history: Behavioural and neuroimaging data have recently pointed out that empathy (feeling into someone else) is
Accepted 9 June 2014 associated with mental imagery and transformation related to ones and others visuo-spatial perspectives.
Available online 9 July 2014 Impairments of both empathic and visuo-spatial abilities have been observed in patients with schizophre-
nia. Especially, it has been suggested that schizophrenics are altered in spontaneously simulating another
Keywords: individuals rst-person experience. However, there is so far only little evidence regarding the relationship
Schizophrenia between decits in empathy and disturbances in spontaneous heterocentered coding in schizophrenia. In
Empathy
the present pilot-study, we tested with schizophrenic patients our behavioural paradigm that enables to
Sympathy
Negative symptoms
measure from the bodily postures and movements whether individuals in ecologically more valid condi-
Executive functions tions are interacting with another individual by using egocentered as in sympathy (feeling with someone
Inhibitory processing else) or heterocentered as in empathy visuo-spatial mechanisms. For that, ten patients and ten con-
trols, standing and moving, interacted with a virtual tightrope walker, displayed life-sized, standing and
moving as well. We show that patients with higher negative symptoms had, in most cases, decits in spon-
taneously using heterocentered visuo-spatial mechanisms and employed preferentially an egocentered
referencing to interact with the avatar. In contrast, preserved spontaneous heterocentered visuo-spatial
strategies were not linked to a prevailing negative or positive symptomatology. Our data suggest that
the severity of the negative symptoms in schizophrenia relates with disturbances of spontaneous (on-
line) empathic processing in association with lower scoring self-reported trait cognitive empathy.
2014 Elsevier Inc. All rights reserved.

1. Introduction
Clinical data from behavioural and neuroimaging studies with
psychiatric populations have provided increasing support that
schizophrenia is associated with deviant social functioning (Brne,
2005a; Corrigan & Nelson, 1998; Frith, 2004; Shamay-Tsoory,
Corresponding author. Address: Laboratoire de Physiologie de la Perception et
de lAction, Collge de France, 11 Place Marcelin Berthelot 75231, Paris cedex 05,
France. Fax: +33 1 44 27 13 82.
E-mail address: berangerethirioux@hotmail.com (B. Thirioux).
1
Present address: Institute for Advanced Studies of Paris, 17 Quai dAnjou, Paris
F-75004, France.
2 is only limited evidence regarding the relation between empathy
Present address: Service universitaire daddictologie de liaison du C.H.U de
Nantes, Nantes F-44093, France.
Shur, Harari, & Levkovitz, 2007; Sperber & Wilson, 2002). Under-
standing the structure of these social behavioural impairments is
of critical importance for establishing predictive markers of the ill-
ness as social abnormalities have been often observed to precede
the psychosis outcome (Brne, 2005b; Schenkel, Spaulding, &
Silverstein, 2005). Notably, schizophrenic patients and people with
high schizophrenia-like traits have been suggested to suffer respec-
tively from altered and reduced empathic abilities (Decety &
Moriguchi, 2007; Dinn, Harris, Aycicegi, Greene, & Andover, 2002;
Henry, Bailey, & Rendell, 2008; Lee, Farrow, Spence, & Woodruff,
2004; Milgram, 1960; Montag, Heinz, Kunz, & Gallinat, 2007;
Shamay-Tsoory et al., 2007; Thakkar & Park, 2010). However, there
decits and schizophrenia (Bora, Gken, & Veznedaroglu, 2008).

http://dx.doi.org/10.1016/j.bandc.2014.06.006
0278-2626/ 2014 Elsevier Inc. All rights reserved.
88 B. Thirioux et al. / Brain and Cognition 90 (2014) 8799
1.1. The multidimensional approach of empathy
Empathy is the capacity to share, react to and understand the
lived experience and associated mental state of others (Davis,
1980, 1994). As a complex and multifaceted socio-cognitive con-
struct (Berthoz, 2004; Preston, 2007; Preston & de Waal, 2002;
Thakkar, Brugger, & Park, 2009), empathy incorporates automatic,
emotional, cognitive and regulatory processes and combines
cooperating and/or competing activations (Berthoz, 2004) in
topographically distributed and functionally distinct brain net-
works (Decety, 2007; Decety & Jackson, 2004). The automatic
and emotional components of empathy similar to the rst-person
like processes involved in simulation (Goldman, 2006) enable to
internally reproduce another persons subjective experience, as if
individuals were experiencing this given mental state themselves.
The cognitive and regulatory components refer to a controlled
process whereby people understand the mental state of others
while adopting their psychological viewpoint based upon perspec-
tive-taking and self-other distinction. These are strongly akin to
the processes involved in Theory of Mind (ToM) (Premack &
Woodruff, 1978) or mentalizing (Frith & Frith, 2003) which is the
ability to represent and attribute mental state to others. Self-regu-
lation mechanisms further contribute to decoupling computational
mechanisms between rst- and second-person information and
tap into executive functions (Decety & Jackson, 2004; Decety &
Michalska, 2009; Frith & Frith, 2003; Ochsner & Gross, 2005; Van
der Meer, Groenewold, Nolen, Pijnenborg, & Aleman, 2011).
1.2. The visuo-spatial and body-related mechanisms in empathy
Although empathy i.e., putting oneself in the others shoes
is generally admitted to require both self-other distinction and
psychological perspective-taking, little experimental work has
focused on self-regulation and more basic visuo-spatial mecha-
nisms (Thakkar & Park, 2010). However, recent studies have shown
that empathy entails mental imagery and transformations related
to ones and others visuo-spatial perspective (Mohr, Rowe, &
Blanke, 2010; Thakkar et al., 2009; Thirioux, Jorland, Bret,
Tramus, & Berthoz, 2009; Thirioux, Mercier, Blanke, & Berthoz,
2014; Thirioux, Mercier, Jorland, Berthoz, & Blanke, 2010). The pre-
requisite for empathy or feeling into (from the Germane ein
[into] fhlen [to feel]; Jorland & Thirioux, 2008) is a sort of
awareness of being outside the other person and having to reach
[her/him] (Gelhaus, 2011). It enables to understand the others
current experience as the experience of someone else while distin-
guishing oneself from the other (Decety, 2007; Decety & Jackson,
2004; Hein & Singer, 2008; Singer et al., 2004). Therefore, empathy
requires perspective-change and is based upon a mental transfor-
mation of ones own-body in space in which individuals are map-
ping their body into the others body in a rotation-like manner
[Self ? Other] (Thirioux et al., 2009, 2010). Accordingly, empathy
specically modulates self-location (the experience of where I
am in space; Blanke, 2012) and the egocentered (centered on ones
own-body) visuo-spatial perspective (the experience from which I
perceive the world; Blanke, 2012), two key phenomenological
aspects of the bodily self which are substantial for self-other inter-
action. Empathy is, thus, associated with disembodied self-location
(in which the imagined self-location does not match the position of
ones physical body in space; Blanke et al., 2005) and heterocen-
tered (centered on another individuals body; Cleret de Langavant
et al., 2011; Degos, Bachoud-Lvi, Ergis, Petrissans, & Cesaro,
1997) visuo-spatial perspective (Fig. 1A).
We have newly assumed that empathy relies upon continual
and bi-directional perspective-change processes, i.e., dynamic
shifts between the egocentered and heterocentered visuo-spatial
frameworks, enabling on-line comparisons between rst- and
second-person signals, moment-to-moment adaptation to changes
in the others behaviours, and maintaining self-other distinction
(Berthoz, 2004; Berthoz & Thirioux, 2010; Thirioux & Berthoz,
2011; Thirioux, 2011).
Using electrical neuroimaging (EEG)-based measurements with
non-clinical populations, we reported that heterocentered coding
in empathy is sustained by activations in the left temporo-parietal
junction (TPJ) at 520630 ms post-stimulus onset (PSO) (Thirioux
et al., 2010) and preceded by sequential activations in the mirror
neuron system (MNS) from the left insula to the right inferior fron-
tal gyrus (IFG) via the inferior parietal lobule (IPL) at 65425 ms
and co-activations in the right dorsolateral prefrontal cortex
(dlPFC) at 330425 ms (Thirioux et al., 2014). This activation of
the TPJ a key-region of the heteromodal cortex and vestibular
system integrating body-related and self-location information
(Blanke, Landis, Spinelli, & Seeck, 2004; Blanke, Ortigue, Landis, &
Seeck, 2002; Kahane, Hoffmann, Minotti, & Berthoz, 2003; Lobel,
Kleine, Bihan, Leroy-Willig, & Berthoz, 1998) and sustaining per-
spective-taking in ToM (Decety & Lamm, 2007; Schnell, Bluschke,
Konradt, & Walter, 2011) strengthens the hypothesis that
empathy is associated with visuo-spatial transformations. More-
over, this earlier recruitment of the executive functions in our data
echoed inhibitory processes and shifts from egocentered strategies
in the MNS to heterocentered strategies in given nodes of the men-
talizing network (TPJ) (Frith & Frith, 2006) (Thirioux et al., 2014). It
corroborates the view that non-egocentered simulation requires
inhibiting ones egocentered perspective (Nardini, Burgess,
Breckenridge, & Atkinson, 2006) and is dlPFC-dependent (Van der
Meer et al., 2011; Vogeley et al., 2001). In the same vein, a correla-
tion has been found between rightward biases in spatial attention
and scores to affective empathy in self-rating questionnaires
(Thakkar et al., 2009). And, Mohr et al. (2010) reported that faster
reaction times (RTs) in egocentered transformation tasks positively
correlate with high scoring self-reported trait empathy.
1.3. Heterocentered vs. egocentered referencing dissociate empathy
from sympathy
Disentangling the involvement of egocentered vs. heterocen-
tered visuo-spatial mechanisms in empathy is essential as it
further enables to dissociate empathy from sympathy or feeling
with (mit [with] fhlen; Jorland & Thirioux, 2008; Hojat et al.,
2011; Hojat, Spandorfer, Louis, & Gonnella, 2011). These intersub-
jective phenomena are most often conated in experimental
studies with non-clinical, neurological and psychiatric populations.
This is doubtless due to that empathy and sympathy are closely
related and in part converge. The feeling, common to both phe-
nomena, corresponds to the mental experience of ones physiolog-
ical and bodily states and changes (Damasio & Carvalho, 2013) that
are generated by the perception of the others current experience
and enables to access the embodied mind of others, i.e., in their
bodily and behavioural expressions (Zahavi, 2008). However,
when sympathizing (feeling with), individuals are feeling the same
thing as others are feeling (the same kind of inner state; Gelhaus,
2011) and at the same time (Olinick, 1987), tending to merge iden-
tities (Wilmer, 1968). It leads to attributing the others experience
to oneself as if individuals were the other person (Gelhaus, 2011).
This self-attribution is based upon a body-related mental imagery
and spatial transformation process in which individuals are map-
ping the others body into their own-body in a mirror-like linear
manner [Other ? Self] (Thirioux et al., 2009, 2010). Accordingly,
sympathy is associated with embodied self-location (the normal
experience that the self is located within ones bodily borders at
a specic position in space; Arzy, Thut, Mohr, Michel, & Blanke,
2006) and egocentered visuo-spatial perspective (Fig. 1A), i.e.,
without perspective-change, contrary to empathy (Berthoz &
 B. Thirioux et al. / Brain and Cognition 90 (2014) 8799 89

Fig. 1. Theoretical schemas. (A) Empathy (feeling into; left column) and sympathy (feeling with; right column) are associated with distinct self-location (disembodied vs.
embodied) and visuo-spatial mechanisms (heterocentered vs. egocentered) (see the red and blue dotted arrows). (B) Two individuals, A (in red; or Self) and B (in blue; or
Other) are facing each other. In rotation symmetry, reecting empathy (left column), A is leaning to his right when B is leaning to his right (black arrow) and vice versa (i.e.,
leftleft). In reection symmetry, reecting sympathy (right column), A is leaning to his left when B is leaning to his right (black arrow) and vice versa (i.e., rightleft)
(adapted from Thirioux et al., 2009, 2010).

Thirioux, 2010; Thirioux, 2011; Thirioux & Berthoz, 2011). In our
prior EEG studies, egocentered visuo-spatial mechanisms in sym-
pathy triggered the typical whole sequence of activations within
the MNS (Nishitani & Hari, 2000, 2002), i.e., from the insula and
superior temporal cortex, via the IPL-IFG, until the output end of
the mirroring processing in the somatosensory and motor cortices
from 65 ms to 630 ms PSO (Thirioux et al., 2010, 2014). These
data suggested that sympathy, in contrast to empathy, was not
associated with inhibitory processes and shift from ego- to
heterocentered strategies.
1.4. Visuo-spatial and empathy impairments in schizophrenia:
limitations and hypotheses
Impaired visuo-spatial abilities have been suggested to relate
with disturbances of empathy under psychotic conditions like
schizophrenia (Langdon, Coltheart, Ward, & Catts, 2001; Mohr
et al., 2010; Thakkar & Park, 2010). Disturbed cognitive functions
generating spatial representations (Franck et al., 2001; Keefe
et al., 1995; Park, Puschel, Sauter, Rentsch, & Hell, 1999), spatial
attention decits (Amado et al., 2009; Bracha, Livingston,
Clothier, Linington, & Karson, 1993; Brugger & Graves, 1997) and
bias towards the left side of space (pseudo-hemineglect;
Cavezian et al., 2007) are often observed in schizophrenic patients.
People with high schizophrenia-like traits are impaired in imagin-
ing themselves to be located in the body position of a schematic
human gure (own-body transformation tasks; Mohr, Blanke, &
Brugger, 2006), as well as ToM and visuo-spatial tasks, notably
when they are asked to imagine how locations would appear from
another perspective than their own one (Langdon & Coltheart,
1999). Conversely, improved accuracy rates in visuo-spatial
perspective-taking transformation tasks have been demonstrated
to correlate with higher scores to self-reported questionnaire sub-
scales assessing the cognitive components of empathy in schizo-
typal women and higher positive schizotypy across genders
(Thakkar & Park, 2010). Landgraf et al. (2010) further reported that
computing object-to-object relations (allocentered computation)
trigger increased RTs and errors rates in chronic patients, com-
pared to controls, whereas own-body centered judgments were
preserved. Patients were also found to have decits in shifting from
an egocentered to an allocentered perspective.
However, critical aspects regarding the alteration of empathy
and non-egocentered simulation in schizophrenia remain unknown.
First, Langdon, Coltheart, and Ward (2006) (see also Langdon, 2003,
2006; Langdon & Coltheart, 2001; Langdon et al., 2001) have put for-
ward that schizophrenics are impaired in spontaneously simulating
another individuals rst-person experience. This hypothesis is com-
patible with the patients spontaneous tendency to not disengage
from themselves as rst reference frame, as reected in increased
egocentricity biased errors and heightened egocentered simulation
(Landgraf et al., 2010). Comparably, low scores on ToM tasks have
been reported to negatively correlate with high scores to the item
lack of spontaneity (N6) of the Positive and Negative Syndrome
Scale (PANSS; Kay, Fischbein, & Opler, 1987) (Abdel-Hamid et al.,
2009), suggesting that the spontaneous features of the socio-behav-
ioural dysfunction in schizophrenia may be a consistent empirical
criterion. Furthermore, this hypothesis partially revises the assump-
tion by Frith (2004) that automatic empathy processing in everyday
interactions (on-line) is preserved, contrasting with break-downs
in explicit experimental tasks (off-line) due to the fact that
patients are not taking part in the interaction and to altered working
memory and meta-cognitive processing on which more weight is
90 B. Thirioux et al. / Brain and Cognition 90 (2014) 8799

put to perform the required explicit task. However, no study to our
knowledge has so far explored the spontaneous visuo-spatial strat-
egies associated with empathy in schizophrenia.
Second, experimental-behavioural paradigms assessing empa-
thy are somewhat rare (Bora et al., 2008; Langdon et al., 2006;
Lee et al., 2004; Montag et al., 2007). Measurements of empathy
and its associated perspective-change processes are typically based
upon self-rating questionnaires. This is a non-negligible limitation
as patients with schizophrenia generally present poor insight
(Erickson, Jaafari, & Lysaker, 2011; Lysaker, Clements, Plascak-
Hallberg, Knipscheer, & Wright, 2002; Lysaker, Hasson-Ohayon,
Kravetz, Kent, & Roe, 2013).
Third, robust behavioural data dissociating decits in empathy
from decits in sympathy with respect to altered heterocentered
vs. egocentered visuo-spatial abilities in schizophrenia are still
missing.
Considering the three above-mentioned limitations, it remains
unknown whether schizophrenics, when tested in ecologically
more valid conditions and taking actively part in self-other interac-
tions (on-line conditions), spontaneously use egocentered or het-
erocentered visuo-spatial mechanisms as respectively associated
with sympathy and empathy. Here, we employed our behavioural
paradigm newly validated with non-clinical populations
(Thirioux et al., 2009, 2010) that enables to test whether individ-
uals are spontaneously interacting with another individual by
using egocentered (sympathy) or heterocentered (empathy)
visuo-spatial mechanisms. For that, schizophrenic patients, stand-
ing and moving, interacted with a life-sized virtual tightrope-
walker, standing and moving as well. We predicted that patients
have decits in spontaneous empathy processing and associated
heterocentered visuo-spatial mechanisms and employ, instead,
egocentered strategies as in sympathy.
2. Methods
2.1. Participants
Ten patients with DSM-IV-TR schizophrenia (axis-I disorders;
French version of the Diagnostic Interview for Genetic Studies
[Numberger et al., 1994]) and ten control volunteers with neither
psychiatric nor neurological history took part in this experiment
(Table 1). Patients and controls matched for sex (all were males),
age (patients: aged 2242 years, 33.3 6.4 years; controls: aged
2242 years, 32.5 5.8 years; p = 0.771) and handedness (all were
right-handed [Oldeld, 1971]) (Table 1). All had normal or
corrected-to-normal vision.
Patients were recruited among the outpatients and inpatients
treated at the Department of Psychiatry of the Henri Laborit Hospital
(Poitiers, France). Diagnosis of DSM-IV-TR schizophrenia was
conrmed by an experienced psychiatrist (L.T.) and two further
senior psychiatrists. Patients included in the study had a diseases
duration between 6 and 19 years (mean SD years of duration,
11.8 1.5 years). Psychopathology was rated by means of the French
version (Guel, 1997) of the Positive and Negative Syndrome Scale
for schizophrenia (PANSS; Kay et al., 1987). To provide additional
information on the positive symptoms, the PANSS was completed
by the clinical dichotomic (yes/no) evaluation of the presence/
absence of Schneiders rst-rank symptoms (Farrer & Franck,
2009). Especially, symptoms 2, 3, and 1519 of the Andreasens posi-
tive symptoms evaluation scale (SAPS, [Andreasen, 1981]; French

Table 1
Patients socio-demographic, medical, clinical and psychometric data.

Age Education Chlor. Equ. Diseases Schneid. MADRS PANSS PANSS PANSS Front SPO (OBT- IRI-
(years) (mg) duration Sympt. total positive negative manner)% PT
All patients
P1 28 12 133 6 pres. 13 98 18 39 85.6 15
P2 27 11 1300 7 pres. 10 116 35 26 95.5 20
P3 22 12 200 9 pres. 11 120 15 38 2.2 10
P4 37 12 30 8 abs. 13 93 18 35 0 14
P5 32 11 1533 15 pres. 13 97 36 23 100 9
P6 42 11 520 19 abs. 13 108 20 35 4.5 11
P7 35 15 900 19 abs. 8 70 18 19 97.4 18
P8 41 13 1700 15 abs. 10 96 17 36 0 8
P9 32 10 260 11 pres. 22 118 18 41 0 12
P10 37 11 68 9 abs. 8 88 21 30 94.4 18
mean 33.3 11.8 664.4 11.8 12.1 100.4 21.6 32.2 25 13.5
se 6.4 0.4 203.5 1.5 1.3 4.9 2.4 2.3 15.8 1.3
SCZ-H
P1 28 12 133 6 pres. 13 98 18 39 85.6 15
P2 27 11 1300 7 pres. 10 116 35 26 95.5 20
P5 32 11 1533 15 pres. 13 97 36 23 100 9
P7 35 15 900 19 abs. 8 70 18 19 97.4 18
P10 37 11 68 9 abs. 8 88 21 30 94.4 18
mean 31.8 12 768.8 11.2 10.4 93.8 25.6 27.4 94.7 16
se 2.0 0.8 298 2.5 1.1 7.5 4.0 3.4 2.5 2.0
SCZ-E
P3 22 12 200 9 pres. 11 120 15 38 2.2 10
P4 37 12 30 8 abs. 13 93 18 35 0 14
P6 42 11 520 19 abs. 13 108 20 35 4.5 11
P8 41 13 1700 15 abs. 10 96 17 36 0 8
P9 32 10 260 11 pres. 22 118 18 41 0 12
mean 34.8 11.6 542 12.4 13.8 107 17.6 37 1.34 11
se 3.7 0.5 300 2.0 2.1 5.5 0.8 1.1 0.3 1.0

Socio-demographic (age, education), medical (duration of the disease, daily dosage of chlorpromazine equivalent [Chlr. Equ.]), clinical (presence/absence of Schneiders rst-
rank symptoms [Schneid. Sympt.]), and psychometric (MADRS, total PANSS, positive and negative dimensions on PANSS) data are shown for each patient. Data are rst
presented for all ten patients irrespective of their distribution into groups and, then, for each group (SCZ-H and SCZ-E) separately (mean values and standard errors are
indicated in bold). We further show the percentages of tilts in OBT-manner for the front SPO-task and scores on the IRI Perspective-Taking subscale (IRI-PT) as these differed
between the two groups of patients (for more details, see also Tables 2 and 3).
 B. Thirioux et al. / Brain and Cognition 90 (2014) 8799
version [Guel, 1997]) were evaluated. At the time of the clinical
examination, ve patients were assessed with positive symptoms
(P1, P2, P3, P5, and P9). Depressive symptoms were evaluated by
the Depression Rating Scale (MADRS; Montgomery & Asberg,
1979). All tested patients were treated with stable doses of atypical
antipsychotics (chlorpromazine equivalent; CPZ; Woods, 2003) and
stabilized since at least three months (Table 1). Patients with con-
current axis-1 disorders according to DSM-IV-TR criteria, a diseases
duration superior to 20 years, a stable regime of benzodiazepines
and/or mood stabilizers at the time of the behavioural testing, an
acute depressive symptomatology, anxiety disorders, sensorimotor,
language production and/or comprehension or other neurological
disorders as well as substance-abuse or dependence were systemat-
ically excluded from participation. We here note that, except one
patient [P9], all patients obtained low scores on MADRS. We
included P9 in the study as the clinical examination showed a stable
mood symptomatology.
Patients and controls were naive to the purpose of the experi-
ment and gave written informed consent. The study protocol has
been approved by the local ethics research committee of the Henri
Laborit Hospital and performed in accordance with the ethical
standards laid down in the Declaration of Helsinki.
2.2. Experimental setup and procedures
The paradigm (2.2.1), stimuli (2.2.2) and tasks (2.2.3) that we
employed enable to test participants in ecologically more valid
conditions, approximating daily-life and on-line conditions. For
that, we controlled three key phenomenological aspects of interin-
dividual relationships: interactive, naturalistic and spontaneous
(for more details, see Thirioux et al., 2009).
2.2.1. Paradigm
Focusing on the visuo-spatial features of empathy and sympa-
thy, our behavioural paradigm measures from the bodily postures
and movements whether individuals, without explicit instruction,
are interacting with another individual by using an egocentered
as in sympathy or heterocentered as in empathy reference
frame (Fig. 1A).
If two individuals A (Self) and B (Other) are facing each other
and B is leaning to his/her right, A can copy Bs tilts by leaning
either to his/her left or right. In the rst case, A reacts by mirroring
Bs tilts. This reection symmetry indicates that A, imagining his/
her own-body at its actual physical position (embodied self-loca-
tion) and keeping his/her own visuo-spatial perspective (egocen-
tered), is further imagining that Bs tilts are his/her own-body
movements as reected in the mirror. This mapping of Bs bodily
movements into As own-body and egocentered transformation
tend to merge identities between A and B, leading to movements
self-attribution. Accordingly, reection symmetry reects that A
is sympathizing with B (or feeling with B, i.e., the same kind of
action-related inner state and at the same time) (Fig. 1A right
column).
In contrast, the second case or rotation symmetry indicates
that A is imagining himself/herself at Bs body position (disembod-
ied self-location) and adopting Bs visuo-spatial perspective (het-
erocentered) by performing a mental transformation of his/her
own-body. Accordingly, rotation symmetry reects that A is empa-
thizing with B (or feeling into B, i.e., with the awareness of being
outside B and having to reach her/him while maintaining self-other
distinction) (for more details, see Thirioux et al., 2009, 2010, 2014)
(Fig. 1A left column).
2.2.2. Stimulus and apparatus
Short colour movies of a computer-generated female tightrope
walker were presented using E-Prime Software (Psychology
91
Software) (images per movie, 37; refresh rate, 100 Hz; movie dura-
tion, 1480 ms). The tightrope walker was designed by using AnyFlo
System (Bret, 1988) which generates virtual avatars with a neural
network model taking into account the rules of natural movements
and biomechanical constraints of the body (2/3 power law;
Berthoz, 1997; Viviani & Flash, 1995; Viviani & Terzuolo, 1982).
To reinforce the ecological aspects of the experiment, the animated
tightrope walker was further displayed life-sized onto a large
screen (2 m  2 m) [naturalistic features]. The tightrope walker
was shown standing on a rope with the arms horizontally out-
stretched either in front- or back-facing orientation. In each orien-
tation, she performed lateral body tilts either to her left or right.
Thus, four movies were presented (front-left; front-right; back-
left; back-right). In each movie, the onset of the tightrope walkers
tilt was delayed with respect to the stimulus onset by 50 ms. A trial
contained one movie and was initiated after a variable interstimu-
lus interval (randomly chosen between 500 ms and 2000 ms;
mean, 1500 ms).
Patients and controls stood in front of the screen at a viewing
distance of 2 m. To mimic everyday social encounters and
strengthen interaction, giving participants the impression to act
in the same spatial environment as the tightrope walker, partici-
pants further stood on a red line (3 m  10 cm; length  width)
which prolonged on the ground the avatars rope on the screen.
Moreover, before the movies started, we instructed participants
to stand in the so-called Romberg position (Romberg, 1846) with
one foot in front of the other on the red line, i.e., in a standing posi-
tion approximating the unbalanced position as the tightrope
walker, because most social interactions occur in the same body
position (Bavelas, Black, Chovil, Lemery, & Mullett, 1988; Bavelas,
Black, Lemery, & Mullet, 1987; Parsons, 1987; Reed &
McGoldrick, 2007) [interactive features]. Participants were further
asked to choose the most comfortable position (i.e., either with the
right or left foot in front of the other). Ten patients and seven
controls chose standing with their right foot in front of the left.
Participants held a metal bar (length, 65 cm) horizontally in front
of them and placed their thumbs on two buttons that were posi-
tioned at the left and right ends of the bar. These buttons were
used to record the tilt direction (left or right) and reaction times
(RTs) (Fig. 2).
2.2.3. Tasks
2.2.3.1. Spontaneous task. To test whether patients with schizo-
phrenia spontaneously use egocentered (as in sympathy) or het-
erocentered (as in empathy) visuo-spatial mechanisms to interact
with the avatar, we only instructed them to observe the tilts of
the tightrope walker and to lean when she was leaning. The exact
instruction was you will see a tightrope walker leaning on a rope.
Please lean when she is leaning. No instruction with respect to
direction of leaning, self-location or visuo-spatial perspective was
given. This spontaneous task (SPO-task) that allows participants
to use their own transformation and visuo-spatial strategies, com-
parable to strategies as used in daily life (spontaneous features),
was always delivered rst.
2.2.3.2. Explicit tasks. To investigate whether the spontaneous
visuo-spatial transformations in self-other interaction are relying
on the same behavioural mechanisms as explicit egocentered (as
in sympathy) or heterocentered (as in empathy) visuo-spatial
transformations, patients in the second and third experimental
conditions were explicitly instructed to perform two distinct self-
location and visuo-spatial tasks while leaning.
The Mirroring task [MIR-task] (Arzy et al., 2006) tested for
embodied self-location and egocentered visuo-spatial strategies
in sympathy. The exact instruction was you will see a tightrope
walker leaning on a rope. Please, lean when she is leaning while
92 B. Thirioux et al. / Brain and Cognition 90 (2014) 8799
Fig. 2. Experimental settings and stimuli. (A) Patients and healthy volunteers were facing a large screen and standing in the Romberg position on a line on the ground. They
were holding a metal bar with response-buttons positioned at the left and right ends of the bar, horizontally in front of them. (B) Movie samples as used in the three tasks. A
virtual female tightrope walker, performing whole-body tilts either to the left (L) or right (R) from different orientations (front or back-facing), was shown on the computer
screen and displayed life-sized.
imagining that your body is at its actual physical position and
while keeping your own visuo-spatial perspective. Please, further
imagine that the tightrope walkers tilts are your own-body move-
ments as reected in a mirror. In both front and back orientations,
we expected a contralateral leaning pattern (i.e., left/right tilt of
the tightrope walker ? right/left tilt of participants).
The Own-Body Transformation task [OBT-task] (Blanke et al.,
2005) tested for disembodied self-location and heterocentered
visuo-spatial strategies in empathy. The exact instruction was
you will see a tightrope walker leaning on a rope. Please, lean
when she is leaning while imagining that your body is in the posi-
tion of the tightrope walkers body and while adopting her visuo-
spatial perspective. An ipsilateral leaning pattern was expected
in both front and back orientations (i.e., left/right tilt of the tight-
rope walker ? left/right tilt of participants).
The order of the MIR- and OBT-tasks was counterbalanced. In all
tasks, participants were instructed to initiate their tilt with the
same speed as the avatars tilt and to press with their thumb the
left or right button of the bar corresponding to the direction of
their tilt when they judged that their tilt had arrived at its maximal
amplitude. In a training session, before the experiment, partici-
pants were instructed to lean to the left and right and to press
the corresponding button at the same time. Before task perfor-
mance and after the SPO-task, the MIR- and OBT-tasks were
trained in 90 trials. In each MIR- and OBT-task, participants were
instructed to perform the requested visuo-spatial transformation
while leaning and before giving the response. Each condition con-
tained three blocks. Within a block, in a random order, each of the
four movies appeared 15 times, giving rise to 60 trials per block
and 180 trials per condition.
2.2.4. Interpersonal Reactive Index
After the recording, all participants completed the French ver-
sion of the Interpersonal Reactive Index (IRI; Davis, 1983), a four
7-items subscales self-report assessing empathic abilities. The
Perspective-Taking (PT) and Fantasy scales (FS) respectively
measuring the ability to adopt the viewpoint of others in daily-life
situations and the tendency to put oneself into the experience of
ctional characters evaluate the cognitive components of empa-
thy (Cognitive Empathy [IRI-CE]). The Empathic Concern (EC)
and Personal Distress (PD) scales respectively assessing the
capacity for concerned and compassionate feelings for others and
the occurrence of self-oriented responses to the negative experi-
ences of others evaluate the emotional component of empathy
(Emotional Empathy; [IRI-EE]).
2.3. Data acquisition and analysis
2.3.1. Behavioural data
For each trial, E-Prime recorded the tilt direction (left or right as
indicated by button presses) and the reaction time. For each com-
bination of task (SPO, OBT, MIR) and orientation (front, back), we
computed the percentage of tilts according to reection symmetry
(tilts in MIR-manner) and rotation symmetry (tilts in OBT-man-
ner). For the MIR- and OBT-tasks, we computed mean RTs for
responses in reection and rotation symmetry, respectively. For
the SPO-task, we calculated the mean RTs for tilts in OBT- or
MIR-manner (same as in Thirioux et al., 2010).
To test for statistical differences between controls and patients,
we rst computed an unpaired 3  2  2 repeated-measures
ANOVA on the percentage of tilts in OBT-manner with the factor
task (SPO, OBT, MIR), orientation (front, back), and group (controls,
schizophrenics). The direction of tilts allowed us analysing
whether tilts in the SPO-task were similar to those of OBT- or
MIR-task (same as in Thirioux et al., 2010). For response speed,
we calculated an unpaired 3  2  2 ANOVA on the RTs with task,
orientation and group as factors.
Concerning leaning performance, we found a signicant
task  orientation  group interaction attributable to different
behavioural patterns of half patients in the front SPO-task, differ-
ing from the remaining ve patients and controls (see
Section 3.1). Accordingly, we split the patients group into two
sub-groups. We calculated 3  2 repeated-measures ANOVAs
(with task and orientation as factors) for each group on tilts per-
formance and RTs, separately. To test for statistical comparisons
between groups, we further computed two-tailed unpaired
t-tests.
2.3.2. Socio-demographic, medical, clinical, psychometric and IRI data
To compare the IRI scores between controls and patients as well
as socio-demographic (age, education), medical (daily dosage of
chlorpromazine equivalent), clinical (duration of the disease, pres-
ence/absence of Schneiders rst-rank symptoms), and psychomet-
ric (MADRS, total PANSS, negative and positive dimension on
PANSS, IRI) data between patients in both groups, we calculated
two-tailed unpaired t-tests.
Patients in the second group were found to exhibit higher
scores to the negative PANSS than patients in the rst group (see
Section 3.2.2). Thus, to test whether the alteration of spontaneous
empathy processing relates or not with the severity of the negative
symptomatology, we nally performed a Spearman Rank-Order
Correlation analysis in all tested patients (N = 10) on the negative
 B. Thirioux et al. / Brain and Cognition 90 (2014) 8799 93

PANSS scores and percentages of tilts in OBT-manner in the front
SPO-task (see Section 3.2.3).
3. Results
3.1. Behavioural results
We rst statistically tested for differences in leaning patterns
between controls and patients. Statistical analyses on tilts percent-
ages showed a signicant effect of task (F(2,36) = 367.8; p < 0.001)
and orientation (F(1.18) = 7.123; p = 0.006) as well as signicant
task  group (F(2,36) = 7.331; p = 0.002), orientation  group
(F(1,18) = 6.049; p = 0.024), task  orientation (F(2,36) = 9.159;
p = 0.001) and task  orientation  group (F(2,36)=9.296; p = 0.001)
interactions. The distribution of tilts percentages indicated that
the task  orientation  group interaction was due to heteroge-
neous behavioural patterns (rotation vs. reection symmetry) in
the front SPO-task between patients. Accordingly, we split the
patients group into two sub-groups. The rst group included P3,
P4, P6, P8 and P9, and the second group included P1, P2, P5, P7
and P10 (see Section 3.1.2).
Concerning RTs, there were a signicant effect of orientation
(F(1,18) = 12.29; p = 0.003) and signicant task  group
(F(2,36) = 9.208; p = 0.001) and task  orientation (F(2,36) = 19.06;
p < 0.001) interactions.
3.1.1. Control group
Controls performed correctly for MIR- and OBT-tasks, leaning
respectively in reection (97.8 1.0%; mean SD) and rotation
(98.3 0.8%) symmetry. The tilt performance in the SPO-task
followed closely the tilt performance in the OBT-task but differed
from that in the MIR-task, i.e., all ten participants leaned in OBT-
manner in almost all trials (94.9 2.7%) (Table 2; Fig. 3). This
was conrmed by statistical analyses, showing a signicant effect
of task (F(2,18) = 1878; p < 0.001), attributable to a signicant differ-
ence between the OBT- and MIR-tasks (p < 0.001) and SPO- and
MIR-tasks (p < 0.001) (post hoc tests; pairwise comparison; least
signicant difference [LSD]). In contrast, the SPO- and OBT-tasks
did not signicantly differ (p = 0.059). This leaning pattern indi-
cated that controls have spontaneously used a heterocentered
visuo-spatial referencing to interact with the avatar. Concerning
RTs, statistical analyses indicated a signicant effect of orientation
(F(1,9) = 6.345; p = 0.033), a signicant task  orientation interac-
tion (F(1,9) = 7.123; p = 0.005) and a trend for the factor task
(F(2,18) = 3.155; p = 0.067). RTs were faster for the back than front
orientation in the OBT- (p = 0.020) and SPO-tasks (p = 0.001). The
inverse pattern was found for the MIR-task, although this effect
failed to be signicant (Table 2; Fig. 3).
3.1.2. Schizophrenic patients
The rst group of patients behaved as controls and performed
tilts in OBT-manner in the SPO-task (94.9 1.8%), indicating that
they spontaneously used a heterocentered coding (SCZ-H; N = 5).
Patients further leaned correctly in reection and rotation symme-
try in the MIR-task (95.2 2.4%) and OBT-task (94.7 4.7%), respec-
tively (Table 2; Fig. 4). Statistical analyses showed a signicant
effect of task (F(2,8) = 320.4; p < 0.001) that was due to a signicant
difference between the OBT- and MIR-tasks (p < 0.001) and
SPO- and MIR-tasks (p < 0.001). The SPO- and OBT-tasks did not dif-
fer (p = 0.942). Statistical analyses on RTs showed a signicant

Table 2
Tilts performance and reaction times.

MIR-task OBT-task SPO-task

Back Front Back Front Back Front
% MIR RTs (ms) % MIR RTs (ms) % OBT RTs (ms) % OBT RTs (ms) % OBT RTs (ms) % OBT RTs (ms)
Controls
C1 100 685 100 666 100 634 90 729 97.8 738 88.9 793
C2 100 749 97.7 596 96.7 698 96.7 847 100 664 97.8 761
C3 100 816 98.8 835 100 825 100 859 100 1145 98.8 1139
C4 98.9 927 98.9 885 100 831 100 856 100 892 94.4 915
C5 94.4 639 87.8 683 98.9 538 94.4 711 64.4 559 98.8 598
C6 96.7 658 96.7 655 98.9 614 100 699 98.9 613 94.4 664
C7 97.8 680 98.9 664 97.8 712 95.6 735 96.7 963 82.2 986
C8 92.2 687 98.9 672 98.9 597 98.9 633 100 622 97.8 705
C9 100 777 100 662 100 780 98.9 767 98.9 796 93.3 834
C10 98.9 900 98.9 915 100 922 100 899 96.7 934 100 969
mean 97.9 752 97.7 723 99.1 715 97.4 773 95.3 793 94.6 836
se 0.9 32 1.1 35 0.4 39 1.0 27 3.5 59 1.7 53
SCZ-H
P1 81.1 1102 91.1 1125 97.7 1042 92.2 1155 93.3 1120 85.6 1270
P2 96.7 1266 91.1 1206 65.5 1198 97.7 1332 91.1 980 95.5 1189
P5 100 1015 98.8 899 98.9 834 100 930 100 708 100 854
P7 98.8 664 96.7 674 97.8 579 100 616 98.8 694 97.4 755
P10 97.8 1135 100 1095 98.8 736 98.8 892 93.3 725 94.4 856
mean 94.9 1036 95.5 1000 91.7 878 97.7 985 95.3 845 94.6 985
se 3.5 101 1.9 96 6.6 110 1.4 122 1.7 87 2.4 102
SCZ-E
P3 60 1279 84.4 1260 97.8 1180 94.4 1169 96.7 970 97.8 955
P4 93.3 877 99 836 100 826 100 869 99 719 100 696
P6 87.3 778 88.9 765 96.6 630 95.5 717 100 519 95.5 497
P8 96.6 998 98.9 945 98.8 1140 85.5 1265 100 784 100 794
P9 98.8 902 100 830 98.8 747 98.8 779 100 743 100 715
mean 87.2 967 94.2 927 98.4 905 94.8 960 99.1 747 98.7 731
se 7.1 86 3.2 88 0.6 109 2.6 109 0.6 72 0.9 74

Percentages of tilts (in MIR-manner for the MIR-task, in OBT-manner for the OBT-task and in OBT- or MIR-manner in the SPO-task) and corresponding reaction times are
shown for each control (C) and patient (P) in each group (SCZ-H and SCZ-E) and for each spatial orientation (back and front). Mean values are also indicated for each task and
orientation (in bold).
94 B. Thirioux et al. / Brain and Cognition 90 (2014) 8799

Fig. 3. Leaning performance and reaction times Control Group. (A) Tilt performance. Results show that healthy volunteers in the SPO-task behaved as in the OBT-task: they
performed tilts in OBT-manner, independently from the stimulus orientation. (B) Reaction times. In general, RTs tended to be longer in the spontaneous (SPO) than explicit
(OBT/MIR) tasks. Moreover, response latencies increased from back to front orientation in the SPO- and OBT-tasks, i.e., when the rotation angle between the participants body
and the avatars body increased. There was no statistical difference between the back and front orientation in the MIR-task.

Fig. 4. Patients leaning performance and reaction times. Tilt performance (left column). (A) Five patients (SCZ-H) behaved as controls: they performed correctly for the OBT-
and MIR-tasks and leaned in OBT-manner for the SPO-task in both front and back orientations. (B) The remaining ve patients (SCZ-E) performed tilts in MIR-manner in the
front SPO-task, differing from controls and the rst group of patients. In contrast, they behaved correctly for the OBT- and MIR-tasks in both orientations and leaned in OBT-
manner for the back SPO-task as controls and SCZ-H. Reaction times (right column). (C) Patients with preserved spontaneous heterocentered processing performed slower in
the front than back orientation for the SPO/OBT-tasks. RTs did not distinguish between the front and back orientations in the MIR-task. (D) Patients with decits in
spontaneous heterocentered processing performed faster in the front than back MIR-task. There was no statistical difference between the front and back orientations in the
SPO- and OBT-tasks.

effect of orientation (F(1,4)=29.47; p = 0.006) and a signicant (p = 0.006) and SPO-task (p = 0.004). RTs were slower in the back
task  orientation interaction (F(2,8)=15.96; p = 0.002). Patients than front MIR-task, although this effect was not signicant
performed faster in the back than front orientation for the OBT-task (Table 2; Fig. 4).
 B. Thirioux et al. / Brain and Cognition 90 (2014) 8799 95

Patients in the second group performed tilts in MIR-manner for Table 3

the front SPO-task (98.7 0.9%) indicating that they spontaneously Scores on the Interpersonal Reactive Index.

used an egocentered coding (SCZ-E; N = 5) and distinguishing from IRI-FS IRI-PT IRI-CE total IRI-EC IRI-PD IRI-EE total IRI-TOTAL
controls and the rst group of patients (Table 2; Fig. 4). In contrast, (FS + PT) (EC + PD) (CE + EE)
patients in SCZ-E leaned in OBT-manner for the back SPO-task and Controls
performed correctly for the MIR-task (tilts in reection symmetry: C1 10 22 32 21 3 24 56
90.8 5.4%) and OBT-task (tilts in rotation symmetry: 96.6 1.9%), C2 13 18 31 15 4 19 50
C3 11 10 21 13 14 27 48
as controls and patients in SCZ-H. Statistical analyses showed a sig- C4 15 24 39 20 10 30 69
nicant effect of task (F(2,8) = 194.6; p < 0.001) due to a signicant C5 23 15 38 22 20 42 80
difference between the OBT- and MIR-tasks (p < 0.001) and OBT- C6 12 13 25 16 4 20 45
and SPO-tasks (p < 0.001). There was a signicant effect of orienta- C7 20 21 41 17 19 36 77
C8 8 20 28 25 6 31 59
tion (F(1,4) = 483.1; p < 0.001) and a signicant task  orientation
C9 5 8 13 17 10 27 40
interaction (F(1,4)=307.9; p < 0.001) attributable to a signicant dif- C10 4 20 24 14 2 16 40
ference between the back and front SPO-task (p < 0.001), compared mean 12.1 17.1 29.2 18 9.2 27.2 56.4
to the back and front MIR-task (p = 0.115) and OBT-task (p = 0.096). se 1.9 1.7 2.8 1.2 2.1 2.5 4.6
Concerning RTs, statistical analyses showed a signicant effect of All patients
task (F(2,8) = 8.889; p < 0.009) due to faster RTs in the SPO-task than P1 16 15 31 19 20 39 70
MIR-task (p = 0.003) and OBT-task (p = 0.036). There was a signi- P2 27 20 47 23 18 41 88
P3 10 10 20 20 21 41 61
cant task  orientation interaction (F(1,4) = 11.15; p < 0.001). Post
P4 17 14 31 19 20 39 70
hoc tests showed that RTs were signicantly longer in the back P5 19 9 28 11 16 27 55
than front orientation in the MIR-task (p = 0.002) but did not differ P6 13 11 24 27 12 39 63
between orientations in the OBT-task (p = 0.078) and SPO-task P7 12 18 30 21 13 34 64
P8 4 8 12 8 15 23 35
(p = 0.080), contrasting with the RTs patterns in controls and
P9 5 12 17 15 16 31 48
SCZ-H (Table 2; Fig. 4). P10 19 18 37 19 20 39 76
mean 14.2 13.5 27.7 18.2 17.1 35.3 63
3.1.3. Statistical comparisons between groups se 2.2 1.3 3.2 1.8 1.0 2.0 4.7
Statistical comparisons indicated that the tilt performance did SCZ-H
not signicantly differ for the MIR- and OBT-tasks and the back P1 16 15 31 19 20 39 70
SPO-task between groups (all p > 0.050). In contrast, for the front P2 27 20 47 23 18 41 88
P5 19 9 28 11 16 27 55
SPO-task, there was a signicant difference between controls and
P7 12 18 30 21 13 34 64
SCZ-E (p < 0.001) and between the two groups of patients P10 19 18 37 19 20 39 76
(p < 0.001). Controls and SCZ-H did not signicantly differ mean 18.6 16 34.6 18.6 17.4 36 70.6
(p > 0.050). se 2.5 1.9 3.4 2.0 1.3 2.5 5.6
RTs in the MIR-task were faster in controls than patients leaning SCZ-E
in OBT-manner in the front SPO-task (SCZ-H) (back: p = 0.004; P3 10 10 20 20 21 41 61
P4 17 14 31 19 20 39 70
front: p = 0.005) and patients leaning in MIR-manner in the same
P6 13 11 24 27 12 39 63
task (SCZ-E) (back: p = 0.012; front: p = 0.022). There was no differ- P8 4 8 12 8 15 23 35
ence between patients (back: p = 0.614; front: p = 0.592). Controls P9 5 12 17 15 16 31 48
performed signicantly faster in the front OBT-task than both mean 9.8 11 20.8 17.8 16.8 34.6 55.4
patients groups (SCZ-H [p = 0.0038]); SCZ-E [p = 0.045]). Patients se 2.4 1.0 3.2 3.1 1.7 3.4 6.2

did not differ (p = 0.881). There was no statistical difference
between groups for the back OBT-task as well as front and back
SPO-task (all p > 0.050).
3.2. Socio-demographic, clinical and psychometric data
3.2.1. IRI data
There was no statistical difference on the total-IRI between
groups (all p > 0.050).
Concerning the cognitive component of empathy (IRI-CE),
scores were signicantly lower in patients leaning in MIR-manner
in the front SPO-task (SCZ-E) than patients leaning in OBT-manner
in the same task (SCZ-H) (p = 0.019). These scores tended to be
higher in controls than SCZ-E (p = 0.089) but did not differ between
controls and SCZ-H (p = 0.266). Scores on IRI-FS were higher in
SCZ-H than SCZ-E (p = 0.035) and tended to be higher in SCZ-H
than controls (p = 0.067). Controls and SCZ-E did not differ
(p = 0.477). Concerning the IRI-PT, there was no difference between
controls and SCZ-H (p = 0.617). In contrast, scores were lower in
SCZ-E than SCZ-H (p = 0.049) and controls (p = 0.032) (Table 3).
Regarding the emotional component of empathy (IRI-EE), scores
were signicantly higher in patients leaning in OBT-manner in the
front SPO-task than controls (p = 0.022) whereas they did not differ
between controls and patients leaning in MIR-manner (p = 0.109).
There was no difference between patients groups (p = 0.748).
Groups did not differ in the IRI-EC scores (all p > 0.050). In contrast,
Total scores on the Interpersonal Reactive Index (IRI-Total), scores on the cognitive
(CE) and emotional (EE) empathy, each CE subscale (Fantasy subscale [FS]; Per-
spective-Taking [PT]) and EE subscale (Empathic Concern [EC] and Personal Distress
(PD]) are shown for each control (C) and patient (P) of each group (SCZ-H and SCZ-
E). Mean values for all controls and each patients group are also indicated (in bold).
controls had signicantly lower IRI-PD scores than SCZ-H
(p = 0.005) and SCZ-E (p = 0.014). Patients did not differ (Table 3).
3.2.2. Patients socio-demographic, medical, clinical and psychometric
data
Socio-demographic (age, and education), medical (daily doses of
chlorpromazine equivalent) and clinical (duration of the disease
and presence/absence of Schneiders rst-rank symptoms) vari-
ables did not statistically differ between groups (all p < 0.050).
Concerning psychometric data, patients had similar scores on
MADRS and total PANSS (all p < 0.050). However, scores on the
negative PANSS were higher in patients performing tilts in MIR-
manner for the front SPO-task (SCZ-E) than patients performing
tilts in OBT-manner in the same task (SCZ-H) (p = 0.028). In con-
trast, scores on the positive PANSS tended to be higher in the latter
than the former (p = 0.091) (Table 1).
3.2.3. Spearman Rank-Order correlation analysis
The percentages of tilts in OBT-manner for the front SPO-task
for all tested patients (N = 10) negatively correlated with the scores
96 B. Thirioux et al. / Brain and Cognition 90 (2014) 8799
on the negative PANSS (rs = 0.837; p = 0.003), i.e., the lower the
percentages of tilts in OBT-manner for the front SPO-task, the
higher the negative PANSS scores.
4. Discussion
In the present pilot-study, we investigated the egocentered and
heterocentered visuo-spatial mechanisms respectively associated
with sympathy and empathy in schizophrenia. We predicted that
patients have decits in spontaneously using heterocentered
visuo-spatial mechanisms and employ preferentially an egocen-
tered referencing to interact with a life-sized avatar. This working
hypothesis was partially veried. Our main ndings, although still
preliminary and needing to be further conrmed on a much larger
sample of patients, suggest that the severity of the negative symp-
toms in schizophrenia relates with disturbances of spontaneous
heterocentered and empathic processing. These decits were
associated with lower scores to self-reported questionnaire sub-
scales assessing the cognitive components of empathy, namely
perspective-taking. We discuss these data with respect to the
relation between impairments in heterocentered referencing,
empathic abilities and self-regulatory processing in patients with
a prevailing negative symptomatology.
4.1. Distinct spontaneous visuo-spatial referencing in patients with
schizophrenia during self-other interaction
Analyses of leaning performance showed that patients distin-
guished into two sub-groups because of inverse behavioural
responses in the front spontaneous (SPO) task. Half patients
(N = 5; SCZ-H) behaved as controls. That is, spontaneous visuo-
spatial transformations in response to the avatars body tilts
triggered indistinguishable behavioural patterns as explicit
heterocentered (OBT-task) visuo-spatial transformation. On the
contrary, the remaining ve patients (SCZ-E) had decits in
spontaneously using heterocentered visuo-spatial mechanisms.
They behaved in the front SPO-task as in the front MIR-task, i.e.,
spontaneously employed egocentered visuo-spatial transforma-
tions. Scores on PANSS (Kay et al., 1987) indicated that patients
with such decits exhibited higher negative symptoms. In contrast,
the symptomatology was heterogeneous in patients with preserved
spontaneous heterocentered referencing as they suffered from
prevailing positive (N = 2), negative (N = 2) or mixed (N = 1)
symptoms. Spearman correlation analysis further showed that
the percentages of tilts in OBT-manner in the front SPO-task nega-
tively correlated with the negative PANSS scores.
This similarity between the SPO- and OBT-tasks replicates our
prior studies with non-clinical populations (Thirioux et al., 2009,
2010). In both tasks, tilts were performed in rotation symmetry
and RTs were faster for the back than front orientation. This typical
increase of response speed supports earlier observations that
visuo-spatial and body-related mental transformations are
cognitively more demanding with respect to front-facing stimuli
requiring a mental rotation by 180 of ones own-body to align
it with the target stimuluss body than back-facing stimuli
yielding a linear mental projection of the body without egocen-
tered transformation (Arzy et al., 2006; Blanke et al., 2005;
Easton, Blanke, & Mohr, 2009; Mohr et al., 2006; Parsons, 1987;
Thirioux et al., 2010; Zacks, Rypma, Gabrieli, Tversky, & Glover,
1999). These behavioural patterns rst suggest that explicit het-
erocentered referencing was presumably not altered in the rst
group of patients and, second, that these patients, as controls, have
spontaneously empathized with the avatar.
In the front and back MIR-task, patients, again as controls,
performed correctly body tilts in reection symmetry and were
somewhat faster in the front than back orientation. However, this
effect failed to be signicant. In accordance with previous studies
on self-location (Arzy et al., 2006; Easton et al., 2009; Mohr
et al., 2006; Thirioux et al., 2010), the back MIR-task is the most
complicated of all tested mental own-body transformation tasks
as it requires to computing a mental translation of ones own-body
by 180 while imagining that the stimuluss back is one own-back
as seen in the mirror. This absence of effect conforms to our prior
study, reporting that spontaneous heterocentered preference is
associated with relative difculties in correctly performing the
back MIR-task (Thirioux et al., 2010). The present data suggest that
participants may have automatized the task, i.e., leaned correctly
but without performing the requested mental own-body
transformation.
4.2. Altered spontaneous heterocentered processing in schizophrenia is
partly independent from decits in executive control
Similar leaning patterns for the front SPO- and MIR-tasks in the
second group of patients (SCZ-E) reected that these patients have
spontaneously kept their egocentered visuo-spatial perspective
and sympathized with the avatar. They further performed signi-
cantly slower in the back than front MIR-task i.e., as expected
for embodied mental transformation (Arzy et al., 2006) differing
from the remaining patients and controls. Moreover, RTs did not
increase from back to front orientation in the OBT-task. Hence,
the patients inability to spontaneously give up an egocentered ref-
erencing in the front SPO-task was associated with difculties to
correctly perform explicit heterocentered visuo-spatial tasks but
enhanced facilities to explicitly keep an egocentered framework,
as reected in the OBT- (back = front) and MIR-task (back > front)
RTs patterns. Taken together, our data are in line with previous
work showing that schizophrenics suffer from disrupted visuo-
spatial information processing (Keefe et al., 1995; Landgraf,
Amado, Bourdel, Leonardi, & Krebs, 2008; Park & Holzman, 1992)
and allocentric simulation (Langdon & Coltheart, 2001). Second,
our results reinforce the hypothesis of spontaneous heterocentered
perspective-taking and simulation decits in schizophrenia
(Langdon et al., 2006). We suggest that heterocentered visuo-spa-
tial and associated empathic abilities may be altered in on-line
(SPO) conditions (second group) but preserved in explicit (off-line)
experimental tasks (OBT) (rst group) in schizophrenics. This par-
tially modulates, thus, the automatic empathy-related hypothesis
by Frith (2004; see also McCabe, Leudar, & Antaki, 2004).
Patients were faster in the spontaneous than explicit tasks
whereas controls presented the inverse response speed pattern
(SPO > OBT/MIR). Concordant with our prior work (Thirioux et al.,
2010), this suggests that explicit instructions in non-clinical popu-
lations, probably involving motor preparation, have contributed to
reducing the time needed to react. We cannot rule out that these
increased RTs for the explicit tasks echoed executive control and
planning disorders in patients. However, such disturbances cannot
fully explain the observed decits. The fact that heterocentered
visuo-spatial functions were altered in both spontaneous and
explicit tasks reinforces the hypothesis that impaired heterocen-
tered simulation may be partly independent from disturbances of
executive and more general cognitive functions.
4.3. Disturbances of spontaneous empathic processing relate with the
severity of the negative symptoms
Our results further suggest that impaired spontaneous
heterocentered visuo-spatial functions relate with the severity of
the negative symptoms. The patients difculties in inhibiting their
egocentered perspective and disengaging from themselves are
compatible with the negative PANSS items measuring social
 B. Thirioux et al. / Brain and Cognition 90 (2014) 8799
withdrawal and restriction in social interaction. Moreover, decits
in spontaneous heterocentered visuo-spatial strategies (SPO-task)
predicted disturbances in explicit heterocentered visuo-spatial
tasks (OBT-task). The relation between decits in social cognition,
disturbances in visuo-spatial functions and symptomatology
(positive vs. negative) has not been entirely cleared up yet
(Abdel-Hamid et al., 2009; Montag et al., 2007; Sergi et al.,
2007). Published data are still misleading, depending on tasks
and experimental designs. However, prior behavioural studies
have shown that patients with negative symptoms are more
impaired in recognizing emotions from facial expressions and in
more general social abilities, compared to patients with positive
symptoms (Brne, 2005a; Mueser et al., 1996; Penn, Spaulding,
Reed, & Sullivan, 1996). Preeminent negative symptomatology
has been also reported to relate with acuter impairments in ToM
performance, specically when the patients symptomatology is
similar to that of autism (Brne, 2005b; Langdon et al., 1997). This
would be due to that patients with negative features are incapable
to represent mental states at all whereas patients with positive
features are altered in ascribing the correct mental state (Frith,
2004). ToM performances under non-pathological conditions rely
upon accurate inferences on contextual information, perspective-
taking and self-other distinction (Walter, 2012). Interestingly,
decits in both visuo-spatial and psychological/cognitive perspec-
tive-taking have been further shown to co-occur in schizophrenia
(Langdon et al., 2006). These ndings are concordant with the
inability of patients with negative features to inhibit their egocen-
tered perspective and to empathize with another individuals
rst-person experience in our study.
The symptomatology was not homogenous in the rst group of
patients (SCZ-H). This is, thus, more difcult to account for the
relation between preserved heterocentered processing and dimen-
sions of schizophrenia. Concerning patients with positive symp-
toms (N = 2), it could be rst advanced that these were not
specically impaired in their heterocentered visuo-spatial and
empathic abilities. However, a recent behavioural work reported
that greater accuracy on perspective -taking and self-location tasks
on front- vs. back-facing human pictures positively correlates with
increased positive syndrome schizotypy (Thakkar & Park, 2010).
According to the authors, these ndings suggest that schizotypal
individuals suffering from anomalous cognitive and perceptual
experiences have augmented facilities in inhibiting their egocen-
tered perspective (Thakkar & Park, 2010). In the same vein,
Abu-Akel (1999) hypothesized that patients with preeminent posi-
tive symptoms may have hyper ToM. These augmented if not
aberrant competences would lead patients to overrate and/or
over-attribute intentions, thoughts etc. to other people, as reected
in delusions (Abu-Akel, 1999; Abu-Akel & Bailey, 2000; Brne,
2005b).
Two patients with preserved empathic abilities presented a
dominant negative symptomatology. At rst sight, this may con-
tradict our above hypothesis that altered spontaneous and explicit
heterocentered visuo-spatial mechanisms relate with the severity
of the negative symptoms. However, this objection is not totally
admissible. First, as reported above, we found a highly signicant
negative correlation computed on all ten patients between the
percentages of tilts in OBT-manner in the front SPO-task and the
negative PANSS scores. Second, these data may rather point to a
potential limitation of our paradigm and employed tasks. Rotation
symmetry in the SPO-task, without additional debriengs and/or
associated neuroimaging data, does not enable to distinguish
whether participants have imagined themselves in the avatars
body position by performing a mental rotation of their own-body
or have mentally rotated the avatars body into their own-body.
In both cases, these body-related visuo-spatial transformations
would have generated similar ipsilateral leaning patterns. Though,
97
these would differ in that the former and latter are respectively
associated with heterocentered and egocentered referencing. In
their study on schizotypy, Thakkar and Park (2010) provided sim-
ilar conclusions regarding their paradigm and proposed that exces-
sive egocentered referencing as well as decits in non-egocentered
simulation would comparably reduce empathic understanding and
abilities. New paradigms, inspired from that used in the present
study, should enable to dene empirical criteria distinguishing
between normal vs. augmented heterocentered and egocentered
visuo-spatial mechanisms. Moreover, future experiments combin-
ing visuo-spatial, ToM and emotion tasks, should investigate
whether difculties of patients with negative symptoms in disen-
gaging from their egocentered visuo-spatial perspective relate
with the incapacity to take into account the beliefs, desires, and
emotions of others whereas facilities of patients with positive
symptoms in inhibiting their egocentered reference frame relate
with the tendency to overrate and over-attribute intentions,
thoughts etc. to other people.
4.4. Low scoring self-reported perspective-taking abilities is associated
with altered spontaneous empathic processing
Patients with decits in spontaneous empathic processing had
signicantly lower scores on the IRI Perspective-Taking subscale
than controls and patients with preserved empathic abilities. This
rst supports the leaning performance and RTs patterns as
observed in the SPO- and OBT-tasks, suggesting that disturbances
in spontaneous heterocentered and empathic processing are asso-
ciated with low scoring self-reported trait cognitive empathy,
notably perspective-taking. This is further concordant with high
negative PANSS scores found for these patients. Second, although
schizophrenics have poor insight and decits in the meta-cognitive
knowledge of their impairments (Bora et al., 2008), our data
indicate that patients may reexively access to their inability to
simulate a non-egocentered perspective, in accordance with prior
studies (Montag et al., 2007). However, these ndings must be
taken with caution as data in the devoted literature are still
equivocal. No clear-cut and stable relationship has been so far
established between scores to cognitive empathy and perspec-
tive-taking subscale, insight and symptomatology (Montag et al.,
2007). However, negative correlations have been observed
between perspective-taking and negative symptoms (Brne,
2005b; Frith, 2004), in line with our data. We here note that the
absence of difference on the IRI-CE scores between controls and
patients with altered spontaneous empathic processing was prob-
ably due to that patients and controls, although scoring differently
on the IRI-PT, did not differ on the IRI-FS.
5. Conclusions
In the present pilot-study, we investigated whether spontaneous
empathic and heterocentered visuo-spatial mechanisms are altered
in schizophrenia. For that, we employed our behavioural paradigm,
measuring from the bodily postures and movements, the spontane-
ous use of egocentered as in sympathy or heterocentered as in
empathy reference frame during self-other interaction. We report
that patients with a prevalent negative symptomatology were
impaired in spontaneously (on-line) as well as explicitly
(off-line) simulating a non-egocentered visuo-spatial perspective.
These decits were associated with lower scoring self-reported trait
cognitive empathy, namely, perspective-taking. Our ndings
suggest that the severity of the negative symptoms relates with
disturbance of spontaneous empathic processing in patients with
schizophrenia.
98 B. Thirioux et al. / Brain and Cognition 90 (2014) 8799
Acknowledgments
This study was promoted by the Unit de recherche clinique
intersectorielle en psychiatrie vocation rgionale of the Henri
Laborit Hospital (Poitiers, France) which received a nancial sup-
port from the Agence Rgionale de Sant en Poitou-Charentes.
B.T. was supported by the French Academy of Science (Prize for
Postdoctoral Research). B.T. further thanks the Institute for
Advanced Studies of Paris for nancial support. The authors thank
Michel Bret (Arts et Tchnologies de lImage; Universit Paris 8) for
preparing stimuli, France Maloumian (Laboratoire de Physiologie
de la Perception et de lAction, Collge de France) for preparing
illustrations (Figs. 1 and 2) as well as the outpatients and inpa-
tients treated at the Henri Laborit psychiatric Hospital for kindly
taking part in this study.
References
Abdel-Hamid, M., Lehmkmper, C., Sonntag, C., Juckel, G., Daum, I., & Brne, M.
(2009). Theory of mind in schizophrenia: The role of clinical symptomatology
and neurocognition in understandin other peoples thoughts and intentions.
Psychiatry Research, 165, 1926.
Abu-Akel, A. (1999). Impaired theory of mind in schizophrenia. Pragmatics and
Cognition, 7, 247282.
Abu-Akel, A., & Bailey, A. L. (2000). The possibility of different forms of theory of
mind. Psychological Medicine, 30, 735738.
Amado, I., Bourdel, M. C., Daban, C., Poirier, M. F., Loo, H., Bouhours, P., et al. (2009).
Preattentional processes and disorganization in schizophreni: Inuence of a 6-
week risperidone treatment. Progress in Neuro-Psychopharmacology and
Biological Psychiatry, 33, 11071112.
Andreasen, C. (1981). Negative vs positive schizophrenia: Denition and validation.
Archives of General Psychiatry, 39, 789794.
Arzy, S., Thut, G., Mohr, C., Michel, C. M., & Blanke, O. (2006). Neural basis of
embodiment: Distinct contribution of temporo-parietal junction and
extrastriate body-area. The Journal of Neuroscience, 26, 80748081.
Bavelas, J. B., Black, A., Lemery, C. R., & Mullet, J. (1987). Motor mimicry as primitive
empathy. In N. Eisenberg & J. Stayers (Eds.), Empathy and its development
(pp. 317338). Cambridge: Cambridge University Press.
Bavelas, J. B., Black, A., Chovil, N., Lemery, C. R., & Mullett, J. (1988). Form and
function in motor mimicry: Topographic evidence that the primary function is
communicative. Human Communication Research, 14, 275300.
Berthoz, A. (1997). Le Sens du Mouvement. Paris: Odile Jacob, pp. 158160.
Berthoz, A. (2004). Physiologie du changement de point de vue. In A. Berthoz & G.
Jorland (Eds.), LEmpathie (pp. 251275). Paris: Odile Jacob.
Berthoz, A., & Thirioux, B. (2010). A spatial and perspective change theory of the
difference between sympathy and empathy. Paragrana, 19, 3261.
Blanke, O., Ortigue, S., Landis, T., & Seeck, M. (2002). Stimulating illusory own-body
perceptions. Nature, 419, 269270.
Blanke, O., Landis, T., Spinelli, L., & Seeck, M. (2004). Out-of-body experience and
autoscopy of neurological origin. Brain, 127, 243258.
Blanke, O., Mohr, C., Michel, C. M., Pascual-Leone, A., Brugger, P., Seec, M., et al.
(2005). Linking out-of-body experience and self-processing to mental own-
body imagery at the temporo-parietal junction. The Journal of Neuroscience, 25,
550557.
Blanke, O. (2012). Multisensory brain mechanisms of bodily self-consciousness.
Nature Review Neuroscience, 13, 556571.
Bora, E., Gken, S., & Veznedaroglu, B. (2008). Empatihic abilities in people with
schizophrenia. Psychiatry Research, 160, 2329.
Bracha, H. S., Livingston, R. L., Clothier, J., Linington, B. B., & Karson, C. N. (1993).
Correlation of severity of psychiatric patients delusions with right hemispatial
inattention (left-turning behavior). American Journal of Psychiatry, 150,
330332.
Bret, M. (1988). Anyo: Logiciels dAnimation 3D, Imaginaire Numrique. Paris:
Hermes.
Brugger, P., & Graves, R. E. (1997). Right hemispatial inattention and magical
ideation. European Archives of Psychiatry and Clinical Neuroscience, 247, 5557.
Brne, M. (2005a). Emotion recognition, theory of mind, and social behaviour in
schizophrenia. Psychiatry Research, 133, 135147.
Brne, M. (2005b). Theory of mind in schizophrenia: A review of the literature.
Schizophrenia Bulletin, 31, 2142.
Cavezian, C., Danckert, J., Lerond, J., Dalery, J., dAmato, T., & Saoud, M. (2007).
Visual-perceptual abilities in healthy controls, depressed patients, and
schizophrenia patients. Brain and Cognition, 64, 257264.
Corrigan, P. W., & Nelson, D. R. (1998). Factors that affect social cur recognition in
schizophrenia. Psychiatry Research, 78, 189196.
Cleret de Langavant, L., Remy, P., Trinkler, I., McIntyre, J., Dupoux, E., Berthoz, A.,
et al. (2011). Behavioral and neural correlates of communication via pointing.
PLoS ONE, 6, e17719.
Damasio, A., & Carvalho, G. B. (2013). The nature of feelings: Evolutionary and
neurobiological origins. Nature Review Neuroscience, 14, 143152.
Davis, M. H. (1980). A multidimensional approach to individual differences in
empathy. JSAS Catalog of Selected Documents in Psychology, 10, 85.
Davis, M. H. (1983). Measuring individual differences in empathy: Evidence for a
multidimensional approach. Journal of Personality and Social Psychology, 44,
113126.
Davis, M. H. (1994). Empathy: A social psychological approach. Dubuque, IA: Wm C
Brown Communications.
Decety, J., & Jackson, P. L. (2004). The functional architecture of human empathy.
Behavioural and Cognitive Neuroscience Reviews, 3, 71100.
Decety, J. (2007). A social cognitive neuroscience model of human empathy. In E.
Harmon-Jones & P. Winkielman (Eds.), Social neuroscience: Integrating biological
and psychological explanations of social behaviour. New York: Guilford Press.
Decety, J., & Lamm, C. (2007). The role of the right temporoparietal junction in social
interaction: How low-level computational processes contribute to meta-
cognition. Neuroscientist, 13, 580593.
Decety, J., & Moriguchi, Y. (2007). The empathic brain and its dysfunction in
psychiatric populations: Implications for intervention across different clinical
conditions. BioPsychoSocial Medicine, 1, 2265.
Decety, J., & Michalska, K. J. (2009). Neurodevelopmental changes in the circuits
underlying empathy and sympathy from childhood to adulthood.
Developmental Science, 13, 886899.
Degos, J. D., Bachoud-Lvi, A. C., Ergis, A. M., Petrissans, J. L., & Cesaro, P. (1997).
Selective inability to point to extrapersonal targets after left posterior parietal
lesion: An objectivisation disorder? Neurocase, 3, 3139.
Dinn, W. M., Harris, C. L., Aycicegi, A., Greene, P., & Andover, M. S. (2002). Positive
and negative schizotypy in a student sample: Neurocognitive and clinical
correlates. Schizophrenia Research, 56, 171185.
Easton, S., Blanke, O., & Mohr, C. (2009). A putative implication of fronto-parietal
connectivity in out-of-body experiences. Cortex, 45, 216227.
Erickson, M., Jaafari, N., & Lysaker, P. (2011). Insight and negative symptoms as
predictors of functioning in a work setting in patients with schizophrenia.
Psychiatry Research, 189, 161165.
Farrer, F., & Franck, N. (2009). Sens du corps dans la schizophrnie. LEncphale, 35,
4351.
Franck, N., Farrer, C., Georgieff, N., Marie-Cardine, M., Dalery, J., dAmato, T., et al.
(2001). Defective recognition of ones own actions in patients with
schizophrenia. American Journal of Psychiatry, 158, 454459.
Frith, U., & Frith, C. D. (2003). Development and neurophysiology of mentalizing.
Philosophical Transactions of the Royal Society B: Biological Sciences, 358, 459473.
Frith, U. (2004). Schizophrenia and theory of mind. Psychological Medicine, 34,
385389.
Frith, U., & Frith, C. (2006). The neural basis of mentalizing. Neuron, 6, 218229.
Gelhaus, P. (2011). The desired moral attitude of the physician: (I) empathy.
Medicine, Healthy, Care and Philosophy, 15, 103113.
Goldman, A. (2006). Simulating minds: The philosophy, psychology and neuroscience of
mindreading. Oxford: Oxford University Press.
Guel, J. D. (1997). Lvaluation Clinique standardise en psychiatrie. Tome II. Castres:
Ed Mdicales P. Fabre.
Hein, G., & Singer, T. (2008). I feel how you feel but not always: The empathic brain
and its modulation. Current Opinion in Neurobiology, 16, 18241829.
Henry, J. D., Bailey, P. E., & Rendell, P. G. (2008). Empathy, social functioning and
schizoptypy. Psychiatry Research, 160, 1522.
Hojat, M., Louis, D. Z., Markham, F. W., Wender, R., Rabinowitz, C., & Gonnella, J. S.
(2011). Physicians empathic and clinical outcomes for diabetic patients.
Academic Medicine, 86, 359364.
Hojat, M., Spandorfer, J., Louis, D. Z., & Gonnella, J. S. (2011). Empathic and
Sympathetic orientations toward patient care: Conceptualization,
measurement and psychometrics. Academic Medicine, 86, 989995.
Jorland, G., & Thirioux, B. (2008). Notes sur lorigine de lempathie. Revue de
Mtaphysique et de Morale, 58, 269280.
Kahane, P., Hoffmann, D., Minotti, L., & Berthoz, A. (2003). Reappraisal of the human
vestibular cortex by cortical electrical stimulation. Annals of Neurology, 54,
615624.
Kay, S. R., Fischbein, A., & Opler, L. A. (1987). The positive and negative syndrome
scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261276.
Keefe, R. S., Roitman, S. E., Harvey, P. D., Blum, C. S., DuPre, R. L., Prieto, D. M., et al.
(1995). A pean-and-paper human analogue of a monkey prefrontal cortex
activation task: Spatial working memory in patients with schizophrenia.
Schizophrenia Research, 17, 2533.
Landgraf, S., Amado, I., Bourdel, M. C., Leonardi, S., & Krebs, M. O. (2008). Memory-
guided saccade abnormalities in schizophrenic patients and their healthy, full
biological siblings. Psychological Medicine, 38, 861870.
Landgraf, S., Krebs, M. O., Oli, J. P., Committeri, G., van der Meer, E., Berthoz, A.,
et al. (2010). Real world referencing and schizophrenia: Are we experiencing
the same reality? Neuropsychologia, 48, 29222930.
Langdon, R., Michie, P. T., Ward, P. B., McConaghy, N., Catts, S., & Coltheart, M.
(1997). Defective self and/or other mentalising in schizophrenia: A cognitive
neuropsychological approach. Cognitive Neuropsychiatry, 2, 167193.
Langdon, R., & Coltheart, M. (1999). Mentalising, schizotypy, and schizophrenia.
Cognition, 71, 4371.
Langdon, R., Coltheart, M., Ward, P. B., & Catts, S. V. (2001). Visual and cognitive
perspective-taking impairments in schizophrenia: A failure of allocentric
simulation? Cognitive Neuropsychiatry, 6, 241269.
Langdon, R., & Coltheart, M. (2001). Visual perspective-taking and schizotypy:
Evidence for a simulation-based account of mentalizing in normal adults.
Cognition, 82, 126.
 B. Thirioux et al. / Brain and Cognition 90 (2014) 8799
Langdon, R. (2003). Theory of mind and social dysfunction: Psychotic solipsism
versus autistic asociality. In B. Rechapoli & V. Slaughter (Eds.), Individual
differences in theory of mind: Implications for typical and atypical development
(pp. 241270). Hove, UK: Psychology Press.
Langdon, R. (2006). Empathetic perspective-taking is impaired in schizophrenia:
Evidence from a study of emotion attribution and theory of mind. Cognitive
Neuropsychiatry, 11, 133155.
Langdon, R., Coltheart, M., & Ward, P. B. (2006). Empathic perspective-taking is
impaired in schizophrenia: Evidence from a study of emotion attribution and
theory of mind. Cognitive Neuropsychiatry, 11, 133155.
Lee, K. H., Farrow, T. F., Spence, S. A., & Woodruff, P. W. (2004). Social cognition,
brain networks and schizophrenia. Schizophrenia Bulletin, 13, 261276.
Lobel, E., Kleine, J. F., Bihan, D. L., Leroy-Willig, A., & Berthoz, A. (1998). Functional
MRI of galvanic vestibular stimulation. Journal of Neurophysiology, 80,
26992709.
Lysaker, P. H., Clements, C. A., Plascak-Hallberg, C. D., Knipscheer, S. J., & Wright, D.
E. (2002). Insight and personal narratives of illness in schizophrenia. Psychology
and Psychotherapy, 84, 5869.
Lysaker, P. H., Hasson-Ohayon, I., Kravetz, S., Kent, J. S., & Roe, D. (2013). Self
perception of empathy in schizophrenia: Emotion recognition, insight, and
symptoms predict degree of self and interviewer agreement. Psychiatry
Research, 206, 146150.
McCabe, R., Leudar, I., & Antaki, C. (2004). Do people with schizophrenia display
theory of mind decits in clinical interactions? Psychological Medicine, 34,
401412.
Milgram, N. A. (1960). Cognitive and empathic factors in role-taking by
schizophrenic and brain damaged patients. Journal of Abnormal and Social
Psychology, 60, 219224.
Mohr, C., Blanke, O., & Brugger, P. (2006). Perceptual aberrations impair mental
own-body transformations. Behavioral Neuroscience, 120, 528534.
Mohr, C., Rowe, A. C., & Blanke, O. (2010). The inuence of sex and empathy on
putting oneself in the shoes of others. Britisch Journal of Psychology, 101,
277291.
Montag, C., Heinz, D., Kunz & Gallinat, J. (2007). Self-reported empathic abilities in
schizophrenia. Schizophrenia Research, 92, 8589.
Montgomery, S. A., & Asberg, M. (1979). New depression scale designed to be
sensitive to change. British Journal of Psychiatry, 134, 382389.
Mueser, K. T., Donnan, R., Penn, D. L., Blanchard, J. J., Bellack, A. S., Nishith, P., et al.
(1996). Emotion recognition and social competence in chronic schizophrenia.
Journal of Abnormal Psychology, 105, 271275.
Nardini, M., Burgess, N., Breckenridge, K., & Atkinson, J. (2006). Differential
developmental trajectories of egocentric, environmental, and intrinsic frames
of reference in spatial memory. Cognition, 101, 153172.
Nishitani, N., & Hari, R. (2000). Temporal dynamics of cortical representation for
action. Proceedings of the National Academy of Sciences of the United States of
America, 97, 913918.
Nishitani, N., & Hari, R. (2002). Viewing lip forms: cortical dynamics. Neuron, 36,
12111220.
Numberger, J. L., Jr., Blehar, M. C., Kaufmann, C. A., York-Cooler, C., Simpson, S. G. L.,
& Harkavy-Friedman, J. (1994). Diagnostic interview for genetic studies.
Rationale, unique features, training. NIMH Genetics initiative. Archives of
General Psychiatry, 51, 849859.
Ochsner, K. N., & Gross, J. J. (2005). The cognitive control of emotions. Trends in
Cognitive Science, 9, 242249.
Oldeld, R. C. (1971). The assessment and analysis of handedness; The Edinburgh
inventory. Neuropsychologia, 9, 97113.
Olinick, S. L. (1987). A critique of empathy and sympathy. In J. Lichtenberg, M.
Bornstein, & D. Silver (Eds.), Empathy (pp. 137166). Hillsdal, New Jersey: The
Analytic Press.
Park, S., & Holzman, P. S. (1992). Schizophrenics show spatial working memory
decits. Archives of General Psychiatry, 49, 975982.
Park, S., Puschel, J., Sauter, B. H., Rentsch, M., & Hell, D. (1999). Spatial working
memory decits and clinical symptoms in schizophrenia: A 4-month follow-up
study. Biological Psychiatry, 49, 975982.
Parsons, L. M. (1987). Imagined spatial transformation of ones body. Journal of
Experimental Psychology, General, 116, 172191.
Penn, D. L., Spaulding, W., Reed, D., & Sullivan, M. (1996). The relationship of social
sognition to ward behaviour in chronic schizophrenia. Schizophrenia Research,
20, 114132.
Premack, D., & Woodruff, G. (1978). Does the chimpanzee have a theory of mind?
Behavioural and Brain Sciences, 1, 515526.
99
Preston, S. D., & de Waal, F. B. (2002). Empathy: its ultimate and proximate bases.
The Behavioral and Brain Sciences, 25, 120.
Preston, S. (2007). A perception-action model for empathy. In T. F. D. Farrow & P. W.
R. Woodruff (Eds.), Empathy in mental illness. Cambridge: Cambridge University
Press.
Reed, C. L., & McGoldrick, J. E. (2007). Actnio during body perception: Processing
time affects self-other correspondences. Social Neuroscience, 2, 134149.
Romberg, M. H. (1846). Lehrbuch der Nervenkrankenheiten des Menschens, Bd 1.
Berlin: Duncker.
Schenkel, L. S., Spaulding, W. D., & Silverstein, S. M. (2005). Poor premorbid social
functioning and theory of mind decit in schizophrenia: Evidence of reduced
context processing? Journal of Psychiatric Research, 39, 499508.
Schnell, K., Bluschke, S., Konradt, B., & Walter, H. (2011). Functional relations of
empathy and mentalizing: Am fMRI study on the neural basis of cognitive
empathy. Neuroimage, 54, 17431754.
Sergi, M. J., Rassovsky, Y., Widmarck, C., Reist, C., Erhart, S., Braff, D. L., et al. (2007).
Social cognition in schizophrenia: Relationship with neurocognition and
negative symptoms. Schizophrenia Research, 90, 316324.
Shamay-Tsoory, S. G., Shur, S., Harari, H., & Levkovitz, Y. (2007). Neurocognitive
basis of impaired empathy in schizophrenia. Neuropsychology, 21, 431438.
Singer, T., Seymour, B., ODoherty, J., Kaube, H., Dolan, R. J., & Frith, C. D. (2004).
Empathy for pain involves the affective but not sensory components of pain.
Science, 303, 11571162.
Sperber, D., & Wilson, D. (2002). Pragmatics, modularity and mind-reading. Mind
and Language, 17, 323.
Thakkar, K. N., Brugger, P., & Park, S. (2009). Exploring empathic space: Correlates of
perspective transformation ability and biases in spatial attention. PlosOne, 4,
e5864.
Thakkar, K. N., & Park, S. (2010). Empathy, schizotypy and visuospatial
transformations. Cognitive Neuropsychiatry, 15, 477500.
Thirioux, B., Jorland, G., Bret, M., Tramus, M. H., & Berthoz, A. (2009). Walking on a
line: A motor paradigm using rotation and reection symmetry to study mental
body transformations. Brain and Cognition, 70, 191200.
Thirioux, B., Mercier, M. R., Jorland, G., Berthoz, A., & Blanke, O. (2010). Mental
imagery of self-location during spontaneous and active self-other interactions:
An electrical neuroimaging study. The Journal of Neuroscience, 30, 72027214.
Thirioux, B. (2011). Perception et apperception dans lempathie: Une critique des
neurons miroir. In P. Attigui & A. Cukier (Eds.), Les Paradoxes de lEmpathie
(pp. 7394). Paris: CNRS Editions.
Thirioux, B., & Berthoz, A. (2011). Phenomenology and physiology of empathy and
sympathy: How intersubjectivity is the correlate of objectivity. In J. Aden, T.
Grimshaw, & H. Penz (Eds.), Teaching language and culture in an era of
complexity: Interdisciplinary approaches for an interrelated world (pp. 4560).
Bruxelles: Peter Lang.
Thirioux, B., Mercier, M. R., Blanke, O., & Berthoz, A. (2014). The cognitive and neural
time course of empathy and sympathy: An electrical neuroimaging study on
self-other interaction. Neuroscience, 267, 286306.
Van der Meer, L., Groenewold, N. A., Nolen, W. A., Pijnenborg, M., & Aleman, A.
(2011). Inhibit yourself and understand the other: neural basis of distinct
processes underlying Theory of Mind. NeuroImage, 56, 23642374.
Viviani, P., & Flash, T. (1995). Minimum jerk, two thirds power law and isochrony.
Converging approaches to movement planning. Journal of Experimental
Psychology Human Perception and Performance, 21, 3253.
Viviani, P., & Terzuolo, C. (1982). Trajectory determines movement dynamics.
Neuroscience, 7, 431437.
Vogeley, K., May, M., Ritzl, A., Falkai, P., Zilles, K., & Fink, G. R. (2001). Neural
correlates of First-person perspective as one constituent of human self-
consciousness. Journal of Cognitive Neuroscience, 16, 817827.
Walter, H. (2012). Social cognitive neuroscience of empathy. Concepts, circuits, and
genes. Emotion Review, 4, 917.
Wilmer, H. A. (1968). The doctor-patient relationship and the issues of pity,
sympathy and empathy. The British Journal of Medical Psychology, 41, 243248.
Woods, S. W. (2003). Chlorpromazine equivalent doses for the newer atypical
antipsychotics. Journal of Clinical Psychiatry, 64, 663667.
Zacks, E., Rypma, B., Gabrieli, J. D., Tversky, B., & Glover, G. H. (1999). Imagined
transformation of bodies: An fMRI investigation. Neuropsychologia, 37,
10291040.
Zahavi, D. (2008). Simulation, projection, and empathy. Consciousness and Cognition,
17, 514522.