Use of compensatory strategies in processing complex communicative situations in patients with schizophrenia

Context and relevance. Social cognitive impairments in schizophrenia often hinder effective everyday communication and underscore the need for interventions grounded in natural compensatory mechanisms. Objective. To investigate spontaneously emerging compensatory communicative strategies in patients with schizophrenia. Hypotheses. (I) Schizophrenia patients employ compensatory communication strategies distinct from healthy controls; (II) The application of these strategies varies depending on the severity of patients’ deficit symptoms. Methods. The study employed a dyadic design. In the experimental group (30 dyads), a patient with paranoid schizophrenia collaborated with a healthy participant on a task involving the identification of characters' cognitive errors in silent film clips. Successful task performance required constructing a theory of mind for the observed character and aligning it with one’s own perception of the communicative situation. The control group included only healthy individuals (20 dyads). The relationship between three variables was examined: (1) group membership (experimental/control), (2) effectiveness in detecting the characters’ cognitive errors, and (3) the use of compensatory strategies that facilitate the interpretation of communicative situations from the characters’ perspective. The compensatory strategies analyzed included the integration of inferred direct speech and observed gestures of referential agents into the participant’s own narrative when retelling the situation to a partner. Patients with schizophrenia were further stratified by the severity of negative symptoms (SANS scores). Results. Results revealed that patients with mild negative symptoms used gestural reenactments significantly more often than both patients with pronounced symptoms and healthy controls. Additionally, patients with mild negative symptoms more frequently integrated direct speech attributed to characters into their own narratives than those with severe symptoms, although they did not differ significantly from healthy participants. Conclusions. 1. A universal compensatory strategy used by both healthy individuals and patients with schizophrenia when perceiving complex communicative situations is the incorporation of presumed character utterances into their own speech. Among patients with schizophrenia, the use of this strategy tends to decline as negative symptoms become more severe. 2. A specific compensatory mechanism observed in patients with schizophrenia is the use of gestures when describing the behavior of perceived characters in complex communicative situations.