Close
Logo
About
FAQ
Home
Collections
Login
USC Login
Register
0
Selected 
Invert selection
Deselect all
Deselect all
 Click here to refresh results
 Click here to refresh results
USC
/
Digital Library
/
University of Southern California Dissertations and Theses
/
Family environment as a moderator of the association between theory of mind and social functioning in people with schizophrenia
(USC Thesis Other) 

Family environment as a moderator of the association between theory of mind and social functioning in people with schizophrenia

doctype icon
play button
PDF
 Download
 Share
 Open document
 Flip pages
 More
 Summarize
 Download a page range
 Download transcript
Contact Us
Contact Us
Copy asset link
Request this asset
Transcript (if available)
Content Running head: FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING  1      
!








Family Environment as a Moderator of the Association Between Theory of Mind and Social
Functioning in People with Schizophrenia


Laura Garcia Cardona  
University of Southern California
M.A. (PSYCHOLOGY)
December 2015





Author Note
This research was supported by the Culture, Neuroscience and Psychosis Program,
Foundation for Psychocultural Research.  
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 2
Table of Contents
Abstract……………………………………….…….…....…………....…………....…….…..…...3
Introduction………………………………….…….…....…………....…………....……….……...4
Methods……………………………………….…….…....…………....…………....……….….....9
Results……………………………………………………………………………………………13
Discussion…………………………………………………………………………….……….....17
References………………………………………………………………………………………..22
Tables and Figures…………………………………………………………………………….....36
Appendix…………………………………………………………………………………………46














FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 3
Abstract
Theory of mind (ToM) deficits are strongly associated with poor social outcomes in
people with schizophrenia, including their inability to function independently and to maintain
social relationships. Drawing upon past research demonstrating that family environments
moderate the relationship between ToM abilities and psychosocial outcomes in children, the
current study investigated the moderating role of family climates in the relationship between the
ToM and the social functioning of people suffering from schizophrenia. Furthermore, this study
examined how family caregiving varies as a function of sociocultural context. Sixty participants
of Mexican-origin and their caregivers residing in Los Angeles, California and Puebla, Mexico
reported on measures of family climate based on the expressed emotion literature (e.g. criticism,
emotional over-involvement, and warmth). The results of this study suggest sociocultural
differences in the perception of warmth and emotional over-involvement, as well as differences
in the way over-involvement relates to social outcomes in each social context. Additionally,
family criticism was shown to moderate the relationship between ToM and social functioning,
such that only at lower levels of criticism, higher ToM abilities are significantly related to better
social functioning. This study highlights that higher ToM abilities may not uniformly relate to
better social functioning, especially when individuals have critical family members. Our results
contribute to the literature by demonstrating how family and cultural contexts may play a role in
the social functioning of people with schizophrenia.  
Keywords: theory of mind, expressed emotion, social functioning


FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 4
Family Environments as a Moderator of the Association Between Theory of Mind and Social
Functioning in People with Schizophrenia
Introduction
Schizophrenia is considered one of the world-leading causes of disability (Murray &
Lopez, 1996; Murray & Lopez, 1997; Üstün et al., 1999; World Health Organization, 2004). In
the United States, the overall cost of schizophrenia was estimated to be $62.7 million in 2002,
reflecting high unemployment rates, lower work productivity, premature mortality and societal
burden (Wu et al., 2005). In addition to experiencing disabling symptomatology, people with
schizophrenia experience substantial deficits in their social functioning, including an inability to
develop or maintain interpersonal relationships, independent living skills and gainful
employment (Bellack et al., 2007; Couture et al., 2006; Green et al., 2008). Because of the
prevalence of these functional impairments, research efforts have been devoted to understanding
the factors that relate to functional outcomes in schizophrenia.  
Social cognition and social functioning
Social cognition (SC), the array of cognitive abilities necessary to understand and
respond to social interactions, has been strongly related to the community functioning  (e.g.,
social networks and employment) and social skills of people with schizophrenia (see Couture et
al., 2006 for a review). SC skills have repeatedly been found to mediate the relationship between
neurocognitive abilities and functional outcomes (Schmidt, Mueller, & Roder, 2011),
highlighting the significance of SC in the social functioning of the individual above and beyond
that of neurocognition. SC is considered a complex construct comprised of many domains such
as theory of mind, emotional processing, social perception, and attributional bias (Bellack et al.,
2007; Green et al., 2008; Kurtz & Richardson, 2012).  
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 5
Recent meta-analyses have highlighted theory of mind as the SC domain most strongly
related to the community functioning of people with schizophrenia (Fett et al., 2011; Savla et al.,
2012). Theory of mind (ToM) refers to the representation and attribution of mental states (e.g.
desires, beliefs, and intentions) necessary to predict or interpret others’ behaviors (Leslie, 1987).
Impairments in ToM have been considered a hallmark of people with schizophrenia (Bora et al.,
2008; Bora et al., 2009; Bora, Yucel, & Pantelis, 2011; Sprong et al., 2007) and are associated
with poorer functional outcomes, including lower problem solving abilities and social
competence (Brüne et al. 2007; 2011; Couture et al., 2011; Lysaker et al., 2010; Pinkham &
Penn, 2006; Roncone et al., 2002;). Although the relationship between ToM and social
functioning in schizophrenia has been studied considerably, little research has examined whether
environmental factors (e.g., family dynamics) play a role in this relationship. There are
independent lines of study, however, that examine family environments as they relate to ToM
and social functioning.
Family Factors and Social Cognition
Family factors have been shown to be associated with the development of ToM (Galende,
Sanchez de Miguel, & Arranz, 2011; Hughes and Ensor, 2006). For example, frequently talking
to children about mental states and having an authoritative parenting style facilitates children’s
mastery of ToM skills (Olson et al. 2011; O’Reilly & Peterson, 2014; Peterson & Slaughter
2003; Ruffman et al., 2006; Slaughter et al. 2007; Symons et al. 2006). When examining child
outcomes, developmental researchers show that the family environment plays a moderating role
in the relationship between ToM and outcomes. For example, the interaction between ToM and
parenting strategies has been significantly related to children’s behavioral problems, such that
children with higher ToM skills exposed to harsh parenting are less likely to have behavioral
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 6
problems than children with lower ToM abilities exposed to this environment (Hughes & Ensor,
2006). Additionally, Cahill, Deater-Deckard, Pike, and Hughes, (2007) found that the interaction
between ToM and maternal warmth was significantly related to children’s self-worth.  Children
with higher ToM skills who are exposed to high maternal warmth are more likely to have better
perceptions of self-worth than children exposed to low maternal warmth. The results of both of
these studies emphasize an interaction between familial environments and ToM when explaining
psychosocial outcomes in children.  
Family factors and Social Functioning
In the schizophrenia literature, evidence for the relationship between family
environments and social functioning has been mixed. For example, some researchers have found
that individuals living with relatives high in expressed emotion (EE; critical or emotionally
overinvolved) have lower social functioning as reported by their caregivers (Barrowclough &
Tarrier, 1990; Inoue et al. 1997; Miura et al., 2004). In contrast, King and Dixon (1995) showed
that emotional over-involvement (EOI) was related to better social functioning. This finding was
replicated by O’Brien et al. (2005), who found that caregivers’ EOI, and warmth, were both
related to better social functioning in a sample of adolescents at high risk for psychosis. However,
Schlosser et al. (2010) found that, as opposed to having a direct relationship, the interaction
between EOI and warmth was significantly related to social functioning, such that only at
moderate levels of EOI, higher warmth was significantly associated with better social
functioning. Although findings regarding the direct relationship between EE and social outcomes
are unclear, the latter study highlights the possibility of interactions among EE indicators in the
prediction of social functioning. Therefore, it is plausible that family environments may also
interact with variables strongly related to social functioning. For example, the interaction
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 7
between ToM and family factors related to the psychosocial outcomes in children may also relate
to the functional outcomes in the schizophrenia population.  
Sociocultural Context
Research has uncovered that ethnic groups differ in their expression of EE (Bhugra &
McKenzie, 2003). For example, it has been shown that Mexican Americans express less critical
and hostile comments, but more EOI and warmth than Anglo Americans (Lopez et al., 2009).
Furthermore, the relationship between expressed emotion and clinical outcomes has been shown
to vary as a function of ethnic status (Kopelowicz et al., 2002; Lopez et al., 2009, Singh, Harley,
& Suhail, 2011). Although researchers have tried to disentangle these intergroup differences by
examining variables such as acculturation or interdependence (Aguilera et al., 2010; Tsai et al.,
2014), limited attention has been given to groups’ social worlds and how these can inform our
understanding of these family dynamics (Lopez & Guarnaccia, 2000). In an effort to examine the
sociocultural context of family caregiving, we chose to study families of Mexican origin but in
very different sociocultural contexts, particularly with regard to mental health care. In Los
Angeles, families have access to public outpatient and inpatient mental health care. In fact, even
undocumented immigrants can access services if they qualify for financial need, which can cover
the costs of medication as well as outpatient and inpatient care.  Although care is readily
available, inpatient care is brief, usually less than one week (Funk, 2006; Alegria et al., 2012;
Stone et al., 2012).  In contrast, in Puebla Mexico mental health services are limited. There are
public outpatient and inpatient services and even a health insurance that covers the expenses of
very poor individuals (Seguro Popular).  However, both funds and services are very limited and
patients go extended periods of time without medication and treatment (Berenzon Gorn et al.,
2013). The family burden can become so great, that when their ill relatives are hospitalized some
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 8
families abandon their ill relatives to the care of the hospital. Of the 22 states in Mexico that
reported data in 2011, Puebla served the 5th lowest number of patients within their psychiatric
hospital (500 patients), served the lowest number of patients in outpatient and community-based
services (33 patients per 100,000) and had the second highest percentage of hospitalized patients
whose stay was longer than 10 years (62.3%; WHO-AIMS, 2011). Given very different
sociocultural contexts with regard to mental health care, family caregiving and its relationship to
their ill relatives’ functioning may differ. To explore this possibility we carried out this study
with a sample of Mexican-origin individuals residing in Los Angeles, California and Puebla,
Mexico.  
Study Objective
The purpose of this study was to explore if family caregiving and its relationship to ToM
and social functioning varied given the families’ sociocultural context. Furthermore, we assessed
the moderating role of family environments in the association between ToM and social outcomes
in schizophrenia. We posited that individual’s family environments might interact with ToM
levels, such that the strength and direction of the relationship between ToM and social
functioning might vary as a function of family climates (e.g., levels of criticism, emotional over-
involvement, or warmth). For example, if the family environment of an individual with
schizophrenia is mostly critical or over-involved, the relationship between ToM and social
functioning may be weaker than in a less critical or over-involved atmosphere. On the other hand,
in a warm environment, better ToM skills may be significantly related to higher social
functioning, such relationship may be weaker at lower levels of warmth.


FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 9
Methods
Overview
Data for this study was collected as part of the “Family Socialization, Neural Functioning,
and Positive Symptoms in Schizophrenia” study. Participants were recruited through
collaboration with mental health outpatient centers in two metropolitan areas: Los Angeles and
Puebla, Mexico Medical staff in those centers referred patients who met the DSM-IV criteria for
schizophrenia or schizoaffective disorder and who also had regular contact with family members.
Patients received information about the study and participated in a telephone screening to
confirm their eligibility. Inclusion criteria were that participants had been diagnosed with the
DSM-IV criteria for schizophrenia, were aged 18-65, of Mexican origin, capable of giving
consent, and had a key relative willing to participate in the study, who had no cognitive
impairments. Exclusion criteria included any organic impairment or mental retardation and
ethnicities other than of Mexican origin.
Following the screening, a home visit was conducted by research assistants, during which
participants completed questionnaires, answered a set of open-ended questions for an audiotaped
interview, and participated in a set of videotaped interactions with their primary caregivers.
Families were compensated for their time and effort. The universities’ Institutional Review
Boards approved the study and all participants gave written consent before participating in the
study.
Participants
A total of 60 participants (21 residing in Los Angeles and 39 residing in Puebla, Mexico)
are included in the present study. Participants ranged in age from 19–64 years (M= 38.9, SD =
11.32). The sample was 61.7 % male and only 25% were employed. All participants identified
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 10
their race/ethnicity as of Mexican descent with 20.3% being born in Los Angeles, 44.1% in
Puebla, and 35.6% in other locations. Caregivers ranged in age from 20–86 years (M = 54.8, SD
= 15.67) and 78.3 % were female. All caregivers identified their race/ethnicity as of Mexican
descent with 6.8% being born in Los Angeles, 42.4% in Puebla, and 50.8% in other locations.
Out of all caregivers, 44.8% were currently employed.
Measures
The following measures were provided in English and Spanish as necessary.
Psychometric properties are reported for the entire sample, as these were comparable across
languages.  
Theory of Mind. The Hinting Task (Corcoran et al., 1995) is a widely used implicit
measure of ToM. It contains 10 vignettes in which one of the characters makes a “hint” about his
or her intentions to another character. A sample vignette reads: “Mary opened the door to leave
home. Helen yelled, ‘‘someone has forgotten to take out the garbage.’’ The participant is then
asked, “What did Mary mean?” Participants are asked to verbally make inferences about the
intentions of one of the characters. Participants who respond correctly during the first trial are
given a score of 2, participants who need another hint to answer correctly are given a score of 1,
and participants who answer incorrectly after two hints are given a score of 0. The scores are
averaged across the items to determine a total score, which ranges from 0-2 points. Higher scores
indicate greater ToM abilities. The Hinting Task has been used widely in studies of
schizophrenia and other psychological disorders, demonstrating good face validity and
sensitivity to ToM deficits (Bertrand et al., 2007; Corcoran et al. 2000; Corcoran & Frith, 2003;
Pinkham & Penn, 2006). The Spanish language version provided by the authors was used with a
slight modification for a few words that are more commonly used in Mexico than in Spain.  
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 11
Family interviewers wrote down the verbatim response to each item. Two research assistants
were trained to score the written responses.  They both coded 100% of the sample and achieved
high inter-rater reliability for each item (ICC’s ranging from .85 to .99). Internal consistency was
high for this measure (α =.80).  
Social Functioning. The Role Functioning scale (Goodman, Sewell, Cooley, & Leavitt,
1993) was used to assess four dimensions of functioning: working productivity, independent
living, self-care, and social networks. Ratings are made on a 7-point Likert scale ranging from 1
= severe to 7 = optimal levels. Each rating contains specific descriptions of the area of
functioning, and research assistants would assign a score that matched the description of the
participant’s functioning described by the caregiver. The participants’ scores were averaged,
with a range of 1 to 7, with higher scores indicating better functioning. This scale has
demonstrated to be reliable, valid, and sensitive to change in various clinical groups (McLachlan
et al 1999; Osoba et al 1998). The internal consistency of this measure was very good (α = .89).  
Family Environments. The Brief Dyadic Scale of Expressed Emotion—Expanded
Version (Medina-Pradas, Navarro, Lopez, Grau, & Obiols, 2011) was used to assess the
caregiver and participant’s perceptions of EE (criticism, EOI, and warmth). This scale is
composed of 14 items measured on a 10-point Likert scale ranging from 1 = never/not at all to
10 = always/very much. Scores for each of the dimensions are calculated based on Medina-
Pradas et al., (2011). Three subscales are derived from this assessment: criticism, warmth, and
EOI. The subscale of criticism contains 4 items. A sample item from the caregivers’ perspective
is “How disapproving are you of what your ill family member does?” and from the participants’
perspective “How much do the things you do annoy _____?” The subscale of EOI contains 6
items. A sample item from the caregivers’ perspective is “I meddle in or interfere with
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 12
________’s activities (his/her life and affairs)” and from the participants’ perspective
“_______makes me feel like I am not capable of taking care of myself”. The subscale of warmth
contains 4 items. A sample item from the caregivers’ perspective is “Do the things that you do or
say make ________ feel loved by you?” and from the participants’ perspective “How much does  
_____ like to spend time and do things with you?” This assessment has been shown to correlate
with multiple family-based measures including the Camberwell Family Interview (CFI; Vaughn
& Leff, 1976) and the Parental Bonding Instrument (PBI; Parker et al., 1979). The internal
consistency of the participant subscales were .73 (criticism), .67 (EOI) and .80 (warmth) and the
caregiver subscales were .72 (criticism), .46 (EOI), and .63 (warmth).
Clinical Functioning. The Positive and Negative Syndrome Scale (PANSS: Kay et al.,
1987) was used to assess the clinical functioning of participants. The PANSS is a 30-item
clinician- rated scale that assesses positive and negative symptoms of schizophrenia as well as
general psychopathology. Items are rated on a 7-point Likert scale ranging from 1 = absence of
symptoms to 7 = severe or extreme psychopathology. Total positive and negative subscale scores
range from 7 to 49, and general symptoms scores range from 16 to 112. External validity of this
scale has been supported by its strong relationships with socio-demographic variables, DSM
diagnoses, and clinical characteristics (Kay, Opler, & Lindenmayer, 1988; Van den Oord et al.,
2006). Internal consistency was very good for the each subscale: positive symptoms (α = .84),
negative symptoms (α = .85), and general symptoms (α = .86).  




FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 13
Results
Statistical Analyses
Initial analyses included independent-samples t-tests across sites to identify any relevant
differences among the study variables. In addition, separate correlation analyses were conducted
to better understand the way in which EE indicators relate to the outcomes of this study in two
different sociocultural contexts. The significance of the differences in correlation was tested
according to Fisher’s r-to-Z transformations (Cohen & Cohen, 1983; Preacher, 2002).
Correlation analyses were also conducted for the entire sample.
Analyses to determine the moderating role of family environments in the relationship
between participants’ ToM, and social functioning were initially conducted for each site
independently in order to identify possible differences in the patterns of results. Consequently, if
patterns were not evidently different, the sample was then combined and the moderation analyses
were conducted with a greater sample size. These analyses followed procedures by Hayes and
Matthes (2009) through their SPSS macro (http://www.processmacro.org). The macro tests the
significance of the change in R
2
produced by the interactions between the independent (ToM)
and moderator variables (warmth, EOI, and criticism). The macro also provides information to
examine of the significance of the relationship between ToM and social functioning at low (−1
SD below the mean) and high (+1 SD above the mean) levels of the moderator. Negative
symptoms were added as covariates in every moderation analyses, as the literature suggest these
are strongly related to social functioning (Leifker et al., 2009).
All analyses were later conducted while using the SPSS maximum likelihood algorithm
for missing data. No differences in the results were evident while using the transformed data, and
for this reason we report the results without this transformation.  
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 14
T-Tests and Correlations  
Independent-samples t-tests revealed that there were no significant differences in the
theory of mind, social functioning and positive symptoms of the ill relatives. The only difference
regarding the ill relatives pertained to negative symptoms. Those residing in Puebla
demonstrated significantly higher negative symptoms than those in Los Angeles t(54) = −3.44, p
= .001.  With regard to the family climates, there were no group differences in terms of criticism
but there were differences in terms of EOI and warmth. Caregivers residing in Puebla reported
significantly higher EOI t(52) = −3.73, p < .001 and significantly lower warmth , t(55) = 2.42, p
= .019, than those residing in Los Angeles. The ill relatives from Los Angeles also judged their
caregivers to be higher in warm, t(55) = 2.33, p = .023.  No significant difference was found
regarding ill relatives’ perception of EOI (Table 1).  
Separate correlation matrices based on site were first computed (Table 2). These
correlations were transformed to z-scores to test for the significance of the difference between
the coefficients from each site. The relationships between the participants’ perceived EOI and
social functioning (z = -3.70, p = .000), theory of mind (z = -2.78, p = .005), and negative (z =
2.40, p = .016) and positive symptoms (z = 3.18, p < .001) were significantly different between
the sample sites. Specifically, for participants in Puebla, participants’ perceived EOI was
positively related to ToM (r = .38, p = .019) but not significantly related to positive (r = -.17, p
= .31) and negative (r = -.17, p = .29) symptoms and social functioning (r = .24, p = .17). In the
Los Angeles sample, participants’ perceived EOI was positively related to their positive (r = .68,
p = .002) and negative (r = .52, p = .03) symptoms, and negatively related to their theory of mind
(r = -.40, p = .08) and social functioning (r = -.70, p = .001). No other significant differences
were encountered.
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 15
Correlations among the variables for the combined sample are presented in Table 3. ToM
was positively related to social functioning (r = .37, p = .005) and negatively related to negative
(r =-.33, p = .01) and positive symptoms (r =-.29, p = .03). Furthermore, social functioning was
also negatively related to negative (r = -,53, p < .001) and positive symptoms (r = -.29, p =.03).
Positive and negative symptoms were inter-correlated (r = .56, p < .001). Negative symptoms
were entered as covariates in all the following analyses as these were strongly associated with
social functioning.
Moderation Analyses
Criticism. Results revealed that the interaction between caregivers’ reports of criticism
(caregiver criticism) and ToM was significantly related to the social functioning of participants
from Puebla F(4,29) = 12.39, R
2
= .53, p = .000; β = -.46, p = .017. This indicates that only at
lower levels of criticism higher ToM skills were significantly related to higher social functioning
(t (29)= 2.49, p = .019). This same pattern of correlations was present for participants’
perceptions of caregivers’ criticism (perceived criticism) in Puebla, but the interaction term was
not statistically significant (p = .13). Although no interactions were statistically significant in the
Los Angeles sample, as presented in Figure 1, the patterns of the relationship between ToM and
social functioning at low and high levels of criticism are similar to those from Puebla.  
When combining the samples, the interaction between ToM and caregiver criticism,
accounting for negative symptoms and study site, produced a significant change in R
2
for social
functioning, F (5,44) = 8.32, R
2
= .39, p < .001 (Table 4). Moreover, neither ToM (p=.30) nor
criticism (p=.63) were independently related to social functioning. The supported interaction
indicates that at low levels of caregiver-reported criticism (−1 SD below the mean), higher levels
of ToM were significantly related to higher levels of social functioning (t (44)= 3.19, p = .003).
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 16
Conversely, when caregivers reported higher levels of criticism (+1 SD above the mean),
participants’ levels of ToM skills were not significantly related to their social functioning (t
(44)= -.51, p = .62). Figure 2 shows the nature of the interaction where a positive relationship
between ToM and social functioning is only significant at low levels of criticism by caregivers (-
1 SD below the mean). Although the overall interaction term was not significant for participants’
perceived criticism, a similar pattern of relationships was present. In particular, when comparing
the correlation between ToM and social functioning across low and high levels of criticism (t
(46)= -.13, p = .89), this relationship was only significant at low levels of criticism (t (46)= 2.47,
p = .02).  
EOI. The interaction between ToM and EOI was not significantly related to social
functioning in any of the independent samples or the combined sample (ps range from .55 to .91).
This pattern was the same when testing both the caregivers’ report of EOI (caregiver EOI) and
the participants’ perception of their caregiver’s EOI (perceived EOI).  Therefore, there was no
support for EOI moderating the relationship between ToM and social functioning (Figure 3 and
4).  
Warmth. The interaction between ToM and warmth was not significantly related to
social functioning in any of the independent samples or the combined sample (ps range from .41
to .59). This pattern was the same when testing both the caregivers’ report of warmth (caregiver
warmth) and the participants’ perception of their caregiver’s warmth (perceived warmth).
Therefore, there was no support for warmth moderating the relationship between ToM and social
functioning (Figure 5 and 6).  


FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 17
Discussion
By including individuals residing in Los Angeles, California and in Puebla, Mexico, this
study explored whether the relationship between family environments and ToM and social
functioning varied across sociocultural contexts. Furthermore, we examined how family climates
moderated the relationship between ToM and social outcomes in schizophrenia. Specifically,
three indicators of family environment, based on the expressed emotion literature, were assessed:
criticism, EOI, and warmth.
Sociocultural Context  
In terms of family environments, we found that caregivers in Puebla reported less warmth
and more EOI than caregivers in Los Angeles. Participants in Puebla also perceived less warmth
from their caregivers than those in Los Angeles. In addition, for participants residing in Puebla,
perceived EOI was related to better ToM, and its relationship with social functioning was
positive in nature, although not statistically significant. On the other hand, perceived EOI was
negatively related to the ToM and social functioning for participants in Los Angeles. Although
the relationships between caregiver’s reports of EOI and ToM and social functioning were not
significant, these were negative in nature for both groups. Furthermore, our results also
demonstrated that participants residing in Puebla demonstrated higher levels of negative
symptoms than those living in Los Angeles.
The results of this study are indicative of a difference in perceptions of EOI and how
these relate to social outcomes across groups. It is possible that, in Mexico, because of the
limited accessibility of psychosocial treatments (Liberman, 2007; Ortega & Valencia, 2001;
Valencia et al., 2010) and the high cost of second-generation antipsychotics (Apiquian et al.,
2004), caregivers may assume greater responsibility of taking care of their ill relatives than in
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 18
settings where more care was available, contributing to potentially greater EOI. Simultaneously,
it is also likely that this greater involvement may burden caregivers, straining family
relationships and reducing the amount of their expressed warmth (Gomez de Regil et al., 2014;
Scazufca & Kuipers, 1996). The limited availability and high cost of services may also explain
the fact that people in Puebla demonstrated more negative symptoms. Furthermore, the
differential relationships between perceived EOI and social outcomes across samples could be
explained by the possibility that participants in Puebla did have the same perception of EOI as
participants in Los Angeles. For example, Rosenfarb et al., (2006) found that intrusive and
critical caregiver behaviors were related to better clinical outcomes for African Americans but
worse clinical outcomes for Euro-Americans. They indicated that it was possible that African
Americans perceived these intrusive and critical behaviors as evidence of caring. In this sample,
it is also likely that participants perceived their caregivers’ EOI as demonstrations of care, and
because of this, EOI may not have a strong negative relationship with social outcomes. These
results support the notion that the meaning of EOI may shift given the sociocultural context of
families, and that future research should investigate possible explanations for these patterns.  
Moderation of Family Factors
Although not pervasive, the group differences across sites suggested that it was best to
test first the family moderation hypotheses in the two samples independently and then as a
combined sample. The results of this study uncovered criticism’s role in the way ToM and social
functioning relate. Results from the Puebla site and the combined sample indicated that the
interaction between caregivers’ reports of criticism and ToM was significantly related to social
functioning. Albeit not statistically significant, a similar pattern was found for participants
residing in Los Angeles when testing the interaction between participants’ perceived criticism
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 19
and ToM. These results suggest that only at lower levels of caregiver-reported criticism, higher
ToM abilities are significantly related to better social functioning. Conversely, at high levels of
criticism, greater ToM abilities are not related to increased social functioning.  
These results suggest that having high ToM skills may increase people’s sensitivity to
criticism (Lecce, Caputi, & Pagnin, 2014). For instance, children with better ToM skills have
demonstrated more sensitivity to criticism (Cutting & Dunn, 2002; Dunn, 1995). This sensitivity
to criticism has been shown to mediate the relationship between ToM and teacher-rated
achievement in school-aged children, such that children with better ToM abilities were able to
use criticisms to promote their academic achievement (Lecce, Caputi, & Hughes, 2011; Lecce,
Caputi, & Pagnin, 2014). In contrast to children, people with schizophrenia may be unable to
respond to others’ criticisms, as they may lack the necessary abilities or they may experience
symptoms that make it more difficult for them to address these criticisms. Therefore, it is
possible that higher ToM skills combined with critical environments may precipitate
psychological and biological processes such as stress and emotional instability that reduce a
person’s ability to function socially (e.g. Cutting et al., 2006; Finnegan., 2011).  
For the variables of EOI and warmth, no interactions with ToM were significantly related
to social functioning in any of the samples. When controlling for negative symptoms, none of the
EE indicators, showed a significant relationship with social functioning in either the independent
or combined samples. Since it is still unclear how EOI and warmth relate to the social
functioning of individuals, future research should assess other ways in which these variables may
contribute to social outcomes. For example, as demonstrated by Schlosser et al., (2010), these
two constructs may interact when predicting social functioning, such that at moderate levels of
EOI, higher warmth relates to better social functioning. Although the current study did not assess
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 20
interactions among the family climate indicators, future research should assess how these and
other aspects of family environments relate to social functioning.
Interestingly, this study also revealed that after accounting for negative symptoms,
neither ToM nor the measures of family climate were independently related to social functioning.
This is consistent with literature showing that ToM may not directly relate to functional
outcomes, but rather is indirectly related through other factors (e.g. negative symptoms; Mehta et
al., 2013). Additionally, this study’s findings suggest that social functioning may be best
explained by an interaction between ToM and familial contexts, rather than by ToM alone.
Future research should further examine whether family environments interact with other
constructs relevant in the social functioning of people with schizophrenia (e.g. social competence,
negative symptoms, etc.)
This study had multiple limitations. For example, we conducted analyses with a small
sample, especially for each of the individual sites. Consequently, the analyses that were
conducted had low power, and because of the possibility of an increase in Type I error, the
results of this study should be interpreted with caution. Because the present study is correlational
and cross-sectional, it is not possible to infer causality. Future studies should make use of other
types of research designs to support related findings. For example, assessing family
environments and social functioning before and after a ToM intervention may provide a better
delineation of the directionality of these effects. Another limitation is that this study is based on
the assumption that EE levels are constant within family environments. However, it may be
plausible that family climates are continuously changing and adapting to other contextual factors.
For this reason, future studies should examine how family environments may change over time,
and the variables related to this change. This study would have benefited from including
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 21
assessments of other aspects of social cognition, as the literature on other domains is very strong
(Fett et al., 2011). Furthermore, different methods to assess family environments (e.g. behavioral
assessments) may present a more accurate description rather than self-report, especially the
measure of caregiver reports of EOI did not demonstrate adequate internal consistency.  
Despite these limitations, this study contributed to the literature by demonstrating that
family processes may play a role in the relationship between ToM and social functioning in
people with schizophrenia while also highlighting the importance of the sociocultural contexts in
these relationships. Based on this study’s results, further research on family relationships and
social outcomes could potentially provide ways to integrate families in clinical interventions
aimed at increasing sociocognitive abilities. For example, Tas et al. (2012) incorporated families
as “practice partners” in a social cognition training (Horan et al., 2009) and found that this led to
improved ToM skills, quality of life, and social functioning of people with schizophrenia
compared to a group without family members. This study provides support for further research
into the role of families and cultural contexts in individuals’ social functioning.  
Running head: FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING  22      
!
References
Aguilera, A., López, S. R., Breitborde, N. J. K., Kopelowicz, A., & Zarate, R. (2010). Expressed
emotion and sociocultural moderation in the course of schizophrenia. Journal of
Abnormal Psychology, 119(4), 875-885. doi:10.1037/a0020908
Alegría, M., Lin, J., Chen, C-N., Duan, N., Cook, B., & Meng, X.-L. (2012). The impact of
health insurance coverage in diminishing racial and ethnic disparities in behavioral health
services. Health Services Research, 47, 1322–1344.
Apiquian, R., Fresán, A., de la Fuente-Sandoval, C., Ulloa, R., & Nicolini, H. (2004). Survey on
schizophrenia treatment in Mexico: Perception and antipsychotic prescription patterns.
BMC Psychiatry, 4(1), 12-12. doi:10.1186/1471-244X-4-12
Barrowclough C, Tarrier N. (1990) Social functioning in schizophrenic patients: The effects of
expressed emotion and family intervention. Social Psychiatry and Psychiatric
Epidemiology, 25, 125- 129.
Bertrand, M.C., Sutton, H., Achim, A.M., Malla, A.K., Lepage, M., (2007). Social cognitive
impairments in first-episode psychosis. Schizophrenia Research, 95, 124–133.
Bellack, A.S., Green, M. F., Cook, J. A., Fenton, W., Harvey, P. D., Heaton R. K., et al. (2007).
Assessment of community functioning in people with schizophrenia and other severe
mental illnesses: A white paper based on an NIMH-sponsored workshop. Schizophrenia
Bulletin, 33, 805–822.  
Berenzon Gorn S., Saavedra Solano, N., Medina-Mora Icaza, M. E., Aparicio Basaurí, V., &
Galvan Reyes, J. (2013). Evaluación del sistema de salud mental en México: ¿Hacia
dónde encaminar la atención? Revista Panamericana de Salud Publica. 33(4), 252-258.
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 23
Betancourt, H., & Lopez, S. R. (1993).  The study of culture, ethnicity, and race in American
psychology.  American Psychologist, 48, 629-637.
Bhugra, D., & McKenzie, K. (2003). Expressed emotion across cultures. Advances in Psychiatric
Treatment, 9(5), 342-348. doi:10.1192/apt.9.5.342
Bora E, Gokcen S, Kayahan B et al. (2008) Deficits of social-cognitive and social-perceptual
aspect of theory of mind in remitted patients with schizophrenia: Effect of residual
symptoms. The Journal of Nervous and Mental Disease, 196, 95-99.
Bora, E., Yucel, M., & Pantelis, C. (2009). Theory of mind impairment in schizophrenia: A
meta-analysis. Schizophrenia Research, 109, 1–9.  
Breitborde, N. J. K., López, S. R., Wickens, T. D., Jenkins, J. H., & Karno, M. (2007). Toward
specifying the nature of the relationship between expressed emotion and schizophrenic
relapse: The utility of curvilinear models. International Journal of Methods in
Psychiatric Research, 16(1), 1-10. doi:10.1002/mpr.194
Brüne, M., Abdel-Hamid, M., Lehmkämper, C., & Sonntagd, C. (2007). Mental state attribution,
neurocognitive functioning, and psychopathology: What predicts poor social competence
in schizophrenia best? Schizophrenia Research, 92, 151–159.  
Brüne, M., Schaub, D., Juckel, G., & Langdon, R. (2011). Social skills and behavioral problems
in schizophrenia: The role of mental state attribution, neurocognition and clinical
symptomatology. Psychiatry Research, 190(1), 9–17.  
Butzlaff, R. L. & Hooley, J. M. (1998). Expressed emotion and psychiatric relapse: A meta-
analysis. Archives of General Psychiatry, 55, 547–552.
Cahill, K. R., Deater-Deckard, K., Pike, A., & Hughes, C. (2007). Theory of mind, self-worth
and the mother–child relationship. Social Development, 16, 45–56.
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 24
Caraveo-Anduaga, J., Aguilar-Gaxiola, S., Vega, W. A., Kolody, B., Alderete, E., & Catalano, R.
(1998). Lifetime prevalence of DSM-III-R psychiatric disorders among urban and rural
Mexican Americans in California. Archives of General Psychiatry, 55(9), 771-778.
doi:10.1001/archpsyc.55.9.771
Cohen, J., & Cohen, P. (1983). Applied multiple regression/correlation analysis for the
behavioral sciences. Hillsdale, NJ: Erlbaum.
Corcoran, R., & Frith, C. D. (2003). Autobiographical memory and theory of mind: Evidence of
a relationship in schizophrenia. Psychological Medicine, 33(5), 897-905.
doi:10.1017/S0033291703007529
Corcoran R., Mercer, G., & Frith, C. (1995). Schizophrenia, symptomatology and social
inference: Investigating ‘theory of mind’ in people with schizophrenia. Schizophrenia
Research, 17, 5–13.  
Corcoran, R. (2001). Theory of mind in schizophrenia. In D. Penn and P.W. Corrigan (Ed.),
Social Cognition and Schizophrenia, (pp. 149–174). APA: Washington, DC.
Couture, S. M., Granholm, E. L., & Fish, S. C. (2011). A path model investigation of
neurocognition, theory of mind, social competence, negative symptoms and real-world
functioning in schizophrenia. Schizophrenia Research, 125(2–3), 152–160.  
Couture S. M., Penn D. L., & Roberts, D. L., (2006). The functional significance of social
cognition in schizophrenia: A review. Schizophrenia Bulletin, 32, S44–S63.  
Cutting, A. L., & Dunn, J. (2002). The cost of understanding other people: Social cognition
predicts young children's sensitivity to criticism. Journal of Child Psychology and
Psychiatry, 43(7), 849-860. doi:10.1111/1469-7610.t01-1-00047
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 25
Cutting, L. P., Aakre, J. M., & Docherty, N. M. (2006; 2005). Schizophrenic patients'
perceptions of stress, expressed emotion, and sensitivity to criticism. Schizophrenia
Bulletin, 32(4), 743-750. doi:10.1093/schbul/sbl001
Dunn, J. (1995). Children as psychologists: The later correlates of individual differences in
understanding of emotions and other minds. Cognition and Emotion, 9(2), 187-201.
doi:10.1080/02699939508409008
Evans, J.D., Bond, G.R., Meyer, P.S., Kim, H.W., Lysaker, P.H., Gibson, P.J., & Tunis, S.,
(2004). Cognitive and clinical predictors of success in vocational rehabilitation in
schizophrenia. Schizophrenia Research, 70, 331–342.
Fett, A. K., Viechtbauer, W., Dominguez, M. D., Penn, D. L., van Os, J., & Krabbendam, L.
(2011). The relationship between neurocognition and social cognition with functional
outcomes in schizophrenia: A meta-analysis. Neuroscience and Biobehavioral Reviews,
35, 573–588.  
Finnegan, D., Onwumere, J., Green, C., Freeman, D., Garety, P., & Kuipers, E. (2014). Negative
communication in psychosis: Understanding pathways to poorer patient outcomes. The
Journal of Nervous and Mental Disease, 202(11), 829-832.
doi:10.1097/NMD.0000000000000204
Funk, M. (2006). A framework to guide full service partnerships for adults; in CiMH Training on
Full Service Partnerships. Los Angeles, Los Angeles County Department of Mental
Health.
Galende, N., de Miguel, M. S. and Arranz, E. (2011), The Role of Physical Context, Verbal
Skills, Non-parental Care, Social Support, and Type of Parental Discipline in the
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 26
Development of ToM Capacity in Five-Year-Old Children. Social Development, 20: 845–
861. doi: 10.1111/j.1467-9507.2011.00625.x
Gómez-de-Regil, L., Kwapil, T.R., & Barrantes-Vidal, N. (2014) Predictors of expressed
emotion, burden and quality of life in relatives of Mexican patients with psychosis.
Journal of Psychiatric and Mental Health Nursing, 21, 170–179.
Goodman, S. H.. Sewell, D. R., Cooler, E. L., et al. (1993). Assessing levels of adaptive
functioning: the Role Functioning Scale. Community Mental Health Journal, 29, 119-
131.  
González-Pier, E., Gutierrez, C., Stevens, G., Barraza, M., Porras, R., Caravalho, N., et al.
(2006). Priority setting for health interventions in Mexico´s system of social protection in
health. The Lancet, 368(9547), 1608–1618.
Green, M.F., Penn, D.L., Bentall, R., Carpenter, W.T., Gaebel, W., Gur, R.C., Kring, A.M., Park,
S., Silverstein, S.M. & Heinssen, R. (2008). Social cognition in schizophrenia: An NIMH
workshop on definitions, assessment, and research opportunities. Schizophrenia Bulletin,
34, 1211–1220.
Hayes, A. F., & Matthes, J. (2009). Computational procedures for probing interactions in OLS
and logistic regression: SPSS and SAS implementations. Behavior Research Methods, 41,
924–936.
Horan, W. P., Kern, R. S., Shokat-Fadai, K., Sergi, M. J., Wynn, J. K., & Green, M. F. (2009).
Social cognitive skills training in schizophrenia: An initial efficacy study of stabilized
outpatients. Schizophrenia Research, 107, 47–54.  
Hughes, C., & Ensor, R. (2006). Behavioural problems in 2-year-olds: Links with individual
differences in theory of mind, executive function and harsh parenting. Journal of Child
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 27
Psychology and Psychiatry, 47, 488–497.  
Inoue S., Tanaka S., Shimodera S., Mino Y. Expressed emotion and social function. Psychiatry
Research, 72, 33-39.
Kay, S. R., Opler, L. A., & Fiszbein, A. (1987). The positive and negative syndrome scale
(PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261–276.  
Kay S. R., Opler L. A., Lindenmayer J. P. (1988). Reliability and validity of the positive and
negative syndrome scale for schizophrenics. Psychiatry Research, 23, 99–110.
King S. & Dixon M. (1995) Expressed emotion, family dynamics and symptom severity in a
predictive model of social adjustment for schizophrenic young adults. Schizophrenia
Research, 14, 121-132.
Kopelowicz, A., Zarate, R., Gonzalez, V., Lopez, S. R., Ortega, P., Obregon, N., & Mintz, J.
(2002). Evaluation of expressed emotion in schizophrenia: A comparison of caucasians
and mexican-americans. Schizophrenia Research, 55(1), 179-186. doi:10.1016/S0920-
9964(01)00193-1
Kopelowicz A., Zarate R., Wallace C., et al. (2012). The ability of multifamily groups to
improve treatment adherence in Mexican Americans with schizophrenia. Archives of
General Psychiatry, 69, 265–273.  
Kurtz M. M., & Richardson, C. L. (2012). Social cognitive training for schizophrenia: A meta-
analytic investigation of controlled research. Schizophrenia Bulletin, 38, 1092–1104.  
Lecce, S., Caputi, M., & Hughes, C. (2011). Does sensitivity to criticism mediate the relationship
between theory of mind and academic achievement? Journal of Experimental Child
Psychology, 110(3), 313-331. doi:10.1016/j.jecp.2011.04.011
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 28
Lecce, S., Caputi, M., and Pagnin, A. (2014). Long-term effect of theory of mind on school
achievement: the role of sensitivity to criticism. European Journal of Developmental
Psychology. 11(3), 531-555. doi: 10.1080/17405629.2013.821944  
Leifker, F. R., Bowie, C. R., & Harvey, P. D. (2009). Determinants of everyday outcomes in
schizophrenia: The influences of cognitive impairment, functional capacity, and
symptoms. Schizophrenia Research, 115, 82–87.
Leslie, A. M. (1987). Pretense and representation: The origins of “theory of mind.”
Psychological Review, 94, 412–426.  
Liberman, R.P. (2007). Dissemination and adoption of social skills training: Social validation of
an evidence-based treatment for the mentally disabled. Journal of Mental Health, 16,
595-623.
Lopez, S. R., Garcia, J. I. R., Ullman, J. B., Kopelowicz, A., Jenkins, J., Breitborde, N. J. K., &
Placencia, P. (2009). Cultural variability in the manifestation of expressed emotion.
Family Process, 48(2), 179-194. doi:10.1111/j.1545-5300.2009.01276.x
Lopez, S. R. & Guarnaccia, P. J. (2000).  Cultural psychopathology:  Uncovering the social
world of mental illness.  Annual Review of Psychology, 51, 571-598.
López, S. R., Hipke, K. N., Polo, J. A., Jenkins, J. H., Karno, M., Vaughn, C., et al. (2004).
Ethnicity, expressed emotion, attributions, and course of schizophrenia: Family warmth
matters. Journal of Abnormal Psychology, 113, 428–439.
Lysaker, P. H., Salvatore, G., Grant, M. L. A., Procacci, M., Olesek, K. L., Buck, K. D., . . .
Dimaggio, G. (2010). Deficits in theory of mind and social anxiety as independent paths
to paranoid features in schizophrenia. Schizophrenia Research, 124(1), 81-85.
doi:10.1016/j.schres.2010.06.019
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 29
Medina-Mora, M. E., Borges, G., Lara, C., Benjet, C., Blanco, J., Fleiz, C., et al. (2003).
Prevalencia de trastornos mentales y uso de servicios: Resultados!de la Encuesta
Nacional de Epidemiología Psiquiátrica en México. Salud Mental (Mex), 26(4), 1–16.
Medina-Mora, M. E., Borges, G., Lara, C., Benjet,!C., Blanco, J., Fleiz, C., et al. (2005).
Prevalence, service use, and demographic correlates of 12-month!DSM-IV psychiatric
disorders in Mexico: Results from the Mexican National Comorbidity!Survey.
Psychological Medicine, 35, 1–11.
Medina-Pradas, C., Navarro, J. B., Lo´pez, S. R., Grau, A., & Obiols, J. E. (2011). Further
development of a scale of perceived expressed emotion and its evaluation in a sample of
patients with eating disorders. Psychiatry Research, 190, 291–296.
doi:10.1016/j.psychres.2011.06.011
Medina-Pradas, J. B. Navarro, E. Pousa, M. I. & Montero, J. E. (2013). Expressed and perceived
criticism, family warmth, and symptoms in schizophrenia. Spanish Journal of Psychology,
16(e45), 1–8.
McLachlan S. A., Devins G. M., & Goodwin P. J. (1999). Factor analysis of the psychosocial
items of the EORTC QLQ-C30 in metastatic breast cancer patients participating in a
psychosocial intervention study. Quality of Life Research, 8(4), 311-317.  
Miura, Y., Mizuno, M., Yamashita, C., Watanabe, K., Murakami, M., & Kashima, H. (2004).
Expressed emotion and social functioning in chronic schizophrenia. Comprehensive
Psychiatry, 45(6), 469-474. doi:10.1016/j.comppsych.2004.07.006
Murray C. J. L., & Lopez A. D. (1996). Quantifying the burden of disease and injury attributable
to ten major risk factors. In C. J. L. Murray & A. D. Lopez (Eds.), The Global Burden of
Disease, Vol I, (pp. 295–324). Cambridge, MA: Harvard University Press.  
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 30
Murray, C. J. L., & Lopez, A. D. (1997). Regional patterns of disability-free life expectancy and
disability adjusted life expectancy: Global burden of disease study. Lancet, 349, 1347–
1352.  
Muthén, L. K., & Muthén, B. O. (2010). Mplus user’s guide (6th ed.). Los Angeles, CA: Muthén
& Muthén.
Olson, S. L., Lopez-Duran, N., Lunkenheimer, E. S., Chang, H., & Sameroff, A. J. (2011).
Individual differences in the development of early peer aggression: Integrating
contributions of self-regulation, theory of mind, and parenting. Development and
Psychopathology, 23(1), 253-266. doi:10.1017/S0954579410000775
O'Brien, M. P., Gordon, J. L., Bearden, C. E., Lopez, S. R., Kopelowicz, A., & Cannon, T. D.
(2006). Positive family environment predicts improvement in symptoms and social
functioning among adolescents at imminent risk for onset of psychosis. Schizophrenia
Research, 81(2), 269-275. doi:10.1016/j.schres.2005.10.005
O’Reilly, J., & Peterson, C. C. (2014). Theory of mind at home: Linking authoritative and
authoritarian parenting styles to children’s social understanding. Early Child
Development and Care, 184(12), 1934-1947. doi:10.1080/03004430.2014.894034
Organización Panamericana de la Salud/Organización Mundial de la Salud. IESM-OMS Informe
sobre el sistema de salud mental en México. (2011). México: OPS/OMS. [Consultado
2012 mayo 24]. Disponible en:
http://www.inprf.gob.mx/opencms/export/sites/INPRFM/psicosociales/
archivos/iesm_oms.pdf.
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 31
Ortega, H., & Valencia, M. (2001). Pharmacological treatment for schizophrenia. In H. Ortega &
M. Valencia (Eds.), Schizophrenia: Current Views and Perspectives (pp. 349-398).
Mexico City: Editorial Laser.
Osoba D., Rodrigues G., Myles J., Zee B., & Pater J. (1998). Interpreting the significance of
changes in health-related quality-of-life scores. Journal of Clinical Oncology, 16(1), 139-
144.  
Otsuka T., Nakane Y., & Ohta Y. (1994). Symptoms and social adjustment of schizophrenic
patients as evaluated by family members. Acta Psychiatrica Scandinavica, 89, 111-116.
Parker, G., Tupling, H., Brown, L.B. (1979). A parental bonding instrument. British Journal of
Medical Psychology, 52, 1–10.
Peterson, C., & Slaughter, V. (2003). Opening windows into the mind: Mothers’ preferences for
mental state explanations and children’s theory of mind. Cognitive Development, 18(3),
399-429. doi:10.1016/S0885-2014(03)00041-8
Pinkham A. E., Penn D. L. (2006) Neurocognitive and social cognitive predictors of
interpersonal skill in schizophrenia. Psychiatry Research, 143, 167- 178.  
Preacher, K. J. (2002). Calculation for the test of the difference between two independent
correlation coefficients [Computer software]. Available from http://quantpsy.org. C.  
Rabin, J. S., Gilboa, A., Stuss, D. T., Mar, R. A., & Rosenbaum, R. S. (2010). Common and
unique neural correlates of autobiographical memory and theory of mind. Journal of
Cognitive Neuroscience, 22(6), 1095-1111. doi:10.1162/jocn.2009.21344
Roncone, R., Falloon, I. R. H., Mazza, M., De Risio, A., Pollice. R., Necozione, S., Morosini. P.,
& Casacchia, M. (2002). Is theory of mind in schizophrenia more strongly associated
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 32
with clinical and social functioning than with neurocognitive deficits? Psychopathology,
35, 280–288.  
Rosenfarb, I. S., Bellack, A. S., & Aziz, N. (2006). Family interactions and the course of
schizophrenia in african american and white patients. Journal of Abnormal Psychology,
115(1), 112-120. doi:10.1037/0021-843X.115.1.112
Ruffman, T., Slade, L., Devitt, K., & Crowe, E. (2006). What mothers say and what they do: The
relation between parenting, theory of mind, language and conflict/cooperation. The
British Journal of Developmental Psychology, 24, 105.
Rylands, A. J., McKie, S., Elliott, R., Deakin, J. F. W., & Tarrier, N. (2011). A functional
magnetic resonance imaging paradigm of expressed emotion in schizophrenia. The
Journal of Nervous and Mental Disease, 199(1), 25-29.
doi:10.1097/NMD.0b013e3182043b87
Savla, G. N., Vella, L., Armstrong, C. C., Penn, D. L., & Twamley, E. W. (2013). Deficits in
domains of social cognition in schizophrenia: A meta-analysis of the empirical evidence.
Schizophrenia Bulletin, 39, 979-992.
Scazufca M. & Kuipers E. (1996) Links between expressed emotion and burden of care in relatives of patients with schizophrenia. British Journal of Psychiatry, 168, 580–587.  
Schlosser, D. A., Zinberg, J. L., Loewy, R. L., Casey-Cannon S., O’Brien M. P., Bearden C. E. et
al. (2010). Predicting the longitudinal effects of the family environment on prodromal
symptoms and functioning in patients at-risk for psychosis. Schizophrenia Research, 118,
69–75.
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 33
Schmidt, S. J., Mueller, D. R., & Roder, V. (2011). Social cognition as a mediator variable
between neurocognition and functional outcome in schizophrenia: empirical review and
new results by structural equation modeling. Schizophrenia Bulletin, 37, S41–54.  
Singh, S. P., Harley, K., Suhail, K. (2011). Cultural specificity of emotional overinvolvement: A
systematic review. Schizophrenia Bulletin, 39(2), 449-463.
http://dx.doi.org/10.1093/schbul/sbr170
Slaughter, V., Peterson, C. C., & Mackintosh, E. (2007). Mind what mother says: Narrative input
and theory of mind in typical children and those on the autism spectrum. Child
Development, 78(3), 839-858. doi:10.1111/j.1467-8624.2007.01036.x
Smith, T.E., Hull, J.W., Huppert, J.D., Silverstein, S.M., (2002). Recovery from psychosis in
schizophrenia and schizoaffective disorder: Symptoms and neurocognitive ratelimiters
for the development of social behavioral skills. Schizophrenia Research, 55, 229–237.
Spreng, R. N., Mar, R. A., & Alice S. N. Kim. (2009). The common neural basis of
autobiographical memory, prospection, navigation, theory of mind, and the default mode:
A quantitative meta-analysis. Journal of Cognitive Neuroscience, 21(3), 489-510.
doi:10.1162/jocn.2008.21029
Sprong, M., Schothorst, P., Vos, E., Hox, J., & Van Engeland, H. (2007). Theory of mind in
schizophrenia: Meta-analysis. British Journal of Psychiatry, 191, 5-13.
Stone, A., Rogers, D., Kruckenberg, S., & Lieser, A. (2012). Impact of the mental healthcare
delivery system on California emergency departments. Western Journal of Emergency
Medicine, 13(1), 51.  
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 34
Symons, D. K., Fossum, K. M., & Collins, T. B. K. (2006). A longitudinal study of belief and
desire state discourse during Mother–Child play and later false belief understanding.
Social Development, 15(4), 676-692. doi:10.1111/j.1467-9507.2006.00364.x
Tas, C., Danaci, A. E., Cubukcuoglu, Z., & Brüne, M. (2012). Impact of family involvement on
social cognition training in clinically stable outpatients with schizophrenia: A randomized
pilot study. Psychiatry Research, 195(1-2), 32–38.  
Tsai, K. H., López, S., Marvin, S., Zinberg, J., Cannon, T. D., O'Brien, M., & Bearden, C. E.
(2014). Perceptions of family criticism and warmth and their link to symptom expression
in racially/ethnically diverse adolescents and young adults at clinical high risk for
psychosis. Early intervention in psychiatry.!doi: 10.1111/eip.12131
Üstün, T. B., Rehm, J., Chatterji, S., Saxena, S., Trotter, R., Room, R., & Bickenbach, J. (1999).
Multiple-informant ranking of the disabling effects of different health conditions in 14
countries. Lancet, 354(9173), 111–115.  
Valencia, M., Rascon, M. L., Juarez, F., Escamilla, R., Saracco, R., & Liberman, R. P. (2010).
Application in Mexico of psychosocial rehabilitation with schizophrenia patients.
Psychiatry, 73(3), 248–263.
Van den Oord, E., Rujescu, D., Robies, J., et al. (2006). Factor structure and external validity of
the PANSS Factor structure and external validity of the PANSS revisited. Schizophrenia
Research, 82, 213-223.  
Vaughn, C. E., Leff, J., (1976). The measurement of expressed emotion of families of
psychiatric patients. British Journal of Social and Clinical Psychology, 15, 157–165.
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 35
Ventura, J., Wood, R. C., Hellemann, G. S. (2013). Symptom domains in neurocognitive
functioning can help differentiate social cognitive processes in schizophrenia: A
metaanalysis. Schizophrenia Bulletin, 39, 102–111.
World Health Organization. (2008) The Global Burden of Disease: 2004 Update. Geneva,
Switzerland.  
Wu, E. Q., Birnbaum, H. G., Shi, L., Ball, D. E., Kessler, R. C., Moulis, M., et al. (2005). The
economic burden of schizophrenia in the United States in 2002. Journal of Clinical
Psychiatry, 66(9), 1122–1129. doi:10.4088/JCP.  
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 36
Tables and Figures
Table 1  

Independent sample t-tests comparing study variables across sample sites

Note: EOI = emotional over-involvement
** p <.005



Los Angeles
(n = 18)

Puebla
(n = 34)


M SD  M SD  t-test
1. Positive Symptoms 1.79 .60  1.91 .83    -.51
2. Negative Symptoms 2.45 .71  3.35 .99  -3.44**
3. Theory of Mind 1.79 .60  1.90 .83    -.73
4. Social Functioning 4.42 1.69  3.85 1.04   1.52
5. Caregiver Criticism  4.31 2.93  5.37 2.84  -1.84
6. Perceived Criticism 4.13 2.57  4.95 2.44  -1.29
7. Caregiver EOI  5.15 .77  6.17 1.09  -3.73**
8. Perceived EOI  3.79 2.21  4.66 1.69  -1.66
9. Caregiver Warmth 8.39 1.10  7.44 1.56   2.42
10. Perceived Warmth  8.31 1.68  7.21 2.21   2.33
       
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                              37
   
#
#
Table 2

Pearson Correlations among study variables by sample site

1 2 3 4 5 6 7 8 9 10
1. Positive Symptoms __  .43 -.23 -.59*  .06  .39  .17  .68** -.10  .01
2. Negative Symptoms  .63** __ -.54* -.53* -.24  .12  .11  .52* -.25  .07
3. Theory of Mind -.33* -.40* __  .46*  .20 -.17 -.24 -.40 -.14 -.11
4. Social Functioning -.15 -.59**  .36* __ -.16 -.31 -.12 -.70**  .30 -.24
5. Caregiver Criticism   .03 -.10  .18  .10 __ -.38  .29  .27 -.32 -.16
6. Perceived Criticism -.13 -.15  .33*  .18  .28 __  .10  .70**  .12 -.40
7. Caregiver EOI   .05  .06 -.16 -.35  .14 -.02 __  .15 -.14  .22
8. Perceived EOI  -.17 -.18  .38*  .24  .23  .51**  .09 __ -.06  .21
9. Caregiver Warmth  .22  .27 -.04 -.08 -.31 -.02  .18  .02 __  .12
10. Perceived Warmth  -.09 -.09  .01  .14 -.28 -.12  .08 -.18  .31 __

Note: Lower triangle comprises correlations among participants from Mexico; Ns range from 35 to 38. Upper triangle comprises
correlations among participants from Los Angeles; Ns range from 17 to 21. Note: EOI = emotional over-involvement
* p <.05; ** p <.01; *** p <.001









FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 38
Table 3

Means, Standard Deviations, and Pearson Correlations among study variables for all participants

1 2 3 4 5 6 7 8 9 10
1. Positive Symptoms __ .56** -.29* -.29*  .06  .03  .05  .10  .16 -.09
2. Negative Symptoms __ __ -.33* -.53* -.03  .01  .25  .09  .01 -.17
3. Theory of Mind __ __ __  .37*  .15  .15 -.11  .08 -.09  .00
4. Social Functioning __ __ __ __ -.07 -.11 -.31* -.31*  .14  .23
5. Caregiver Criticism  __ __ __ __ __  .34*  .27  .29* -.36** -.30*
6. Perceived Criticism __ __ __ __ __ __  .10  .61** -.04 -.26*
7. Caregiver EOI  __ __ __ __ __ __ __  .20 -.05 -.25
8. Perceived EOI  __ __ __ __ __ __ __ __  -.07 -.24
9. Caregiver Warmth __ __ __ __ __ __ __ __ __  .36**
10. Perceived Warmth  __ __ __ __ __ __ __ __ __ __
         
Means 3.06 1.87 .85 4.07 4.98 4.67 5.78 4.36 7.79 7.61
SDs   .10   .76 .47 1.33 2.14 2.38 1.09 1.91 1.48 1.79

Note: EOI = emotional over-involvement
* p <.05; ** p <.01; *** p <.001











FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING!!!!! !!!! !!!39!
!
Table 4

Regression analysis investigating criticism as moderator of the association between ToM and
social functioning for all participants  











































B SE T ratio df p
Perceived Criticism          
Study Site .35 .39 .90 44          .37
 Negative Symptoms  -.64 .16 -4.15 44          .001
 Theory of Mind .52 .42 1.25 44          .22
 Criticism -.02 .08 -1.03 44          .31
 Theory of Mind x
criticism
-.26 .19 -1.38 44          .18
     
Caregiver Criticism            
Study Site .04 .40 .11 44          .91
 Negative Symptoms  -.52 .17 -3.04 44          .004
 Theory of Mind .65 .38 1.72 44          .09
 Criticism -.00 -.06 -.15 44          .88
 Theory of Mind x
criticism
-.43 .15 -2.71 44          .001
     
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 40
Figure 1. Simple slopes of theory of mind in relation to social functioning for 1 SD below the mean of criticism and 1 SD above the
mean of criticism by sample site.  
 






















         
                         






Los Angeles (n = 18)
!
Puebla (n = 34)
!
Note: For Puebla, slopes are significant only at low levels of caregiver-reported criticism (Caregiver Criticism: −1 SD below
the mean; t (29)= 2.49, p = .019).  
!
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 41
Figure 2. Simple slopes of theory of mind in relation to social functioning measures for 1 SD below the mean of criticism and 1 SD
above the mean of criticism for all participants.  


                                     

                                   
Note: Slopes are significant only at low levels of caregiver-reported criticism (Caregiver Criticism: −1 SD below the mean; t (44)=
3.19, p = .003).













FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 42
Figure 3. Simple slopes of theory of mind in relation to social functioning for 1 SD below the mean of criticism and 1 SD above the
mean of EOI by sample site.  
 






























Los Angeles (n = 18)
!
Puebla (n = 34)
!
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 43
Figure 4. Simple slopes of theory of mind in relation to social functioning measures for 1 SD below the mean of EOI and 1 SD above
the mean of EOI for all participants.  
 

                                     

















FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 44
Figure 5. Simple slopes of theory of mind in relation to social functioning for 1 SD below the mean of warmth and 1 SD above the
mean of warmth by sample site.  
 





























Los Angeles (n = 18)
!
Puebla (n = 34)
!
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        ! 45

Figure 6. Simple slopes of theory of mind in relation to social functioning measures for 1 SD below the mean of Warmth and 1 SD
above the mean of warmth for all participants.  


                                     














FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING!!!!!!!!!!!!!! !!!46!
!!
Appendix

Hinting Task.

Instructions.
I'm going to read out a set of 10 stories involving two people. Each story ends with one of the
characters saying something. When I've read the stories out I'm going to ask you some questions
about what the character said.

Here's the first story. Listen carefully to it.

1. George arrives in Angela's office after a long and hot journey down the motorway. Angela
immediately begins to talk about some business ideas. George interrupts Angela saying:

"My, my! It was a long, hot journey down that motorway!"

QUESTION: What does George really mean when he says this?

1b. ADD: George goes on to say:
  "I'm parched!"

QUESTION: What does George want Angela to do?  

2. Melissa goes to the bathroom for a shower. Anne has just had a bath. Melissa notices the bath
is dirty so she calls upstairs to Anne:

"Couldn't you find the Ajax, Anne?"

QUESTION: What does Melissa really mean when she says this?

2b. ADD: Melissa goes on to say:
  "You're very lazy sometimes, Anne!"

QUESTION: What does Melissa want Anne to do?

3. Gordon goes to the supermarket with his mum. They arrive at the sweetie aisle. Gordon says:

"Cor! Those treacle toffees look delicious."

QUESTION: What does Gordon really mean when he says this?

3b. ADD: Gordon goes on to say:
  "I'm hungry, mum."

QUESTION: What does Gordon want his mum to do?

FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        !
! ! !!
! ! 47
4. Paul has to go to an interview and he's running late. While he is cleaning his shoes, he says to
his wife, Jane:

"I want to wear that blue shirt but it's very creased."

QUESTION: What does Paul really mean when he says this?

4b. ADD: Paul goes on to say:
  "It's in the ironing basket."

QUESTION: What does Paul want Jane to do?


5. Lucy is broke but she wants to go out in the evening. She knows that David has just been paid.
She says to him:

"I'm flat broke! Things are so expensive these days."

QUESTION: What does Lucy really mean when she says this?
 
5b. ADD: Lucy goes on to say:
  "Oh well, I suppose I'll have to miss my night out."

QUESTION: What does Lucy want David to do?

6. Donald wants to run a project at work but Richard, his boss, has asked someone else to run it.
Donald says:

"What a pity. I'm not too busy at the moment."

QUESTION: What does Donald really mean when he says this?

6b. ADD: Donald goes on to say:
  "That project is right up my street."

QUESTION: What does Donald want Richard to do?

7. Rebecca's birthday is approaching. She says to her Dad:

"I love animals, especially dogs."

QUESTION: What does Rebecca really mean when she says this?

7b. ADD: Rebecca goes on to say:
  "Will the pet shop be open on my birthday, Dad?"

FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        !
! ! !!
! ! 48
QUESTION: What does Rebecca want her dad to do?

8. Betty and Michael moved into their new house a week ago. Betty has been unpacking some
ornaments. She says to Michael:

"Have you unpacked those shelves we bought, Michael?"

QUESTION: What does Betty really mean when she says this?

8b. ADD: Betty goes on to say:
  "If you want something doing you have to do it yourself!"

QUESTION: What does Betty want Michael to do?



9. Jessica and Max are playing with a train set. Jessica has the blue train and Max has the red one.
Jessica says to Max:

"I don't like this train."

QUESTION: What does Jessica really mean when she says this?

9b. ADD: Jessica goes on to say:
  "Red is my favourite colour."

QUESTION: What does Jessica want Max to do?

10. Patsy is just getting off the train with three heavy cases. John is standing behind her. Patsy
says to John:

"Gosh! These cases are a nuisance."

QUESTION: What did Patsy really mean when she said this?

10b. ADD: Patsy goes on to say:
  "I don't know if I can manage all three."

QUESTION: What does Patsy want John to do?







FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        !
! ! !!
! ! 49

FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        !
! ! !!
! ! 50







FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        !
! ! !!
! ! 51
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        !
! ! !!
! ! 52
Role Functioning Scale
Score Working Productivity
Rate the client in the most
appropriate expected role
(i.e. homemaker, student,
wage earner).
Independent Living, Self
Care
(Management of
household, eating,
sleeping, hygiene care)
Immediate Social Network
Relationships
(Close friends, Spouse,
Family)
Extended Social
Network Relationships
(Neighborhood,
community church, clubs,
agencies, recreational
activities).
1 Productivity severely
limited; often unable to
work or adapt to school or
homemaking; virtually no
skills or attempts to be
productive
Lacking self-care skills
approaching life
endangering threat; often
involves multiple and
lengthy hospital services;
not physically able to
participate in running a
household.
Severely deviant behaviors
within immediate social
networks (i.e. often with
imminent physical
aggression or abuse to
others or severely
withdrawn from close
friends, spouse, family;
often rejected by immediate
social network).
Severely deviant
behaviors within extended
social networks (i.e.
overly disruptive, often
leading to rejection by
extended social
networks).
2 Occasional attempts at
productivity
unsuccessfully; productive
only with constant
supervision in sheltered
work, home or special
classes.
Marked limitations in self-
care/independent living;
often involving constant
supervision in or out of
protective environment
(e.g. frequent utilization of
crisis services).
Marked limitation in
immediate interpersonal
relationships (e.g. excessive
dependency or destructive
communication in
behaviors).
Often totally isolated from
extended social networks,
refusing community
involvement or belligerent
to helpers, neighbors, etc.
3 Limited productivity; often
with restricted
Limited self-care/
independent living skills;
Limited interpersonally;
often no significant
Limited range of
successful and appropriate
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        !
! ! !!
! ! 53
skills/abilities for
homemaking, school,
independent employment
(e.g. requires highly
structured routine).
often relying on
mental/physical health
care; limited participation
in running household.
participation/communication
with immediate social
network.
interactions in extended
social networks (i.e. often
restricts community
involvement to minimal
survival level
interactions).

4 Marginal productivity (e.g.
productive in sheltered
work or minimally
productive in independent
work or minimally
productive in independent
work; fluctuates at home,
in school; frequent job
changes.)
Marginally self sufficient;
often use REGULAR
assistance to maintain self-
care/independent
functioning; minimally
participates in running
household.
Marginal functioning with
immediate social network
(i.e. relationships are often
minimal and fluctuate in
quality).
Marginally effective
interactions; often in a
structured environment;
may receive multiple
public system support in
accord with multiple
needs.
5 Moderately functional in
independent employment,
at home or in school.
(Consider very spotty
work history or
fluctuations in home, in
school with extended
periods of success).
Moderately self-sufficient;
i.e. living independently
with ROUTINE assistance
(e.g. home visits by nurses,
other helping persons, in
private or self-help
residences).
Moderately affective
continuing and close
relationship with at least one
other person.
Moderately affective and
independent in
community interactions;
may receive some public
support in accord with
need.  
6 Adequate functioning in
independent employment,
Adequate independent
living & self-care with
Adequate personal
relationship with one or
Adequately interacts in
neighborhood or with at
FAMILY, THEORY OF MIND, AND SOCIAL FUNCTIONING                        !
! ! !!
! ! 54
home or school; often not
applying all available
skills/abilities.
MINIMAL support (e.g.
some transportation,
shopping assistance with
neighbors, friends, other
helping persons).
more immediate member of
social network (e.g. friend
or family).
least one community or
other organization or
recreational activity.
7 Optimally performs
homemaking, school tasks
or employment-related
functions with ease and
efficiency.
Optimal care of
health/hygiene;
independently manages to
meet personal needs and
household tasks.
Positive relationships with
spouse or family and
friends; assertively
contributes to these
relationships.
Positively interacts in
community; church or
cubs, recreational
activities, hobbies or
personal interest, often
with other participants.
Individual
Scores
   
Global RFI Score______________
! 
Abstract (if available)
Abstract Theory of mind (ToM) deficits are strongly associated with poor social outcomes in people with schizophrenia, including their inability to function independently and to maintain social relationships. Drawing upon past research demonstrating that family environments moderate the relationship between ToM abilities and psychosocial outcomes in children, the current study investigated the moderating role of family climates in the relationship between the ToM and the social functioning of people suffering from schizophrenia. Furthermore, this study examined how family caregiving varies as a function of sociocultural context. Sixty participants of Mexican-origin and their caregivers residing in Los Angeles, California and Puebla, Mexico reported on measures of family climate based on the expressed emotion literature (e.g. criticism, emotional over-involvement, and warmth). The results of this study suggest sociocultural differences in the perception of warmth and emotional over-involvement, as well as differences in the way over-involvement relates to social outcomes in each social context. Additionally, family criticism was shown to moderate the relationship between ToM and social functioning, such that only at lower levels of criticism, higher ToM abilities are significantly related to better social functioning. This study highlights that higher ToM abilities may not uniformly relate to better social functioning, especially when individuals have critical family members. Our results contribute to the literature by demonstrating how family and cultural contexts may play a role in the social functioning of people with schizophrenia. 
Linked assets
University of Southern California Dissertations and Theses
doctype icon
University of Southern California Dissertations and Theses 
Conceptually similar
Using virtual humans during clinical interviews: examining pathways to self-disclosure
PDF
Using virtual humans during clinical interviews: examining pathways to self-disclosure 
The link between the expression of negative emotion and future well-being: the role of disclosure modality in an East Asian American population
PDF
The link between the expression of negative emotion and future well-being: the role of disclosure modality in an East Asian American population 
The relationship between dating status and academic and social functioning among Latinx and Asian-American middle adolescents
PDF
The relationship between dating status and academic and social functioning among Latinx and Asian-American middle adolescents 
Do you see what I see? Personality and cognitive factors affecting theory of mind or perspective taking
PDF
Do you see what I see? Personality and cognitive factors affecting theory of mind or perspective taking 
Offline social functioning and online communication: how social competence translates to an online context
PDF
Offline social functioning and online communication: how social competence translates to an online context 
Meta-accuracy as a moderator of the association between social experience and emotional adjustment during childhood
PDF
Meta-accuracy as a moderator of the association between social experience and emotional adjustment during childhood 
The impact of family factors on the functioning of African-American consumers living with schizophrenia
PDF
The impact of family factors on the functioning of African-American consumers living with schizophrenia 
Testing biopsychosocial models integrating electrodermal activity, neurocognition, and social cognition to predict the functional outcomes among people with schizophrenia at three time points ove...
PDF
Testing biopsychosocial models integrating electrodermal activity, neurocognition, and social cognition to predict the functional outcomes among people with schizophrenia at three time points ove... 
Working alliance, hope, and functional outcome for individuals with schizophrenia: mechanisms of influence
PDF
Working alliance, hope, and functional outcome for individuals with schizophrenia: mechanisms of influence 
Mixed-method analysis for school-aged children with access and functional needs during the Covid-19 pandemic
PDF
Mixed-method analysis for school-aged children with access and functional needs during the Covid-19 pandemic 
Couple conflict during pregnancy: Do early family adversity and oxytocin play a role?
PDF
Couple conflict during pregnancy: Do early family adversity and oxytocin play a role? 
The influences of anxiety, coping, and social support on physical functioning among heart failure patients
PDF
The influences of anxiety, coping, and social support on physical functioning among heart failure patients 
A multiple systems approach to examining physiological stress and its association with internalizing disorders in adolescence
PDF
A multiple systems approach to examining physiological stress and its association with internalizing disorders in adolescence 
Community violence exposure and children's subsequent rejection within the school peer group: the mediating roles of emotion dysregulation and depressive symptoms
PDF
Community violence exposure and children's subsequent rejection within the school peer group: the mediating roles of emotion dysregulation and depressive symptoms 
An investigation of the factors associated with electronic aggression among college students
PDF
An investigation of the factors associated with electronic aggression among college students 
Evaluating a cultural process model of depression and suicidality in Latino adolescents
PDF
Evaluating a cultural process model of depression and suicidality in Latino adolescents 
The link between maternal depression and adolescent daughters' risk behavior: the mediating and moderating role of family
PDF
The link between maternal depression and adolescent daughters' risk behavior: the mediating and moderating role of family 
Predictors of mHealth engagement in a mindful eating intervention for Type 2 diabetes
PDF
Predictors of mHealth engagement in a mindful eating intervention for Type 2 diabetes 
The relationship between small ensemble experiences, empathy, and emotional self-regulation skills in music students
PDF
The relationship between small ensemble experiences, empathy, and emotional self-regulation skills in music students 
Examining the associations of respiratory problems with psychological functioning and the moderating role of engagement in pleasurable activities during late adolescence
PDF
Examining the associations of respiratory problems with psychological functioning and the moderating role of engagement in pleasurable activities during late adolescence 
Asset Metadata
Creator Garcia Cardona, Laura (author) 
Core Title Family environment as a moderator of the association between theory of mind and social functioning in people with schizophrenia 
School College of Letters, Arts and Sciences 
Degree Master of Arts 
Degree Program Psychology 
Publication Date 12/01/2015 
Defense Date 05/26/2015 
Publisher University of Southern California (original), University of Southern California. Libraries (digital) 
Tag expressed emotion,OAI-PMH Harvest,social functioning,theory of mind 
Format application/pdf (imt) 
Language English
Contributor Electronically uploaded by the author (provenance) 
Advisor Lopez, Steven (committee chair), Margolin, Gayla (committee member), Prescott, Carol (committee member) 
Creator Email lamagaca89@gmail.com,lgarciac@usc.edu 
Permanent Link (DOI) https://doi.org/10.25549/usctheses-c40-201531
Unique identifier UC11278549 
Identifier etd-GarciaCard-4060.pdf (filename),usctheses-c40-201531 (legacy record id) 
Legacy Identifier etd-GarciaCard-4060-0.pdf 
Dmrecord 201531 
Document Type Thesis 
Format application/pdf (imt) 
Rights Garcia Cardona, Laura 
Type texts
Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection) 
Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law.  Electronic access is being provided by the USC Libraries in agreement with the a... 
Repository Name University of Southern California Digital Library
Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA
Tags
expressed emotion
social functioning
theory of mind