Patients with schizophrenia activate behavioural intentions facilitated by counterfactual reasoning

Previous research has associated schizophrenia with an inability to activate behavioural intentions facilitated by counterfactual thinking (CFT) as a step to improving performance. Consequently, these findings suggest that rehabilitation strategies will be entirely ineffective. To extend previous research, we evaluated the influence of CFT in the activation of behavioural intentions using a novel sequential priming paradigm in the largest sample of subjects explored to date. METHOD: The main variables assessed were: answer to complete a target task (wrong or correctly), and percentage gain in the reaction time (RT) to complete a target task correctly depending on whether the prime was a counterfactual or a neutral-control cue. These variables were assessed in 37 patients with schizophrenia and 37 healthy controls. Potential associations with clinical status and socio-demographic characteristics were also explored. RESULTS: When a counterfactual prime was presented, the probability of giving an incorrect answer was lower for the entire sample than when a neutral prime was presented (OR 0.58; CI 95% 0.42 to 0.79), but the schizophrenia patients showed a higher probability than the controls of giving an incorrect answer (OR 3.89; CI 95% 2.0 to 7.6). Both the schizophrenia patients and the controls showed a similar percentage gain in RT to a correct answer of 8%. CONCLUSIONS: Challenging the results of previous research, our findings suggest a normal activation of behavioural intentions facilitated by CFT in schizophrenia. Nevertheless, the patients showed more difficulty than the controls with the task, adding support to the concept of CFT as a potential new target for consideration in future therapeutic approaches for this illness.