How to move forward in social cognition research? Put it into an international perspective

To the Editor

Based on a large-scale multi-site NIMH project (Pinkham et al., 2016, 2018) we now know which social cognitive tasks have sound psychometric properties and are reasonably related to criterion variables such as clinical characteristics and functional outcomes in an American sample. However, we know very little about the broader generalizability of these psychometric properties. Currently, evidence regarding potential cross — cultural differences among social cognitive tasks is lacking, primary due to the absence of studies directly addressing this topic. We believe measurement, particularly as it may be impacted by cultural differences, is a critical area of future development in our field if we want to understand processes underlying social dysfunction and accurately evaluate the effectiveness of pharmacological and psychosocial interventions on social-cognitive impairments.

Our reasons for writing this letter are partially due to our own experiences conducting social cognitive research across different cultural contexts and evidence of cross — cultural differences among healthy individuals in social cognitive abilities. Comparing individualistic (US) and collectivistic cultures (China), Wu and Keysar (2007) found that spontaneous perspective taking (a prerequisite for the higher order mentalizing) differed across cultures, such that Chinese participants were more focused on the perspectives of others than their American counterparts. Studies using functional magnetic resonance imaging also show greater sensitivity of amygdala responses to fearful faces from same vs. other cultures (Chiao et al., 2008), suggesting that culture impacts social processing at the levels of brain and behavior.

In our opinion, both the measurement and understanding of social cognition would benefit by adopting an international perspective that considers culture. Unlike neurocognitive tasks that are less dependent on cultural specificities, social stimuli are often abstract or utilize words with meanings that are not fully equivalent across cultures. For example, two of three tasks recommended in the SCOPE project (Pinkham et al., 2018) cannot be directly used in international RCTs. Despite the sound psychometric properties of the Bell — Lysaker Emotion Recognition Task, the stimulus videos include only a single Caucasian, English-speaking actor, which limits cross — cultural comparisons and completely precludes use in non-English speaking populations. Additionally, the ER — 40, which consists of static facial expressions of people from different races, could also be problematic in that many individuals (e.g., people from central or eastern Europe) may have only limited direct experiences with people from different races, which could impact task performance. This argument is supported by the well-established “other race effect” which was also demonstrated by African American patients with schizophrenia whose impairments were artificially inflated when Caucasian faces were used as stimuli (Pinkham et al., 2008). Finally, the last SCOPE-recommended measure is the Hinting Task, a verbal measure of mentalizing. Simple translation is straightforward, but capturing nuances in the language is crucial, and as of yet, it is unclear how this task will perform in direct cross - cultural comparisons.

The impact of culture is also relevant to treatment in that many social cognitive interventions incorporate training exercises that use social stimuli to teach important skills. If these stimuli are not properly designed for multicultural use, the effectiveness of the intervention may be compromised. Thus, the absence of knowledge about how ethnic or cultural aspects affect social cognition forms a significant barrier to progress.

Unfortunately, despite a call for culturally specific assessments almost ten years ago (Mehta et al., 2011a), cross — cultural differences are not usually reflected in research with patients with schizophrenia. To support our argument, we searched through two prominent schizophrenia research outlets (Schizophrenia Research and Schizophrenia Bulletin) to evaluate whether studies published from 2015 to July 2019 address this topic. Very few studies were carried out across more than one site, and only three studies addressed the potential role of cultural differences. These included two studies from SCOPE that utilized traditional inferential statistics to evaluate between site differences and one admirable study which specifically validated The Social Attribution Task (a culture and ethnicity neutral task that employs movement of geometric shapes) for two cultures using structural equation modeling (Lee et al., 2018). Thus, social cognitive research in schizophrenia clearly lacks attention to international and cross — cultural perspectives, including considerations regarding how tasks function among various cultures within the same country (e.g., African American, Caucasian, Hispanic). It seems that we, as researchers, are silently hoping that measurement models hold for all participants from different cultural backgrounds or that excluding individuals who are not native speakers will save our research from being flawed by the putative cultural bias.

It will be a considerable endeavor, but we again urge researchers in social cognition to move forward by testing the validity and utility of tasks from an international perspective. Using large samples and multisite approaches will align with efforts to improve reproducibility and will clarify both the type and extent of cultural influences on social cognition (e.g., is theory of mind more sensitive to culture than emotion recognition?). Future research in social cognition should also adopt advanced statistical tools for testing measurement invariance of tasks across countries. There are several national adaptations of social — cognitive measures like the Hinting Task and Reading the Mind in the Eyes Task, but we would like to stress that successful national adaptation does not guarantee that scores are comparable across cultures. Ensuring that tasks measure identical constructs across sites is crucial for valid inferences, and a good model for this can be found in work on the MSCEIT demonstrating that it is possible to develop a scoring system which enables use across various cultural contexts (Hellemann et al., 2017). Finally, contextual adaptation of measurement tools, rather than simple literal translation, is critical as this ensures the tool relates to social situations people actually encounter within their culture (Mehta et al., 2011b). From our perspective, the field of social cognition research in schizophrenia and related disorders needs to be more open to international/trans-cultural perspectives as doing so will likely advance both basic and applied research.