Alignment and theory of mind in schizophrenia.

Introduction: We predicted that participants with schizophrenia would be able to successfully "align" during conversation in the context of impaired theory of mind. Alignment is a process by which interlocutors' representations of the conversational situation converge; and it may, in part, explain how people with schizophrenia can often participate successfully in dialogue despite experiencing impaired mentalising.
Methods: Fifty-nine people with schizophrenia and 38 healthy adults completed a standardised, empirical conversational alignment task with a mentalising component and a measure of current IQ. The patients also completed two independent theory of mind tests. We used ANCOVAs to compare the groups' performances.
Results: The participants with schizophrenia and the healthy participants demonstrated equivalent alignment skills even though the schizophrenia participants displayed clear theory of mind difficulties. Symptom subtype analyses found no differences between subtype groups in alignment, but healthy controls and remitted patients performed significantly better on the mentalising component than the paranoia group.
Conclusions: These results are consistent with the schizophrenia participants having intact alignment skills alongside mentalising impairments. We propose that this explains why people with schizophrenia can often participate successfully in conversation but have difficulties with more complex dialogues, with resolving misunderstandings, and with untangling ambiguities during conversation.