Empathic accuracy in individuals at ultra-high risk for psychosis: Using a task with dynamic real-life emotional stimuli

BACKGROUND: Empathy as a key component of social cognition may be impaired in individuals at ultra-high risk (UHR) for psychosis. The Empathic Accuracy Task (EAT) was designed to address the dynamic and interactive nature of real-world social interactions. This study aimed to examine empathic accuracy (EA) in UHR individuals compared to controls and to explore the relationship between EAT and traditional empathy measures and social functioning.

METHODS: UHR individuals (n = 39) and healthy controls (n = 40) completed the EAT alongside the Interpersonal Reactivity Index, the Questionnaire of Cognitive and Affective Empathy, the Faux Pas Test and the Time Use Survey (TUS). Group differences in EAT performance were analyzed, and within-group correlations were examined between EAT scores and the TUS. Additionally, we investigated whether target characteristics (target gender, expressivity, and clip valence) moderated empathic accuracy.

RESULTS: No significant differences in EAT performance were found between groups. However, age emerged as a moderating factor, with older UHR individuals showing lower EA compared to younger UHR individuals and controls. Both groups performed better with positive videos and expressive targets. While UHR individuals reported lower social functioning and lower empathy scores on self-report measures, EAT performance did not correlate with these scores.

CONCLUSION: Cognitive empathy appears preserved in UHR individuals, though subtle deficits may emerge with age. The lack of association between EA, self-reported empathy, and social functioning suggests that these approaches might assess distinct aspects of empathy, underscoring the complexity of empathy as an interpersonal process.