M229. EXPERIMENTAL TRUST AND REAL LIFE SOCIAL INTERACTIONS: CLOSENESS OF THE CONTACT AND EMPATHIC SKILLS MAKE THE DIFFERENCE
Authors: Lemmers-Jansen Imke , Wisman-Van der Teen Mandy , Krijnen Lisa , Oorschot Margreet , Krabbendam Lydia 
Published: May 2020

Abstract

Background
Psychosis is associated with profound problems in interpersonal functioning. One of the key elements of social relationships is trust. Previous research has shown that patients with psychotic disorders display reduced trust in others. Reduced trust may lead to paranoid ideation and (as a consequence) to social withdrawal. Patients with psychotic disorders have fewer social contacts and less social support than comparison groups and they frequently have difficulties in developing and maintaining social relationships. This has also been found in young people with first episode psychosis (FEP), who report having less close friends. However, social functioning and social support are a strong predictor for future outcome: Social networks buffer against the impact of adversities. Social isolation, in turn, is associated with reduced quality of life, increased mortality and poor patient outcomes. Therefore, investigating trust and responses to social interactions in daily life is essential for developing interventions to improve social functioning in the field of schizophrenia research. This study investigated the underlying mechanisms of reduced trust in early psychosis patients by linking experimental trust data with emotional responses to day to day social interactions by means of experience sampling. We hypothesized that early psychosis patients, similar to chronic patients with schizophrenia, show more social withdrawal, and report higher levels of negative affect and lower positive affects when in company of others compared to controls. We expect that these social aspects are associated with reduced trust.

Methods
The sample consisted of 28 patients, of which 16 FEP and 12 patients at clinical high-risk, and 28 healthy controls. Participants performed a trust game during fMRI, and filled in a questionnaire about their social activities and their emotions and symptoms during these activities, 10 times a day, during a week.

Results
Patients had less social contact, and less contact with familiar others than healthy controls. Furthermore, social contact in general was associated with more positive affect. Contact with familiar others was associated with lower positive symptoms in the patient group, and with more positive affect and less negative affect in patients, whereas patients showed higher negative affect when being alone compared to controls. Empathy was a moderator between closeness of contact and mental health. Group differences in baseline trust, with patients showing reduced baseline trust, were not moderated by social withdrawal (the amount of social contact). Nor was baseline trust moderated by negative or positive affect when in company of others.
Social contact was not significantly associated with neural activation. However, in the caudate and the temporo-parietal junction a decrease in activation was apparent, if participants showed more social withdrawal.

Discussion
The results indicate that familiar company is related to better outcomes in psychotic disorders. Subjects with low levels of empathy had more negative affect when in company of close others when compared to being in company of less familiar others. Furthermore, associations of daily social interactions with baseline trust and its neural correlates show link between reduced baseline trust and frequently being alone. Being alone affects neural responses to received trust in patients. Future research should investigate the role of perceived social support, and the motivation to engage in social contact with good friends or family. Treatment involving familiar contacts may be effective in patients with psychotic symptoms to facilitate social contact and strengthen their relationships.