J. Behav. Ther. & Exp. Psychiat.

41 (2010) 125–134

Contents lists available at ScienceDirect

Journal of Behavior Therapy and

Experimental Psychiatry
journal homepage: www.elsevier.com/locate/jbtep

Adopting the perspective of another in belief attribution: Contribution of

Relational Frame Theory to the understanding of impairments in schizophrenia
Matthieu Villatte a, *, Jean-Louis Monestès b, Louise McHugh c, Esteve Freixa i Baqué a, Gwenolé Loas b
a
Departement de Psychologie, Université de Picardie Jules Verne, Chemin du Thil, Amiens, France
b
Service Universitaire de Psychiatrie – Neurosciences Fonctionnelles & Pathologies – CNRS UMR 8160 – Centre Hospitalier Ph. Pinel, France
c
University of Wales, Swansea, UK

a r t i c l e i n f o a b s t r a c t

Article history: Impaired ability of identifying mental states is a characteristic of schizophrenia spectrum disorders. In
Received 24 April 2009 particular, people suffering from this illness tend to fail at attributing a belief to another, which has been
Received in revised form linked to difficulties in changing interpersonal perspective. Following the view of Relational Frame
13 September 2009
Theory on perspective-taking skills, the current study aimed at examining the involvement of social
Accepted 17 November 2009
anhedonia, one of the frequent features of schizophrenia, in the development of deficits in reversing the
I-YOU relation (i.e., adopting the perspective of another). A task consisting of attributing a belief to
Keywords:
another or to the self was employed with 30 non-clinical participants with a high level of social anhe-
Schizophrenia
Social anhedonia donia and with 15 patients diagnosed with schizophrenia. In comparison to two control groups, both
Theory of mind experimental groups showed significant poorer performance when adopting the perspective of another.
Deictic relational responding These results constitute important indications to target specific relational repertoires when attempting
Belief attribution to remediate impairments in mental states attribution linked to schizophrenia.
RFT Ó 2009 Elsevier Ltd. All rights reserved.

1. Introduction
1.1. Belief attribution
The ability to understand that we act on the basis of what we
believe is true, even when such belief is actually false, has been
one of the most studied competencies in the field of Theory of
Mind (i.e., the capacity to infer the beliefs, intentions and
emotions of others in order to explain and predict their behavior
(Premack & Woodruff, 1978)). In one typical false-belief task, the
Unexpected Transfer Task (Baron-Cohen, Leslie, & Frith, 1985),
a participant is told a story about Sally who places her marble in
a basket and then leaves the room. In her absence, Anne moves
the marble from the basket to a box. The participant is then asked
‘‘Where will Sally look first to find her marble?’’. Another version of
this task, the Deceptive Container Task (Perner, Frith, Leslie, &
Leekam, 1989), consists of showing a Smarties box to a participant
and asking ‘‘What is inside the box?’’. After the box has been
opened, the participant can see that the box contains pencils
instead of Smarties and is asked ‘‘Before we opened the box, what
did you think was inside the box?’’. A meta-analysis by Wellman,
* Corresponding author.
E-mail address: matthieu.villatte@u-picardie.fr (M. Villatte).
Cross, and Watson (2001) revealed that children below the age of
four usually fail at false-belief tasks, suggesting that these situa-
tions require complex cognitive skills that young children do not
yet possess in their repertoire.
Cognitive psychologists have been the first to study the mech-
anisms underlying attribution of belief in general and false-belief in
particular. An important issue in this field of research concerns the
involvement of language in such competency. Some authors argue
that one needs an ability to infer mental states of others to acquire
language since the use of symbols require attributing a state of
knowledge to the listener regarding the meaning of these symbols
(Baron-Cohen, 1999; Hobson, 2000). Conversely, de Villiers (2000)
proposed that the structure of language plays a key-role in the
development of belief understanding. Notably, the mastery of
a specific aspect of syntax called tensed complements might be
a prerequisite to the acquisition of Theory of Mind. A tensed
complement is a clausal object following communication or mental
verbs (e.g., say or think) that, according to de Villiers, provides the
opportunity to experience the relativity of mental states because
the overall sentence may be true even if the complement is false.
For example, in ‘‘Paul thinks that Mary is not there’’, it is necessary to
distinguish the truth value of each proposition: ‘‘Paul thinks’’ is true,
whereas ‘‘Mary is not there’’ may be false. Thus, such sentences lead
the participant to adopt the perspective of others and to under-
stand that this belief (‘‘Mary is not there’’) is true from Paul’s

0005-7916/$ – see front matter Ó 2009 Elsevier Ltd. All rights reserved.
doi:10.1016/j.jbtep.2009.11.004
126 M. Villatte et al. / J. Behav. Ther. & Exp. Psychiat. 41 (2010) 125–134
perspective but may be false from another’s. Consistent with this
view, de Villiers and Pyers (2002) observed in a longitudinal study
with children from the age of 3 to 5 years that early complement
understanding and later false-belief performance were related.
Further supporting the language false-belief connection, a study by
Hale and Tager-Flusberg (2003) revealed that training in a specific
form of grammatical language, that is, tensed complements
improved false-belief understanding in preschoolers.
1.2. A relational frame analysis of belief attribution
Recently, the account of language and cognition provided by
Relational Frame Theory (RFT) in terms of arbitrarily applicable
relational responding has lead McHugh, Barnes-Holmes, Barnes-
Holmes, and Stewart (2006) to propose a behavior analytic
approach to belief attribution. At the core of RFT lies the concept of
framing, which consists of responding to a stimulus in relation to
another stimulus according to characteristics that can be arbitrary
(i.e., defined by social community) or non-arbitrary (i.e., indepen-
dent of social community) (Hayes, Barnes-Holmes, & Roche, 2001).
The simplest form of such relating can be referred to as coordina-
tion framing, which can be exemplified as follows: a child could
learn that the written word ‘‘DOG’’ is the same as the spoken word
‘‘DOG’’ in line with the arbitrary characteristics of these two stimuli
while their non-arbitrary properties are very different. According to
RFT, it is the ability to learn to relate objects and events based on
arbitrary properties that allows the massive generativity of
language in human beings.
Among the different ways in which two stimuli can be related
(such as relations of ‘coordination’ and ‘opposition’ (Dymond &
Barnes, 1996); ‘distinction’ (Roche & Barnes, 1996); ‘comparison’
(Dymond & Barnes, 1995; O’Hora, Roche, Barnes-Holmes, & Smeets,
2002), ‘hierarchy’ (Griffee & Dougher, 2002); ‘analogy’ (Barnes,
Hegarty, & Smeets, 1997; Stewart, Barnes-Holmes, & Roche, 2004);
‘temporality’ (O’Hora, Barnes-Holmes, Roche, & Smeets, 2004;
O’Hora et al., 2002)), Barnes-Holmes, Hayes, and Dymond (2001)
have underlined the role of a specific class of relational responding
termed deictic frames, which are assumed to account for
perspective-taking skills. Specifically, the frames of I-YOU, HERE-
THERE and NOW-THEN would be learned through a history of
exposure to verbal events allowing us to adopt different points of
view along interpersonal, spatial, and temporal dimensions. For
example, responding to questions such as ‘‘What did you do in town
yesterday? Did you see the same movie as me?’’ requires the listener
to change perspective along the three dimensions as follows: ‘‘I am
here now but when I was there and then, I did.’’ and ‘‘You saw that
movie but I saw.’’.
Barnes-Holmes, McHugh, and Barnes-Holmes (2004) have
argued that belief attribution might be conceptualized as deictic
relational responding since one needs to adopt different perspec-
tives along the spatial and temporal dimensions in these types of
tasks. Relational complexity is also added by the implication of the
frame of logical NOT for the attribution of a false-belief. In the
example of a correct response to the Deceptive Container Task, the
involvement of these specific relational frames can be outlined as
follows: ‘‘I did not see inside there and then, but I do see inside here
and now’’. In concert with this interpretation, McHugh et al. (2006)
observed that accuracy in a series of tasks designed to assess deictic
relational responding involved in true- and false-belief attribution
increased as a function of age. In particular, 3- to 5-year-old chil-
dren demonstrated a weaker performance than all the older age
groups and the 5- to 7-year-olds, although better than the younger
group, were significantly worse than the three older groups (8–10,
12–14, and 18–35 year-olds). As noted by the authors, this evolution
of accuracy across ages follows a trend consistent with literature
using traditional false-belief tasks.
More recently, McHugh, Barnes-Holmes, Barnes-Holmes, Stew-
art, and Dymond (2007) have assumed that the attribution of belief
to another involves more relational complexity than self-attribu-
tion of belief. In the following example: ‘‘If you (the participant) put
the pencils in the Smarties box and I am not there, I (the experi-
menter) would think the Smarties box contains.’’, the participant
has to derive ‘‘If I were you, I would think that.’’ (i.e., reversing the
frame of I-YOU) in order to adopt the perspective of the experi-
menter. Consistent with their hypothesis, McHugh et al. (2007)
observed longer response latencies for attribution to another than
for self-attribution in a sample of adult participants.
Hence, RFT provides a useful behavioral account of belief
attribution underlying the functional role of language that could
overlap with de Villiers’ linguistic approach. That is, verbs of
communication and verbs of mental states probably require
deictic relational responding because the listener needs to reverse
the frames of I-You, Here-There or Now-Then to judge accurately
the truth value of the whole sentence, as in the following exam-
ples: ‘‘Paul thinks that Mary is not there’’ (I know that Mary is there
but if I were Paul, I would think that Mary is not there), ‘‘Paul is
behind his desk (here) and not in front of the window (there). He
thinks that Mary is not in the garden.’’ (Paul is here and cannot see
Mary through the window but if here was there, Paul would know)
or ‘‘I did not know this morning that you would be here tonight’’
(I know now that you are here but if now was then I would not
know). RFT constitutes an approach to language and cognition
which explains these phenomena, including mental states attri-
bution, in terms of generalized relational responding. While RFTs
explanation of the provenance of these abilities is unique, its
empirically guided conception of the behavioral patterns involved
in these abilities is potentially compatible with mainstream
conceptions.1
1.3. Impairments in belief attribution in schizophrenia spectrum
disorders
Although deficits in Theory of Mind have first been studied in
autistic disorders (Baron-Cohen et al., 1985), weaker performance
in a series of tasks requiring attributing mental states, including
false-belief, have been observed more recently in schizophrenia
(see Brüne, 2005a for a review and Sprong, Schothorst, Vos, Hox, &
Van Engeland, 2007 for a meta-analysis). Such difficulties are linked
to a deficit in social functioning and integration, which constitute
some of the most problematic features of this pathology (Bora,
Eryavuz, Kayahan, Sungu, & Veznedaroglu, 2006; Brüne, 2005b,
2006; Hyronemus, Penn, Corrigan, & Martin, 1998; Roncone et al.,
2002; Schenkel, Spaulding, & Silverstein, 2005). According to
Langdon and Coltheart (2001) and Langdon, Coltheart, Ward, and
Catts (2001), these impairments in mental states attribution in
schizophrenia spectrum disorders are due to inefficient abilities to
reconstruct another first-person experience (allocentric simula-
tion). Indeed, Langdon et al. observed that schizotypal participants
and participants with schizophrenia performed less accurately than
controls on a visual perspective-taking task when the principle was
to imagine the appearance of an object under a rotation of the
1
Although comparing models of mental states attribution would require a more
extended discussion than the current paper allows, it should be mentioned that the
RFT approach shares notably certain similarities with Simulation Theory (Gordon,
1996; Harris, 1992) since both models put perspective-taking at the core of this
ability (see Villatte, Monestès, McHugh, & Freixa i Baqué, 2009 for a systematic
comparison between the RFT approach and other main models of ToM).
 M. Villatte et al. / J. Behav. Ther. & Exp. Psychiat. 41 (2010) 125–134
viewer (allocentric simulation), whereas no deficit appeared when
participants were required to imagine the appearance of an object
under a rotation of the object (egocentric simulation). Thus,
perspective-taking skills would be impaired in schizophrenic
spectrum disorders when it is required to adopt the perspective of
another. In RFT terms, the ability to respond in accordance with the
deictic frame of I-YOU would be impaired when additional rela-
tional responding is necessitated by the inclusion of the IF-THEN
frame (i.e., ‘‘If I were you then I would believe that.’’).
1.4. The role of social anhedonia in the development of ToM
impairments
According to dimensional approaches to schizophrenia, this
illness reflects an extreme level on a continuum between normal
and pathological functioning. That is, characteristics of schizo-
phrenia (including impulsive non-conformity, perceptual aberra-
tion, magical ideation, physical and social anhedonia (Chapman,
Chapman, & Kwapil, 1995)) can be present in non-clinical pop-
ulation but at different levels. The higher young individuals score
on these schizotypal dimensions, the more the risk to develop
symptoms of schizophrenia increases. For instance, Chapman,
Chapman, Kwapil, Eckblad, and Zinser (1994) observed that among
an initial sample of over five hundred individuals, those with high
scores on schizotypal dimensions (i.e., a score of two standard
deviations above the mean) developed more psychoses and
psychotic-like experiences across a 10-year longitudinal study.
Gooding, Tallent, and Matts (2005) reported similar results in
a more recent 5-year longitudinal study. In concert with the
symptoms amplification between high levels of schizotypy and
schizophrenic syndrome, several studies have reported the exis-
tence of slight deficits in mental states attribution in non-clinical
populations with a high profile of schizotypy (Langdon & Coltheart,
1999 – with a false-belief task; Platek, Critton, Myers, & Gallup,
2003 – with a ‘‘faux-pas’’ task based on a higher level of false-belief
understanding).
Among schizotypal dimensions, social anhedonia, which is
characterized by social disinterest, withdrawal and a lack of plea-
sure from social contact (Eckblad, Chapman, Chapman, & Mishlove,
1982), constitutes a main factor of vulnerability to the development
of schizophrenic spectrum disorders (Gooding et al., 2005; Kwapil,
1998), even when it is associated with low scores on other sub-
scales of schizotypy (Horan, Brown, & Blanchard, 2007). In addition,
certain features of schizophrenia are also present at a lower level in
non-clinical populations with high social anhedonia, such as slight
impairments in working memory (Gooding & Tallent, 2001) and in
sustained attention (Kwapil & Diaz, 2000), or perseverating errors
using the WCST (Barrantes-Vidal et al., 2003; Gooding, Kwapil, &
Tallent, 1999; Tallent & Gooding, 1999). Considering the lack of
social interactions experienced by individuals with high social
anhedonia (Brown, Silvia, Myin-Germeys, & Kwapil, 2007) and the
crucial role of social experiences in the development of accurate
mental states attribution (Bartsch, 2002), it is possible to conceive
this specific dimension as a key factor of deficits in Theory of Mind
in schizophrenia. In line with this view, slight impairments in
attribution of mental states have been observed in studies
employing a traditional Theory of Mind task (Monestès, Villatte,
Moore, Yon, & Loas, 2007; Villatte, Monestès, McHugh, Freixa i
Baqué, & Loas, 2008). According to RFT, because social interactions
constitute opportunities to adopt another individual’s point of
view, the ability to switch perspective between the self and another
(i.e., the ability to reverse the frame of I-YOU) should be particularly
impaired by a deficit in this kind of experience. If this prediction is
correct, young individuals with a profile of high social anhedonia
127
should present a subtle deficit in belief attribution to others, which
might precede more severe difficulties when the illness arises.
The current research aims at assessing deictic relational
responding involved in belief attribution in people diagnosed with
schizophrenia. If the RFT approach to this type of mental states
understanding is accurate, these participants should demonstrate
deficits in false-belief attribution similar to those reported in
mainstream cognitive studies. In addition, the specific design of RFT
protocols will allow distinguishing between two different rela-
tional repertoires, that is, attribution to the self and attribution to
another (i.e., simple vs. reversed I-YOU). Because individuals
suffering from schizophrenia usually perform weaker than controls
on attribution of false-belief and on attribution of others’ mental
states in general, we expect these participants to be impaired both
when the frame of logical NOT or an inversion of the frame of I-YOU
is involved. In order to test the prediction that deficits in belief
attribution to another are linked to social anhedonia, deictic rela-
tional responding involved in belief attribution will also be assessed
in a sample of non-clinical participants scoring two standard
deviations above the mean or higher on a social anhedonia scale;
poorer performances being expected when an inversion of the
frame of I-YOU is required.
2. Study I
2.1. Method
2.1.1. Measures
The Revised Social Anhedonia Scale (SAS) (Eckblad et al., 1982) is
a true-false self-report questionnaire that measures social with-
drawal, a lack of interest in social relationships and/or a lack of
pleasure derived from interpersonal relationships with 40 items
such as ‘‘I sometimes become deeply attached to people I spend a lot of
time with’’ (keyed false) or ‘‘If given the choice, I would much rather
be with others than be alone’’ (keyed false).
One thousand two hundred and fifty five first-year psychology
students participated in the study by completing the SAS. Thirty
participants chosen randomly among individuals with a high score
(i.e., scoring at or above two SD’s above the mean of the same sex
sample) constituted the experimental group. Thirty participants
chosen randomly among individuals scoring not higher than 0.5 SD
from the mean of the same sex sample were retained to constitute
the control group.2 Exclusion criteria included any head injury or
psychiatric illness and French as a second language.
Since intellectual competencies were demonstrated to impact
on ToM performance of people with schizophrenia in several
studies (see Sprong et al., 2007), Raven’s Progressive Matrices
(Raven, 1960) were employed to assess intellectual competencies of
all the participants selected for the experimental protocol in order
to control for effects of IQ and thus, isolate the effect of social
anhedonia.
2.1.2. Participants3
Experimental group: 10 males and 20 females. Ages ranged from
18 to 21 years (mean 19.33 years; SD: 0.8). Mean score on the SAS:
22.07 (SD: 4.76). Mean score on Raven’s Progressive Matrices: 48.7
(SD: 4.47).
2
The inclusion criteria for the constitution of the two groups were the same as
those of most of the studies on social anhedonia and schizotypy (see for instance
Chapman et al., 1994; Collins, Blanchard, & Biondo, 2005; Gooding & Tallent, 2003;
Gooding et al., 1999, 2005; Horan et al., 2007; Kwapil, 1998; Tallent & Gooding,
1999).
3
The participants took part also in another study. However, the presentation
order of the two protocols was counterbalanced.
128 M. Villatte et al. / J. Behav. Ther. & Exp. Psychiat. 41 (2010) 125–134
Table 1
Examples of trials of the belief-attribution task.
Self-attribution
True-belief False-belief
If I put the pencils in the Smarties box If I put the pencils in the Smarties
and you are here, you would think box and you are not here, you would
the Smarties box contains think the Smarties box contains
Pencils/smarties Pencils/smarties
Control group: 10 males and 20 females. Ages ranged from 18 to
22 years (mean 19.27 years; SD: 1.05); there was no significant
difference in age between experimental and control groups:
(t(58) ¼ 0.28, p > 0.05). Mean score on the SAS: 7.13 (SD: 1.17). Mean
score on Raven’s Progressive Matrices: 48.6 (SD: 4.37); there was no
significant difference between experimental and control groups:
(t(58) ¼ 0.03, p > 0.05).
No significant correlation emerged between participants scores
on the SAS and scores on Raven’s Progressive Matrices (r ¼ 0.08,
p > 0.05).
All the participants took part in the study to meet part of their
course requirements.
2.1.3. Procedure
An E-PrimeÒ (version 1.1) program was compiled in order to
present the task to the participants on a Personal Computer with
a 660 MHz processor, a 15-inch color monitor and a numeric pad. All
trials in the program were presented in French (black letters, font 26).
The experiment consisted of one block of 48 true-false trials that
were divided in four categories, according to two types of attribu-
tion (self and other) crossed with two types of belief (true and
false). Thus, among trials of self-attribution, there were twelve
trials for true-beliefs and twelve trials for false-beliefs. There was
the same ratio of true- and false-beliefs for trials of attribution to
other and there was an equal number of true and false statements
(see examples in Table 1). Three objects sets appeared in the
statements: a Smarties box and pencils; a farina box and cacao;
a cacao box and farina. As in McHugh et al. (2007), these objects
were selected for the purpose of false-belief attribution because
one would normally expect to find farina rather than cacao, for
example, inside a farina box.
The instruction given to the participants was as follows: ‘‘You
will see appear on the screen the first part of a statement. Once you
have read the first part, you must press the key ‘‘enter’’ in order for the
end of the statement to appear. Then your job will be to press 1 if the
whole statement is true and 2 if it is false. In the different statements
that you will read, ‘‘You’’ refers always to you and I to anyone else who
would be talking to you’’.
Both accuracy rates and response times were recorded (with
longer response latencies predicted to reflect poorer performance).
Response latencies were recorded as follows: once the participant
had read the first part of the statement (example: ‘‘If I put the pencils
in the Smarties box and you are here, you would think the Smarties box
contains’’), s/he had to press the key ‘‘Enter’’. Then, the end of the
statement and the two allowable responses appeared on screen
(example: ‘‘PENCILS’’ True/False). Response latencies were recorded
between the participant pressing ‘‘Enter’’ after having read the first
part of the statement and his/her response by pressing one of the
two activated keys (response latencies that exceeded two SD’s
above the mean were removed from the statistical analyses). All
trials were presented randomly and no feedback was given after the
participant’s response.
In this task, it is important for the participant to understand that
‘‘You’’ and ‘‘I’’ represent the perspective of the participant and the
perspective of anyone who would be talking to the participant,
Attribution to other
True-belief False-belief
If You put the pencils in the Smarties If You put the pencils in the Smarties
box and I am here, I would think the box and I am not here, I would think
Smarties box contains the Smarties box contains
Pencils/smarties Pencils/smarties
respectively. To ensure that all participants responded in the same
way, after the session, each of the participants was asked if ‘‘I’’
corresponded to him/her or to anyone else (and the same question
for ‘‘You’’). Anyone who did not respond correctly to these two
questions was excluded from the analyses.
2.2. Results
2.2.1. Accuracy
The percentage of accuracy was calculated for each participant.
These results were then grouped by SAS level and trial-type. The
data indicate that the two groups demonstrated a rate of accuracy
above 0.85 for all trial-types. Nevertheless, while the two groups
produced almost the same number of errors on self-attribution of
true- and false-belief, the group with high social anhedonia per-
formed poorer on both true- and false-belief attributions to another
than the control group: participants with high social anhedonia
produced 75% more errors on true-belief and three times more
errors on false-belief than control participants.
When regrouping true- and false-beliefs rates of accuracy (see
Fig. 1), it appeared that experimental participants produced almost
three times more errors than controls on attribution to another
(0.95 vs. 0.86), whereas both groups obtained a similar mean score
on attribution to the self (0.95 vs. 0.94).
A 2  2  2 mixed repeated measures multivariate analyses of
variance (MANOVA) was employed with group-type (low vs. high
score on the SAS) as the between subject variable, attribution-type
(self vs. other) and belief-type (true vs. false) as within subject
variables and with accuracy and response latencies as the two
dependent variables. The main effect of group-type was significant
(Wilk’s (2,57) ¼ 5.08, p < 0.01). There was a significant main effect
of attribution-type (Wilk’s F(2,57) ¼ 19.69, p ¼ 0.000). There was
a statistical tendency for an interaction between group-type and
attribution-type (Wilk’s F(2,57) ¼ 2.97, p ¼ 0.06), suggesting that
the two groups were differently affected by the type of attribution.
1
Mean rate of accuracy
0,9
0,8
0,7
0,6
0,5
Self Other
Attribution type
Control Experimental
Fig. 1. Accuracy (proportion correct) for experimental and control participants on each
type of attribution (self vs. other).

Proportion of participants scoring above 0.67
1
0,8
0,6
0,4
0,2
0 on adopting another’s perspective, consistent with the analysis of
Self/True belief
Fig. 2. Proportion of participants from the two groups scoring over 0.67 on each type
of attribution and belief.
The effect of belief-type was not significant (Wilk’s F(2,57) ¼ 0.18,
p ¼ 0.84), neither was the interaction between group-type and
belief-type (Wilk’s F(2,57) ¼ 0.01, p ¼ 0.91), indicating that the two
groups of participants were not affected by the type of belief to
report. The interaction between attribution-type and belief-type
was significant (Wilk’s F(2,57) ¼ 6.88, p < 0.01), indicating that the
effect of attribution-type that influenced all the participants
performances was influenced by the type of belief. Finally, the
interaction between subject, attribution-type and belief-type was
not significant (Wilk’s F(2,57) ¼ 0.67, p ¼ 0.5).
Univariate analysis revealed a significant main effect of group-
type (Wilk’s F(1,58) ¼ 6.1, p ¼ 0.02). The main effect of attribution-
type was also significant (Wilk’s F(1,58) ¼ 6.2, p ¼ 0.02) as well as
the interaction between group-type and attribution-type
(F(1,58) ¼ 6.2, p ¼ 0.02). There was no significant effect of belief-
type (Wilk’s F(1,58)¼0.34, p ¼ 0.56) and no interaction between
belief-type and group-type (Wilk’s F(1,58)¼1.35, p ¼ 0.25). Finally,
there was no significant interaction between attribution-type and
belief-type (Wilk’s F(1,58)¼1.63, p ¼ 0.21) and between attribution-
type, belief-type and group-type (Wilk’s F(1,58) ¼ 0, p ¼ 1). In brief,
accuracy of the two groups differed from each other as a function of
the type of attribution involved, whereas the type of belief had no
influence.
Though no difference appeared between the score of the two
groups on Raven’s test, we conducted an ANCOVA to examine if the
effect of group-type remained significant. The results of this anal-
ysis revealed a significant effect of group-type (F(1,57) ¼ 3.34;
p < 0.05) and no significant effect of the score on Raven’s test
(F(1,57) ¼ 2.47; p > 0.05). Thus, the difference in performance
observed between the two groups was not due to a variation of
general intellectual competencies between the participants.
Post-hoc tests (Fishers PLSD) were conducted to analyse
comparisons between the two groups among the different types of
attribution (using Bonferroni corrections to control for Type I
errors). These analyses revealed that experimental participants
were significantly less accurate than controls on attribution to
another (p ¼ 0.02); but no difference appeared on self-attribution
(p > 0.05). Furthermore, experimental participants were less
accurate on attribution to another than on self-attribution
(p < 0.01), whereas no significant difference emerged between the
two types of attribution for the control group (p > 0.05).
Because accuracy rates of 0.5 can be interpreted as chance level
responding, we calculated the proportion of each group’s partici-
pants whose scores were over 0.67 (see Fig. 2). These proportions
were not significantly different between the two groups for self-
attribution but were superior in the control group for attribution to
M. Villatte et al. / J. Behav. Ther. & Exp. Psychiat. 41 (2010) 125–134 129
another: 97% vs. 83% for true-belief (statistical tendency,
c2(1) ¼ 2.96; p ¼ 0.08) and 100% vs. 83% for false-belief (significant
difference, c2(1) ¼ 5.45; p < 0.05). These results are consistent with
the previous analyses of variance, revealing that the experimental
participants produced more errors than controls only on tasks that
involve attribution to another.
Finally, correlation analyses (using Bonferroni corrections)
revealed that the score on the SAS correlated negatively with
accuracy on attribution to another (r ¼ 0.36; p ¼ 0.02) but not on
self-attribution (r ¼ 0.03; p > 0.05). These results indicate a link
between higher levels of social anhedonia and poorer performance
Self/False belief Other/True belief Other/False belief variance conducted earlier.
Trial type
Control Experimental
2.2.2. Response latencies4
The data indicate that the response latencies of the two groups
were very close on all trial-types. In general, the response latencies
were longer on attribution to another than on self-attribution.
Across the self-attributions, response latencies were slightly longer
on false-belief than on true-belief. An inverse trend appeared
across the attributions to another.
Univariate analysis revealed that the main effect of group-type
was not significant (Wilk’s F(1,58) ¼ 0.26; p ¼ 0.61). The main effect
of attribution-type was significant (Wilk’s F(1,58)¼ 34.19;
p ¼ 0.000), but not the interaction between group-type and attri-
bution-type (Wilk’s F(1,58) ¼ 2.55, p ¼ 0.12). There was no effect of
belief-type (Wilk’s F(1,58) ¼ 0, p ¼ 0.95) and no interaction
between group-type and belief-type (Wilk’s F (1,58) ¼ 0.03,
p ¼ 0.85). The interaction between attribution-type and belief-type
was significant (Wilk’s F(1,58) ¼ 11.72, p < 0.01). Finally, no inter-
action appeared between the types of group, attribution, and belief
(Wilk’s F (1,58) ¼ 0.26, p ¼ 0.61). To summarize, the two groups
were faster on self-attribution than on attribution to another,
which was influenced by the type of belief to report.
Planned comparisons were conducted (using Bonferroni
corrections) to examine the interaction between attribution-type
and belief-type in the whole sample of participants. These analyses
revealed that participants were faster on self-attribution than on
attribution to another (t(59) ¼ 5.13; p ¼ 0.000 for true-belief and
t(59) ¼ 3.5; p < 0.01 for false-belief). When analysing self-attribu-
tion, it appeared that participants were faster on true-belief than on
false-belief (t(59) ¼ 2.76; p < 0.04). No variation emerged as
a function of belief-type on attribution to another (t(59) ¼ 2.18;
p ¼ 0.13). In brief, participants were faster on self-attribution and
particularly on true-belief.
2.3. Discussion
The results of this first study supported our main prediction.
Participants with a high level of social anhedonia demonstrated
poorer performance than controls when they were required to
reverse the frame of I-YOU, that is, when attributing a belief to
another. In addition, these participants produced more errors on
attribution to another than on attribution to the self, whereas no
difference between these two types of attribution appeared in
controls. Such findings are in line with Villatte et al. (2008), in which
participants with high social anhedonia were significantly less accu-
rate than controls on highest levels of deictic relational complexity in
a perspective-taking task. Our results thus support once again the
view that fewer social interactions impact on the development of
4
Response latencies that exceeded two SD’s above the mean were removed from
statistical analyses. However, the exclusion of these data had no effect on the
statistical analyses.
130 M. Villatte et al. / J. Behav. Ther. & Exp. Psychiat. 41 (2010) 125–134
deficits in mental states attribution. Because people characterized by
a lack of interest in social contact tend to engage in fewer interactions
with others, they practice less often changing perspective, which
results in anomalies when compared to the control population.
Such interpretation of our results seems consistent with
previous research on the links between social interactions and ToM
in children. Indeed, social experiences like disputes seem to
enhance social cognition; the presence of adults using terms of
intention predicts the age of children’s references to beliefs and the
presence of siblings is correlated with better performance on ToM
task (see Bartsch, 2002 for a review). In turn, impairments in ToM
likely lead to important difficulties in social interactions, in
particular in schizophrenic spectrum disorders. As Brüne, Abdel-
Hamid, Lehmkämper, and Sonntag (2007) have shown, perfor-
mance in mental states attribution is indeed a strong predictor of
poor social competence in this population. Hence, social anhedonia
might be even increased by its own consequences, that is, a lack of
interest in social contact leads to less training in mental states
attribution, which then leads to poorer social competence and less
interest in social contact.
The causal link that, as we suggest, defines the relation between
social anhedonia and deficits in mental states attribution might
also be confirmed by comparative research between humans and
great apes. Indeed, observations of apes severely lacking social
interactions due to their captivity have already revealed a decrease
in social competences (see Brüne, Brüne-Cohrs, McGrew, & Pre-
uschoft, 2006); using experimental tasks akin to ToM assessments
(see Scott, 2001) might show poorer skills of subjects experiencing
less social contact independently of their interest in such contact.
However, the question of the primary origins of a lack of plea-
sure for social interaction still remains. According to Lebreton et al.
(2009), favorable dispositions towards social relationships are
linked to specific neuro-anatomical characteristics (i.e., the density
of gray matter in the orbitofrontal cortex, basal ganglia, and
temporal lobes). Although the study demonstrated only a correla-
tion between these two variables, one can hypothesize that
conversely, in the case of social anhedonia, certain neuro-
anatomical anomalies constitute a starting point in a sequence of
variables that ends in impairments in adopting the perspective of
another.
Contrary to our prediction, no difference appeared on latencies
between the two groups as a function of attribution-type, which
suggests that latencies do not constitute a sufficiently discrimina-
tive dependent variable to distinguish between two non-clinical
populations with this type of task. However, since participants with
high social anhedonia were as fast as controls, it is possible to rule
out the hypothesis that the more important number of errors they
produced was caused by impulsivity. In addition, latencies results
were consistent with the data reported by McHugh et al. (2007):
participants responded more quickly on tasks involving self-attri-
bution than on tasks involving belief attribution to another, which
supports the RFT prediction that participants need to reverse the
frame of I-YOU in the latter and hence, need more time to derive
their responses. The involvement of the frame of logical NOT
seemed also to have a slight effect on latencies of both groups,
whereas such effect was not observed in McHugh et al.’s study.
Since a greater number of trials was employed in this previous
research, the repetition of trials might have trained participants to
respond as fast on both types of belief, thus explaining the
discrepancy between our respective results.
3. Study II
The aim of Study II is to examine whether the pattern of
performance observed in patients diagnosed with schizophrenia in
an RFT based belief-attribution task will be similar to those
demonstrated using cognitively based ToM tasks. In addition to this
employing the RFT task will afford a direct comparison between the
different aspects of belief attribution (i.e., attribution to the self vs.
to another, true-belief vs. false-belief).
3.1. Method
3.1.1. Measures
As in study I, IQ of all the participants was estimated in the
current study using Raven’s Progressive Matrices (Raven, 1960) in
order to control for effects of intellectual competencies.
3.1.2. Participants5
The study was approved by the local ethics committee (CCPPRB
de Picardie) and all participants provided informed consent.
Patients were recruited from the University-Psychiatric Hospital
Ph. Pinel of Amiens (France) and controls from personal acquain-
tances of the experimenters. Participants did not receive any
payment for participation.
Experimental group: 15 patients (8 males and 7 females) diag-
nosed with schizophrenia according to ICD-10 (World Health
Organization, 1992). Ages ranged from 22 to 53 years (mean 33.3
years; SD: 8.4). Estimated IQ: 99.13 (SD: 12.4). Mean duration of
illness: 5.13 (SD: 4.8). Mean age of onset of the disease was at 28.1
(5.5). Fourteen of the 15 patients were treated with conventional or
atypical neuroleptics.
Control group: 15 healthy participants (8 males and 7 females).
Ages ranged from 20 to 63 years (mean 30.08 years; SD: 11.2); there
was no significant difference in age between the experimental and
the control group: t(28) ¼ 0.68; p > 0.5. Estimated IQ: 110.07 (SD:
10.78). The difference in IQ between both groups was significant
(t(28) ¼ 2.58; p < 0.02); however, analyses of co-variance were
conducted with IQ as the co-variate (as reported in the results
section).
Exclusion criteria for all participants: any brain injury, age below
18 or above 65, and French as a second language.
Exclusion criteria for control participants: any history of psychi-
atric illness.
3.1.3. Procedure
The procedure employed in this task was the same as that of
study I except for the number of trials which was of 24. However,
the proportion of trials per type of attribution and type of belief was
the same as in study I (6 trials per trial-type). The duration of the
task was reduced in comparison with study I to adapt the protocol
to constraints linked to the hospitalisation of the patients.
3.2. Results
3.2.1. Accuracy
The percentage of accuracy was calculated for each participant.
These results were then grouped by participant-type and trial-type.
The data indicate that participants of the control group demon-
strated a rate of accuracy comprised between 0.91 and 0.95 for all
trial-types. Although patients performed very similarly with
controls on self-attribution of true-belief, they produced more
errors on attribution to another (accuracy rates of 0.73 on true-belief
and 0.74 on false-belief) and on self-attribution of false-belief (0.69).
5
The participants took part also in another study (Villatte, Monestès, McHugh,
Freixa i Baqué, & Loas, in press). However, the presentation order of the two
protocols was counterbalanced.
 M. Villatte et al. / J. Behav. Ther. & Exp. Psychiat. 41 (2010) 125–134
Mean rate of accuracy
0,9
0,8
0,7
0,6
0,5
Self Other
Trial type
Controls Patients
Fig. 3. Accuracy (proportion correct) for patients and controls on each type of attri-
bution (self vs. other).
When comparing the two types of attribution independently of
the type of belief as in Study I (see Fig. 3), the difference between
the two groups was more important on attribution to another (0.95
for controls vs. 0.73 for patients) than on self-attribution (0.93 for
controls vs. 0.78 for patients).
A 2  2  2 mixed repeated measures multivariate analyses of
variance (MANOVA) was employed with group-type (patients vs.
controls) as the between subject variable, attribution-type (self vs.
other) and belief-type (true vs. false) as within subject variables
and with accuracy and response latencies as the two dependent
variables. The main effect of group-type was significant (Wilk’s
(2,27) ¼ 8.69, p ¼ 0.001). There was a significant main effect of
attribution-type (Wilk’s F(2,27) ¼ 6.6, p < 0.01) and a tendency for
an effect of belief-type (Wilk’s F(2,27) ¼ 2.97, p ¼ 0.07). Because
accuracy’s variances were not homogeneous across the two groups,
interaction effects were not analysed with the MANOVA.
Univariate analysis revealed a significant main effect of group-
type (Wilk’s F(1,28) ¼ 17.12, p < 0.001). The main effect of attribu-
tion-type was not significant (Wilk’s F(1,28) ¼ 0.51, p ¼ 0.48),
neither was the effect of belief-type (Wilk’s F(1,28)¼2.16, p ¼ 0.15).
Again, interaction effects were not analysed due to the lack of
homogeneity in variance.
Since the two groups differed on the score on Raven’s test, an
ANCOVA was carried out to examine if the effect of group-type
remained significant. The results of this analysis revealed a signifi-
cant effect of group-type (F (1,27) ¼ 3.93; p ¼ 0.01) and no signifi-
cant effect of the score on Raven’s test (F(1,27) ¼ 1.26; p ¼ 0.31).
Thus, the difference in performance observed between the two
groups was not due to a variation of general intellectual compe-
tencies between the participants.
Although no analysis of interaction was conducted with the
ANOVA, a series of non-parametric planned comparisons (Mann-
Whitney U with Bonferroni corrections) were carried out in order
to examine if the difference in performance between the two
groups varied as a function of attribution- and belief-type, as
descriptive analyses suggested earlier. These analyses revealed that
patients were significantly less accurate than controls on self-
attribution of false-belief (Z ¼ 2.98; p ¼ 0.04); they also produced
more errors than controls on attribution to another (statistical
tendencies: Z ¼ 2.78; p ¼ 0.06 for true-belief and Z ¼ 2.8;
p ¼ 0.06 for false-belief). Conversely, no difference appeared on
self-attribution of true-belief (Z ¼ 0.25; p > 0.9). Thus, patients
were less accurate than controls when they had to report a false-
belief and/or the belief of another.
131
Proportion of participants scoring over 0.67
1
0,8
0,6
0,4
0,2
0
Self/True belief Self/False belief Other/True belief Other/False belief
Trial type
Controls Patients
Fig. 4. Proportion of participants from the two groups scoring over 0.67 on each type
of attribution and belief.
Furthermore, patients tended to be less accurate on self-attri-
bution of false-belief than on self-attribution of true-belief
(t(14) ¼ 2.91, p ¼ 0.12; significant before correction). A similar trend
appeared when comparing self-attribution and attribution to
another of true-belief: (t(14) ¼ 2.82, p ¼ 0.12 significant before
correction). No difference emerged as a function of attribution- or
belief-type in control participants. In brief, while patients’ perfor-
mance seemed affected by the types of belief and attribution,
controls were equally accurate on all trial-types.
As in study I, the proportion of each group’s participants whose
scores were over 0.67 was calculated (see Fig. 4). These proportions
were not significantly different between the two groups for self-
attribution of true-belief (87% for controls vs. 73% for patients,
c2(1) ¼ 0.83; p ¼ 0.9), but were superior in the control group for
self-attribution of false-belief (100% for controls vs. 40% for
patients, c2(1) ¼ 12.86; p ¼ 0.001) and both attributions to another
(true-belief: 100% for controls vs. 40% for patients, c2(1) ¼ 12.86;
p ¼ 0.001; false-belief: 100% for controls vs. 33% for patients,
c2(1) ¼ 15.00; p < 0.001). These results are consistent with the
previous analyses of variance: patients were less accurate than
controls when reporting either a false-belief or the belief of another
but demonstrated a performance similar to controls’ when attrib-
uting a true-belief to the self.
3.2.2. Response latencies6
The data indicate that the response latencies of the two groups
were very close on all trial-types. In general, the response latencies
were longer on attribution to another than on self-attribution.
Across the self-attributions, response latencies were slightly longer
on false-belief than on true-belief.
Univariate analysis revealed that the main effect of group-type
was not significant (Wilk’s F(1,28) ¼ 1.41, p ¼ 0.24). The main effect
of attribution-type was significant (Wilk’s F(1,28)¼ 13.44,
p ¼ 0.001), but not the interaction between group-type and attri-
bution-type (Wilk’s F(1,28) ¼ 0.05, p ¼ 0.83). The effect of belief-
type was significant (Wilk’s F(1,28) ¼ 4.35, p < 0.05) but not the
interaction between group-type and belief-type (Wilk’s F
(1,28) ¼ 1.13, p ¼ 0.3). The interaction between attribution-type and
belief-type was not significant (Wilk’s F(1,28) ¼ 2.59, p ¼ 0.12), and
no interaction appeared neither between the types of group,
attribution and belief (Wilk’s F(1,28) ¼ 0.74, p ¼ 0.4). To summarize,
6
Response latencies that exceeded two SD’s above the mean were removed from
statistical analyses. However, the exclusion of these data had no effect on the
statistical analyses.
132 M. Villatte et al. / J. Behav. Ther. & Exp. Psychiat. 41 (2010) 125–134
the two groups were faster on self-attribution than on attribution
to another and on true-belief than on false-belief.
3.3. Discussion
The results of this second study were consistent with our
predictions. Patients with schizophrenia were clearly less accurate
than controls when required to reverse the frame of I-YOU (attri-
bution of belief to another) and/or to respond in accordance with
the frame of Logical not (attribution of a false-belief). These find-
ings are line with the growing literature on mental states attribu-
tion in schizophrenia showing that patients who suffer from this
condition present a deficit in attribution of a false-belief (see Brüne,
2005a and Sprong et al., 2007). It also supports the idea that these
patients have an important disability of adopting another’s point of
view, as already suggested by Langdon et al. (2001).
As in the first study, latencies recordings did not reveal the same
trend as mean rates of accuracy, both groups performing very
closely on all trial-types (in a manner generally similar to partici-
pants from study I and McHugh et al. (2007) when comparing
attribution to the self vs. to another). This result suggests once
again that response latencies might not be a sufficiently discrimi-
native dependent variable in this context. However, such findings
tend to rule out the hypothesis that accuracy differences observed
between group mean scores may have been a by product of
neuroleptic treatment rather than participants clinical condition
per se. That is, if medication would have significantly handicapped
the patients of the current research, they would probably have
demonstrated longer latencies than controls on all trial-types. In
addition, and as in study I, impulsivity is unlikely responsible for
poorer accuracy of the patients since they were neither faster than
controls on any trial-type.
4. General discussion
The current research aimed at using a relational frame approach
in order to examine the involvement of social anhedonia in the
impaired capacity to adopt another’s point of view of people with
schizophrenia. Results showed that participants with a profile of
high social anhedonia were, as patients with schizophrenia, less
accurate than controls when reversing the I-YOU relation. These
findings are compatible with the hypothesis that the lack of social
interactions linked to social disinterest might be responsible for the
development of deficits in attribution of mental states to others in
schizophrenia spectrum disorders. Although non-clinical partici-
pants demonstrated only slight impairments (all mean rates
reaching at least 85%), such subtle anomalies match the data
reported by the literature on mental states attribution in schizotypy
(Irani et al., 2006; Langdon & Coltheart, 1999; Platek et al., 2003) and
might be viewed as a predictor of more severe impairments when
psychotic symptoms develop, as suggested by results from Study II.
The fact that participants with high social anhedonia were as
accurate as controls on false-belief attribution, whereas patients
with schizophrenia demonstrated a clear impairment in this task
contributes to specify the possible role of this dimension. Experi-
encing less social interactions would cause difficulties in appreci-
ating the point of view of others but would have no influence on
understanding that people can act on the basis of a false-belief. This
particular competency might be deteriorated by other schizotypal
dimensions, such as magical ideation or perceptual aberration. So
far, while Theory of Mind impairments in schizophrenia have been
linked to anhedonia (see Frith, 2004) and disorganized thought
(Sarfati & Hardy-Baylé, 1999) the impact of these different spheres
of the symptomatology on specific aspects of mental states attri-
bution is still unknown. Based on the findings from the current
study, we suggest that it would be useful to conduct further
research to address this question.
Although the results strongly support the involvement of social
anhedonia in the development of an impaired ability to adopt
another’s perspective, certain limitations of the current studies
should be mentioned. First, since other schizotypal dimensions
were not assessed in the sample of participants with high social
anhedonia, high levels on some of these dimensions might be
responsible (at least in part) for the poorer performances observed.
However, recent research on social anhedonia indicate that this
dimension is particularly crucial to understand the progressive
apparition of psychotic symptoms, even when it is not associated
with other dimensions of schizotypy (Horan et al., 2007). Replica-
tion of our results controlling levels on the different dimensions
will allow clarifying this issue.
Similarly, although our data bring certain arguments to explain
the impairments of people with schizophrenia in changing inter-
personal perspective in terms of fewer social interactions, we
cannot determine if this variable effectively impacted on patients’
performance. Indeed, social anhedonia was not assessed in our
sample of patients and it is possible that this dimension was not
present at a high level, even though social disinterest is reported as
a main characteristic of schizophrenia in the classification of mental
disorders (DSM-IV-TR – American Psychiatric Association, 2000;
ICD-10 – World Health Organization, 1992). With regard to the view
that only disorganized patients are impaired in mental states
attribution (Hardy-Baylé, Sarfati, & Passerieux, 2003), other
measures, such as disorganized thought (using the TLC – Andreasen,
1979), might be also conducted to disentangle the influence of the
specific compounds of schizophrenia on deictic relational
responding involved in belief attribution. Finally, since an influence
of deficits in executive functioning on ToM performance in schizo-
phrenia has been mentioned (see Pickup, 2008 for a review), the
absence of assessment in this domain of competency in the current
study leads to the possibility that such influence exists in our sample
of participants. It is worth noting, however, that Pickup’s review
suggests that impairments in mental states attribution cannot be
fully explained by executive functioning deficits in this illness.
Using RFT to study impairments in belief attribution aimed at
providing data regarding the performance of participants in specific
aspects of this competency. Indeed, the functional conceptualiza-
tion of belief attribution offered by RFT allowed a distinction to be
made between the specific relational repertoires involved (i.e.,
simple vs. reversed I-YOU relation; Logical NOT) and helped shed
some light on an area frequently considered as a whole (i.e.,
without separating the different aspects of mental state attribution,
such as attribution to the self vs. to another). Findings from the
current research indicate that reversing the I-YOU relation consti-
tutes a key behavioral target for remediating deficits demonstrated
by people with schizophrenia and high social anhedonia. Thus
procedures recently developed from the RFT perspective (see
Rehfeldt & Barnes-Holmes, 2009) might be employed to train
deictic relational responding in these populations. So far, several
training studies of this kind have proven efficiency in accelerating
the development of these repertoires in normal developing chil-
dren (Barnes-Holmes, Barnes-Holmes, & McHugh, 2004) as well as
in children with high-functioning autism spectrum disorder
(Rehfeldt, Dillen, Ziomek, & Kowalchuk, 2007). In addition, a study
by Weil, Hayes, and Capurro (2007) revealed that using similar
tasks to those of the current research in the frame of training
procedures positively impacted on post-test performances on
traditional false-belief tasks. Future research will show if these
promising recent developments in the field of behavioral remedi-
ation can be applied usefully to schizophrenia spectrum disorders.
Finally, we propose that the likely implication of a lack of social
 M. Villatte et al. / J. Behav. Ther. & Exp. Psychiat. 41 (2010) 125–134
interactions in the development of deficits in adopting anothers’
perspective (and consequently in attributing mental states to
others) should be taken into account in remediation programs for
patients with schizophrenia. Numerous studies have demonstrated
the utility of role-playing to train social skills among people with
psychosis (Dilk & Bond, 1996; Kurtz & Mueser, 2008); findings from
our research suggest that patients might benefit from this kind of
exercise to specifically enhance their capacity of accurately iden-
tifying others’ mental states.
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