Academic journal article Journal of the Indian Academy of Applied Psychology

Theory of Mind in Mild Traumatic Brain Injury

Academic journal article Journal of the Indian Academy of Applied Psychology

Theory of Mind in Mild Traumatic Brain Injury

Article excerpt

Human behaviour is a system of complex and dynamic interactions requiring an innate, and highly developed cognitive capacity (Adolphs, 2001). In order to grasp and execute rules of this complex system, an aspect known as social cognition is required. Social cognition (or social intelligence) is defined as the ability to interpret others' behaviour in terms of mental states, to conceptualise relationships between oneself and others, to use these concepts to guide one's own behaviour, and predict that of others (Baren-Cohen et al., 1999). It has been suggested that this ability may be independent of general intelligence, with different information processing demands (Adolphs, 2001; Baron-Cohen et al., 1999). One key aspect of social cognition is Theory of mind (ToM). It refers broadly to the ability to understand others' emotions, motivations, and thoughts and to understand their behavior accordingly (Bibby & McDonald, 2005). This ability helps an individual to think about other people's mental states (eg. thoughts, beliefs, intentions, and desires) and use them to understand and predict others' behaviour. A wide range of different approaches have been used to assess ToM. These approaches have varied in terms of factors such as subjects they were designed for (ranging from normal adults to children with autism) and their capacity to distinguish between different developmental levels of ToM (eg. first-order, second-order and applied uses of ToM inferences).

The specific mechanism and neural pathways of ToM are not well understood (Happe, Malhi, & Checkley, 2001 ) and remain controversial. A considerable amount of evidence from imaging studies has suggested that the frontal lobe activity is necessary for this ability (Goel, Grafman, Sadato & Hallett, 1995; Channon & Crawford, 2000) . There are evidences that provide considerable support for the role of the right frontal lobes in ToM as well (Tranel, Bechara, & Denburg, 2002; Stuss, Gallup, & Alexander, 2001).

Theory of Mind is a part of social cognition, and social impairment is a natural consequence of a deficit in ToM. Specifically, a ToM deficit has been linked to difficulties using gestures to affect how others feel as well as taking account of others' interests in conversation (Fletcher et al., 1995), withdrawal from social contact (Happe et al., 2001) , insensitivity to social cues, indifference to others' opinions, poor foresight, egocentrism, lack of restraint and inappropriate affect (Rowe, Bullock, Polkey, & Morris, 2001), pedantic speech, inappropriate non-verbal communication and inability to follow social rules (Bowler, 1992), and difficulty applying theoretical social knowledge to the real situation (Stone, Baron-Cohen & Knight, 1998). Furthermore, research has suggested that impaired ToM may also be associated with communication difficulties. In particular, it has been linked to problems comprehending non-literal speech, such as sarcasm, irony, humour, and deceit (e.g. Channon & Crawford, 2000; Happe, 1993).

One group that has been found to demonstrate many of the social and communication difficulties outlined above are people who have sustained a traumatic brain injury (TBI). Subjects with TBI have been shown to have impaired social competence (Spatt, Zebenholzer, & Oder, 1997); to be socially isolated (Lezak, 1995); and to have difficulties with non-literal language (Dennis, Purvis, Barnes, Wilkinson, & Winner, 2001). They have also been described as having poor insight, talkativeness and inappropriate expressions of affection (Santoro & Spiers, 1994); reduced empathy (Eslinger, 1998); lack of foresight, tact and concern (Lishman, 2001); egocentrism and inappropriate levels of social interaction (McDonald & Pearce, 1996); impaired understanding of non-verbal signals (Lezak, 1995); and difficulty applying social knowledge (Dimitrov, Grafman, & Hollnagel, 1996). The overlap between these observations and the social difficulties thought to be associated with ToM deficits raises the question of whether patients with TBI have impairment in ToM. …

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