Do patients with schizophrenia do dialogue differently? Christine - - PowerPoint PPT Presentation

Do patients with schizophrenia do dialogue differently?

Christine Howes, Mary Lavelle, Patrick G.T. Healey, Julian Hough, Rose McCabe JAM 2017 26th July 2017

1

Background

2

Method

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Results

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Conclusions

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1

Background

2

Method

3

Results

4

Conclusions

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• Disfluencies. . .

such as self-repairs, filled pauses (‘erm’, ‘uhh’) and unfilled pauses. . .

are pervasive in dialogue (Schegloff et al., 1977) are regarded as symptomatic of problems with communication (Levelt, 1983) – issues with self-monitoring or production are also interactive (Goodwin, 1979) – they occur in direct response to feedback are associated with increased gesture

Seyfeddinipur and Kita (2014); Healey et al. (2015)

– people use additional multimodal resources

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Patients with schizophrenia. . .

. . . experience problems in interaction

have difficulty monitoring their own behaviour (Johns et al., 2001) are less effective at ‘meshing’ turns (Mueser et al., 1991) use fewer speaking gestures (Lavelle et al., 2013) have mismatched gesture use and speech (Millman et al., 2014) use fewer self-repairs (Caplan et al., 1996) . . . or more self-repairs? (McCabe et al., 2013; Howes et al., 2012) . . . or the same amount? (Leudar et al., 1992)

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Studies on patients. . .

usually rely on

non-interactive data (e.g. monologues, offline tasks) or dialogues with known interlocutors (e.g. therapist, family members) or ‘dialogues’ with experimenters who know the patient’s diagnosis

What happens in social interactions with unknown partners?

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Studies on interactions. . .

show that the presence of a patient with schizophrenia influences the non-verbal behaviour of their interacting partners:

in clinical contexts (Lavelle et al., 2015) during first meetings with healthy controls, when the patient’s diagnosis is undisclosed (Lavelle et al., 2013, 2014)

Does interaction itself play a crucial role in patients’ deficits in dialogue? Do their healthy partners modify their own behaviours?

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1

Background

2

Method

3

Results

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Conclusions

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Data

Triadic conversations of approximately 5 minutes 20 patient interactions

• ne patient

two healthy controls who were unaware of the patient’s diagnosis

20 control interactions

three healthy participants

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Who would you throw out?

William Harris: Balloon pilot Susanne Harris: 7 months pregnant wife Robert Lewis: Cancer research scientist Heather Sloan: Musical child prodigy

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Data

(1) Video (2) Motion capture

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(3) Transcriptions

A The lady’s, the lady’s pregnant, so we’re saying we don’t want to throw her out C [Well, I don’t know, we can chuck her] A [And the little child], the little child, I don’t think she’s any use C Yeah, [who let a nine year old child go on a hot air balloon?] A [But, it it’s just because she’s young] B [Yeah]. A [But, sh-] even if they did throw her out, she’d be quite light B Yeah A So pause 220ms she wouldn’t really [make a difference] C [So you] should throw out the pregnant woman, [because erm, she’s probably gonna be the heaviest, and]= A [She’s two people] C =I’m guessing they’re all like normal weight A Ummm pause 3200ms I think the husband B Yeah, but he’s he’s the only one with any flying experience

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Analysis

Gesture (Lavelle et al., 2012)

derived from MoCap hand movements data hand movement speeds > 1 sd above an individual’s mean hand movement speed

Self-repair (Hough and Purver, 2014)

STIR (STrongly Incremental Repair detection) state-of-the-art incremental disfluency detector

Filled pauses (Howes et al., 2014)

Find-and-replace er, eerrrrmm, uhmmm etc → er

Unfilled pauses (Zellner, 1994)

Speech-free spaces >200ms between segments of speech by the same speaker

Rates per turn and per 100 words calculated for each individual

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Automatic annotations

A The lady’s, the lady’s pregnant, so we’re saying we don’t want to throw her out C [Well, I don’t know, we can chuck her] A [And the little child], the little child, I don’t think she’s any use C Yeah, [who let a nine year old child go on a hot air balloon?] A [But, it it’s just because she’s young] B [Yeah]. A [But, sh-] even if they did throw her out, she’d be quite light B Yeah A So pause 220ms she wouldn’t really [make a difference] C [So you] should throw out the pregnant woman, [because erm, she’s probably gonna be the heaviest, and]= A [She’s sh- sh- two people] C =I’m guessing they’re all like normal weight A Ummm pause 3200ms I think the husband B Yeah, but he’s he’s the only one with any flying experience

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Automatic annotations

A The lady’s, the lady’s pregnant, so we’re saying we don’t want to throw her out C [Well, I don’t know, we can chuck her] A [And the little child], the little child, I don’t think she’s any use C Yeah, [who let a nine year old child go on a hot air balloon?] A [But, it it’s just because she’s young] B [Yeah]. A [But, sh-] even if they did throw her out, she’d be quite light B Yeah A So pause 220ms she wouldn’t really [make a difference] C [So you] should throw out the pregnant woman, [because erm, she’s probably gonna be the heaviest, and]= A [She’s sh- sh- two people] C =I’m guessing they’re all like normal weight A Ummm pause 3200ms I think the husband B Yeah, but he’s he’s the only one with any flying experience

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Automatic annotations

A The lady’s, the lady’s pregnant, so we’re saying we don’t want to throw her out C [Well, I don’t know, we can chuck her] A [And the little child], the little child, I don’t think she’s any use C Yeah, [who let a nine year old child go on a hot air balloon?] A [But, it it’s just because she’s young] B [Yeah]. A [But, sh-] even if they did throw her out, she’d be quite light B Yeah A So pause 220ms she wouldn’t really [make a difference] C [So you] should throw out the pregnant woman, [because erm, she’s probably gonna be the heaviest, and]= A [She’s sh- sh- two people] C =I’m guessing they’re all like normal weight A Ummm pause 3200ms I think the husband B Yeah, but he’s he’s the only one with any flying experience

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1

Background

2

Method

3

Results

4

Conclusions

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Overview

Patient Partner Control total Turns 43.78 56.22 57.43 Words 247.67 439.03 399.63 Self-repair 3.56 10.13 10.49 Filled pause 2.11 4.47 8.08 Unfilled pause 14.94 32.92 22.00 per turn Words per turn 5.583 7.993 7.215 Self-repair 0.081 0.186 0.181 Filled pause 0.046 0.081 0.140 Unfilled pause 0.362 0.650 0.426 per 100 words Self-repair 1.330 2.203 2.507 Filled pause 0.774 1.004 1.811 Unfilled pause 6.582 7.691 5.929

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Self-repair

significant main effect of condition

(F2,96 = 10.71, p < 0.01)

patients use fewer self-repairs than partners

(t1,96 = −3.48, p < 0.01)

patients use fewer self-repairs than controls

(t1,96 = −3.64, p < 0.01

same pattern for self-repairs per 100 words

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Filled pauses

significant main effect of condition

(F2,102 = 5.93, p < 0.01)

patients fewer filled pauses than controls

(t1,102 = −3.35, p < 0.01)

patients’ partners also fewer than controls

(t1,102 = −2.36, p = 0.02)

same pattern for filled pauses per turn

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Unfilled pauses

significant main effect of condition

(F2,102 = 5.34, p < 0.01)

patients’ partners use more than patients

(t1,102 = 3.24, p < 0.01)

patients’ partners use more than controls

(t1,102 = 2.48, p = 0.02)

no significant effects by 100 words

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Gesture

patients fewer gestures as speaker repair rate and gesture correlated in controls

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1

Background

2

Method

3

Results

4

Conclusions

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During social interaction

patients with schizophrenia . . .

repair their own speech less use fewer filled pauses (‘er’, ‘um’) gesture less when speaking no association between gesture and speech

patients’ healthy interlocutors also . . .

use fewer filled pauses than controls use more unfilled pauses no association between gesture and speech

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Implications for turn-taking?

Reduced competition for the floor in patient interactions?

turn holding techniques (filled pauses) less necessary increased within-turn pauses for patients’ partners where they expect/encourage the patient to take the floor. patients less responsive to turn taking cues and/or more reluctant to select as next speaker?

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Future directions

This is a really broad brush approach

by participant

• ver the whole conversation

but suggests we should look more closely at turn-taking (including gesture and gaze?) and repair

and the usefulness of automatically derivable data from speech (potentially live)

(the start of) a fruitful line of research in investigating the difficulties experienced by patients in social interaction . . .

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Conclusions

Patients’ behaviours do not follow typical patterns

which may be (unconsciously?) picked up on by their interlocutors who may modify their behaviours (to compensate?)

this contributes to patients’ social exclusion and offers insights into “normal” interaction disfluencies are communicative solutions, not problems

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Questions?

Thanks to our many co-authors! (among others)

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References I

Caplan, R., Guthrie, D., and Komo, S. (1996). Conversational repair in schizophrenic and normal children. Journal of the American Academy of Child & Adolescent Psychiatry, 35(7):950 – 958. Goodwin, C. (1979). The interactive construction of a sentence in natural conversation. In Psathas, G., editor, Everyday Language: Studies in Ethnomethodology, pages 97–121. Irvington Publishers, New York. Healey, P . G. T., Plant, N., Howes, C., and Lavelle, M. (2015). When words fail: Collaborative gestures during clarification dialogues. In 2015 AAAI Spring Symposium Series: Turn-Taking and Coordination in Human-Machine Interaction. Hough, J. and Purver, M. (2014). Strongly incremental repair detection. In Proceedings

• f the 2014 Conference on Empirical Methods in Natural Language Processing

(EMNLP), Doha, Qatar. Association for Computational Linguistics. Howes, C., Hough, J., Purver, M., and McCabe, R. (2014). Helping, I mean assessing psychiatric communication: An application of incremental self-repair detection. In Proceedings of the 18th SemDial Workshop on the Semantics and Pragmatics of Dialogue (DialWatt), pages 80–89, Edinburgh. Howes, C., Purver, M., McCabe, R., Healey, P . G. T., and Lavelle, M. (2012). Helping the medicine go down: Repair and adherence in patient-clinician dialogues. In Proceedings of the 16th SemDial Workshop on the Semantics and Pragmatics of Dialogue (SeineDial), pages 155–156, Paris.

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References II

Johns, L. C., Rossell, S., Frith, C., Ahmad, F., Hemsley, D., Kuipers, E., and McGuire, P . (2001). Verbal self-monitoring and auditory verbal hallucinations in patients with

• schizophrenia. Psychological medicine, 31(04):705–715.

Lavelle, M., Dimic, S., Wildgrube, C., McCabe, R., and Priebe, S. (2015). Non-verbal communication in meetings of psychiatrists and patients with schizophrenia. Acta Psychiatrica Scandinavica, 131(3):197–205. Lavelle, M., Healey, P . G., and McCabe, R. (2013). Is nonverbal communication disrupted in interactions involving patients with schizophrenia? Schizophrenia bulletin, 39(5):1150–1158. Lavelle, M., Healey, P . G., and McCabe, R. (2014). Participation during first social encounters in schizophrenia. PloS one, 9(1). Lavelle, M., Healey, P . G. T., and McCabe, R. (2012). Is nonverbal communication disrupted in interactions involving patients with schizophrenia? Schizophrenia Bulletin. Leudar, I., Thomas, P ., and Johnston, M. (1992). Self-repair in dialogues of schizophrenics: Effects of hallucinations and negative symptoms. Brain and Language, 43(3):487 – 511. Levelt, W. (1983). Monitoring and self-repair in speech. Cognition, 14(1):41–104.

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References III

McCabe, R., Healey, P . G. T., Priebe, S., Lavelle, M., Dodwell, D., Laugharne, R., Snell, A., and Bremner, S. (2013). Shared understanding in psychiatrist-patient communication: Association with treatment adherence in schizophrenia. Patient Education and Counselling. Millman, Z. B., Goss, J., Schiffman, J., Mejias, J., Gupta, T., and Mittal, V. A. (2014). Mismatch and lexical retrieval gestures are associated with visual information processing, verbal production, and symptomatology in youth at high risk for

• psychosis. Schizophrenia Research, 158(1-3):64 – 68.

Mueser, K. T., Bellack, A. S., Douglas, M. S., and Morrison, R. L. (1991). Prevalence and stability of social skill deficits in schizophrenia. Schizophrenia research, 5(2):167–176. Schegloff, E., Jefferson, G., and Sacks, H. (1977). The preference for self-correction in the organization of repair in conversation. Language, 53(2):361–382. Seyfeddinipur, M. and Kita, S. (2014). Gestures and self-monitoring in speech

• production. In Annual Meeting of the Berkeley Linguistics Society, volume 27,

pages 457–464. Zellner, B. (1994). Pauses and the temporal structure of speech. In Keller, E., editor, Fundamentals of speech synthesis and speech recognition, pages 41–62. Chichester: John Wiley.

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