With funding from APF, Ivy Tso, PhD, studied why people with schizophrenia have problems reading social cues. (credit: Dwight Cendrowski)

Are you looking at me? For people with schizophrenia, answering that question can be difficult.

Psychologist Ivy F. Tso, PhD, is trying to figure out why people with schizophrenia have so much trouble with one of the most important clues we have about what other people are thinking.

With support from the American Psychological Foundation's Benton-Meier Neuropsychology Scholarship, Tso completed her dissertation research on how people with schizophrenia process where other people are looking. After earning her doctorate at the University of Michigan in 2012 and completing a postdoc there in 2013, she became a clinical lecturer in Michigan's psychiatry department last September. gradPSYCH talked to Tso about her ongoing research.

Why focus on what you call "eye-gaze processing"?

People with schizophrenia have trouble inferring other people's mental states. Eye-gaze direction is a ubiquitous social cue that we use to direct attention and infer what other people are thinking, what their intentions are. Not being able to process eye-gaze direction can in turn cause problems in how well people with schizophrenia function in relationships, at work and beyond.

How did you study it?

My first experiment was to show people faces with different eye-gaze angles, from averted to direct gaze. I found that when people with schizophrenia saw ambiguous gazes, they were more uncertain about whether the face was looking at them than the healthy controls.

In the second experiment, I looked at brain electricity signals when healthy people and people with schizophrenia looked at faces with averted or direct gazes. I found that people with schizophrenia had a greater electrophysiological response than healthy controls, but only when the faces they were shown had fearful emotion and averted gaze. That increased response was correlated significantly not just with perceived threat but with delusions like "People can read my mind" or "People have malicious intentions toward me." It seems people with schizophrenia are more hypersensitive to potential danger.

These behavioral and electroencephalogram experiments tell us something's wrong with eye-gaze processing among people with schizophrenia. The logical next question is what the source of that problem is — whether they have problems with all kinds of basic perceptions or just problems understanding social information. Answering that question could help us design effective interventions, so in my third experiment, I looked at more basic visual perception and found that people with schizophrenia performed worse than healthy controls.

How did the grant help your career?

This research resulted in two manuscripts, one published in the Journal of Abnormal Psychology and one in Schizophrenia Bulletin and another under revision. I'm planning to submit it to Schizophrenia Research.

What's next for you?

The findings from my three experiments tell us there's something wrong with gaze perception in people with schizophrenia, maybe related to basic perceptual problems. But these are all correlational data, so we don't know for sure where the problem is.

What I'm proposing to do next is to use fMRI to look at brain regions related to eye-gaze processing to find out more about the direction of all these processes: Do problems with basic perception lead to problems of gaze perception, or is it a higher level function — a problem with attention or memory in general — that drives the problem with more basic perception?

What are the possible implications of your research?

My findings may inform the development of treatment options, such as cognitive training or medications, targeting specific brain areas or functions for people with schizophrenia. Maybe they could be trained to integrate visual information more efficiently, for example. Or they could restructure their cognitions, so they tell themselves that, even though it feels very real, people aren't looking at them.

Is there an APF grant in your future?

Each year, the American Psychological Foundation awards more than 45 grants worth $700,000. Find out if there's one for you.