Feeling in control of one's own action: a behavioural approach in healthy volunteers and mental diseases. – FeelInControl

Several cognitive impairments have been described in patients with schizophrenia and bipolar disorders. These deficits impact severely on the patients’ psychosocial functioning. It follows that remediating these impairments is of great benefit. However, despite important progress, the mechanisms of the impairments and their relationships with clinical symptoms remain largely unknown. It is thus not clear what cognitive impairment should be remediated in priority, and to which amount cognitive deficits differ in patients with schizophrenia and bipolar disorder. One of the reasons for this stems from the fact that even in healthy subjects the precise mechanisms underlying complex behaviours are not well understood. Here we address the case of feeling of control, which might play an important role in the emergence of delusions of control during acute phases of psychosis, especially in schizophrenia: patients with such delusions do not recognize themselves as the authors of their acts or thoughts, which they attribute to an external source.
Our previous studies identified two ‘elementary’ mechanisms that are impaired in stabilized patients with schizophrenia, 1) the processing of sensory information, and 2) the ability to build mental representations for sequenced actions. With the use of virtual reality, our project will help to determine the role of these two elementary mechanisms in the ability to feel in control of voluntary actions, in healthy volunteers and in patients with schizophrenia and bipolar disorder. The inclusion of 2 patient groups will provide the means to assess the specificity of the impairments to schizophrenia. The distinction of patients with or without a history of delusions of control will further allow to relate the impairments with clinical symptoms, and to distinguish the effects of the pathology and of the drugs, as a majority of the patients are treated with neuroleptics. The project will benefit from multidisciplinary concepts and original methods, issued from the virtual reality field, and from several fields of experimental psychology: timing, visual perception and motor control.
It is a fact that each time an action is planned, sensory consequences are predicted and compared to true sensory feedback. Congruency between predicted and actual sensory consequences thus helps to feel in control. Our first hypothesis is that a diminished feeling of control is linked to the fact that patients possess less sensory information, especially regarding time. We will use haptic devices in virtual reality environments to conduct tapping tasks. Thanks to adapted software developments the haptic feedback will be anticipated or delayed. This will provide the means to test time distortion detection. Moreover, adaptation of the action following a sub-threshold distortion will indicate whether or not sub-threshold perception is impaired in patients. Our second hypothesis regards the ability to build a representation for action planning. To test this, we will transfer innovative methods issued from the visual perception field to manipulate the complexity of the representation to be built for the planning of a sequential action, in manual or oculomotor tasks. This will be done with or without phasic sensory feedback to test the impact of difficult planning in isolation and combined with sensory difficulties. The virtual reality settings will allow to test easily the ability of subjects to feel in control (everyone has experienced difficulty to control a computer mouse). In each trial, subjects will be asked to evaluate their feeling of control on visual analogic scales. The project will help to answer fundamental questions regarding multisensory integration and elementary mechanisms of the feeling of control, and applied questions regarding the pathophysiology of mental diseases. Most importantly, the project will help to develop original remediation methods in which visual and haptic information are manipulated.