Theory of mind skill predicts anticipatory guilt-proneness in schizophrenia

SZ participants anticipated equal affective guilt-proneness but reduced adaptive behavioural responses to guilty feelings, resulting in more chronic guilt in daily life than would be predicted by TOSCA-3 and GASP responses. The discrepancy between emotional experience and expression may partly explain previous findings of reduced TOSCA-3 guilt-proneness, as TOSCA-3 operationalises guilt as reparative, prosocial behaviours. Results highlight perceptions of reparation potential as an intervention target, with likely downstream reductions in chronic and delusional guilt and shame.