Motivation and Social Withdrawal in Schizophrenia: Factors Related to Passive Social Withdrawal and Active Social Avoidance

Schizophrenia is a disabling disorder and social withdrawal in schizophrenia is related to particularly adverse outcomes. Social withdrawal may be a result of “passive” motivation (disinterest or lack of drive to engage with others) or “active” motivation (fear, hostility, or distrust of others). The purpose of this study was to better understand passive social withdrawal and active social avoidance, by exploring their relationships with social abilities and social functioning outcomes. In addition, we explored whether the EEG frontal alpha asymmetry hypothesis, which has been previously linked to shyness and sociability, might contribute to our understanding of social withdrawal motivation. This was a cross-sectional study that used regression models to evaluate the relationships between motivation to withdraw, social abilities, and social functioning outcomes. Electroencephalographic (EEG) recordings were also used to explore whether frontal alpha asymmetry is related to differences in symptoms. Overall, we found differences in passive and active withdrawal across predictors and functional outcomes. Passive social withdrawal substantially predicts social functioning and is distinct from the effects of social cognition and social competence. Active social avoidance is uniquely associated with cognitive bias. Finally, we describe a potential relationship between frontal alpha asymmetry and social withdrawal motivation, although our sample size was not large enough to make generalizations. Overall, this study suggests the importance of focusing specifically on motivation when treating social withdrawal and presents suggestions for future research and interventions