Psychiatry Research ()

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Psychiatry Research
journal homepage: www.elsevier.com/locate/psychres

Anomalous echo: Exploring abnormal experience correlates

of emotional motor resonance in Schizophrenia Spectrum
Mariateresa Sestito a,b,n, Andrea Raballo c,d, Maria Alessandra Umilt e, Mario Amore f,
Carlo Maggini g, Vittorio Gallese a
a

Department of Neuroscience, Unit of Physiology, University of Parma, Parma, Italy

Cognitive Neuroscience Center, Unit mixte de recherche 5229, Centre National pour la Recherche Scientique (CNRS), Bron, France
c
Department of Mental Health, AUSL of Reggio Emilia, Reggio Emilia, Italy
d
Psychiatric Center Hvidovre, Copenhagen, Denmark
e
Department of Pharmacy, University of Parma, Italy
f
Department of Neuroscience, Psychiatric Division, University of Genova, Italy
g
Department of Neuroscience, Psychiatric Division, University of Parma, Italy
b

art ic l e i nf o

a b s t r a c t

Article history:
Received 4 November 2014
Received in revised form
28 May 2015
Accepted 31 May 2015

Anomalous experiences such as Basic Symptoms (BS) are considered the rst subjective manifestation of
the neurobiological substrate of schizophrenia. The purpose of this study was to explore whether a low
or high emotional motor resonance occurring in Schizophrenia Spectrum (SzSp) patients was related to
patients' clinical features and to their anomalous subjective experiences as indexed by the Bonn Scale for
the Assessment of Basic Symptoms (BSABS). To this aim, we employed a validated paradigm sensitive in
evoking a congruent facial mimicry (measured by means of facial electromyographic activity, EMG)
through multimodal positive and negative emotional stimuli presentation. Results showed that SzSp
patients more resonating with negative emotional stimuli (i.e. Externalizers) had signicantly higher
scores in BSABS Cluster 3 (Vulnerability) and more psychotic episodes than Internalizers patients. On the
other hand, SzSp patients more resonating with positive emotional stimuli (i.e. Externalizers) scored
higher in BSABS Cluster 5 (Interpersonal irritation) than Internalizers. Drawing upon a phenomenologicalbased perspective, we attempted to shed new light on the abnormal experiences characterizing
schizophrenia, explaining them in terms of a disruption of the normal self-perception conveyed by
the basic, low-level emotional motor mechanisms.
& 2015 Elsevier Ireland Ltd. All rights reserved.

Keywords:
Basic symptoms
Embodiment
Facial EMG
Emotions
Motor resonance
Phenomenology
Schizophrenia Spectrum

1. Introduction
Although there is substantial empirical evidence indicating that
experiential phenotypes such as anomalous subjective experiences
are a core research target to delineate the underlying psychobiological vulnerability to schizophrenia (Parnas and Henriksen,
2014) the relation between phenomenological experiences and
neurobiological disorders in schizophrenia is still signicantly
under-investigated.
Over recent years, indeed, uncharacteristic subjective experiences occurring in schizophrenia have become an important
theme in psychopathological research. Among those, Basic Symptoms (BS) were conceptualized as the rst subjective echo of the
n
Corresponding author at: Department of Neuroscience, Unit of Physiology,
University of Parma, Via Volturno 39, I-43100 Parma, Italy. Tel.: 39 0521 903873;
fax: 39 0521 903881.
E-mail address: mariateresa.sestito@nemo.unipr.it (M. Sestito).

entailed neurobiological underpinnings of schizophrenia. Stemming from the Jasperian phenomenological psychopathology, BS
are non-psychotic subtle phenomena privately experienced as
unelaborated, yet discomforting, interferences in daily experience
(Gross, 1989). On a clinical level, BS and similar anomalies of
subjective experience are detectable in different schizophreniarelated conditions, such as full-blown schizophrenia, prodromal/at
risk mental states, schizotipy (Handest and Parnas, 2005; Parnas
et al., 2005; Nordgaard and Parnas, 2014) as well as genetically
high-risk individuals (Maggini and Raballo, 2004; Raballo and
Parnas, 2011; Raballo et al., 2011).
Recent works (Nelson et al., 2014a, 2014b) outlined how
various aspects of the phenomenological basic self-disturbances
occurring in schizophrenia may correlate with neurocognitive
disturbances, suggesting new avenues for empirical investigations
into these proposed associations. A wealth of neurophysiological
studies considered the involuntary facial mimicry in response to
emotional stimuli as an important low-level mechanism that leads

http://dx.doi.org/10.1016/j.psychres.2015.05.038
0165-1781/& 2015 Elsevier Ireland Ltd. All rights reserved.

Please cite this article as: Sestito, M., et al., Anomalous echo: Exploring abnormal experience correlates of emotional motor resonance
in Schizophrenia Spectrum. Psychiatry Research (2015), http://dx.doi.org/10.1016/j.psychres.2015.05.038i

M. Sestito et al. / Psychiatry Research ()

individuals to feel what others feel, hence facilitating a rstperson, un-reective empathic understanding of others' emotions
via their bodily simulation (Preston and De Waal, 2002; SonnbyBorgstrm, 2002; Gallese, 2003, 2005; Niedenthal, 2007; Hess and
Fischer, 2013; Likowski et al., 2012). A recent study (Sestito et al.,
2015) investigated possible connections between phenomenological experience and physiological mechanisms in Schizophrenia
Spectrum (SzSp) patients, explored by means of motor facial
mimicry in response to emotional stimuli. Interestingly, a correlation between Self-Disorders BSABS-derived subscore (i.e., a preEASE-SD-analog scale constructed from the available data
obtained from the Bonn Scale for the Assessment of Basic Symptoms (BSABS), see Parnas et al. (2003)) and electromyographic
(EMG) facial reactions in response to negative stimuli presented
only in the auditory modality was detected. Besides of a polarized
sensitivity for negative stimuli, in an earlier study (Sestito et al.,
2013) schizophrenia patients exhibited, with respect to healthy
controls, a non-specic Zygomaticus muscle activation in
response to positive as well as to negative emotions, that is, an
improper smile response occurring both when laugh and cry
stimuli were presented. This phenomenon appeared to be similar
to what Heiman and Spoerri called mimic disintegration (1957)
namely, an indecipherable and bizarre mimic pattern reecting a
disruption of patients' ability to resonate with others' emotions
through facial mimicry, possibly contributing to the well recognized empathizing decits present in schizophrenia (Varcin et al.,
2010; Derntl et al., 2012). Further studies capitalizing the integration across the phenomenological and neurophysiological levels
are hence necessary, in order to provide advances in the understanding of vulnerability markers in schizophrenia and enhance
early identication and intervention approaches.
The aim of this study is to explore whether a weak or high
emotional motor resonance occurring in SzSp patientsconsidered a mirror mechanismproxy (Carr et al., 2003; Seitz
et al., 2008; Derntl et al., 2012)is related to patients' clinical
features and to their anomalous subjective experiences as indexed
by the Bonn Scale for the Assessment of Basic Symptoms (BSABS).
In order to do this, we employed an experimental paradigm able to
evoke a congruent facial mimicry (measured by means of facial
EMG activity) through multimodal positive and negative emotional stimuli exposure. This paradigm has been previously proven
to detect decits in facial mimicry in schizophrenia patients
(Sestito et al., 2013).

2. Methods
In order to explore subjective anomalous experiences characterizing SzSp
patients with different degrees of motor resonance to emotional stimuli, participants were divided into two groupsInternalizers and Externalizersbased,
Table 1
Demographic variables and psychopathological features of the SzSp sample.
Characteristic

Mean S.D.

Range (scale range)

Age (years)
SAPS
SANS
BSABS
Length of illness (years)
Age at rst recognized psychotic episode
Number of hospitalizations
Dose of typical and atypical antipsychoticsa
Dose of atypical antipsychoticsa
Dose of typical antipsychoticsa

34.11
24.01
46.34
41.72
11.06
24.06
3.35
26.41
20.01
6.40

2549
158 (0170)
1583 (0125)
2986 (0103)
224
1934
07

6.73
16.26
17.63
16.52
4.84
4.30
1.82
19.54
15.64
5.72

a
Drugs are expressed as the cumulative value measured in dose-years in the
form of (chlorpromazine equivalent in mg)  (time on dose measured in years)
(Andreasen et al., 2010).

respectively, on their low and high emotional resonance following the same
method adopted in previous works (Kring and Gordon, 1998; Sestito et al., 2013).
Internalizer and Externalizer classication was used exclusively to characterize
individual differences of emotional EMG facial reactivity to specic emotional
stimuli as previously reported (Sestito et al., 2013) and did not refer to personality
traits and/or coping mechanisms (Asendorpf and Scherer, 1983). Clinical features
(positive and negative symptoms, length of illness, age at rst recognized psychosis
and number of psychotic episodes) and anomalous subjective experiences (BSABS
scores) differences between these two subsamples were then explored.

2.1. Sample
The sample included 19 outpatients (14 males, 5 females, mean age 34.11 years
S.D.7 6.73) recruited at the Psychiatry Section of Parma University Department of
Neuroscience. All participants were diagnosed with a Schizophrenia Spectrum
disorder (SzSp) (i.e. schizophrenia or schizotypal personality disorder according to
DSM-IV diagnostic criteria (American Psychiatric Association, 1994) and were
clinically stable (i.e., with no current psychotic symptoms) at the time of the
assessment. Fifteen participants included in this sample have been considered in
the earlier validation study (Sestito et al., 2013).
Before inclusion, all patients were screened for eligibility and those with any
history of organic brain disorders, brain injury, alcohol or substance abuse and
mental retardation were excluded from the study. Clinical features were documented with the Scales for the Assessment of Positive and Negative Symptoms
(SANS, SAPS; Andreasen, 1984a, 1984b), whereas disturbances of subjective
experience were explored through the Bonn Scale for the Assessment of Basic
Symptoms (BSABS) (Gross et al., 1992). Since all patients were under psychopharmacologic treatment with antipsychotics, the cumulative measure of lifetime drugs
exposure was calculated following Andreasen et al. (2010). Demographic and
psychopathological features of the sample are provided in Table 1.
Written informed consent was obtained from all participants before entering
the study, after the treating clinician gave them an exhaustive explanation about
the experimental procedure. The Ethics Committee of the University of Parma
approved the study, that was carried out according with the ethical standards of
the 2013 Declaration of Helsinki.

2.2. Bonn Scale for the Assessment of Basic Symptoms (BSABS)

Disturbances of subjective experience were investigated through the Bonn
Scale for the Assessment of Basic Symptoms (BSABS) (Gross et al., 1992). The BSABS
is a semi-structured interview targeting the BS, i.e. self-perceived disturbances in
volition, drive, stream of thought, perception, stress tolerance, neurovegetative and
cenesthesic experiences (Schultze-Lutter, 2009, 2010).
These subjective symptoms have been empirically clustered into ve subsyndromes (Klosterktter et al., 1996, 1997):
1. Thought, language, perception and motor disturbances (formerly termed Information processing disturbances) cluster includes BS involving autopsychic
dissonance in cognition, naturalness of agency, perception and linguistic
interaction.
2. Impaired bodily sensations (Coenesthesias) includes a cluster of cenesthesic BS
mainly affecting bodily proprioceptive reexive and pre-reexive sensory
awareness.
3. Impaired tolerance to normal stress (Vulnerability) cluster includes some BS
characterized by abnormal intolerance to social, working and attentional
demands deriving from the daily environmental engagement.
4. Disorders of emotion and affect (Adynamia) cluster includes the so-called
adynamic BS, associated with a lack of dynamic-affective empowerment of
emotional and attentional goal directedness.
5. Increased emotional reactivity (Interpersonal irritation) cluster is dened by BS
expressing hyperreactivity, enhanced impressionability and disturbances in
emotional responsiveness.

2.3. Experimental paradigm: stimuli and procedure

The experimental paradigm (Sestito et al., 2013) consists of the following
procedure. Participants were presented with 2-s colored video clips portraying
positive (laugh), negative (cry) and neutral (control) emotional stimuli in visual (i.e.,
Video), auditory (i.e., Audio) modalities. Video or Audio modalities were either in
isolation (i.e. V or A alone), or combined (i.e. AV). AV combination were either
congruent (AudioVisual Congruent, AVC) i.e. A and V conveying the same emotion (e.
g. Laugh) or incongruent (AudioVisual Incongruent, AVI), i.e. A and V conveying
contradictory information (for example, in AVI Cry participants saw an actor laughing
but heard crying whereas in AVI Laugh participants saw an actor crying but heard
laughing). Participants were requested to recognize and quantitatively rate the
emotional value of the perceived stimuli (see Fig. 1), while EMG activity of Corrugator

Please cite this article as: Sestito, M., et al., Anomalous echo: Exploring abnormal experience correlates of emotional motor resonance
in Schizophrenia Spectrum. Psychiatry Research (2015), http://dx.doi.org/10.1016/j.psychres.2015.05.038i

M. Sestito et al. / Psychiatry Research ()

statistics. In order to explore possible differences between SzSp Internalizer and

Externalizer subsamples with respect to clinical features and abnormal subjective
experiences, we ran a series of Student's t tests. Separately for positive and negative
emotion valence, we set the Motor Resonance factor (Internalizers and Externalizers) as independent variable whereas SAPS, SANS, BSABS scores (total amount
score and Cluster 1, 2, 3, 4, 5 subscores), length of illness (in years), age at rst
recognized psychosis and number of psychotic episodes factors constituted the
dependent variables. Since clinical information was incomplete for two patients
and BSABS scores were not available for one participant, we conservatively
excluded the cases with missing data from the analysis. For all performed analyses,
p o0.05 was considered to be statistically signicant. Because this study was
designed as an explorative pilot study (see Bechdolf et al. (2002)) and the sample
sizes were limited, no error adjustment for multiple testing was made.

3. Results
3.1. BSABS subscales item analyses

Fig. 1. Experimental paradigm. Photographs illustrate examples of stimuli depicting Laugh (A), Cry (B) and Control (C). After exposure to each video clip, when the
question mark symbol (?) appeared on the screen, participants were requested to
verbally rate how much positive or negative the stimulus was perceived on a Likert
scale ranging from  3 (very negative) to 3 (very positive), where 0 indicated lack
of perceived emotional content.
Supercilii and Zygomaticus Major muscles was recorded. See Sestito et al. (2013) for
further details about stimuli, experimental procedure and EMG recording.
2.4. Data analysis
2.4.1. Internalizers and Externalizers
Following the previous study (Sestito et al., 2013), the EMG signal was
normalized with respect to the baseline (i.e., the averaged pre-stimulus signal
activity), resulting in a percentage value. An EMG normalized value above the 100%
means an activation of a given muscle with respect to the baseline, whereas an
EMG normalized value below the 100% indicates a relaxation of that muscle with
respect to the baseline. SzSp patients were dichotomized as follows (Kring and
Gordon, 1998; Sestito et al., 2013). First, separately for Zygomaticus and Corrugator
activityrepresenting positive and negative emotions relevant muscles, respectivelywe calculated the median EMG response of the whole sample, irrespective
of time-epochs and modalities (i.e., considering all together the modalities
previously proven to congruently elicit the activation of a given muscle, that is:
AVC Laugh, Audio Laugh, Video Laugh and AVI Cry for Zygomaticus muscle; AVC
Cry, Audio Cry, Video Cry and AVI Laugh for Corrugator muscle, for further details
see Sestito et al. (2013)). Afterwards, still separately for each emotion valence
(positive, negative) each participant was allocated in a different group (i.e.
Externalizer or Internalizer) according to whether his/her median EMG response
expressed in a percentage value was above or below the whole sample's one. That
is, if this value was equal or greater than the median value calculated separately for
positive and negative emotions, we classied this participant as Externalizer. If,
instead, this value was smaller than the median value calculated separately for
positive and negative emotions, we classied this participant as Internalizer (see
Kring and Gordon (1998) and Sestito et al. (2013)). Following this procedure, we
obtained the median EMG value of 94.36% (10 Externalizers and 9 Internalizers) for
positive emotions (i.e. referred to Zigomaticus congruent responses), whereas we
calculated a median EMG value of 100.00% (10 Externalizers and 9 Internalizers)
for negative emotions (i.e. referred to Corrugator congruent responses) (see
Appendix A).
2.4.2. BSABS subscales item analyses
BSABS items were grouped into clusters covering ve main phenomenological
areas (Klosterktter et al., 1996, 1997): (1) Information processing disturbances, (2)
Coenesthesias, (3) Vulnerability, (4) Adynamia, and (5) Interpersonal irritation.
First, we checked for a good internal consistency by means of coefcient alpha
(Cronbach, 1951) computation. In order to improve coefcient alpha each cluster
was subjected to an item analysis, and those which tended to degraded it
signicantly were removed from the original item pool. Finally, only the clusters
reaching a satisfactory internal consistency ( 40.50) were retained for the
subsequent analyses.
2.4.3. Internalizer vs. Externalizer group: experiential and clinical differences
KolmogorovSmirnov test applied on all the dependent variables revealed a
normal data distribution (all ps 40.2), hence allowing us to employ parametric

After item analyses, all BSABS clusters reached a satisfactory

alpha coefcient ( 40.50; for item composition and alpha coefcients for each cluster, see Appendix B) and were retained for the
subsequent analyses.
3.2. Internalizer vs. Externalizer group: experiential and clinical
differences
With respect to positive emotions, Externalizers participants
scored higher than Internalizers in BSABS Cluster 5 (Interpersonal
irritation, for item composition see Appendix C) (n 18; t2.47
po 0.03) (Fig. 2, upper panel).
Whereas, with respect to negative emotions, Externalizers
presented higher scores in BSABS Cluster 3 (Vulnerability, for item
composition see Appendix C) (Fig. 2, lower panel) (n 18; t2.73
po 0.02) as well as more psychotic episodes (n 17; t 2.48
po 0.03) (Fig. 3) than Internalizers.
For all the other clinical features, we found no signicant
differences (all ps 40.05).
4. Discussion
This study adopted a multimodal paradigm to evoke congruent
electromyographic facial reactions in SzSp participants. The latter
were then dichotomized into Externalizers vs. Internalizers,
according to the intensity of their emotional motor resonance to
positive and negative stimuli. SzSp participants with high (i.e.,
Externalizers) or low (i.e., Internalizers) EMG congruent responses
revealed a different pattern of specic anomalous subjective
experiences as well as different clinical features.
Those SzSp patients who were more resonating with negative
emotional stimuli (i.e., Externalizers for negative emotions) presented higher scores in BSABS Cluster 3 (Vulnerability) as well as
more psychotic episodes than the Internalizers group. On the
other hand, SzSp patients that were more resonating with positive
emotional stimuli (i.e., Externalizers for positive emotions) scored
higher in BSABS Cluster 5 (Interpersonal irritation) than
Internalizers.
Overall the results indicate that the electrophysiological endophenotypes (i.e. Internalizers vs. Externalizer for positive vs.
negative emotional stimuli) actually capture relevant endophenotypic features at a clinical level.
SzSp subjects that reacted more to negative emotional stimuli
(i.e., Externalizers for negative stimuli) also had increased levels of
anomalous subjective experiences indicative of overall impaired
tolerance to any daily solicitations in the socio-functional sphere
(i.e. BSABS Cluster 3 vulnerability, see Appendix C for details) as
well as more recurrent psychotic episodes. This coheres with the
evidence indicating the relevance of mechanisms such as aberrant

Please cite this article as: Sestito, M., et al., Anomalous echo: Exploring abnormal experience correlates of emotional motor resonance
in Schizophrenia Spectrum. Psychiatry Research (2015), http://dx.doi.org/10.1016/j.psychres.2015.05.038i

M. Sestito et al. / Psychiatry Research ()

of anomalous subjective experiences indicates an overall hyperreactivity with enhanced impressionability and disturbances in
emotional responsiveness (e.g. decrease in facial expression, intonation and communication gestures).
Thus, on a clinical-experiential level, those who are Externalizers for positive emotions (i.e. patients more resonating with
positive stimuli) tend to contextually experience a disorder in
the immediate, phenomenic relation to others, particularly with
respect to the impression of an inadequate emotional responsiveness at a mimic-expressive level (as indicated by the BSABS Cluster
Interpersonal irritation), as if the smile reaction exhibited
although congruent with the emotion perceivedis something
completely extraneous from what is actually felt.
For indicative purposes, we reported some BSABS Cluster
5 related descriptions:
During social interactions (), I feel a tense expression on my
face as I ought to laugh or make a face, stupidly.
I laugh in such a beastly and ridiculous way, and I feel I am
disgured. My face lineaments are completely altered. I have a
different appearance now, my smile, my eyes, all is changed
(Gross et al., 1992; our translation).

Fig. 2. In the upper panel are presented BSABS Cluster 5 mean scores for
Externalizer and Internalizer subsamples for positive emotions. In the lower panel
are presented BSABS Cluster 3 mean scores for Externalizer and Internalizer groups
for negative emotions. Error bars represent standard deviations of mean (DS).
*po 0.05.

Fig. 3. Mean number of psychotic episodes (n) are presented for Externalizer and
Internalizer groups for negative emotions. Error bars represent standard deviations
of mean (DS). *po 0.05.

assignment of salience, selective bias toward negative stimuli, and

tendency to ascribe meaning where none is present (Kapur, 2003;
Hoffman et al., 2007; Sestito et al., 2013; Nelson et al., 2014b) for
the development of positive symptoms (see Klosterktter (1992)).
On the contrary, SzSp participants that were Externalizers for
positive emotions scored higher in Interpersonal irritation BSABS
Cluster 5 (Interpersonal irritation) than Internalizers. This cluster

Overall these results, together with other studies that investigated the facial reactiveness to emotional stimuli of SzSp (Sestito
et al., 2013, 2015), seem to revitalize the notion of mimic disintegration (Heimann and Spoerri, 1957; Juckel and Polzer, 1998), as a
graded phenomenon (ranging from altered, uncoordinated muscular reactions and reaching more radical expressive manifestations such as manneristic and parathymic facial expressions) that
plausibly goes along with a multisensory integration impairment
and disturbances of emotional responsiveness in schizophrenia
(Sestito et al., 2015).
Indeed, these descriptions are consistent with what we found
in our earlier study (Sestito et al., 2013) in which the smile EMG
reaction occurred not only when patients perceived laughter, but
alsooddlywhen cry stimuli were presented. In this context we
are inclined to consider that the disruption of the automatic, lowlevel processes related to facial mimicry probably fosters patients'
sense of detachment, thereby increasing disconnection between
the expressed and the felt I. This growing disconnection
crucially creates a sense of distanceand even alienationfrom
patient's own experience, ending up in a scission of the Self.
A disjunction between one's subjectivity and bodily experience
is frequently observed in SzSp conditions, particularly during the
preonset or prodromal phase (Klosterktter et al., 2001; Maggini
and Raballo, 2004). Specically in our study, a tendency to
resonate and experientially go along with negative stimuli is
nonetheless accompanied by an apparent experiential disconnection between the self and the bodily resonance for positive
emotions. Under these circumstances, the body would end up to
be experienced as an object, rather than an emotion-fullled aspect
of selfhood (Nelson and Sass, 2009). Hence, as Stanghellini and
Fusar-Poli (2012) argued: Schizophrenic persons undergo a special
kind of depersonalization: the living body becomes a functioning
body, a thing-like mechanism in which feelings, perceptions, and
actions take place as if they happened in an outer space. (p. 338).
Embodiment is a fundamental condition of selfhood (Gallese and
Sinigaglia, 2010, 2011; Stanghellini et al., 2012; Gallese and Ferri,
2013), and such disembodiment of emotion (Fuchs, 2005; Voduek
et al., 2013) we found in our studyactualized through a bodily,
anomalous echofurther remarks the need to conceptualize schizophrenia as a disorder of the Self and of the Intersubjective
attunement (Stanghellini and Fusar-Poli, 2012).
Considerations about limitations concerning the described results include the modest samples size nally obtained by

Please cite this article as: Sestito, M., et al., Anomalous echo: Exploring abnormal experience correlates of emotional motor resonance
in Schizophrenia Spectrum. Psychiatry Research (2015), http://dx.doi.org/10.1016/j.psychres.2015.05.038i

M. Sestito et al. / Psychiatry Research ()

dividing the whole sample in subgroups, resulting in a possible

reduced statistical power. However, despite these intrinsic limitations, the current study adopts a novel trans-domain approach to
track the phenomenic, experiential correlates of the underlying
physiological, motor facial mimicry mechanisms occurring in
Schizophrenia Spectrum disorders. Such approach allows a closer
integration of ndings belonging to the phenomenological and
physiological levels of analysis. In this respect, our results indicate
that certain candidate neurobiological underpinnings (e.g. electromyographic facial reactions) of Schizophrenia Spectrum vulnerability are non-randomly associated to clinical-phenomenological
endophenotypes (BSABS clusters and psychotic episodes) that
index patients' subjective experiences and symptomatic manifestations. Therefore, our results might represent an inspiring
advance in research investigating the relation between (neuro)
physiological and phenomenological trait markers of susceptibility
to schizophrenia.

Contributors
Conceived and designed the experiment: MS, MAU, VG. Performed the experiment: MS. Analyzed the data: MS and AR. Wrote
the paper: MS, supervised by AR. All the authors contributed to the
nal revision of the manuscript.
Financial disclosures
The authors have declared that there are no conicts of
interests in relation to the subject of this study.

Acknowledgements
This work was supported by a Postdoctoral Fellowship from
Fyssen Fondation to M.S., by the EU grant Towards an Embodied
Science of InterSubjectivity (TESIS, FP7-PEOPLE-2010-ITN, 264828)
and by a grant from Chiesi Foundation to V.G. The authors
acknowledge Drs. Emanuela Leuci, Matteo Tonna, Giancarlo De
Paola and Renata Fortunati for their help in clinical data collection.

Appendix A. Supplementary Information

Supplementary data associated with this article can be found in
the online version at http://dx.doi.org/10.1016/j.psychres.2015.05.038.
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Please cite this article as: Sestito, M., et al., Anomalous echo: Exploring abnormal experience correlates of emotional motor resonance
in Schizophrenia Spectrum. Psychiatry Research (2015), http://dx.doi.org/10.1016/j.psychres.2015.05.038i