Improving social thinking and social functioning in schizophrenia

INTERVENTION: In this study we sought to compare the independent effects of two programs to improve social cognition in schizophrenia: “SoCog” Mental‐State Reasoning Training (MSRT) and “SoCog” Emotion Recognition Training (ERT). Both SoCog programs consist of 12 one‐hour sessions over 6 weeks . Training is run by two facilitators in small groups of 3‐6 participants using a manual‐driven suite of activities including games developed by us [e.g., Social Trivia (MSRT) and Face Detective (ERT)] and Tropfest Videos (http://tropfest.com/au/). The training approach of SoCog provides repeated exposure and practice of the skills that underlie complex mental‐state reasoning abilities or emotion recognition abilities. A weekly points system with prizes is used to provide extrinsic motivation. So, when a participant wins a game or they contribute a valid hypothesis or observation they can be awarded points at the discretion of the facilitator. Points are tallied and a prize (e.g., small toiletries and stationery items) is awarded to the participant with the most points at the end of each week. Likewise, intrinsic motivation plays an important role in overcoming the core motivational impairments in schizophrenia. With the latter in mind, we structured SoCog sessions to give a sense of control over training and to enhance engagement with the treatment; thus, facilitators set the activity for the first 20 minutes of a session and then participants chose an activity for the second 20 minutes with a 10‐minute break between the first and second activity. The specific training approach of SoCog‐MSRT is that participants receive repeated exposure and practice of the skills that underlie complex mental‐state reasoning abilities (e.g., interpreting and predicting other people’s actions/behaviours in terms of causal mental states; e.g., “Fred will do ‘x’ since he wants ‘y’ and believes ‘z’ about the situation”). Thus, activities centre on vignettes of social situations with a focus on making inferences and predictions about characters’ thoughts, feelings, and behaviours. Similar vignettes are repeated across different activities with frequent repetition of training materials and concepts and a focus on making inferences and predictions about characters’ thoughts, feelings, and behaviours. The facilitators’ roles are to guide discussion, and to explore a range of possible hypotheses for beliefs, perceptions, or behaviors that will involve the group in developing a reasonable explanation for a particular situation. This further allows for different possible interpretations and inferences from all group members, which presents an invaluable learning experience about the often ambiguous social interaction in the real world. In contrast, SoCog‐ERT is focussed on drawing attention to salient facial features that are important for accurate recognition of others’ emotions`. As with SoCog‐MSRT this program relies on a suite of manualised games and activities developed specifically to direct attention to relevant facial features of commonly confused emotional expressions (e.g. using the eyebrows to distinguish fear from surprise). Adherence to treatment was monitered via sign‐off sheets which each participant was expected to sign before starting each group session. To encourage attendance 100% attendance certificates were awarded at a graduation ceromony at the completion of treatment. Completion certificates were also awarded. CONDITION: social cognitive impairments in schizophrenia PRIMARY OUTCOME: 2. The Reading the Mind in the Eyes Test . ; Improved scores on the following measures of social cognitive and social functioning abilities: ; ; 1.Basic facial emotion recognition assessed using video clips of real‐life vignettes of social interactions from the Emotion Evaluation Task component of The Awareness of Social Inference Test. ; 3. The Picture Sequencing Task is a classic measure of non‐verbal ToM and, specifically, the ability to accurately sort false‐belief story sequences to tell a story about a cartoon character who has acted on a false‐belief . ; ; SECONDARY OUTCOME: Basic social skills including the tendency to make eye contact, maintain appropriate social distance, and to initiate and maintain conversation using the Social Skills Checklist developed by Bellack and colleagues (2004). The short form of the Empathy Quotient which is a self‐report measure of changes in cognitive empathy (understanding of another’s mental states), social skills (intuitive understanding of social situations), and emotional reactivity (ability to identify one’s own emotional response to others’ feelings). INCLUSION CRITERIA: A diagnosis of schizophrenia or schizoaffective disorder.