Review: Social Cognition Skills Training in Schizophrenia

The paper reviewed here is ‘Social Cognition Skills Training in Schizophrenia’ by Horan and colleagues. In this  study, the authors are looking to see if a new social cognition skills training program that they have developed is effective at improving social cognition. They begin with a brief observation that while symptom control in schizophrenia has been effective this is not necessarily linked to functioning. They discuss the term social cognition very briefly in the introduction. I find this concept quite complex and it is probably in a state of flux at the moment. They then look at some of the evidence suggesting that there can be difficulties with social cognition in schizophrenia and then summarise some of the research into methods that improve social cognition in people with schizophrenia. Such approaches include the Training in Affect Recognition program and Social Cognitive and Interaction Training (SCIT). The researchers observe that in a number of studies in the area of social cognition skills training in schizophrenia there were no control groups, it was not clear if the changes in skills resulted from a confounding improvement in general cognition and also the studies had not looked at inpatients.

In this study, the researchers conducted a 6-week trial with 34 participants. Subjects met the DSM-IV criteria for schizophrenia or schizoaffective disorder and were recruited from a healthcare centre in Los Angeles. 60% of the subjects in the social cognition group were African-American and 27% caucausian while 50% of the subjects in the control group were African-American and 31% caucasian. 26 of the subjects were taking atypical antipsychotics (not in combination with typicals). The control group underwent an ‘illness self-management and relapse prevention skills training’ program. They give a broad overview of the control program which includes a ‘fully manualised training program’ with videos and scripted exercises that focus on 4 areas which include identification of relapse warning signs.

The intervention consisted of ‘two 6-session phases’ which covered

(a) ‘Emotional and social perception’.

(b) ‘Social attribution and Theory of Mind’.

In the first phase, the subjects underwent training to identify ‘basic emotions on the face and in the voice’ borrowing from established programs and using ‘computerised facial affect perception training exercises.. and facial mimicry exercises’. Training continued with ‘social cue perception skills and social context appreciation’. This involved recognition of social norms and non-verbal gestures.

In the second phase, paranoia was considered as an emotion and the subjects were trained to distinguish between ‘useful’ suspicion and ‘harmful’ suspicion, between facts and guesses and checking out beliefs with the evidence.

The four social cognition outcome measures were

(a) The Facial Emotion Identification Test

(b) The Half-Profile of Nonverbal Sensitivity (PONS)

(c) The Ambiguous Intentions Hostility Questionnaire (AIHQ)

(d) The Awareness of Social Inference Test (TASIT)

I couldn’t see the details on the validity and reliability for each of the above although the researchers have cited the original papers.

Cognition was assessed using the MATRICS Consensus Cognitive Battery (MCCB).

The researchers use the ANCOVA for the primary outcome measures which consist of the differences in the cognition and social cognition measures between the two groups.  Essentially there was a significant between group effect only for the facial affect perception. What this meant was that on this measure the social cognition skills training group improved significantly more than the control group. A ‘moderate to large effect’ was noted in the social cognition skills training group. There wasn’t a significant difference between the groups on the MATRICS.

I thought this was an interesting study. This is a relatively short trial at 6-weeks and it would be interesting to see if the effects are sustained and if they are replicated in a larger group given the promising initial results.

References

Horan W P, Kern R S, Shokat-Fadai K, Sergi M J, Wynn J K and Green M F. Social cognitive skills training in schizophrenia:An initial efficacy study of stabilized outpatients. Schizophrenia Research. 107. 2009. 47-54.

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