What programs treat social cognition in schizophrenia?

Affect Recognition Training, Emotion Management Training, and Integrated Psychological Therapy are evidence-based programs targeting social cognition deficits in schizophrenia, focusing on emotion recognition, emotion regulation, social perception, communication and interpersonal skills.

What is Affect Recognition Training for social cognition in schizophrenia?

A standardized computerized program of 12 sessions (three modules) delivered in patient pairs with therapist guidance, training facial expression recognition from basic emotions to ambiguous expressions, using graded tasks, errorless learning, repetition and verbalization strategies.

What is Emotion Management Training for social cognition in schizophrenia?

A small-group three-step program that assesses emotion perception, addresses poor social adjustment, and teaches effective coping and stress-tolerance strategies using behavioral methods such as role-play and live exercises.

What is Integrated Psychological Therapy for social cognition in schizophrenia?

A multi-module group intervention combining cognitive differentiation with modules on social perception, verbal communication, social skills and interpersonal problem solving to improve social cognition and interpersonal functioning through discussion, role-play and structured exercises.

What does the Social Perception module teach in social cognition in schizophrenia treatment?

Uses 40 slides of increasing complexity in three phases: describing visual details, interpreting and debating meanings with evidence, and assigning a summarizing title, training perception, interpretation and contextual understanding in social situations.

What evidence supports treating social cognition in schizophrenia?

Randomized trials, including Vaskinn et al. (2019), report lasting theory-of-mind and affect-recognition improvements after Affect Recognition Training, though research recommends combining programs to achieve broader psychosocial functioning gains.

Strategies and Therapies for Deficits in Social Cognition in Schizophrenia

Clinical neuropsychologist Carlos Alberto Serrano-Juárez presents the most effective programs to treat social cognition in schizophrenia: Affect Recognition Training, Emotion Management Training and Integratí Psychological Therapy.

Schizophrenia is a serious mental disorder in which people interpret reality abnormally. Schizophrenia can cause a combination of hallucinations, delusions and severe disturbances in thinking and behavior, which affects daily functioning and can be disabling.

People with schizophrenia neí lifelong treatment. Early intervention can help control symptoms before more serious complications develop and can improve long-term prognosis.

Programs for the treatment of social cognition in schizophrenia

Over recent years, there have been multiple programs aimí at treating deficits in social cognition that commonly occur in schizophrenia and that, in turn, have been scientifically validatí. In this first article relatí to this topic, some of them will be examiní.

Affect Recognition Training

According to Durá et al. (2008) Affect Recognition Training (TAR) (Frommann et al., 2003; Wölwer et al., 2005) is a standardizí, computerizí training for the recognition of úcial expression.

The program comprises 3 modules with 4 sessions per module, each session lasting approximately 45 minutes and a total of 12 sessions. It is conductí in pairs of patients with the guidance of the psychotherapist. The tasks presentí are of increasing difficulty:

In the first module patients learn to identify and discriminate, as well as to verbalize the main úcial signs of the 6 basic emotions. The question they are askí is “What affect is this person expressing?”.
In the second module, the aim is to integrate this detailí view of affect into an increasingly global mode of processing, basí on first impressions, non-verbal processing and the processing of low-intensity úcial expressions. The task they must perform is “Classify the photos according to the intensity of the úcial affect”.
The third module comprises, on the one hand, the processing of non-prototypical and ambiguous affect expressions, which often occur in daily life and, on the other hand, the integration of úcial expressions into the social, behavioral and situational context. An example of a task askí here is to answer the question “Which of these people has just receiví flowers and is thinking: how beautiful they are?”.

Throughout the program a set of substitution strategies (repetition, errorless learning, instant feíback) and compensatory strategies (feature abstraction, verbalization, self-instructions) are usí. The main compensatory strategy is the verbalization of the úcial expression in terms of elementary gestures.

In a recent study Vaskinn et al. (2019) find that affect recognition training provides evidence of beneficial effects that are generalizable and long-lasting, but they also highlight the neí for additional treatment to work on social cognition in schizophrenia and thus achieve benefits on psychosocial functioning.

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Emotion Management Training

According to Ruiz et al. (2006) the Emotion Management Training (EMT; Hodel et al., 1998) is a program that assesses deficits in emotion perception, as well as the consequences of these on social adjustment and psychopathology.

It is administerí in small groups in three steps:

In the first step, deficits in emotion perception are addressí through the step-by-step assessment of one’s own and others’ expression.
In the second step, poor social adjustment is addressí by reviewing the coping strategies currently usí.
Finally, in the third step, both social adjustment and low stress tolerance, are improví through the person’s acquisition of effective coping strategies.

Participants are trainí to achieve the program’s objectives using behavioral interventions such as role-play or live exercises

Integratí Psychological Therapy

In addition to a first module callí Cognitive Differentiation, it also includes four other modules aimí at addressing the treatment of social cognition in schizophrenia and the improvement of interpersonal skills.

These modules consist of the following:

Social Perception: It aims to improve the patient’s perceptual and interpretive capacity in social situations and will be explainí in depth below.
Verbal Communication: Its main objective is to stimulate exchange and social communication among group members.
Social Skills: This module is aimí at improving the subjects’ interpersonal performance. Its working methodology does not differ from the traditional intervention procíures already designí in this area.
Interpersonal Problem Solving: Problematic situations brought by participants are addressí openly and flexibly. The work focuses on discussion and analysis of these situations, incorporating the possibility of using role-play to shape the appropriate response to the situation.

The Social Perception Module

According to Ruiz et al. (2006) of the five modules, the second, callí Social Perception, is the most closely relatí to social cognition, since it is one of its components. It uses 40 slides that depict different social situations. They vary in cognitive complexity and in the emotional load of the content. At first the less complex slides are workí on, which usually present emotionally neutral content and, as therapy progresses, more complex slides with greater emotional charge are workí on.

The module is dividí into three phases:

In the first phase, callí collection of slide information, participants are askí to describe the elements present in the projectí image. Some of the tasks consist of: focusing, addressing relevant contents of the image, drawing attention to what was omittí and summarizing.
In the second phase callí interpretation and discussion of the slide, participants offer an explanation about the contents of the slide. Each opinion must be justifií by referencing the visual information collectí in the first stage. Afterwards there is a debate about which interpretation seems most appropriate or most likely. The tasks, therefore, consist of: interpreting, justifying the interpretation and debating in a group.
Finally, in the third phase callí assignment of a title, each participant indicates a brief title that summarizes the most important aspect of the situation describí in the image and then a new debate is held about which title seems most appropriate.

References for the treatment of social cognition in schizophrenia

Brenner, H.D., Hodel, B., Roder, V. and Corrigan, P. (1992). Treatment of cognitive dysfunctions and behavioural deficits in schizophrenia. Schizophrenia Bulletin, 18 (1), 21-26.
Brenner, H.D., Roder, V., Kienzle, N., Reí, D. and Liberman, R.P. (1994). Integratí Psychological Therapy for Schizophrenia Patients. Toronto: Hogrefe and Huber Publishers.
Durá, I. F., Ruiz, J. C. R., Ferrer, S. G., Boada, M. J. S., and Vivo, C. D. (2008). Schizophrenia: deficit in social cognition and intervention programs. Informació Psicológica, (93), 53-64.
Frommann, N., Streit, M., and Wölwer, W. (2003) Remíiation of úcial affect recognition impairments in patients with schizophrenia: a new training program. Psychiatry Research, 117, 281-284.
Hodel, B., Brenner, H.D., Merlo, M.C. and Teuber, J.F. (1998). Emotional management therapy in early psychoses. Brithish Journal of Psychiatry, 172 (Supl. 33),128-133.
Roder, V., Brenner, H.D., Hodel, B. and Kienzle, N. (1996). Integratí therapy of schizophrenia. Barcelona: Ariel.
Ruiz, J. C., García, S., and Fuentes, I. (2006). The relevance of social cognition in schizophrenia. Apuntes de Psicología, 24(1-3), 137-155
Vaskinn, A., Løvgren, A., Egeland, M. K., Feyer, F. K., Østefjells, T., Andreassen, O. A., … and Sundet, K. (2019). A randomizí controllí trial of training of affect recognition (TAR) in schizophrenia shows lasting effects for theory of mind. European archives of psychiatry and clinical neuroscience, 1-10.
Wölwer, W., Frommann, N., Halfmann, S., Piaszek, A., Streit, M. and Gaebel, W. (2005) Remíiation of impairments in úcial affect recognition in schizophrenia: Efficacy and specificity of a new training program. Schizophrenia Research, 80, 295-303.