Treatment of schizophrenia: how to work on social cognition III

Programs for the Treatment of Social Cognition in Schizophrenia

Over the last few years, there have been many programs aimed at the treatment of deficits in social cognition that usually occur in the case of schizophrenia and which, in turn, have been scientifically validated. In this third and last article related to this topic, some of them will be discussed.

Cognitive rehabilitation program in psychosis

As Ojeda et al (2012) point out, the REHACOP program (neuropsychological rehabilitation in psychosis), also consists of four modules aimed at intervening on some of the components of social cognition. These modules are called emotional perception, social cognition, theory of mind and moral dilemmas.

In addition, recent research has proven the significant improvements produced by this program in the treatment of social cognition in schizophrenia (Peña et al, 2015, 2016).

Emotional training program

This program is accessed from the website www.e-motionaltraining.com (in Spanish) and is developed entirely in computer support.

The first 4 sessions (1 hour each session) are dedicated to recognizing facial emotions. This section includes a pre- and post-test, tutorials and scale mini-games starting with eyes and mouth and finally expression micro-trainings.

The next 8 sessions (1 hour each) include watching a short cartoon in which a couple invites their friends to their house for a party. As the story unfolds, there is miscommunication between the actors, leading to various emotions and mental conditions such as anger, affection, appreciation and jealousy. After each scene, the user is asked what happened, with questions on theory of mind (interpretation of irony, innuendo, faux pas, second-order false beliefs, etc.), social perception (interpretation and analysis of the social situation through the visual content of each scene) and attributional style, as well as, control questions. In case of making mistakes, the game displays a hyperlink with information and metacognitive strategies, whose objective is to help users understand the scene they were watching.

Social cognition training program

Like the previous program, this intervention is also entirely computer-based, and can be accessed from the web site www.proyectoscores.es (in Spanish).

It consists of four modules that focus on emotion recognition training, theory of mind and attributional style, social perception and content personalization. The first three modules include theoretical content and exercises that reinforce what has been reviewed in the theory. The program includes a total of twenty-eight sessions.

The four modules focus on the treatment of social cognition in schizophrenia.

Module 1 is aimed at working on emotion processing. It consists of nine sessions that focus on the recognition of the facial features that constitute each of the six basic emotions, the analysis of the influence of thoughts and externals on each emotion, as well as the reactions that are elicited by the emotions. There is also a special emphasis on learning how to cope with negative reactions and on promoting the emergence of positive emotions through the performance of pleasurable activities.

Module 2 focuses on theory of mind and attributional style. It is composed of ten sessions dedicated to describing the concept of theory of mind, understanding language with double meaning, and trying to make proper use of information, avoiding errors such as jumping quickly to conclusions. In addition to external and internal, attributional styles are described and linked to possible delusional or distorted ideas, trying to follow the approach proposed by cognitive therapy for symptom management.

Module 3 focuses on social perception. It consists of four sessions, during which the concepts of social norms and roles are introduced. Also, special emphasis is placed on the importance of context for the correct interpretation of social situations and, in general, a distinction is made between two contexts: formal and informal.

Finally, module 4, called “personalization”, consists of five sessions in which patients are encouraged to apply all the revised content to personal experiences. Ten examples or assumptions are used for its development.

References of social cognition treatment in schizophrenia.

Gil-Sanz, D., Fernández-Modamio, M., Bengochea-Seco, R., Arrieta-Rodríguez, M., y Pérez-Fuentes, G. (2016). Efficacy of the social cognition training program in a sample of outpatients with schizophrenia. Clinical schizophrenia & related psychoses, 10(3), 154-162.

Ojeda, N., Peña, J., Bengoetxea, E., García, A., Sánchez, P., Elizagárate, E., … y Eguíluz, J. I. (2012). Evidencias de eficacia de la rehabilitación cognitiva en psicosis y esquizofrenia con el programa REHACOP [Evidence of efficacy of cognitive rehabilitation in psychosis and schizophrenia with the REHACOP program]. Rev Neurol, 54, 577-86.

Peña, J., Ibarretxe-Bilbao, N., y Ojeda, N. (2015). Improvement in Social Cognition and Functional Outcome after Group Cognitive Remediation Treatment (rehacop Program): a Randomized Controlled Trial. European Psychiatry, 30, 414.

Peña, J., Ibarretxe-Bilbao, N., Sánchez, P., Iriarte, M. B., Elizagarate, E., Garay, M. A., … y Ojeda, N. (2016). Combining social cognitive treatment, cognitive remediation, and functional skills training in schizophrenia: a randomized controlled trial. NPJ schizophrenia, 2, 16-37.

Vázquez-Campo, M., Maroño, Y., Lahera, G., Mateos, R., y García-Caballero, A. (2016). e-Motional Training®: Pilot study on a novel online training program on social cognition for patients with schizophrenia. Schizophrenia Research: Cognition, 4, 10-17.