Social Cognition Training for People With a Psychotic Disorder: A Network Meta-analysis

Abstract

Deficits in social cognition are common in people with psychotic disorders and negatively impact functioning. Social Cognition Training (SCT) has been found to improve social cognition and functioning, but it is unknown which interventions are most effective, how characteristics of treatments and participants moderate efficacy, and whether improvements are durable. This meta-analysis included 46 randomized studies. SCTs were categorized according to their focus (targeted/broad-based) and inclusion of cognitive remediation therapy (CRT). Network meta-analysis was conducted, using both direct (original) and indirect (inferred from the network of comparisons) evidence. All SCT types were compared to treatment as usual (TAU; the chosen reference group). Moderators of outcome were investigated with meta-regression and long-term efficacy with multivariate meta-analysis. Compared to TAU, emotion perception was improved by targeted SCT without CRT (d = 0.68) and broad-based SCT without CRT (d = 0.46). Individual treatments worked better for emotion perception. All treatments significantly improved social perception (active control, d = 0.98, targeted SCT with and without CRT, d = 1.38 and d = 1.36, broad-based SCT with and without CRT, d = 1.45 and d = 1.35). Only broad-based SCT (d = 0.42) improved ToM. Broad-based SCT (d = 0.82 without and d = 0.41 with CRT) improved functioning; group treatments worked significantly better. Male gender was negatively related to effects on social functioning and psychiatric symptoms. At follow-up, a moderate effect on social functioning (d = 0.66) was found. No effect was found on attribution, social cognition (miscellaneous), and psychiatric symptoms. While targeted SCT is the most effective for emotion perception and social perception, broad-based SCT produces the best overall outcomes. CRT did not enhance SCT effects.

Dynamic Interactive Social Cognition Training in Virtual Reality (DiSCoVR) for People With a Psychotic Disorder: Single-Group Feasibility and Acceptability Study

“…Our second module may have involved too much emphasis on emotion perception and too little on higher-order reflective processes. While little is known about what it takes to improve ToM [ 50 ], a recent meta-analysis [ 8 ] suggested that SCTs encompassing multiple domains of social cognition may be more effective than targeted interventions. Therefore, going forward, a greater emphasis on integration of higher-order social cognitive processes and application in social situations may be necessary.…”

“…Social cognition has become an important treatment target for improvement of social functioning; a multitude of behavioral approaches to improve social cognition and social functioning has emerged in recent years [ 5 ]. Three meta-analyses have found moderate to large effects of social cognition training (SCT) interventions on social cognition [ 6 - 8 ]. Broad-based or comprehensive forms of SCT (eg, Social Cognition and Interaction Training [ 9 ]) appear to be the most effective overall [ 8 ].…”

“…Three meta-analyses have found moderate to large effects of social cognition training (SCT) interventions on social cognition [ 6 - 8 ]. Broad-based or comprehensive forms of SCT (eg, Social Cognition and Interaction Training [ 9 ]) appear to be the most effective overall [ 8 ]. Improvements in social functioning were found in 2 meta-analyses [ 6 , 8 ], though only for broad-based SCT in the latter meta-analysis [ 8 ].…”

“…Second, findings regarding the generalization of social cognitive gains, as measured by social cognition tasks, to daily life social functioning are mixed; many studies do not find a significant effect [ 5 ]. Third, the durability of treatment effects has not yet been established; of the available studies, some find sustained improvements at follow-up, whereas others do not [ 5 , 8 ]. Thus, while SCT has a demonstrated effect on social cognition, particularly lower-order domains, these improvements do not always enduringly carry over to higher-order social cognitive domains and social functioning.…”

Exploring the Interplay Between Adversity, Neurocognition, Social Cognition, and Functional Outcome in People With Psychosis: A Narrative Review

“…A better understanding of the nature of the association between adversity and functional decline, as well as its interplay with neurocognition and social cognition, may help to better define patients at risk of developing such deleterious outcomes and to specifically apply interventions that can target possible mediating mechanisms. Moreover, whether traumatized individuals with psychosis may better benefit from interventions commonly addressed to improve neurocognition or social cognition ( 8 , 18 , 27 , 28 ) remains an intriguing unexplored question.…”