A randomized controlled trial of training of affect recognition (TAR) in schizophrenia shows lasting effects for theory of mind

Abstract

Background: Schizophrenia is characterized by social cognitive impairments that predict functioning. Social cognitive training aims to target these impairments. Although it can improve the targeted social cognitive domain, it is unclear if the training generalizes to non-targeted domains and to functioning, with lasting effects. This randomized controlled trial examined the effect of a targeted facial affect recognition training program, Training of Affect Recognition (TAR), in persons with schizophrenia. Method: Individuals with schizophrenia were randomized to receive treatment as usual and TAR (n = 24) or treatment as usual (n = 24) after assessments with a comprehensive protocol at baseline (T1). Participants were reassessed immediately after the intervention period (T2: after 8 weeks) and at 3-month follow-up (T3). The protocol included tests of social cognition (facial or body affect recognition, theory of mind), nonsocial cognition (Matrics Consensus Cognitive Battery), clinical symptoms (Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia), functioning (self-reported, social or nonsocial functional capacity), selfesteem, self-efficacy and insight. Results: Linear mixed models yielded a significant group x time interaction effect for a non-targeted social cognitive domain (theory of mind) and a trend-level effect for social functional capacity with the intervention group performing better over time. No beneficial effects on nonsocial cognition, other measures of functioning, clinical symptoms, or self-esteem/self-efficacy appeared for the TAR program. Conclusions: This study provides evidence for transfer and durability effects of facial affect recognition training to theory of mind, but also highlights the need for additional treatments in order to achieve functional benefits.

Theory of mind, emotion recognition, delusions and the quality of the therapeutic relationship in patients with psychosis – a secondary analysis of a randomized-controlled therapy trial

“…Third, it could be helpful to train ER (and metacognition) in patients with psychosis using specialized interventions from several social cognition trainings in the framework of Cognitive Remediation [86]: the Social Cognition and Interaction Training [87] and the Metacognitive Training (Moritz and Woodward [88]) aim on improving both ToM and ER, whereas the Training of Affect Recognition [41] aims more closely on ER. In general, these trainings were able to enhance both ToM and ER abilities [87,[89][90][91] and their general positive effect on social functioning is large [92,93]. It is also possible, that an integration in or a combination of these trainings with CBT in order to improve ER might be beneficial.…”

Theory of Mind, emotion recognition, delusions and the quality of the therapeutic relationship in patients with psychosis – a secondary analysis of a randomized-controlled therapy trial.

“…Third, it could be helpful to train ER (and metacognition) in patients with psychosis using specialized interventions from several social cognition trainings in the framework Training of Affect Recognition (41) aims more closely on ER. In general, these trainings were able to enhance both ToM and ER abilities (86,(88)(89)(90) and their general effect on social functioning is large (91,92). It is also possible, that an integration in or a combination of these trainings with CBT in order to improve ER might be beneficial.…”

Social cognition in addiction

“…Moreover, as social cognition and prosocial behaviour can covary with alterations in substance use across time, indicating their potential for plasticity (14,15), new treatments of SUD might address these specific social problems more distinctively in order to improve the therapeutic relationship and their overall social functional level and, consequently, the treatment success. Promising results in this regard are emerging from other neuropsychiatric disorders, such as traumatic brain injury (154,155), schizophrenia (156)(157)(158)(159), autism (160)(161)(162), and depression (7) suggesting that socio-cognitive abilities are trainable per se and that this can also have a positive impact on treatment outcome. However, social cognitive training schemes specialized for SUD are not available thus far, although recently some encouraging results emerged from very small studies with SUD patients applying mentalizationbased interventions -a psychodynamic approach shown to be effective in borderline personality disorder that targets reflective functions such as perspective-taking (163,164).…”