Neurocognition and social cognition training as treatments for violence and aggression in people with severe mental illness

Abstract

Aggressive and violent behavior, including both verbal and physical aggression, have considerable adverse consequences for people with schizophrenia. There are several potential causes of violent behavior on the part of people with severe mental illness, which include intellectual impairments, cognitive and social-cognitive deficits, skills deficits, substance abuse, antisocial features, and specific psychotic features. This review explores the interventions that have been tested to this date. Computerized Cognitive Training (CCT) or Computerized Social-Cognitive Training (CSCT) have been associated with reductions in violence. Combined CCT and CSCT have been found to improve social cognition and neurocognition, as well as everyday functioning when combined with rehabilitation interventions. These interventions have been shown to reduce violence in schizophrenia patients across multiple environments, including forensic settings. The reductions in violence and aggression have manifested in various ways, including reduced violent thinking and behavior, reduced physical and violent assaults, and reduced disruptive and aggressive behaviors. Effects of cognitive training may be associated with improvements in problem-solving and the increased ability to deploy alternative strategies. The effect of social cognition training on violence reduction appears to be direct, with improvements in violence related to the extent of improvement in social cognition. There are still remaining issues to be addressed in the use of CCT and CSCT, and the benefits should not be overstated; however, the results of these interventions are very promising.

Neurocognition and social cognition in patients with schizophrenia spectrum disorders with and without a history of violence: results of a multinational European study

“…As both of these domains have independently been associated with violence and aggression [ 14 , 16 ], it is possible that both contribute to these distinctions. Further, treatment of both neurocognition and SC have been found to reduce violence, in both general population and forensic patients [ 17 , 18 ]. Finally, combining SC and neurocognition training leads to greater treatment gains, even in very chronic patients [ 19 , 20 ].…”

Aggression Amongst Outpatients With Schizophrenia and Related Psychoses in a Tertiary Mental Health Institution

“…This raises an interesting possibility as cognitive impairment could benefit from cognitive remediation therapy ( 59 ). Cognitive training and social cognitive training have been shown to be effective in reducing violence in patients with schizophrenia, which is encouraging ( 60 ) although further research is needed.…”

Psychotically driven aggression is associated with greater mentalizing challenges in psychotic spectrum disorders

“…Although there is a burgeoning corpus of studies regarding the probable positive effects of training social cognition in schizophrenia [34] there is a smaller but emerging literature suggesting that social cognition training, especially in conjunction with cognitive remediation, can reduce aggression recidivism in individuals with schizophrenia with a history of aggression [35]. If the results of our study are replicated, it would be interesting to know if the PDA and non PDA groups respond similarly to such interventions or if there needs to be tailoring of interventions according to the mechanisms underlying the aggressive acts.…”