Remediating impairments in social cognition

Abstract

Brain damage resulting from acute neurological disorders, such as traumatic brain injury (TBI) or stroke; insidious neurological disorders, such as brain tumors or multiple sclerosis (MS); or neurodegenerative diseases, such as frontotemporal dementia (FTD), can result in changes in social behaviour. This is particularly the case when prefrontal areas, or the circuits associated with these areas, are affected. Similar social behavioural presentations have been observed in various neurodevelopmental disorders, such as autism spectrum disorders (ASD), and neuropsychiatric disorders, such as schizophrenia spectrum disorders (SSD).In 1990, Neil Brooks, who extensively investigated sequelae of brain damage, remarked the following: "Of all three areas of deficit (physical, cognitive, behavioural) it is the behavioural deficit that lasts longest, is most difficult to treat, and has the most negative consequences on successful social and vocational rehabilitation" (p. 77). In this citation, he emphasised not only the disruptive nature of behavioural changes but also their immunity to treatment. Despite this, for a long time, clinical neuropsychology neglected social behavioural problems in brain disorders as a relevant domain. Proper assessment and treatment methods were sorely needed but yet to be developed. This changed with the emergence of the field of social neuroscience at the end of the previous century. Social neuroscientists acknowledged that humans have to survive in a complex social world; hence, brain anatomy and function have evolved in such a way so as to optimally facilitate social interactions (Brothers, 1990). We humans, thus, have a social brain with specialised areas dedicated to the processing of socially relevant information.Social cognitive information processing involves a series of stages (Adolphs, 2001;Beer & Ochsner, 2006). First, socially relevant information, e.g. expressions of emotions on other peoples' faces or in their voices (prosody), has to be attended to and perceived. Secondly, this perceived information, combined with knowledge regarding social rules and conventions, has to be interpreted, leading to an understanding of another's thoughts, feelings, and beliefs. In other words, this processing allows individuals to form a theory of other peoples' minds, and to take their perspective (the mentalising system; Frith & Frith,