Social-Cognitive Remediation in Schizophrenia: Generalization of Effects of the Training of Affect Recognition (TAR)

Abstract

In the last decade, several social cognitive remediation programs have been developed for use in schizophrenia. Though existing evidence indicates that such programs can improve social cognition, which is essential for successful social functioning, it remains unclear whether the improvements generalize to social cognitive domains not primarily addressed by the intervention and whether the improved test performance transfers into everyday social functioning. The present study investigated whether, beyond its known effects on facial affect recognition, the Training of Affect Recognition (TAR) has effects on prosodic affect recognition, theory of mind (ToM) performance, social competence in a role-play task, and more general social and occupational functioning. Thirty-eight inpatients with a diagnosis of schizophrenia or schizoaffective disorder were randomly assigned to 6 weeks of treatment with the TAR--primarily targeted at facial affect recognition-or Cognitive Remediation Training (CRT)--primarily targeted at neurocognition. Intention-to-treat analyses found significantly larger pre-post improvements with TAR than with CRT in prosodic affect recognition, ToM, and social competence and a trend effect in global social functioning. However, the effects on ToM and social competence were no longer significant in the smaller group of patients who completed treatment according to protocol. Results suggest that TAR effects generalize to other social cognitive domains not primarily addressed. TAR may also enhance social skills and social functioning, although this has to be confirmed. Results are discussed with regard to the need to improve functional outcome in schizophrenia against the background of current evidence from other social cognitive remediation approaches.

Social cognitive functioning in prodromal psychosis: A meta-analysis

“…The performance in ToM was impaired in schizophrenia, even in patients who were completely free of residual symptoms (Bora et al, 2008). Furthermore, evidence that social cognitive remediation improves EP in patients with schizophrenia exists; however, ToM is difficult to improve with social cognitive remediation compared with other social cognitive domains (Horan et al, 2011;Wölwer and Frommann, 2011). However, the present study demonstrated that the performance in AB in individuals at CHR was most impaired among the social cognitive domains.…”

A new computerized cognitive and social cognition training specifically designed for patients with schizophrenia/schizoaffective disorder in early stages of illness: A pilot study

“…No other significant effect in social cognition measures were found with the NPT-MH training. ToM, and to a less degree attributional biases, have been found to improve after SCT in schizophrenia patients (Penn et al, 2007;Wolwer and Frommann, 2011;Bechi et al, 2012), but, to our knowledge, CRT or SCT effects in these social cognition domains in early-stages psychosis have not been studied yet.…”

“…SCT seem to impact in ToM alterations (Wolwer and Frommann, 2011;Bechi et al, 2012), emotional processing deficits, attributional biases (Penn et al, 2007) as well as functional outcomes (Wolwer and Frommann, 2011;Tas et al, 2012). There are several studies using SCT in the early phases of schizophrenia, but no SCT programs specifically designed for patients at early stages of psychosis currently exist.…”

Emotion recognition deficits as predictors of transition in individuals at clinical high risk for schizophrenia: a neurodevelopmental perspective

“…To the extent that emotion recognition deficits do contribute directly to development of psychosis, early detection may be critical to permit timely intervention. Recent studies suggest that impaired face emotion recognition may be remediable, with generalization of effect including improved prosody and social function (Wolwer & Frommann, 2011), and normalization of activity in the face-processing network (Habel et al 2010). Implementation of such efforts during the CHR period may thus be critical for altering long-term course.…”