Social cognition and interaction training (SCIT) for outpatients with schizophrenia: A preliminary study
Introduction
Social cognition is impaired in schizophrenia (Penn et al., 2006), is relatively independent of traditional neurocognitive domains (e.g. attention, memory, executive functioning), and may be the strongest predictor of functional outcome in this illness (Couture et al., 2006, Brϋne et al., 2007). For these reasons, there has been recent interest in social cognitive treatment interventions. Most of these interventions can be conceptualized as either “targeted” (e.g. Silver et al., 2004) or “broad-based” (e.g. Hogarty et al., 2004) approaches. Targeted interventions focus on a single social cognitive ability (e.g. emotion perception), whereas broad-based interventions typically comprise a variety of psychosocial strategies, including techniques for improving social cognitive skills. Both of these approaches have shown promise, but both have important limitations. Notably, both conceptualize social cognitive dysfunction as a deficit state despite evidence that social cognitive biases play an important role in this population (Rosse et al., 1994, Bentall et al., 2001, Allen et al., 2004). Similarly, intervention techniques are adapted from information processing models that do not account for the qualitatively different characteristics of social cognitive stimuli (Penn et al., 1997) or brain functions (Frith and Wolpert, 2003).
We developed a treatment model and intervention package aimed at addressing these limitations. Social cognition and interaction training (SCIT; Roberts et al., 2006) is a 20-week, manualized group intervention that targets dysfunctional social cognitive processes which have been observed in schizophrenia, including problems with emotion perception and Theory of Mind (ToM), hasty judgment making, and biased social attributions. The treatment comprises the following three phases: (1) Emotions, which addresses emotion perception dysfunction; (2) Figuring out situations, which addresses attributional biases and ToM dysfunction; and (3) Integration, in which participants practice applying learned skills to interpersonal problems in their own lives.
Preliminary studies suggest that SCIT is feasable, and may improve social cognition and social functioning in inpatient populations (Penn et al., 2005, Combs et al., 2007a). The current study was a quasi-experimental trial comparing SCIT plus treatment-as-usual (TAU) to TAU among individuals with schizophrenia-spectrum disorders. Consistent with the inpatient findings, we predicted that SCIT would be associated with improved emotion perception, Theory of Mind, and social skill, as well as reduced attributional bias, relative to the TAU condition.
Section snippets
Participant recruitment and sample characteristics
Thirty-one adults with schizophrenia-spectrum diagnoses and without current substance use problems were recruited from an outpatient psychiatry clinic. All participants were receiving regular outpatient psychiatric treatment, including antipsychotic medication, throughout the study. Participants were assigned to the TAU group who either (1) declined to participate in the SCIT group (n = 4), (2) were unable to attend SCIT due to a scheduling conflict (n = 1), or (3) had participated in previous
Data sample
All 31 study participants completed baseline and post-test assessments. Study hypotheses were evaluated using two experimental samples: the full intent-to-treat (ITT) sample and a “Completer” sample (n = 14 or 70% of the full SCIT group sample); completion was defined as attendance to at least 50% of the therapy sessions with at least two sessions in each of SCIT's three phases. We required attendance at sessions in all three phases because the skills taught in SCIT are cumulative, with
Discussion
This study provides preliminary evidence that SCIT is feasible among outpatients, and may yield improvements in social cognition and social skill. Specific findings are discussed below.
Individuals who received SCIT + TAU showed significant improvement in emotion perception relative to TAU. This finding generally replicates the recent inpatient study of SCIT (Combs et al., 2007a) and is consistent with previous research demonstrating that it is possible to modify performance in this domain among
Acknowledgments
This work was supported by a grant from the Foundation of Hope for Research and Treatment of Mental Illness. The authors thank Dr. Piper Meyer, Sarah Uzenoff, and David Johnson for their help in this research.
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