Improving Social Functioning in Schizophrenia through Social Cognitive Remediation

Individual tailored program performed in group setting which aims to improve deficit functioning in three areas of social cognition; Theory of Mind, Attribution Style and Emotion Processing. Participants complete both group based activities and learning interspersed with individual computer training based on the three social cognitive constructs. The intervention is run in small groups of 6 Participants per group by a provisional psychologist. The program will be delivered over 13 weeks and each of these 13 weekly session is 1 hour in duration. The sessions are comprised of a mixture of group activities and computer based training tasks. Computer based tasks: Training in 3 areas of social cognition: a) Theory of Mind Computerised tasks which require participants to consider the actions and intentions of people in the format of video vignettes of various social scenarios. Written vignettes of social situations presented whereby participant has to explain (by choosing multiple choice answer) what the faux pas is/ why someone said this.., etc. Perspective taking task - False beliefs are presented in written form and user must interpret situations appropriately, e.g. If this happened...... then what would A think about B (focusing on second-order beliefs). b) Emotion Recognition Baron-Cohen 'Mind reading-Interactive guide to emotion' consists of facial expressions and vocalisations in a story for 412 emotions (24 groups). c) Attribution Style Situations presented in form of a statement and four interpretations to choose from – then Decision made and/or plausibility rating given for each interpretation. Further information is then given and a second decision is made and/or a change in plausibility ratings (i.e. if they want to change) 25 scenarios – in addition to an initial statement – followed by two successive statements, each providing additional information that further disambiguates the scenario. Participant asked to change decision/plausibility rating if desire. Paintings presented (on computer in power-point show) and four possible titles to choose from according to plausibility. Group Based Activities: Emotion Processing-'' Learning how to observe emotion'' a) Confusing Emotions- Each participant asked to briefly dot point a time in their own lives when they confused the emotion of someone else (pen/paper). This will be introduced with a brief antidote by clinician to illustrate (5mins) b) Knowing Emotion- Each participant asked to list as many emotions possible (pen/paper) (5mins). These individual lists are then combined to form a group list of emotions (whiteboard) (5 mins) c) Linking emotions to facial expressions- Group uses knowledge from part b (knowing emotions) to identify emotions in Elkman's Photo's (slideshow/ group generated whiteboard list) (15 mins). Participants then pair up for a quiz which requires them to identify the emotion depicted in a series of other photos, cartoons, paintings showing facial emotion (20 items) (20 mins) Attribution Style- 'Social Investigators' a) Causal Explanations- Group brainstorms list of possible explanations for positive and negative events (slide show) 10 items-5 positive/5negative) (15 mins). B) Using facts (situation variables or statements) rather than inferences to draw conclusions- Illustrated with a game of '20 questions' conducted in pairs. Each participant gets a printed scenario of an ambiguous event and partner must ask questions to obtain information about the cause (answer also included on sheet) (40 mins). Theory of Mind- 'Recognising the beliefs of other people' a) Video-based training- Group views 10 scenes (showing 2 or more people) from popular cinema which requires identification of character mental states. Each participants dot points a general description of the scene (who involved/what were they doing/what happened). Participants must then dot point what the characters might think/feel/want (can be further prompted with questions: why do you think they did that?) (pen/paper) (40 mins) b) False Belief Picture sequence- Quiz which requires participants to order short cartoon sequence in order to tell a story (4 items per sequence/4 sequences) presented on slideshow (15 mins)