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Can Social Functioning in Schizophrenia Be Improved through Targeted Social Cognitive Intervention?

DOI: 10.1155/2012/742106

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Abstract:

Efforts to use cognitive remediation in psychosocial intervention for schizophrenia have increasingly incorporated social cognition as a treatment target. A distinction can be made in this work between “broad-based” interventions, which integrate social cognitive training within a multicomponent suite of intervention techniques and “targeted” interventions; which aim to enhance social cognition alone. Targeted interventions have the potential advantage of being more efficient than broad-based interventions; however, they also face difficult challenges. In particular, targeted interventions may be less likely to achieve maintenance and generalization of gains made in treatment. A novel potential solution to this problem is described which draws on the social psychological literature on social cognition. 1. Introduction Over the past twenty years, it has become clear that front line treatments for schizophrenia, in particular medication, do not yield sufficient improvement in functional outcome in this population [1]. Thus, treatment developers have sought new intervention approaches. Prominent among these has been neurocognitive training (We use the term “neurocognitive” rather than “cognitive” to draw a clearer contrast for the reader between neurocognition and social cognition.), which aims to improve basic cognitive functions (e.g., attention, memory, and executive function) through compensatory strategies and/or remediative practice. Although still a relatively young field, research now suggests that neurocognitive training can enhance cognitive functioning among individuals with schizophrenia, and there is growing evidence that it can improve functional outcomes [2, 3]. Importantly, the effect of neurocognitive training on functional outcomes appears to be greatest when it is bundled within a broader treatment package that includes more functionally proximal interventions, such as vocational placement [4]. Recognizing the importance of targeting functionally proximal domains in treatment, some researchers have incorporated social cognition as an intervention target in psychosocial treatment for schizophrenia. Social cognition refers to the mental operations underlying interpersonal functioning [5]. In schizophrenia research, it most often is seen as comprising emotion perception (the ability to infer others’ emotional states), theory of mind (ToM; the ability to infer others’ mental states), and attributional bias (individual tendencies in explaining the causes of social events [6]). As a treatment target, social cognition has the advantage of being

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