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Thibaudeau E, Peyroux E, Franck N, Carling H, Lepage M. Navigating Social Cognitive Impairments in Schizophrenia Spectrum Disorders: Protocol for a Pilot Pre-Post Quasi-Experimental Study for Remote Avatar-Assisted Cognitive Remediation Therapy. JMIR Res Protoc 2024; 13:e54251. [PMID: 38477975 DOI: 10.2196/54251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Social cognitive impairments are prevalent in schizophrenia spectrum disorder (SSD) and have detrimental effects on functioning. Cognitive remediation (CR) has shown its efficacy in improving social cognitive impairments, although the transfer of these skills to daily life and the personalization of these interventions remain challenging. RC2S (Remédiation Cognitive de la Cognition Sociale dans la Schizophrénie; Cognitive remediation of social cognition in Schizophrenia) is a French CR that combines the learning of strategies and practice using paper-and-pencil exercises and digital relational simulations. This French program was designed as an in-person intervention. OBJECTIVE This project aims to culturally adapt the RC2S program, in French-Canadian and North American English and to assess the feasibility, acceptability, safety, and implementation of a remote version in people with SSD. An exploratory objective is to assess the preliminary effect of remote RC2S on goal attainment, social cognition, and psychosocial outcomes. METHODS We will use a pre-post quasi-experimental design. First, the translation and cultural adaptation in North American English and French-Canadian of RC2S is presented. Then, 20 participants aged ≥18 years with a diagnosis of SSD, presenting with a subjective or an objective impairment in social cognition, will be included to receive RC2S. In addition, 5 therapists will be included as research participants to assess their perspective on RC2S. Participants with SSD will undergo a baseline remote assessment of their social cognition, clinical symptoms, and functioning. They will then start remote RC2S for 24 biweekly individual 1-hour sessions with a therapist. Following the case formulation and goal setting, participants will complete personalized paper-and-pencil exercises to develop strategies and integrative digital relational simulations, during which they will help an avatar navigate through a variety of social contexts and relationships. The last 2 sessions are dedicated to the transfer to daily life. All participants will complete in-session questionnaires assessing therapeutic alliance, motivation, acceptability, feasibility, and implementation. Following RC2S, the participants with SSD will repeat the same assessment as the baseline. Descriptive statistics will be used to summarize the data about acceptability, feasibility, safety, and implementation. To assess the preliminary effect of RC2S, an intention-to-treat approach will be used with linear mixed models for repeated measures with fixed effects of time. RESULTS So far, 45% (9/20) of participants with SSD (mean age 37.9, SD 9.3 years) have completed the project. They received a mean of 20.5 out of 24 (SD 3.5) sessions of RC2S. A total of 5 therapists also completed the project. CONCLUSIONS Improving social cognitive impairments is an important target in SSD to promote functional recovery. Using digital technologies to address these impairments and deliver the intervention is a promising approach to increase the ecological validity of CR and access to the intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT05017532; https://classic.clinicaltrials.gov/ct2/show/NCT05017532. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54251.
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Affiliation(s)
- Elisabeth Thibaudeau
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Research Center, Montreal, QC, Canada
| | | | - Nicolas Franck
- Centre Hospitalier Le Vinatier, Lyon, France
- Université Claude-Bernard-Lyon-I, Lyon, France
| | - Hannah Carling
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Research Center, Montreal, QC, Canada
| | - Martin Lepage
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Research Center, Montreal, QC, Canada
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Cheung PPP, Yu ML, Brown T. Qualitative Evaluation of a Social Cognitive Training Program for Parents of Children with Autism from Hong Kong. Occup Ther Health Care 2021; 35:286-305. [PMID: 34061691 DOI: 10.1080/07380577.2021.1930325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A key feature of autism spectrum disorder is a dysfunction in social participation. This study aimed to explore the parents' perceptions and experiences of social cognitive training for their child with autism in the Hong Kong context. Using a qualitative narrative approach, twenty-three parent participants were interviewed using purposive sampling techniques. Data were analyzed using content analysis method. Three themes included: Improvements and changes in children's social participation across different settings; Challenges in the implementation of and engagement in the social cognitive training; and Parents' views and suggestions about the training. The findings supported that there were parent perceived improvements in their child's social skills and social participation. The interviews also revealed generalization of social skills and behaviors across home, school and community settings. The results of this study can inform therapists to design appropriate social cognitive intervention and improve social participation for this population group.
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Affiliation(s)
- Phoebe Pui Pui Cheung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Mong-Lin Yu
- Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, Victoria, Australia
| | - Ted Brown
- Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, Victoria, Australia
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Peyroux E, Franck N. Is social cognitive training efficient in autism? A pilot single-case study using the RC2S+ program. Neurocase 2019; 25:217-224. [PMID: 31522609 DOI: 10.1080/13554794.2019.1666877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In high-functioning autism, deficits in emotional processing and theory of mind are relevant to understanding the particularities of social functioning. Here we used a multiple baseline and ABA single-case design to assess the efficacy of an individualized social cognitive training program using both pen-and-paper and computerized materials for an 18-year old patient. After the treatment phase, we found significant improvement in both emotional processes and theory of mind. These results provide further significant data showing that therapeutic tools based on digital relational simulation are a promising way for helping people with autism to compensate for their impaired social functioning.
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Affiliation(s)
- Elodie Peyroux
- University Department of Rehabilitation (SUR-CL3R), Le Vinatier hospital , Lyon , France.,Reference Center for Rare Diseases (GénoPsy), Le Vinatier hospital , Lyon , France
| | - Nicolas Franck
- University Department of Rehabilitation (SUR-CL3R), Le Vinatier hospital , Lyon , France.,Ressource Center for psychosocial rehabilitation and cognitive remediation (CRR), Le Vinatier hospital , Lyon , France.,UMR 5229, CNRS et Université Claude Bernard Lyon 1, Université de Lyon, Institut des Sciences Cognitives Marc Jeannerod , Lyon , France
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Haut KM, Dodell-Feder D, Guty E, Nahum M, Hooker CI. Change in Objective Measure of Empathic Accuracy Following Social Cognitive Training. Front Psychiatry 2019; 10:894. [PMID: 31920748 PMCID: PMC6914938 DOI: 10.3389/fpsyt.2019.00894] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/13/2019] [Indexed: 01/27/2023] Open
Abstract
Background: The capacity for empathy plays an important role in interpersonal relationships and social functioning, and impairments in empathy can have negative effects on social interactions and overall social adjustment. This suggests that empathy may be a critical target for intervention in individuals who struggle with social interactions, yet it is unclear if the skills required for empathy are malleable. This study investigates the efficacy of targeted social cognitive training for improving empathic skills. Methods: Forty-five individuals (mean age = 24) were included in this study. Twenty-four individuals were allocated to the active social cognition training group and 21 individuals were allocated to a computer games control condition. Subjects completed approximately 10.5 h of training over two weeks. Pre- and post- training, they completed measures of empathy and emotion recognition, including the Interpersonal Reactivity Inventory (IRI) and an empathic accuracy task. ANOVA and regression analyses tested changes in participants' performance on the empathic accuracy task and scores on the IRI subscales were used to assess the effect of the social cognitive training. Results: Repeated measures ANOVA show that there is a significant group by timepoint interaction on the Empathic Accuracy task, with individuals who completed the social cognition training showing a significant improvement in performance following training. There were no significant changes for either group on any of the self-report IRI subscales. Individuals in the active training group show significant improvement on negative valence videos and a trend towards improvement on positive valence videos. In addition, individuals in social cognition active training group who reported higher intrinsic motivation demonstrated greater improvement on the Empathic Accuracy task. Conclusions: Individuals who completed a computerized social cognition training program demonstrated improved performance on a rater objective measure of empathic accuracy while individuals who completed a computer game control condition did not demonstrate any significant changes in their performance on the empathic accuracy task. These results suggest that targeted training in social cognition may increase empathic abilities, even in healthy individuals, and that this training may be beneficial to individuals with social cognitive deficits.
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Affiliation(s)
- Kristen M Haut
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - David Dodell-Feder
- Department of Psychology, University of Rochester, Rochester, NY, United States
| | - Erin Guty
- Department of Psychology, Pennsylvania State University, State College, PA, United States
| | - Mor Nahum
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Christine I Hooker
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
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Trujillo S, Trujillo N, Lopez JD, Gomez D, Valencia S, Rendon J, Pineda DA, Parra MA. Social Cognitive Training Improves Emotional Processing and Reduces Aggressive Attitudes in Ex-combatants. Front Psychol 2017; 8:510. [PMID: 28428767 PMCID: PMC5382221 DOI: 10.3389/fpsyg.2017.00510] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/20/2017] [Indexed: 01/15/2023] Open
Abstract
Emotional processing (EP) is a complex cognitive function necessary to successfully adjust to social environments where we need to interpret and respond to cues that convey threat or reward signals. Ex-combatants have consistently shown atypical EP as well as poor social interactions. Available reintegration programs aim to facilitate the re-adaptation of ex-combatants to their communities. However, they do not incorporate actions to improve EP and to enhance cognitive-emotional regulation. The present study was aimed at evaluating the usefulness of an intervention focused on Social Cognitive Training (SCT), which was designed to equip ex-combatants enrolled in the Social Reintegration Route with EP and social cognition skills. A group of 31 ex-combatants (mean age of 37.2, 29 men) from Colombian illegal armed groups were recruited into this study. Of these, 16 were invited to take part in a SCT and the other continued with the conventional reintegration intervention. Both groups underwent 12 training sessions in a period 12–14 weeks. They were assessed with a comprehensive protocol which included Psychosocial, Behavioral, and Emotion Processing instruments. The scores on these instruments prior to and after the intervention were compared within and between groups. Both groups were matched at baseline. Ex-combatants receiving the SCT experienced significant improvements in EP and a reduction in aggressive attitudes, effects not observed in those continuing the conventional reintegration intervention. This is the first study that achieves such outcomes in such a population using SCT intervention. We discuss the implications of such results toward better social reintegration strategies.
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Affiliation(s)
- Sandra Trujillo
- Grupo de Investigación en Salud Mental, Facultad Nacional de Salud Pública, Universidad de AntioquiaMedellín, Colombia.,Doctoral Program in Psychology, Department of Psychology, Universidad de GranadaGranada, España.,Department of Experimental Psychology, University of GranadaGranada, Spain
| | - Natalia Trujillo
- Grupo de Investigación en Salud Mental, Facultad Nacional de Salud Pública, Universidad de AntioquiaMedellín, Colombia.,Grupo de Neurociencias, Universidad de AntioquiaMedellin, Colombia
| | - Jose D Lopez
- SISTEMIC, Facultad de Ingeniería, Universidad de AntioquiaMedellín, Colombia
| | - Diana Gomez
- Grupo de Investigación en Salud Mental, Facultad Nacional de Salud Pública, Universidad de AntioquiaMedellín, Colombia
| | - Stella Valencia
- Grupo de Investigación en Salud Mental, Facultad Nacional de Salud Pública, Universidad de AntioquiaMedellín, Colombia
| | - Jorge Rendon
- Department of Cognitive Neuroscience, Maastricht UniversityMaastricht, Netherlands
| | - David A Pineda
- Grupo de Neuropsicología y Conducta, Universidad de AntioquiaMedellin, Colombia
| | - Mario A Parra
- School of Social Sciences, Psychology, Heriot-Watt UniversityEdinburgh, UK.,Cerebro, Cognición y Procesos Sociales, Psicologia, Universidad Autónoma del CaribeBarranquilla, Colombia
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Bechi M, Bosia M, Spangaro M, Pigoni A, Buonocore M, Scrofani D, Cocchi F, Bianchi L, Guglielmino C, Smeraldi E, Cavallaro R. Visual and audio emotion processing training for outpatients with schizophrenia: an integrated multisensory approach. Neuropsychol Rehabil 2016; 28:1131-1144. [PMID: 27712400 DOI: 10.1080/09602011.2016.1240698] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Deficits in emotion processing (EP) represent a target of rehabilitation in schizophrenia, as they have been related to poor personal and social functioning. To date neither the relationship between these deficits and the generalised cognitive impairment, nor the involvement of specific mechanisms of perception (visual or auditory) are fully comprehended. We developed two treatments targeting EP, through visual or auditory channels, with the aim of disentangling possible differences and/or interactions between the two modalities in schizophrenia-related impairments, also taking into account the role of cognition and social functioning. Thirty five outpatients with schizophrenia were assessed for neurocognition, social functioning and EP (visual and auditory channel) and participated in either visual or auditory EP training or in an active control group. Results showed a significant improvement in EP through the specific channel trained for both groups, with an extended effect also on vocal stimuli for the visual training group. Positive correlations were found between working memory, social functioning and EP. Our findings help to shed light on the possible different involvement of perceptual channels in schizophrenia, as well as supporting previous evidence that emotion recognition may be inter-related but does not overlap with neurocognition and can be specifically trained.
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Affiliation(s)
- Margherita Bechi
- a Department of Clinical Neurosciences , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Marta Bosia
- a Department of Clinical Neurosciences , IRCCS San Raffaele Scientific Institute , Milan , Italy.,b School of Medicine , Università Vita -Salute San Raffaele , Milan , Italy
| | - Marco Spangaro
- a Department of Clinical Neurosciences , IRCCS San Raffaele Scientific Institute , Milan , Italy.,b School of Medicine , Università Vita -Salute San Raffaele , Milan , Italy
| | - Alessandro Pigoni
- a Department of Clinical Neurosciences , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Mariachiara Buonocore
- a Department of Clinical Neurosciences , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Diego Scrofani
- b School of Medicine , Università Vita -Salute San Raffaele , Milan , Italy
| | - Federica Cocchi
- a Department of Clinical Neurosciences , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Laura Bianchi
- a Department of Clinical Neurosciences , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Carmelo Guglielmino
- a Department of Clinical Neurosciences , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Enrico Smeraldi
- a Department of Clinical Neurosciences , IRCCS San Raffaele Scientific Institute , Milan , Italy.,b School of Medicine , Università Vita -Salute San Raffaele , Milan , Italy
| | - Roberto Cavallaro
- a Department of Clinical Neurosciences , IRCCS San Raffaele Scientific Institute , Milan , Italy
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Abstract
A wealth of evidence has revealed that deficits in social cognitive skills (including facial affect recognition (FAR), social cue perception, Theory of Mind (ToM), and attributional style) are evident in schizophrenia and are linked to a variety of domains of functional outcome. In light of these associations, a growing number of studies have attempted to ameliorate these deficits as a means of improving outcome in the disorder through the use of structured behavioral training. This study used quantitative methods of meta-analysis to assess the efficacy of behavioral training programs designed to improve social cognitive function. A total of 19 studies consisting of 692 clients were aggregated from relevant databases. Outcome measures were organized according to whether they were social cognitive tests proximal to the intervention or whether they represented measures of treatment generalization (symptoms, observer-rated community, and institutional function). With respect to social cognitive measures, weighted effect-size analysis revealed that there were moderate-large effects of social cognitive training procedures on FAR (identification, d = 0.71 and discrimination, d = 1.01) and small-moderate effects of training on ToM (d = 0.46), while effects on social cue perception and attributional style were not significant. For measures of generalization, weighted effect-size analysis revealed that there were moderate-large effect on total symptoms (d = 0.68) and observer-rated community and institutional function (d = 0.78). Effects of social cognitive training programs on positive and negative symptoms of schizophrenia were nonsignificant. Moderating variables and implications for future research and treatment development are discussed.
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Affiliation(s)
- Matthew M. Kurtz
- To whom correspondence should be addressed; tel: 860-685-2072, fax: 860-685-2761, e-mail:
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