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A randomized controlled trial of training of affect recognition (TAR) in schizophrenia shows lasting effects for theory of mind

  • Anja VaskinnEmail author
  • André Løvgren
  • Maj K. Egeland
  • Frida K. Feyer
  • Tiril Østefjells
  • Ole A. Andreassen
  • Ingrid Melle
  • Kjetil Sundet
Original Paper

Abstract

Schizophrenia is characterized by social cognitive impairments that predict functioning. Social cognitive training aims to target these impairments. Although it can improve the targeted social cognitive domain, it is unclear if the training generalizes to non-targeted domains and to functioning, with lasting effects. This randomized controlled trial examined the effect of a targeted facial affect recognition training program, Training of Affect Recognition (TAR), in persons with schizophrenia. Individuals with schizophrenia were randomized to receive treatment as usual and TAR (n = 24) or treatment as usual (n = 24) after assessments with a comprehensive protocol at baseline (T1). Participants were reassessed immediately after the intervention period (T2: after 8 weeks) and at 3-month follow-up (T3). The protocol included tests of social cognition (facial or body affect recognition, theory of mind), nonsocial cognition (Matrics Consensus Cognitive Battery), clinical symptoms (Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia), functioning (self-reported, social or nonsocial functional capacity), self-esteem, self-efficacy and insight. Linear mixed models yielded a significant group × time interaction effect for a non-targeted social cognitive domain (theory of mind) and a trend-level effect for social functional capacity with the intervention group performing better over time. No beneficial effects on nonsocial cognition, other measures of functioning, clinical symptoms, or self-esteem/self-efficacy appeared for the TAR program. This study provides evidence for transfer and durability effects of facial affect recognition training to theory of mind, but also highlights the need for additional treatments to achieve functional benefits.

Keywords

Social cognition Emotion perception Social functioning Social cognitive remediation Functional capacity 

Notes

Acknowledgements

This work was supported by the Norwegian ExtraFoundation for Health and Rehabilitation/Norwegian Council for Mental Health (Grant #2011/3/0025 to AV), the South-Eastern Norway Regional Health Authority (Grant #2010007 and #2017069 to AV, #2014102 to IM), Division of Mental Health and Addiction, Oslo University Hospital (to AV and AL), and the Department of Psychology, University of Oslo (personal postdoctoral grant to AV), the Fulbright Foundation for Educational Exchange (visiting researcher scholarship to AV). The authors would like to thank the participants, their treating clinicians, the administrative personnel at our collaborating clinical units, and the research personnel at the Psychosis Research Unit, Oslo University Hospital for making this study possible.

Compliance with ethical standards

Conflict of interest

None of the authors report any conflict of interests.

Ethical standards

The study was approved by Norway’s Regional Ethics Committee for Medical and Health Research (South East) and was performed in accordance with the ethical standards laid down in the Helsinki Declaration. All participants gave their informed consent before their inclusion in the study.

References

  1. 1.
    Green MF, Llerena K, Kern RS (2015) The “right stuff” revisited: what have we learned about the determinants of daily functioning in schizophrenia? Schizophr Bull 41:781–785CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Savla GN, Vella L, Armstrong CC, Penn DL, Twamley EW (2013) Deficits in domains of social cognition in schizophrenia: a meta-analysis of the empirical evidence. Schizophr Bull 39:979–992CrossRefPubMedGoogle Scholar
  3. 3.
    Rocca P, Galderisi S, Rossi A, Bertolini A et al (2016) Social cognition in people with schizophrenia: a cluster-analytic approach. Psychol Med 46:2717–2729CrossRefPubMedGoogle Scholar
  4. 4.
    Hajdúk M, Harvey PD, Penn DL, Pinkham AE (2018) Social cognitive impairments in individuals with schizophrenia vary in severity. J Psychiatr Res 104:65–71CrossRefPubMedGoogle Scholar
  5. 5.
    Fett AK, Viechtbauer W, Dominguez MD, Penn DL, van Os J, Krabbendam L (2011) The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: a meta-analysis. Neurosci Biobehav Rev 35:573–588CrossRefPubMedGoogle Scholar
  6. 6.
    Schmidt SJ, Mueller DR, Roder V (2011) Social cognition as a mediator variable between neurocognition and functional outcome in schizophrenia: empirical review and new results by structural equation modeling. Schizoph Bull 37(Suppl.2):S41–S54CrossRefPubMedGoogle Scholar
  7. 7.
    Pinkham AE (2014) Social cognition in schizophrenia. J Cli Psychiatry 75(Suppl. 2):14–19CrossRefGoogle Scholar
  8. 8.
    Kurtz MM, Richardson CL (2012) Social cognitive training for schizophrenia: a meta-analytic investigation of controlled research. Schizophr Bull 38:1092–1104CrossRefPubMedGoogle Scholar
  9. 9.
    Fiszdon JM, Reddy LF (2012) Review of social cognitive treatments for psychosis. Clin Psychol Rev 32:724–740CrossRefPubMedGoogle Scholar
  10. 10.
    Kurtz MM, Gagen E, Rocha NBF, Machado S, Penn DL (2016) Comprehensive treatments for social cognitive deficits in schizophrenia: a critical review and effect-size analysis of controlled studies. Clin Psychol Rev 43:80–89CrossRefPubMedGoogle Scholar
  11. 11.
    Bordon N, O’Rourke S, Hutton P (2017) The feasibility and clinical benefits of improving facial affect recognition impairments in schizophrenia: systematic review and meta-analysis. Schizophr Res 188:3–12CrossRefPubMedGoogle Scholar
  12. 12.
    Vass E, Fekete Z, Simon V, Simon L (2018) Interventions for the treatment of theory of mind deficits in schizophrenia: systematic literature review. Psychiatry Res 267:37–47CrossRefPubMedGoogle Scholar
  13. 13.
    Frommann N, Streit M, Wölwer w (2003) Remediation of facial affect recognition impairments in patients with schizophrenia: a new training program. Psychiatry Res 117:281–284CrossRefPubMedGoogle Scholar
  14. 14.
    Wölwer W, Frommann N, Halfmann S, Piaszek A, Streit M, Gaebel W (2005) Remediation of impairments in facial affect recognition in schizophrenia: efficacy and specificity of a new training program. Schizophr Res 80:295–303CrossRefPubMedGoogle Scholar
  15. 15.
    Wölwer W, Frommann N (2011) Social-cognitive remediation in schizophrenia: generalization of effects of the training of affect recognition (TAR). Schizophr Bull 37(suppl.2):S63–S70CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Sachs G, Winklbauer B, Jagsch R, Lasser I, Kryspin-Exner I, Frommann N, Wölwer W (2012) Training of affect recognition (TAR) in schizophrenia-impact on functional outcome. Schizophr Res 138:262–267CrossRefPubMedGoogle Scholar
  17. 17.
    Horan WP, Green MF (2017) Treatments of social cognition in schizophrenia: current status and future directions. Schizophr Res.  https://doi.org/10.1016/j.schres.2017.07.013 PubMedGoogle Scholar
  18. 18.
    American Psychiatric Association (2000) The diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Publishing, Washington DCGoogle Scholar
  19. 19.
    First MB, Spitzer RL, Gibbon M, Williams JBW (1996) Structured clinical interview for DSM-IV TR axis I disorders, research version, patient edition (SCID-P). Biometrics Research, New York State Psychiatric Institute, New YorkGoogle Scholar
  20. 20.
    Wechsler D (2007) Wechsler Abbreviated Scale of Intelligence (WASI). Norwegian manual supplement. Pearson Assessment, StockholmGoogle Scholar
  21. 21.
    Norwegian Directory of Health (2013) National guidelines for the assessment, treatment and continued support for individuals with psychotic disorders. Norwegian Directory of Health, OsloGoogle Scholar
  22. 22.
    Ekman P, Friesen W (1976) Pictures of facial affect. Consulting Psychologists Press, Palo AltoGoogle Scholar
  23. 23.
    Heberlein AS, Adolphs R, Tranel D, Damasio H (2004) Cortical regions for judgments of emotions and personality traits from point-light walkers. J Cogn Neurosci 16:1143–1158CrossRefPubMedGoogle Scholar
  24. 24.
    Vaskinn A, Sundet K, Østefjells T, Nymo K, Melle I, Ueland T (2016) Reading emotions from body movement: a generalized impairment in schizophrenia. Front Psyciatry 6:2058Google Scholar
  25. 25.
    Fretland RA, Andersson S, Sundet K, Andreassen OA, Melle I, Vaskinn A (2015) Theory of mind in schizophrenia: error types and associations with symptoms. Schizophr Res 162:42–46CrossRefPubMedGoogle Scholar
  26. 26.
    Dziobek I, Fleck S, Kalbe E, Rogers K, Hassenstab J, Brand M (2006) Introducing MASC: a movie for the assessment of social cognition. J Autism Dev Disord 36:623–636CrossRefPubMedGoogle Scholar
  27. 27.
    Vaskinn A, Fiske AP, Green MF (2017) Enhancing tolerability of a measure of social perception in schizophrenia: comparison of short and long Norwegian versions of the Relationships Across Domains test. Cogn Neuropsychiatry 22:254–262CrossRefPubMedGoogle Scholar
  28. 28.
    Sergi MJ, Fiske AP, Horan WP, Kern RS, Kee KS, Subotnik KL, Nuechterlein KH, Green MF (2009) Development of a measure of relationship perception in schizophrenia. Psychiatry Res 166:54–62CrossRefPubMedGoogle Scholar
  29. 29.
    Nuechterlein KH, Green MF (2009) In: Rund BR, Sundet K (eds) MATRICS consensus cognitive battery. Norwegian version. MATRICS Assessment, Los AngelesGoogle Scholar
  30. 30.
    Pedersen G, Hagtvedt KA, Karterud S (2007) Generalizability studies of the global assessment of functioning-split version. Compr Psychiatry 48:88–94CrossRefPubMedGoogle Scholar
  31. 31.
    Hellvin T, Sundet K, Vaskinn A, Simonsen C, Ueland T, Andreassen OA, Melle I (2010) Validation of the Norwegian version of the Social Functioning Scale (SFS) for schizophrenia and bipolar disorder. Scand J Psychol 51:525–533CrossRefPubMedGoogle Scholar
  32. 32.
    Birchwood M, Smith J, Cochrane R, Wetton S, Copestake S (1994) The Social Functioning Scale: the development and validation of a new measure of social adjustment for use in family intervention programs with schizophrenic patients. Br J Psychiatry 157:853–859CrossRefGoogle Scholar
  33. 33.
    Vaskinn A, Ventura J, Andreassen OA, Melle I, Sundet K (2015) A social path to functioning in schizophrenia: from social self-efficacy through negative symptoms to social functional capacity. Psychiatry Res 228:803–807CrossRefPubMedGoogle Scholar
  34. 34.
    Donohoe CP, Carter MJ, Bloem WD, Hirsch GL, Laasi N, Wallace CJ (1990) Assessment of interpersonal problem-solving skills. Psychiatry 53:329–339CrossRefGoogle Scholar
  35. 35.
    Mausbach BT, Harvey PD, Goldman SR, Jeste DV, Patterson TL (2007) Development of a brief scale of everyday functioning in persons with severe mental illness. Schizophr Bull 33:1364–1372CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Kay SR, Fiszbein A, Opler LA (1987) The positive and negative syndrome scale PANSS) for schizophrenia. Schizophr Bull 13:261–276CrossRefPubMedGoogle Scholar
  37. 37.
    Wallwork RS, Fortgang R, Hashimoto R, Weinberger DR, Dickinson D (2012) Searching for a consensus model of the Positive and Negative Syndrome Scale for schizophrenia. Schizophr Res 137:246–250CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Addington D, Addington J, Maticka-Tyndale E (1993) Assessing depression in schizophrenia: the Calgary Depression Scale. Br J Psychiatry 163(suppl22):39–44CrossRefGoogle Scholar
  39. 39.
    McDermott B (1995) Development of an instrument for assessing self-efficacy in schizophrenic spectrum disorders. J Clin Psychol 51:320–331PubMedGoogle Scholar
  40. 40.
    Rosenberg M (1965) Society and the adolescent self-image. Princeton University Press, PrincetonCrossRefGoogle Scholar
  41. 41.
    Birchwood M, Smith J, Drury V, Healy J, Macmillan F, Slade M (1994) A self-report insight scale for psychosis: reliability, validity and sensitivity to change. Acta Psychiatr Scand 89:62–67CrossRefPubMedGoogle Scholar
  42. 42.
    Frøyhaug M (2018) Theory of mind in severe mental illness. Exploring the psychometric properties of the Norwegian version of the Hinting Task. Master thesis. Department of Psychology, University of Oslo, Oslo, NorwayGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Norwegian Centre for Mental Disorders ResearchOslo University HospitalOsloNorway
  2. 2.Department of PsychologyUniversity of OsloOsloNorway
  3. 3.Department for Specialized Inpatient Treatment, Division of Mental Health and AddictionAkershus University HospitalLørenskogNorway
  4. 4.Institute of Clinical MedicineUniversity of OsloOsloNorway

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