Dennis R. Combs

Social Cognition and Interaction Training (SCIT) for inpatients with schizophrenia spectrum disorders: Preliminary findings

Individuals with schizophrenia exhibit consistent deficits in social cognition such as emotion perception, attributional style, and theory of mind, which may be targets of psychosocial treatments. Previous intervention studies have typically focused on only one aspect of social cognition and have not assessed generalization of treatment to improvements in social functioning. This paper describes preliminary data from a new group-based treatment, Social Cognition and Interaction Training (SCIT), aimed at improving social cognition in schizophrenia. Eighteen inpatients with schizophrenia spectrum disorders completed SCIT and were compared with 10 inpatients who completed a coping skills group. Participants were assessed at pre-test and post-test on measures of emotion and social perception, theory of mind, attributional style (e.g., blame, hostility, and aggression), cognitive flexibility, and social relationships. We also collected data on the frequency of aggressive incidents on the treatment ward. The results showed that compared to the control group, SCIT participants improved on all of the social cognitive measures and showed better self-reported social relationships and fewer aggressive incidents on the treatment unit at post-test. Importantly, this change was independent of changes in clinical symptoms over time and supports the unique role of SCIT in improving social cognitive deficits in schizophrenia.

The Ambiguous Intentions Hostility Questionnaire (AIHQ): A new measure for evaluating hostile social-cognitive biases in paranoia

Introduction. This study reports on the development of a new measure of hostile social-cognitive biases for use in paranoia research, the Ambiguous Intentions Hostility Questionnaire (AIHQ). The AIHQ is comprised of a variety of negative situations that differ in terms of intentionality. Items were developed to reflect causes that were ambiguous, intentional, and accidental in nature. Methods. Participants were 322 college students who completed the AIHQ along with measures of paranoia, hostility, attributional style, and psychosis proneness. The reliability and validity of the AIHQ was evaluated using both correlational and multiple regression methods. Results. The AIHQ had good levels of reliability (internal consistency and interrater reliability). The AIHQ was positively correlated with paranoia and hostility and was not correlated with measures of psychosis proneness, which supported the convergent and discriminant validity of the scale. In addition, the AIHQ predicted incremental variance in paranoia scores as compared to the attributional, hostility, and psychosis proneness measures. Ambiguous items showed the most consistent relationships with paranoia. Conclusions. The AIHQ appears to be a reliable and valid measure of hostile social cognitive biases in paranoia. Recommendations for using the AIHQ in the study of paranoia are discussed.

Emotion Recognition in Schizophrenia : Further Investigation of Generalized Versus Specific Deficit Models

In this study, the authors examined the nature of emotion perception in schizophrenia. Two samples of people with schizophrenia, one receiving acute care for a recent exacerbation of symptoms and the other receiving extended care, were compared with a nonclinical control group on emotion perception and general perception measures. The nonclinical control group obtained the highest scores on all of the study measures, and the acutely ill group obtained the lowest scores. Furthermore, the acutely ill sample had a specific deficit in emotion perception that remained present after controlling for performance on the general perception tasks. Conversely, the deficits in emotion discrimination in the extended-care sample reflected generalized poor performance. Differences in performance on the emotion identification task between the 2 clinical groups were reduced when controlling for active symptoms.

Social perception in schizophrenia: the role of context

The purpose of this study was to examine social context processing in persons with schizophrenia. A secondary goal was to examine the ecological validity of these measures (i.e. how they relate to social behavior in the treatment setting). The performance of 35 persons with DSM-IV diagnosed schizophrenia and/or schizoaffective disorder was compared to a non-clinical control sample of 46 individuals on a battery of social perceptual tasks that require social context processing. In addition, the relationship between social context processing and ward behavior (as measured with the Nurses Observation Scale for Inpatient Evaluation) was examined for the clinical sample only. The results showed that the group with schizophrenia/schizoaffective disorder was impaired on all tasks relative to the control group and showed little evidence of utilizing available contextual information. Task performance for the group with schizophrenia/schizoaffective disorder was relatively independent of symptoms, but was related to social functioning in the treatment setting. Implications for future research are discussed.

Modification of affect perception deficits in schizophrenia

This study investigated two strategies for improving facial affect perception in schizophrenia: monetary reinforcement and promoting facial feedback via mimicry of the expressions of target faces. A total of 40 inpatients with schizophrenia were administered the face emotion identification test during four phases: baseline, intervention, immediate post-test, and 1week follow-up. Subjects were randomly assigned to one of four interventions: repeated practice, monetary reinforcement, facial feedback, and a combination of reinforcement and facial feedback. Generalization of the intervention to a test of facial affect discrimination was also examined. The results showed that all groups of subjects, with the exception of those in the repeated practice group, improved in their ability to identify facial affect, with these effects showing some stability over time. There was limited evidence of these effects generalizing to the test of facial affect discrimination.

The role of subclinical paranoia on social perception and behavior

The purpose of this study was to investigate the effects of subclinical paranoia on social perception and behavior. Two groups of participants, those high and low in subclinical paranoia, were identified based on extreme scores on the Paranoia Scale (PS). As expected, persons high in subclinical paranoia had greater depression, social anxiety, self-consciousness, and lower self-esteem compared to persons low in subclinical paranoia. In addition, persons high in subclinical paranoia performed worse than persons low in subclinical paranoia on laboratory measures of emotion perception and on an in vivo social perception task. Finally, behavioral differences between these two groups were revealed: Persons high in subclinical paranoia sat further away from the examiner and took longer to read the consent form than low-paranoia persons. These behavioral differences were not due to the group differences in clinical functioning, indicating that level of paranoia generally accounted for these findings.

Perceived Racism as a Predictor of Paranoia Among African Americans

Recent theoretical models suggest that perceived racism acts as a stressor for African Americans and may be associated with a variety of negative psychological consequences, notably paranoia. Paranoia among African Americans is believed to reflect the lower end of the paranoia continuum based on experiences with racism. Thus, it may be beneficial to measure paranoia on a continuum, but few studies have adopted this strategy. This study examined the relationship between perceived racism and paranoia across the continuum in 128 African American college students. Participants completed three measures of paranoia and measures of perceived racism, depression, anger, self-consciousness, and hostile perceptions. The continuum of paranoia included measures reflecting cultural, nonclinical, and clinical paranoia. Perceived racism predicted cultural mistrust and nonclinical paranoia (lower end of the paranoia continuum) but not clinical paranoia. The implications of perceived racism in the prediction of paranoia for African Americans are discussed.

Comorbid anxiety corresponds with neuropsychological dysfunction in unipolar depression.

Introduction. Unipolar depressives seem apt to show neuropsychological impairment, particularly involving executive function and memory. Yet, not all depressed patients show such deficits. Major depressive illness shares a high rate of comorbid anxiety disorder, and anxiety disorders also tend to correspond with cognitive difficulties. Consequently, depressed individuals with comorbid anxiety disorders may be inclined to demonstrate greater neuropsychological dysfunction than those without anxiety disorders. Method. We compared nonpsychotic depressed inpatients with (n=22) and without comorbid anxiety disorders (n=30) to a group of control subjects (n=38) on a brief but broad battery of neuropsychological tests. Patients were tested during an inpatient admission, and data were collected retrospectively from available records. Results. Both groups of depressed patients showed worse memory function than the controls. Yet, executive dysfunction and psychomotor slowing were specific to the depressed group with comorbid anxiety. The comorbid anxiety group also had more impaired scores than either the nonanxious depressed group or the control group. The depressed group without a comorbid anxiety disorder demonstrated no significant slowing compared to the control group. Conclusions. Major depressive disorder corresponds with significant memory impairment, regardless of comorbid anxiety disorder. Yet, presence of a comorbid anxiety disorder coincides with deficits involving executive function and psychomotor slowing. Clinical and theoretical relevance of the data is discussed.

A randomized, controlled trial of Social Cognition and Interaction Training (SCIT) for outpatients with schizophrenia spectrum disorders

OBJECTIVES In schizophrenia, the ability to adaptively infer the thoughts and feelings of others (i.e., social cognition) is strongly associated with community functioning. Researchers have designed psychosocial interventions to improve social cognition with the aim of improving downstream social functioning. Social Cognition and Interaction Training (SCIT) is one such intervention. Previous research on SCIT has been promising, but has consisted largely of smaller trials with insufficient experimental control. DESIGN Randomized, controlled trial. METHODS The current article reports on a controlled trial of 66 adults with schizophrenia randomized to receive either SCIT (n = 33), delivered in weekly group sessions, or treatment as usual (n = 33) for 6 months. Participants completed assessments of social cognition, social functioning, neurocognition and symptoms at baseline, post-treatment, and 3-month follow-up. RESULTS Primary analyses suggest that SCIT may improve social functioning, negative symptoms, and possibly hostile attributional bias. Post-hoc analyses suggest a dose-response effect. CONCLUSIONS Findings are discussed in the context of continuing to refine and improve social cognitive interventions for schizophrenia. PRACTITIONER POINTS Social cognitive intervention is a feasible and promising approach to improving social functioning among individuals with schizophrenia-spectrum disorders. Dose-response findings suggest that delivering social cognitive interventions with greater frequency may maximize their benefit to patients. Research on social cognitive interventions is still young and effects from well-controlled trials have been inconsistent. It is not yet clear which components of social cognitive training may be the key active ingredients.

Attentional-shaping as a means to improve emotion perception deficits in schizophrenia

Inability to recognize emotional expressions of others (emotion perception) is one of the most common impairments observed among individuals with schizophrenia. Such deficits presumably contribute much to the social dysfunction characteristic of schizophrenia. This study examined the efficacy of a novel attentional-shaping intervention to improve emotion perception abilities. Sixty participants with schizophrenia were randomly assigned to one of three intervention conditions: 1) attentional-shaping, 2) contingent monetary reinforcement, or 3) repeated practice. Participants completed the Face Emotion Identification Test (FEIT) at pre-test, intervention, post-test, and one week follow-up. Participants also completed the Bell-Lysaker Emotion Recognition Test (BLERT) and the Social Behavior Scale at pre-test and follow-up to measure generalization. The results showed that the attentional-shaping condition had significantly higher scores on the FEIT at intervention, post-test, and follow-up compared to monetary reinforcement and repeated practice. Improvement was also found on the BLERT and a trend was found for improved social behaviors at one-week follow-up. Results will be discussed in terms of face scanning and attentional deficits present in schizophrenia and potential uses of this intervention in the remediation of emotion perception deficits.