Chapter 9 - Social Cognition and Interaction Training: The Role of Metacognition

Abstract

In this chapter, we present a social cognition intervention program called social cognition and interaction training (SCIT), placing special emphasis on its metacognitive components. The first part of the chapter will describe SCIT, a group-based intervention that is delivered weekly over 6 months and is designed to improve social cognition and social functioning in patients with schizophrenia spectrum disorders. SCIT comprises three phases of increasing difficulty and emotional challenge: (1) introduction and emotion recognition, (2) figuring out situations, and (3) integration and application to daily life. In the second part of the chapter, we will show how SCIT integrates metacognitive processes across two different levels: patient and intervention. On the patient level, SCIT is designed to leverage patients’ metacognitive experiences such that it is seen as fun, intrinsically rewarding, and not cognitively demanding. In this way, it helps patients to feel engaged but not overwhelmed. Early sessions of SCIT emphasize easy fictional and impersonal content, whereas later sessions emphasize more complicated and personal content. By gradually increasing emotional and cognitive challenge, SCIT should not feel threatening or intrusive to patients and should provide the necessary time for trust to develop. On the intervention level, SCIT is designed to enhance adaptive integration between automatic cognitive processing, which is more immediate, efficient, unintended and emotion-influenced, and controlled cognitive processing, which is more reflective, effortful, and less vulnerable to emotion-based bias. To accomplish this, SCIT teaches patients techniques for recognizing automatic social cognitive tendencies, evaluating the accuracy of social judgments, and reflecting on how social cognitive processes affect their lives. While the patient level of metacognitive processing promotes adherence to the program and treatment satisfaction, the intervention level teaches skills that help to consolidate and enhance social cognitive improvements. Finally, we summarize SCIT treatment outcome findings and discuss current and future lines of investigation.