Cognitive Social Skills Training Research Articles

Social-cognitive Skills Training on Interpersonal Understanding of Social Norms During Adolescence

Social-cognitive Skills Training on Interpersonal Understanding of Social Norms During Adolescence

Analyzing structural and functional brain changes related to an integrative cognitive remediation program for schizophrenia: A randomized controlled trial.

Cognitive remediation has been shown to improve cognition in schizophrenia, but little is known about the specific functional and structural brain changes related to the implementation of an integrative cognitive remediation program. This study analyzed the functional and structural brain changes identified after implementing an integrative cognitive remediation program, REHACOP, in schizophrenia. The program combined cognitive remediation, social cognitive training, and functional and social skills training. The sample included 59 patients that were assigned to either the REHACOP group or an active control group for 20weeks. In addition to a clinical and neuropsychological assessment, T1-weighted, diffusion-weighted and functional magnetic resonance images were acquired during a resting-state and during a memory paradigm, both at baseline and follow-up. Voxel-based morphometry, tract-based spatial statistics, resting-state functional connectivity, and brain activation analyses during the memory paradigm were performed. Brain changes were assessed with a 2×2 repeated-measure analysis of covariance for group x time interaction. Intragroup paired t-tests were also carried out. Repeated-measure analyses revealed improvements in cognition and functional outcome, but no significant brain changes associated with the integrative cognitive remediation program. Intragroup analyses showed greater gray matter volume and cortical thickness in right temporal regions at post-treatment in the REHACOP group. The absence of significant brain-level results associated with cognitive remediation may be partly due to the small sample size, which limited the statistical power of the study. Therefore, further research is needed to clarify whether the temporal lobe may be a key area involved in cognitive improvements following cognitive remediation.

358 Using autism symptom profiles at intervention baseline to predict social cognitive outcomes

OBJECTIVES/GOALS: 1) Investigate the utility of pragmatic communication profiles in a sample of children with autism at baseline to predict response to treatment in a randomized clinical trial (RCT) of oxytocin augmentation and social cognitive skills training at week 12. 2) Determine if levels of anxiety or hyperactivity moderate child outcome performance. METHODS/STUDY POPULATION: 40 children (37M, 3F), aged 8-11(M=9.25, SD=1.10), with confirmed autism spectrum disorder (ASD), enrolled in an RCT(NCT02918864) were evaluated at baseline on: an assessment of ASD (Autism Diagnosis Observation Schedule, ADOS-2), a task of perspective taking, Theory of Mind ToM, (Reading the Mind from the Eyes Task), pragmatic communication (Pragmatic Rating Scale-School Aged; PRS-SA), IQ (WAIS_I, WISC-V) and anxiety and hyperactivity (Behavior Assessment Scales for Children-3; BASC-3). A Tobii T60 XL was used for eye-tracking visual patterns and attention during the RMET. The PRS-SA was coded by trained, reliable clinicians. Parent ratings indicated over half of the participants’ had At Risk levels or higher on anxiety and hyperactivity on the BASC-3. Week 12 measures included all but the PRS-SA and ADOS-2. RESULTS/ANTICIPATED RESULTS: Baseline preliminary analysis indicated the participants spent more time looking at words (.41ms) than eye images on the RMET(.15ms, p DISCUSSION/SIGNIFICANCE: Findings at baseline suggest pragmatic communication skills are more related to ToM than gaze and attention on the RMET. This relationship will be further investigated over the time of the trial. Mental health indicators need to be considered further in this population. Child profiles at baseline may inform appropriate triage and treatment targets.

Peer specialists deliver cognitive behavioral social skills training compared to social skills training and treatment as usual to veterans with serious mental illness: study protocol for a randomized controlled trial

BackgroundSerious mental illness (SMI) affects 4.6% of the American population. While treatments are available, adherence to specific regimens is often suboptimal. Multiple organizations, such as the Substance Abuse and Mental Health Services Administration (SAMHSA), have called for more options that improve accessibility and engagement to treatment among individuals with SMI. This study protocol answers such calls by testing the effectiveness of peer specialists—individuals with SMI trained to use their experience to help others with SMI—in delivering social skills training (SST) and cognitive behavioral social skills training (CBSST), evidence-based treatments effective at engaging individuals with SMI to make behavioral and cognitive changes. Peer specialists have been shown to be adept at engaging those with SMI in treatment; however, their ability to deliver these structured treatments is unknown.MethodsThis study is a randomized, hybrid 1, research assistant-blinded, superiority trial. A total of 252 veterans with SMI will be recruited and randomized to one of three arms: CBSST-Peer vs. SST-Peer vs. treatment as usual. Participants randomized to CBSST-Peer or SST-Peer will participate in a 20-week group-based intervention that meets weekly for a 60-min class. All participants will complete 4 study assessments at baseline, 10 weeks, 20 weeks, and 32 weeks. A multidimensional battery of functional outcomes will be used with the Independent Living Skills Survey (ILSS) as the primary outcome measure. Post-study completion, veterans who participated in the CBSST-Peer or SST-Peer arms will randomly be invited to participate in focus groups, and peer specialists will complete interviews to further assess the effectiveness of each intervention.DiscussionImproving care and outcomes for individuals with SMI is a national priority. To improve care, it is imperative to think about new ways to improve engagement and accessibility to care. This study provides an innovative solution to this problem by evaluating how two different types of treatment, delivered by peer specialists, compare to usual care. The results of the study will allow for the expansion of treatment options that improve access and engagement among veterans with SMI.

Social cognitive skills groups increase medial prefrontal cortex activity in children with autism spectrum disorder.

Few studies have examined the neural mechanisms of change following social skills interventions for children with autism spectrum disorder (ASD). This study examined the neural effects of social cognitive skills groups during functional MRI (fMRI) tasks of irony comprehension and eye gaze processing in school-aged children with ASD. Verbally fluent children (ages 8-11) were randomized to social cognitive skills groups or facilitated play comparison groups. Behavioral assessments and fMRI scans were obtained at baseline and endpoint (12 weeks). During fMRI, children completed two separate tasks to engage social cognition circuitry: comprehension of potentially ironic scenarios (n= 34) and viewing emotionally expressive faces with direct or averted gaze (n= 24). Whole-brain analyses were conducted to examine neural changes following treatment. Regression analyses were also conducted to explore the relationship between neural and behavioral changes. When comparing the two groups directly, the social cognitive skills group showed greater increases in activity in the medial prefrontal cortex (mPFC), implicated in theory of mind, relative to the comparison group for both irony comprehension and gaze processing tasks. Increased mPFC activity during the irony task was associated with improvement in social functioning on the Social Responsiveness Scale across both groups. Findings indicate that social cognitive skills interventions may increase activity in regions associated with social cognition and mentalizing abilities. LAY SUMMARY: Social skills groups are a common intervention for school-aged children with ASD. However, few studies have examined the neural response to social skills groups in school-aged children with ASD. Here, we report on a study evaluating neural outcomes from an empirically supported social cognitive skills training curriculum using fMRI. This study seeks to understand the effects of targeting emotion recognition and theory of mind on the brain circuitry involved in social cognition in verbally fluent children ages 8-11. Results indicate increased neural activity in the mPFC, a region considered to be a central hub of the "social brain," in children randomized to social cognitive skills groups relative to a comparison group that received a high-quality, child-directed play approach. In addition, increased activation in the mPFC during an irony comprehension task was associated with gains in social functioning across both groups from pre- to post-treatment. This is the first fMRI study of social skills treatment outcomes following a randomized trial with an active treatment condition in school-aged children with ASD.

Effect of cognitive social skills training on positive relationships with others and adjustment of students

Effect of cognitive social skills training on positive relationships with others and adjustment of students

Does the Fast Track Intervention Prevent Later Psychosis Symptoms?

The Fast Track (FT) intervention was a multimodal preventive intervention addressing antisocial development across 10years of childhood and early adolescence. The intervention included parent management training, child social-cognitive skills training, peer coaching and mentoring, academic skills tutoring, and a classroom social-emotional learning program. While not specifically designed to target psychosis symptoms (e.g., social withdrawal, thought abnormalities), the present study aimed to examine whether the FT intervention prevented psychosis symptoms through childhood and adolescence and into adulthood. Participants included the FT intervention and high-risk control samples (N =891; 69% male; M age = 6.58years, SD =.48). Psychosis symptoms were assessed using the "thought problems" subscale of the parent-report Child Behavior Checklist during grades 1, 2, 4, 5, and 7, and the self-report Adult Behavior Checklist at age 25years, in line with prior research using this measure. Growth models included the FT condition and covariates (i.e., initial risk screen score, cohort, socioeconomic status, rural/urban status, race, and sex) as predictors; and child, adolescent, and adult psychosis symptoms as outcomes. Intervention status was not significantly associated with the slope of psychosis symptoms; however, after controlling for concurrent cannabis use, intervention participants reported lower levels of psychosis symptoms over time. Findings suggest that interventions targeting antisocial behavior may prevent psychosis symptoms in the long term.

FMRI biomarkers of social cognitive skills training in psychosis: Extrinsic and intrinsic functional connectivity.

Social cognitive skills training interventions for psychotic disorders have shown improvement in social cognitive performance tasks, but little was known about brain-based biomarkers linked to treatment effects. In this pilot study, we examined whether social cognitive skills training could modulate extrinsic and intrinsic functional connectivity in psychosis using functional magnetic resonance imaging (fMRI). Twenty-six chronic outpatients with psychotic disorders were recruited from either a Social Cognitive Skills Training (SCST) or an activity- and time-matched control intervention. At baseline and the end of intervention (12 weeks), participants completed two social cognitive tasks: a Facial Affect Matching task and a Mental State Attribution Task, as well as resting-state fMRI (rs-fMRI). Extrinsic functional connectivity was assessed using psychophysiological interaction (PPI) with amygdala and temporo-parietal junction as a seed region for the Facial Affect Matching Task and the Mental State Attribution task, respectively. Intrinsic functional connectivity was assessed with independent component analysis on rs-fMRI, with a focus on the default mode network (DMN). During the Facial Affect Matching task, we observed stronger PPI connectivity in the SCST group after intervention (compared to baseline), but no treatment-related change in the Control group. Neither group showed treatment-related changes in PPI connectivity during the Mental State Attribution task. During rs-fMRI, we found treatment-related changes in the DMN in the SCST group, but not in Control group. This study found that social cognitive skills training modulated both extrinsic and intrinsic functional connectivity in individuals with psychotic disorders after a 12-week intervention. These findings suggest treatment-related changes in functional connectivity as a potential brain-based biomarker of social cognitive skills training.

Wasted food on school lunch plates of elementary school children: Development of theoretically founded teaching materials for instructions during school lunch

Leaving portions of meals, known as plate waste, is one problem in children's eating behaviors. Two studies in which interventions were performed during school lunch time to reduce children's plate waste using educational materials based on social cognitive theory or social skills training are described. In the first study, a picture-story showing teaching material based on social cognitive theory was developed to induce first and second-grade children to try foods they disliked by increasing their self-efficacy and outcome expectancy for eating such food. After the instructions, the teachers reported that children enjoyed the picture-show story and they came to try and eat foods they disliked, which suggested the feasibility and teaching effectiveness of the material that was used. In the second study, an educational program using social skills training was conducted. Fifth-grade children learned skills of getting just the right size of meal portions that they could totally consume. Certain attitudes and behaviors of children improved after the program. Both instructions are expected to be widely used in the future to increase desirable eating behaviors of children.

Social Cognitive Skills Training for Psychosis With Community-Based Training Exercises: A Randomized Controlled Trial.

Impairments in social cognition are key determinants of poor functioning in psychosis and an important new target for treatment development. Initial studies support the feasibility and efficacy of training interventions for social cognition, but have been small and have had substantial methodological limitations. This report describes the largest rigorously controlled study of a social cognitive treatment to date. We evaluated the efficacy of a refined version of the 24-session Social Cognitive Skills Training (SCST) program, and whether adding in vivo training sessions in community settings would enhance generalization to functional improvements. One hundred thirty-nine outpatients with psychotic disorders were randomly assigned to one of 3 time- and format-matched conditions: (1) SCST plus in vivo community-based training, (2) SCST plus clinic-based training, or (3) Illness management control condition. SCST targeted the domains of emotion processing, social perception, attributional bias, empathy, and mentalizing. Assessments of social cognition, nonsocial cognition, symptoms, and functioning were completed at baseline, mid-treatment, posttreatment, and 3-month follow-up. On the primary social cognitive outcome measures, there was significant, durable SCST-related improvement in facial emotion identification. There was also a significant SCST benefit for emotional intelligence and an in vivo training effect for empathy, though these improvements were not durable. Further, there were no overall or in vivo-related changes in functioning. This study bolsters and extends support for the efficacy of SCST in a relatively large and rigorously controlled trial, although our effort to enhance generalization to functional improvements through in vivo community-based training was not successful.

Combining social cognitive treatment, cognitive remediation, and functional skills training in schizophrenia: a randomized controlled trial.

This study examined the efficacy of an integrative cognitive remediation program (REHACOP) in improving cognition and functional outcome in patients with schizophrenia. The program combines cognitive remediation, social cognitive intervention, and functional skills training. Few studies have attempted this approach. One hundred and eleven patients diagnosed with schizophrenia were randomly assigned to either the cognitive remediation group (REHACOP) or an active control group (occupational activities) for 4 months (three sessions per week, 90 min). Primary outcomes were change on general neurocognitive performance and social cognition, including theory of mind (ToM), emotion perception (EP), attributional style, and social perception (SP). Secondary outcomes included changes on clinical symptoms (Positive and Negative Syndrome Scale) and functional outcome (UCSD Performance-Based Skills Assessment and the Global Assessment of Functioning). The trial was registered with clinicaltrials.gov (NCT02796417). No baseline group differences were found. Significant differences were found in the mean change between the REHACOP group and control group in neurocognition (), SP (), ToM (), EP (), negative symptoms (), emotional distress (), Global Assessment of Functioning (), and UCSD Performance-Based Skills Assessment (). The combination of cognitive remediation, social cognitive intervention, and functional skills training demonstrated statistically significant and clinically meaningful changes in neurocognition, social cognition, negative, and functional disability.

Cognitive insight and functioning outcomes in cognitive behavioral social skills training for schizophrenia

Cognitive insight and functioning outcomes in cognitive behavioral social skills training for schizophrenia

Oxytocin-Augmented Social Cognitive Skills Training in Schizophrenia

Impairments in social cognition are common in schizophrenia and predict poor functional outcome. The purpose of this proof-of-concept randomized, parallel group clinical trial was to assess whether intranasal oxytocin (OT), given before social cognitive training, enhances learning of social cognitive skills. Twenty seven male outpatients with schizophrenia participated in a 6-week (12 session) training on social cognitive skills. Training focused on three domains: facial affect recognition, social perception, and empathy. Subjects were randomly assigned (double blind) to receive either intranasal OTor placebo 30 min before each session. Participants did not receive OT between sessions or on the day of assessments. We evaluated scores on social-cognition measures, as well as clinical symptoms and neurocognition, at baseline, 1 week following the final training session, and 1 month later. Our prespecified primary outcome measure was a social-cognition composite score comprised of five individual measures. There were main effects of time (indicating improvement across the combined-treatment groups) on the social-cognition composite score at both 1 week and 1 month following completion of training. Subjects receiving OT demonstrated significantly greater improvements in empathic accuracy than those receiving placebo at both posttreatment and 1 month follow up. There were no OT-related effects for the other social cognitive tests, clinical symptoms, or neurocognition. This study provides initial support for the idea that OT enhances the effectiveness of training when administered shortly before social cognitive training sessions. The effects were most pronounced on empathic accuracy, a high-level social cognitive process that is not easily improved in current social cognitive remediation programs.

Adapting and evaluating a social cognitive remediation program for schizophrenia in Arabic

Although growing evidence supports the efficacy of social cognitive training interventions for schizophrenia, nearly all studies to date have been conducted in Westernized countries. In the current study, we translated and adapted an existing social cognitive skills training (SCST) program into Arabic and conducted a preliminary efficacy evaluation in schizophrenia outpatients in Egypt. Twenty-two patients were randomized to 16 sessions of group-based SCST and 20 were randomized to a format- and time-matched illness management training control condition. Pre- and post-intervention assessments included a primary social cognition outcome measure that assessed four branches of emotional intelligence and a battery of neurocognitive tests. The SCST group demonstrated significant treatment effects on total emotional intelligence scores (F=24.31, p<.001), as well as the sub-areas of Identifying Emotions (F=11.77, p<.001) and Managing Emotions (F=23.27, p<.001), compared with those in the control condition. There were no treatment benefits for neurocognition for either condition, and both interventions were well-tolerated by patients. These initial results demonstrate the feasibility of implementing social cognitive interventions in different cultural settings with relatively minor modifications. The findings are encouraging regarding further efforts to maximize the benefits of social cognitive interventions internationally.

Correlates of Trading Sex for Methamphetamine in a Sample of HIV-Negative Heterosexual Methamphetamine Users

While many studies have examined correlates of trading sex for money, few have examined factors associated with exclusive trading of sex for drugs. We identified sociodemographic, behavioral, and psychological correlates of trading sex for methamphetamine in a sample of HIV-negative heterosexual men and women who were enrolled in a sexual risk reduction intervention in San Diego, California. Of 342 participants, 26% overall (21% of males and 31% of females) reported trading sex for methamphetamine in the past two months. Multiple logistic regression analysis revealed that recently trading sex for methamphetamine was independently associated with being female, homeless, binging on methamphetamine, sexual victimization in the past two months, engaging in anal sex 24 or more times in the past two months, and higher sexual compulsivity scores. Effective interventions for this high-risk population should consider gender-focused counseling for sexual abuse, motivational enhancement therapy, social-cognitive skills training, as well as enhanced access and utilization of social services, including drug treatment.

Efficacy and specificity of Social Cognitive Skills Training for outpatients with psychotic disorders

Psychosocial interventions that target social cognition show promise for enhancing the functional outcomes of people with psychotic disorders. This randomized controlled trial evaluated the efficacy and treatment-outcome specificity of a 24-session Social Cognitive Skills Training (SCST) that targets emotional processing, social perception, attributional bias, and mentalizing (or Theory of Mind). Sixty-eight stable outpatients with primary psychotic disorders were randomly assigned to one of four time- and group format-matched treatment conditions: (1) SCST, (2) computerized neurocognitive remediation, (3) standard illness management skills training, or (4) a Hybrid treatment that combined elements of SCST and neurocognitive remediation. The SCST group demonstrated greater improvements over time than comparison groups in the social cognitive domain of emotional processing, including improvement on measures of facial affect perception and emotion management. There were no differential benefits among treatment conditions on neurocognitive or clinical symptom changes over time. Results indicate that a targeted social cognitive intervention led to improvements in social cognition among outpatients with psychosis. Findings provide guidance for continued efforts to maximize the benefits of social cognitive interventions.

Mental state attribution in schizophrenia: What distinguishes patients with “poor” from patients with “fair” mentalising skills?

PurposeAlthough many patients with schizophrenia are impaired in mental states attribution abilities, a significant number perform within normal or near-normal ranges in mental state attribution tasks. No studies have analysed cognitive or behavioural differences between patients with – to some extent – preserved mental state attribution skills and those with poor mentalising abilities. Material and methodsTo examine characteristics of “poor” and “fair” mentalisers, 58 patients with schizophrenia performed a mental state attribution task, a test of general intelligence, and two executive functioning tests. “Poor” and “fair” mentalising skills were defined according to a median-split procedure; the median score in the patient group was also within two standard deviations of the control group. In addition, patients’ social behavioural skills and psychopathological profiles were rated. ResultsPatients performing within normal or near normal ranges on the mental state attribution task had fewer social behavioural abnormalities than patients with poor mentalising abilities (even when controlled for intelligence), but did not differ in executive functioning. Fair mental state performers showed less disorganisation and excitement symptoms than poor performers. The degree of disorganisation mediated the influence of mental state attribution on social behavioural skills. ConclusionsSchizophrenia patients with (partially) preserved mentalising skills have fewer behavioural problems in the social domain than patients with poor mentalising abilities. Conceptual disorganisation mediates the prediction of social behavioural skills through mentalising skills, suggesting that disorganised patients may require special attention regarding social-cognitive skills training.

Context matters in child and family policy.

The traditional model of translation from basic laboratory science to efficacy trials to effectiveness trials to community dissemination has flaws that arise from false assumptions that context changes little or matters little. One of the most important findings in developmental science is that context matters, but this fact is not sufficiently taken into account in many translation efforts. Studies reported in this special issue highlight both the potential of systematic interventions in parenting, peer relations, and social-cognitive skills training, and the problems that will be encountered in trying to bring these interventions to a community context. It is advocated that developmental scientists start from within the community context itself so that translation to policy is only a small step. It is also advocated that this research be conducted through rigorous community randomized controlled trials.

Impact of the Fast Track Prevention Program on Health Services Use by Conduct-Problem Youth

We tested the impact of the Fast Track conduct disorder prevention program on the use of pediatric, general health, and mental health services in adolescence. Participants were 891 public kindergarten boys and girls screened from a population of 9594 children and found to be at risk for conduct disorder. They were assigned randomly (by school) to intervention or control conditions and were followed for 12 years. Intervention lasted 10 years and included parent training, child social-cognitive skills training, reading tutoring, peer-relations enhancement, and classroom curricula and management. Service use was assessed through annual interviews of parents and youth. Youth assigned to preventive intervention had significantly reduced use of professional general health, pediatric, and emergency department services relative to control youth on the basis of parent-report data. For control-group youth, the odds of greater use of general health services for any reason and general health services use for mental health purposes were roughly 30% higher and 56% higher, respectively. On the basis of self-report data, the intervention reduced the likelihood of outpatient mental health services among older adolescents for whom odds of services use were more than 90% higher among control-group youth. No differences were found between intervention and control youth on the use of inpatient mental health services. Statistical models controlled for key study characteristics, and potential moderation of the intervention effect was assessed. Random assignment to the Fast Track prevention program is associated with reduced use of general health and outpatient mental health services in adolescents. Future studies should examine the mechanism of this impact and service use patterns as subjects reach young adulthood.

Social cognitive skills training in schizophrenia: An initial efficacy study of stabilized outpatients

Social cognitive deficits are promising treatment targets for new interventions to improve functional outcome in schizophrenia. A few preliminary studies of inpatients support the feasibility of improving social cognition through psychosocial interventions. This clinical trial evaluated a new 12-session social cognitive skills training program designed to address four aspects of social cognition (affect perception, social perception, attributional style, Theory of Mind) in outpatients with psychosis, a population for whom such interventions will likely be very useful. Thirty-one clinically stabilized outpatients were randomly assigned to a social cognition skills training intervention or a time-matched control condition (illness self-management and relapse prevention skills training), and completed pre- and post-treatment assessments of social cognition, neurocognition, and symptoms. The social cognition group demonstrated a large, significant improvement in facial affect perception, which was not present in the control group. This improvement was independent of changes in basic neurocognitive functioning or symptoms. Results support the efficacy of a social cognitive intervention for community-dwelling outpatients and encourage further development of this treatment approach to achieve broader improvements in social cognition and generalization of treatment gains.