Social Cognitive Skills Training Improves Social Cognition in Psychosis

Functional improvement was evaluated for individuals with psychotic disorders who underwent a 24-session social cognitive skills training program.

The results of a recent study published in Schizophrenia Bulletin demonstrate that social cognitive skills training (SCST) for patients with psychosis provide significant benefit in a number of key social cognition domains. However, in vivo community-based training failed to enhance functional improvements.1

Social cognition refers to the mental functions that inform social interactions, such as perceiving, interpreting, managing, and generating responses to social input.2 Individuals with psychotic disorders often have significant impairments across the 4 social cognitive domains of emotion processing (particularly identification of facial affect), social cue perception, attributional style, and mentalizing.3

In a controlled study, William P. Horan, PhD, of the Veterans Administration Greater Los Angeles Healthcare System and the Department of Psychiatry & Biobehavioral Science, University of California, Los Angeles, and colleagues evaluated a refined version of the 24-session SCST program and whether adding in vivo training sessions in community settings would contribute to functional improvements.

The investigators randomly assigned 139 outpatients with psychotic disorders to 1 of 3 12-week time- and format-matched conditions — SCST plus in vivo community-based training, SCST plus clinic-based training, or illness management control condition. SCST targeted emotion processing, social perception, attributional bias, empathy, and mentalizing. They performed assessments of social cognition, nonsocial cognition, symptoms, and functioning at baseline, midtreatment, posttreatment, and 3-month follow-up.

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Significant, durable SCST-related improvement in facial emotion identification occurred, and there was also a significant SCST benefit for emotional intelligence and an in vivo training effect for empathy, although these last 2 improvements were not durable. No overall or in vivo-related changes in functioning occurred.

Study limitations include the relatively short follow-up period and that in vivo sessions were limited in number — 2 individual sessions and 4 small group sessions. Furthermore, the generalizability of these results is limited by the lack of diversity in the patient population.

The investigators argued that a critical direction for future research in this area is to develop more effective ways to achieve generalization to the greater community of patients.


  1. Horan WP, Dolinsky M, Lee J, et al. Social cognitive skills training for psychosis with community-based training exercises: a randomized controlled trial [published online December 28,2017]. Schizophr Bull. doi:10.1093/schbul/sbx167
  2. Fiske ST, Taylor SE. Social Cognition. 2nd ed. New York, NY: McGraw-Hill Book Company; 1991.
  3. Savla GN, Vella L, Armstrong CC, Penn DL, Twamley EW. Deficits in domains of social cognition in schizophrenia: a meta-analysis of the empirical literature. Schizophr Bull. 2013;39:979-992.