Social Cognition in Schizophrenia

Schizophrenia is a complex and serious mental health disorder characterized by a distorted perception of reality, including hallucinations. It is a life-long condition that can be, in part, managed with therapy and medication. Schizophrenia, due to its severity, affects all aspects of an individual’s life and well-being. This article focuses on social cognition in schizophrenia. It concentrates on the impact and changes that this illness introduces into the social aspect of an individual’s life.

Key takeaways:
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    All domains of social cognition are impaired in schizophrenia.
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    The social impairments are persistent throughout the disorder.
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    There are psychosocial approaches for improving social cognition.

How does schizophrenia affect social life?

Social cognition is a term used to describe how people interpret, learn, and remember information in social contexts, which allows them to predict their behavior and that of others. In other words, every social interaction is carried out in a particular social context and is filled with nonverbal cues, such as facial expression, movement, and posture. The environment and context of a particular social interaction allow people to interpret the situation and social exchange correctly. Children develop social cognition as they grow. They learn empathy and how to “put oneself in someone else’s shoes”, scientifically called Theory of Mind (ToM).

A large part of scientific research has investigated how social cognition is altered in individuals with schizophrenia. Briefly summarized, every domain of social cognition is affected by this mental disorder, namely:

Emotion perception

Individuals with schizophrenia display deficits in emotion perception compared to healthy individuals. This means they have difficulty correctly identifying and understanding others’ emotions, such as tone of voice and facial expressions. Interestingly, this ability is more profoundly affected in schizophrenia than other disorders, especially in negative emotions, if compared to positive ones. In addition, it is difficult for schizophrenia patients to “read between the lines,” for example, interpreting subtle non-verbal cues in social interactions.

The impairments in emotion processing appear early on in the course of illness. However, they tend to stabilize throughout the illness, with slight improvement when individuals are in remission, and more acute difficulties during psychotic episodes.

Theory of mind

ToM allows individuals to understand hints and intentions, correctly interpret metaphors or deception, and understand false beliefs. In individuals with schizophrenia, these abilities are negatively affected. The research suggests that in the case of schizophrenia, this can be an inherited trait. Studies have found that the immediate family of individuals with schizophrenia, who score highly on schizotypy traits, also have an impaired ToM ability. This particular impairment does not seem to be associated with any particular symptom of schizophrenia, nor cognitive function, in inpatient or outpatient individuals, suggesting that it may be an overarching characteristic of schizophrenia.

Attributional style

Attributional style is how individuals place the responsibility of cause and effect in their lives. For example, people commonly tend to attribute the responsibility for positive events to themselves and negative ones to others or the environment.

In schizophrenia, it is common for individuals to suffer from paranoia and persecutory delusions. Research has shown that individuals with schizophrenia tend to blame others, not the situation or environment, in the case of negative events. This is called a personalization bias. In individuals with schizophrenia personalizing, bias may result from regulating self-esteem mechanisms. That means that attributing the cause of negative events in life to others maintains their positive self-image. Unfortunately, this results in extensively negative perceptions of others. Moreover, individuals with schizophrenia often exhibit confirmation bias, which means they are actively seeking confirmatory evidence for their beliefs and disregarding contradicting facts. They are also likely to “jump to” conclusions without taking in or considering all the relevant information.

The combination of the social cognitive deficits and biases may underlie paranoia that is common in schizophrenia, as well as, difficulties in maintaining and initiating healthy social relationships.

How to improve social skills in schizophrenia?

Schizophrenia is a life-long disorder that can be managed with therapy and medication, in which case an individual can be considered in remission. However, since there is no cure for schizophrenia, this mental disorder will be present throughout life.

Pharmacological treatments to improve social cognition in schizophrenia patients be non-effective; thus, most research and development focuses on psychosocial approaches. It is proposed that the “one-size-fits-all” view of social cognition training is not an efficient track, given the disorder’s heterogeneity, meaning varying symptoms between individuals and changes of the disorder thought-out the lifetime.

There is growing evidence that social cognition can be improved in individuals with schizophrenia. Depending on the deficits and symptom severity, treatment approaches can vary. For example, targeted treatment focuses on one particular skill at a time, such as identifying facial expressions by mimicking them. Other treatment approaches are more generalized when addressing learning and reading social interactions. For example, watching videotapes or role-playing. It is proposed that the most effective cognitive training is done together with other therapeutic approaches, meaning that social cognition is linked to other types of functioning, like cognitive training. While more work needs to be done in researching and developing cognitive training techniques, it remains a promising option for schizophrenia patients.

If you or a loved one is suffering from schizophrenia, contact a therapist or dedicated clinician to discuss additional cognitive training, home exercises, or support groups for patients and their family members. Schizophrenia can introduce a high risk of isolation. Therefore, it is important to be involved in social settings. If you have a loved one who is suffering from schizophrenia, understanding their struggles in social contexts is important. Your support can help them to feel more comfortable and involved.

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