71
Review
www.expert-reviews.com ISSN 1473-7175 © 2012 Expert Reviews Ltd 10.1586/ERN.11.183
Forty years have passed since the publication of
Bandura and Barab’s social learning analyses [1] ,
in which some basic theories of social cognition
were described. In the last 10 years, there has
been a substantial revival of older questions from
social psychology as a result of the advancement
of neuroscientific findings regarding social cog-
nition in neuropsychiatric populations. In paral-
lel, new therapeutic strategies to improve path-
ological social functioning deficits in affected
psychiatric and developmental populations have
been inspired by the work in social neurosci-
ence. Research from cognitive psychology and
neuroscience has consistently identified schizo-
phrenia as a group of clinical syndromes not just
composed of positive and negative symptoms,
but also riddled with a spectrum of deficits in
social cognition that translate to impairments in
real-world social functioning [2] . The aim of this
article is not only to review current therapeutic
interventions and their limitations, but also to
highlight relevant work in social neuroscience
that can potentially be bridged with future ther-
apeutic strategies for improving social cognition
in schizophrenia.
Social cognition in schizophrenia
Social cognition has been defined as “the abil-
ity to construct representations of the relations
between oneself and others, and to use those
representations flexibly to guide social behav-
iors” [3] . Social cognition can be considered as
the sum of the cognitive processes required for
social perception and social interaction. Deficits
in social cognition in schizophrenia have a direct
impact on rate of relapse and the need for re-
hospitalization [4] . When asked, the majority of
psychotic patients would prioritize the remedia-
tion of social skills over the recovery of positive
or negative symptoms [5] . However, symptomatic
remission with the use of antipsychotic medica-
tion appears to have little impact on the remis-
sion of social skills [6] . Recent work has revealed
that neurocognitive deficits in schizophrenia
can successfully explain between 20 and 60%
of the overall variance on functioning [7–11] ,
whereas social cognition seems to explain vari-
ance beyond that explained by neurocognition
[12,13] . Accordingly, in the context of discussing
therapeutic interventions, we heretofore focus
on the issues related to the deficits in domains of
Elliot C Brown
1,2
,
Cumhur Tas
1,2
and
Martin Brüne*
1,2
1
International Graduate School of
Neuroscience, Ruhr-University
Bochum, Germany
2
Research Department of Cognitive
Neuropsychiatry and Psychiatric
Preventive Medicine, Department of
Psychiatry, LWL University Hospital,
Ruhr-University Bochum, Germany
*Author for correspondence:
Tel.: +49 234 5077 1130
Fax: +49 234 5077 1329
martin.bruene@rub.de
Therapeutic strategies for improving social cognition in patients with schizophrenia have shown
much promise in improving social functioning, as well as remediating core psychotic symptoms.
However, the efficacy of previous interventions has often been limited by the ambiguity and
inconsistency of the categorized subdomains of social cognition, including theory of mind,
emotion processing, social perception and attributional bias. Recent research in social and
cognitive neuroscience has revealed many new issues that could contribute to the development
of more integrated approaches for improving social functioning. The application of such
neuroscientific work to a therapeutic and diagnostic context is likely to encourage more effective
transference of learned skills to real-world social functioning. This article seeks to provide a
comprehensive review of previous social cognitive interventions for schizophrenia, highlight
some crucial limitations of these and present the relevance of recent advances in neuroscientific
research in possible future treatment strategies. It is emphasized that a more integrated and
naturalistic approach for improving social functioning with greater sensitivity for neuroscientific
findings related to the psychopathology of schizophrenia is warranted.
KEYWORDS:emotionprocessing•learning•metacognition•motivation•schizophrenia•socialcognition•social
interaction•socialneuroscience•theoryofmind•treatmentoutcome
Potential therapeutic avenues
to tackle social cognition
problems in schizophrenia
Expert Rev. Neurother. 12(1), 71–81 (2012)
THEMED ARTICLE y Schizophrenia
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