Schizophrenia and other psychotic spectrum disorders (PSD) are characterized by severe, persistent impairments in social function, which play a large role in a person?s level of disability, community integration, and likelihood of relapse. Social functioning has also been identified as a key unmet treatment need by the very individuals who suffer from PSD. Existing treatments fall short of significantly improving social function. Poor social function in PSD has been linked to significant impairments in social cognition, or how a person processes, interprets and responds to uniquely social information, including complex inferences a person makes about other people?s thoughts, feelings and actions. In an effort to improve social functioning, a number of interventions targeting these complex social cognitive skills have been developed in recent years. These treatments show some promise, but many of the trials have had significant methodological weaknesses, there is limited data about effects on everyday social functioning outcomes, and nearly all the work has been conducted in non-Veteran samples. Impairments in concentration, memory, and problem solving are also common in PSD and can make it challenging to learn complex social cognitive skills. With this in mind, we developed a social cognitive training that leverages successful methods from bottom-up cognitive remediation to reduce cognitive load and aid with acquisition of complex social cognitive skills. The training was developed under an NIMH R34 grant and is called Understanding Social Situations (USS). To date, we have developed and refined USS training content, created a treatment manual, conducted a single-arm pilot of the intervention, and collected preliminary data on the effects of USS when incorporated into a psychosocial rehabilitation program. The current proposal is to conduct a fully powered, rigorous randomized controlled trial to test the efficacy of USS versus an active control condition. One hundred twenty Veterans with PSD will be randomized to 2 months of USS or an active control (AC) intervention matched for duration, therapist contact, and mode of delivery. Key social functioning outcomes will be measured using a multi-method approach of self-report, role- play, and experience sampling, conducted pre-intervention, post-intervention, and at 2 month follow-up, with an additional limited assessment at treatment mid-point. We will also examine moderators and mediators of treatment effects.
Psychotic disorders are characterized by significant functional disability, including severe impairments in social and community function. Existing treatments fall short of significantly improving social and community functioning, and social re-integration is among the top treatment needs consumers feel are not adequately addressed by existing interventions. The proposed study evaluates a novel intervention, Understanding Social Situations (USS), that leverages bottom-up methods from cognitive rehabilitation to target complex social cognitive skills. If effective, the proposed intervention has the potential to promote rehabilitation and recovery efforts by meaningfully impacting the social lives and well-being of Veterans with psychosis.
