Comprehensive treatments for social cognitive deficits in schizophrenia: A critical review and effect-size analysis of controlled studies

• We studied comprehensive treatments for social cognition in schizophrenia.
• There are large-sized effects of training on facial affect recognition.
• There are moderate-sized effects of training on theory-of-mind.
• Training on attributional style produced small to medium-sized effects.
• Social cognitive training studies have often not employed blind raters.

Recent advances in psychosocial treatments for schizophrenia have targeted social cognitive deficits. A critical literature review and effect-size (ES) analysis was conducted to investigate the efficacy of comprehensive programs of social cognitive training in schizophrenia. Results revealed 16 controlled studies consisting of seven models of comprehensive treatment with only three of these treatment models investigated in more than one study. The effects of social cognitive training were reported in 11/15 studies that included facial affect recognition skills (ES = .84) and 10/13 studies that included theory-of-mind (ES = .70) as outcomes. Less than half (4/9) of studies that measured attributional style as an outcome reported effects of treatment, but effect sizes across studies were significant (ESs = .30–.52). Theeffect sizes for symptoms were modest, but, with the exception of positive symptoms, significant (ESs = .32–.40). The majority of trials were randomized (13/16), selected active control conditions (11/16) and included at least 30 participants (12/16). Concerns for this area of research include the absence of blinded outcome raters in more than 50% of trials and low rates of utilization of procedures for maintaining treatment fidelity. These findings provide preliminary support for the broader use of comprehensive social cognitive training procedures as a psychosocial intervention for schizophrenia.