바로가기메뉴

본문 바로가기 주메뉴 바로가기

logo

메뉴

A Study on the efficacy of a Social Cognition Enhancing Rehabilitation Program (SERP) focused on Theory of Mind for individuals with Schizophrenia in the Community

Abstract

People with schizophrenia show major deficits in social cognition, especially theory of mind (ToM). Social cognitive deficits are promising treatment targets for new interventions to improve functional outcome in schizophrenia. The purpose of this study was to examine the efficacy of a Social-Cognition Rehabilitation Program (SERP) focused on theory of mind. This program was modified from the original version, developed by Kwon (2003) and verified by Choi and Kwon (2006), especially for improvement of theory of mind. The SERP focused on theory of mind was composed of 16 sessions, including 14 sessions dealing with faux pas, hidden intentions and emotions and one session each for orientation and ending. The aim of the program was to help individuals with schizophrenia to enhance social cognition including theory of mind and ultimately to promote daily social skills and interpersonal ability. The SERP focused on theory of mind was compared with treatment as usual within a two group pre-post design in 52 people with schizophrenia in the community. Theory of mind, social cognition and functional outcome were assessed before and after the eight week training phase. Patients in the treatment group showed significant improvement theory of mind and social skill abilities after the program, but not in general social cognition and interpersonal abilities. Our findings suggested that theory of mind could be improved in people with schizophrenia by implementation of a social cognition enhancing rehabilitation program focused on theory of mind. Conduct of further study will be needed in order to determine whether enhanced theory of mind will have an effect on general social cognition.

keywords
조현병, 마음이론, 사회인지, 인지재활, Schizophrenia, Theory of Mind, Social cognition, Social-Cognition Enhancing Rehabilitation

Reference

1.

권정혜 (2003). 사회인지 재활프로그램. 학지사.

2.

권정혜, 전진수, & 최기홍 (2003). 사회행동 배열과제의 개발과 타당도 연구. 한국심리학회지: 임상, 22, 629-639.

3.

김성직, & 한양순 (1997). 만성 정신분열병의사회적 기능과 인지적 변인 및 증상과의관계. 한국심리학회지: 임상, 16, 27-40.

4.

김정규, 염태호, 오경자, 박영숙 & 이영호 (1992). 한국판 웩슬러지능검사 개정판의 문항분석. 한국심리학회지: 임상, 11, 1-10

5.

김진성 (2007). 정신분열병 환자를 위한 사회인지 재활프로그램의 효과, 고려대학교 대학원.

6.

김철권, & 변원탁(공역) (2000). 정신과 환자를위한 사회기술훈련. 하나의학사.

7.

리광철, 오상우, 정일관, 백영석, & 박민철 (2002). 정신분열병 환자의 인지결함. 한국 심리학회지: 임상, 21, 377-389.

8.

미국정신의학협회 (1994). Diagnotstic and statistical manual of mental disorders (4 ed.). Washington D. C: Author.

9.

박상규, & 손명자 (2000). 조망적 사회기술훈련이 조현병 환자의 사회기술 향상에 미치는 효과. 한국심리학회지: 임상, 19, 629-643.

10.

신윤정 (2004). 조현병 환자의 마음이론, 서울대학교 대학원.

11.

염태호, 박영숙, 오경자, 김정규, & 이영호 (1992). K-WAIS 실시요강. 한국가이던스.

12.

허두호, 박재홍, 권성민, 김양태, 권도훈, 조성남 & 유병국 (2006). 조현병 환자에서 힌트 과제와 눈빛과제를 이용한 마음이론연구. 생물치료정신의학. 12, 215-223.

13.

Abi-Saab, D., Foszdon, J., Bryson, G., & Bell, M. D. (2006). The implications of memory profiles in schizophrenia on vocational and neuropsychological functioning. Psychiatry Research, 142, 67-78.

14.

Ackerman, B. (1981). Young children’s understanding of a false utterance. Development Psychology, 31, 472-480.

15.

Ashington, J. W., Harris, P. L., & Olson, D. L. (1988). Developing Theory of Mind. Cambridge: University Press.

16.

Baron-Cohen, S. (1991). The theory of mind deficit in autism: How specific is it? British Journal of Development Psychology, 9, 301-314.

17.

Baron-Cohen, S., & Howlin, P. (1993). The theory of mind deficit in autisom: Some questions for teaching and diagnosis. In S. Baron-Cohen, H. Tager-Flusberg, & D. S. Cohen(Eds.), Understanding other minds: Perspectives from autism (pp.466-480). New York: Oxford University Press.

18.

Baron-Cohen, S., Leslie, A. M., & Frith, U. (1985). Does the autistic child have a “theory of mind”? Cognition, 21, 37-46.

19.

Baron-Cohen, S., O’Riordan, M., Stone, V., Jones, R., & Plaisted, K. (1999). Recognition of faux pas by normally developing children and children with Asperger syndrome or highfunctioning autism. Journal of Autism and Development Disorder, 29, 407-418.

20.

Bell, M., Tsang, H. W., Greig, T. C., & Bryson, G. J. (2009). Neurocognition, social cognition, perceived social discomfort, and vocational outcomes in schizophrenia. Schizophrenia Bulletin, 35, 738-747.

21.

Bellack, A. S., Morrison, R. L., Mueser, K. T., Wade, J. H., & Sayers, S. L. (1990). Roleplay for assessing the social competence of psychiatric patients. Psychological Assessment, 248-255.

22.

Bellack, A. S., Morrison, R. L., Wixted, J. T., & Mueser, K. T. (1990). An analysis of social competence in schizophrenia. British Journal of Psychiatry, 156, 809-818.

23.

Blakemore, S. J., Sarfati, Y., Bazin, N., & Decety, J. (2003). The detection of intentional contingencies in simple animations in patients with delusions of persecution. Psychological Medication, 33, 1433-1441.

24.

Blair, R. J., & Cipolotti, L. (2000). Impaired social response reversal. A case of ‘acquired sociopathy’. Brain, 123, 1122-1141.

25.

Bonshtein, U. (2006). Theory of mind in schizophrenia. Harefuah, 145, 926-931, 939.

26.

Bora, E., Eryavuz, A., Kayahan, B., Sungu, G., & Veznedaroglu, B. (2006). Social functioning, theory of mind and neurocognition in outpatients with schizophrenia; mental state decoding may be a better predictor of social functioning than mental state reasoning. Psychiatry Research, 145, 95-103.

27.

Bora, E., Yucel, M., & Pantelis, C. (2009). Theory of mind impairment in schizophrenia: metaanalysis. Schizophrenia Research, 109, 1-9.

28.

Brekke, J., Kay, D. D., Lee, K. S., & Green, M. F. (2005). Biosocial pathways to functional outcome in schizophrenia. Schizophrenia Research, 80, 213-225.

29.

Brenner, H., Roder, V., Hodel, B., Kienzle, N., Reed, D., & Liberman, R. (1994). Integrated psychological therapy for schizophrenia patients. Toronto: Hogrefe & Huber.

30.

Brune, M. (2005). Emotion recognition, ‘theory of mind,’ and social behavior in schizophrenia. Psychiatry Research, 133, 135-147.

31.

Choi, K. H., & Kwon, J. H. (2006). Social Cognition Enhancement Training for Schizophrenia: A Preliminary Randomized Controlled Trial. Community Mental Health Journal, 42, 177-187.

32.

Corcoran, R., Mercer, G., & Frith, C. D. (1995). Schizophrenia, symptomatology and social inference: investigating “theory of mind” in people with schizophrenia. Schizophrenia Research, 17, 5-13.

33.

Corrigan, P. W., & Penn, D. L. (2001). Introduction: framing models of social cognition and schizophrenia Social cognition and schizophrenia (1st ed., pp.3-37). Washington, D.C.: American Psychological Association.

34.

Couture, S. M., Penn, D. L., & Roberts, D. L. (2006). The functional significance of social cognition in schizophrenia: a review. Schizophrenia Bulletin, 32 Suppl 1, S44-63.

35.

de Achaval, D., Costanzo, E. Y., Villarreal, M., Jauregui, I. O., Chiodi, A., Castro, M. N. (2010). Emotion processing and theory of mind in schizophrenia patients and their unaffected first-degree relatives. Neuropsychologia, 48, 1209-1215.

36.

Dilk, M. N., & Bond, G. R. (1996). Meta-analytic evaluation of skills training research for individuals with severe mental illness. Journal of Consulting and Clinical Psychology, 64, 1337- 1346.

37.

Drury, V. M., Robinson, E. J., & Birchwood, M. (1998). ‘Theory of mind’ skills during an acute episode of psychosis and following recovery. Psychological Medicine, 28, 1101-1112.

38.

Dunn, J. (1999). Mindreading and social relationships. In M. Bennett (Ed.), Developmental psychology: Achievements and prospects (pp.55-71). Philadelphia, PA: Psychology Press.

39.

Evans, J. D., Bond, G. R., Meyer, P. S., Kim, H. W., Lysaker, P. H., Gibson, P. J., et al. (2004). Cognitive and clinical predictors of success in vocational rehabilitation in schizophrenia. Schizophrenia Research, 70, 331- 342.

40.

Fanning, J. R., Bell, M. D., & Fiszdon, J. M. (2012). Is it possible to have impaired neurocognition but good social cognition in schizophrenia? Schizophrenia Research, 135, 68- 71.

41.

Fett, A. K. J., Viechbauer, W., Dominguez, M, D., Penn, D, L., van Os, J., & Krabbendam, L. (2011). The relationship between neurocognition and social cognition with functioal outcomes in schizophrenia: a metaanalysis. Neuroscience & Biobehavioral Reviews, 35, 573-588.

42.

Fine, C., Lumsden, J., & Blair, R. J. (2001). Dissociation between ‘theory of mind’ and executive functions in a patient with early left amygdala damage. Brain, 124, 287-298.

43.

Fiske, S. T., & Taylor, S. E. (1991). Social cognition (2nd Ed.). New York: McGraw-Hill.

44.

Frith, C. D. (1992). Schizophrenia as a disorder of self-awareness The Cognitive Neuropsychology of Schizophrenia (pp.113-135). UK.

45.

Frith, C. D., & Corcoran, R. (1996). Exploring ‘theory of mind’ in people with schizophrenia. Psychological Medicine, 26, 521-530.

46.

Glynn, S. M. (1998). Psychopathology and social functioning in schizophrenia. In K. T. Mueser & N. Tarrier (Eds.), Handbook of social functioning in schizophrenia (pp.66-78). Boston: Allyn & Bacon.

47.

Goldberg, J. O., & Schmidt, L. A. (2001). Shyness, sociability, and social dysfunction in schizophrenia. Schizophrenia Research, 48, 343- 349.

48.

Green, M. F. (1996). What are the functional consequences of neurocognitive deficits in schizophrenia? American Journal of Psychiatry, 153, 321-330.

49.

Green, M. F., Kern, R. S., Braff, D. L., & Mintz, J. (2000). Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the “right stuff”? Schizophrenia Bulletin, 26, 119-136.

50.

Green, M. F., Nuechterlein, K. H., Gold, J. M., Barch, D. M., Cohen, J., Essock, S. (2004). Approaching a consensus cognitive battery for clinical trials in schizophrenia: the NIMHMATRICS conference to select cognitive domains and test criteria. Biological Psychiatry, 56, 301-307.

51.

Green, M. F., Nuechterlein, K. H., Kern, R. S., Baade, L. E., Fenton, W. S., Gold, J. M., et al. (2008). Functional co-primary measures for clinical trials in schizophrenia: results from the MATRICS Psychometric and Standardization Study. American Journal of Psychiatry, 165, 221- 228.

52.

Green, M. F., Olivier, B., Crawley, J. N., Penn, D. L., & Silverstein, S. (2005). Social cognition in schizophrenia: recommendations from the measurement and treatment research to improve cognition in schizophrenia new approaches conference. Schizophrenia Bulletin, 31, 882-887.

53.

Green, M. F., & Horan, W. P., (2010). Social cognition in schizophrenia, Current Directions in Psychological Science, 19, 243-248

54.

Greig, T. C., Bryson, G. J., & Bell, M. D. (2004). Theory of mind performance in schizophrenia: diagnostic, symptom, and neuropsychological correlates. Journal of Nerveous and Mental Disease, 192, 12-18.

55.

Halford, W. K., & Hayes, R. L. (1995). Social skills in schizophrenia: assessing the relationship between social skills, psychopathology and community functioning. Social Psychiatry and Psychiatry Epidemiology, 30, 14-19.

56.

Happe, F. G. (1994). Wechsler IQ profile and theory of mind in autism: a research note. Journal of Child Psychology and Psychiatry, 35, 1461-1471.

57.

Harrington, L., Siegert, R. J., & McClure, J. (2005). Theory of mind in schizophrenia: a critical review. Cognitive Neuropsychiatry, 10, 249-286.

58.

Herold, R., Tenyi, T., Lenard, K., & Trixler, M. (2002). Theory of mind deficit in people with schizophrenia during remission. Psychological Medicine, 32, 1125-1129.

59.

Hogarty, G. E., & Flesher, S. (1999a). Developmental theory for a cognitive enhancement therapy of schizophrenia. Schizophrenia Bulletin, 25, 677-692.

60.

Hogarty, G. E., & Flesher, S. (1999b). Practice principles of cognitive enhancement therapy for schizophrenia. Schizophrenia Bulletin, 25, 693-708.

61.

Inoue, Y., Yamada, K., Hirano, M., Shinohara, M., Tamaoki, T., Iguchi, H., et al. (2006). Impairment of theory of mind in patients in remission following first episode of schizophrenia. European Psychiatry Archives of and Clinical Neuroscience, 256, 326-328.

62.

Janssen, I., Krabbendam, L., Jolles, J., & van Os, J. (2003). Alterations in theory of mind in patients with schizophrenia and non-psychotic relatives. Acta Psychiatrica Scandinavica, 108, 110-117.

63.

Jones, W., Bellugi, U., Lai, Z., Chiles, M., Reilly, J., & Lincoln, A.(2000). II. Hypersociability in Williams Syndrome. Journal of Cognitive Neuroscience, 12 Suppl 1, 30-46.

64.

Kaney, S., & Bentall, R. P. (1989). Persecutory delusions and attributional style. British Journal of Medical Psychology, 62, 191-198.

65.

Koelkebeck, K., Pedersen, A., Suslow, T., Kueppers, K. A., Arolt, V., & Ohrmann, P. (2010). Theory of Mind in first-episode schizophrenia patients: Correlations with cognition and personality traits. Schizophrenia Research, 119, 115-123.

66.

Kopelowicz, A., Liberman, R. P., & Zarate, R. (2006). Recent advances in social skills training for schizophrenia. Schizophrenia Bulletin, 32 Suppl 1, S12-23.

67.

Langdon, R., Coltheart, M., Ward, P. B., & Catts, S. V. (2002). Disturbed communication in schizophrenia: the role of poor pragmatics and poor mind-reading. Psychological Medicine, 32, 1273-1284.

68.

Lee, K. H., Farrow, T. F., Spence, S. A., & Woodruff, P. W. (2004). Social cognition, brain networks and schizophrenia. Psychological Medicine, 34, 391-400.

69.

Lysaker, P. H., Bell, M. D., Zito, W. S., & Bioty, S. M. (1995). Social skills at work. Deficits and predictors of improvement in schizophrenia. Journal of Nervous and Mental Disease, 183, 688-692.

70.

Macdonald, E. M., Jackson, H. J., Hayes, R. L., Baglioni, A. J., Jr., & Madden, C. (1998). Social skill as determinant of social networks and perceived social support in schizophrenia. Schizophrenia Research, 29, 275-286.

71.

Marder, S. R., & Fenton, W. (2004). Measurement and Treatment Research to Improve Cognition in Schizophrenia: NIMH MATRICS initiative to support the development of agents for improving cognition in schizophrenia. Schizophrenia Research, 72, 5-9.

72.

Mazza, M., Di Michele, V., Pollice, R., Casacchia, M., & Roncone, R. (2008). Pragmatic language and theory of mind deficits in people with schizophrenia and their relatives. Psychopathology, 41, 254-263.

73.

Mazza, M., Pollice R., Pacitti F., Chizrapino M., Mariano M., Tripaldi., S., Casacchia M., & Roncone R. (2012). Rivista di psychiatria, 47, 327-336

74.

Mindt, M., Moss, M., & Spaulding, W. (1999). Cognitive measures: what can they tell us about social competence? Psychiatry Rehabilitation Skills, 3, 99-123.

75.

Mueser, K. T., Bellack, A. S., Douglas, M. S., & Morrison, R. L. (1991). Prevalence and stability of social skill deficits in schizophrenia. Schizophrenia Research, 5, 167-176.

76.

Mueser, K. T., Wallace, C. J., & Liberman, R. P. (1995). New developments in social skills training. Behavior Change, 12, 31-40.

77.

Ozonoff, S. & Miller, J. N. (1995). Teaching theory of mind: A new approach to social skills training for individuals with autism. Journal of Autism and Development Disorders, 25, 415-433.

78.

Penn, D. L., Addington, J., & Pinkham, A. (2006). social cognitive impairments. In J. A. Liberman, T. S. Stroup & D. O. Perkins (Eds.), American Association Textbook of Schizophrenia (1st ed., pp.261-274). Arington, VA: American Psychiatric Publishing Press.

79.

Penn, D. L., Roberts, D. L., Munt, E. D., Silverstein E., Jones, N., & Sheitman, B. (2005). A pilot study of social cognition and interaction training(SCIT) for schizophrenia. Schizophrenia Research. 80, 357-359.

80.

Penn, D. L., Corrigan, P. W., Bentall, R. P., Racenstein, J. M., & Newman, L. (1997). Social cognition in schizophrenia. Psychological Bulletin, 121, 114-132.

81.

Penn, D. L., Spaulding, W., Reed, D., & Sullivan, M. (1996). The relationship of social cognition to ward behavior in chronic schizophrenia. Schizophrenia Research, 20, 327-335.

82.

Penn, D. L., & Mueser, K. T. (1996). Research update on the psychosocial treatment of schizophrenia. American Journal of Psychiatry, 153, 607-617.

83.

Perner, J., & Witmmer, H. (1985). ‘John thinks that Mary thinks..’. Attribution of secondorder beliefs by 5-10 year old children. Journal of Experimental Child Psychology, 39, 437-471.

84.

Pickup, G. J. (2006). Theory of mind and its relation to schizotypy. Cognitive Neuropsychiatry, 11, 177-192.

85.

Pickup, G. J. (2008). Relationship between Theory of Mind and executive function in schizophrenia: a systematic review. Psychopathology, 41, 206-213.

86.

Pickup, G. J., & Frith, C. D. (2001a). Theory of mind impairments in schizophrenia: symptomatology, severity and specificity. Psychological Medicine, 31, 207-220.

87.

Premack, D., & Woodruff, G. (1978). Does the chimpanzee have a theory of mind? Behavioral and Brain Sciences, 1, 515-526.

88.

Roberts, D. L., & Penn, D. L. (2009). Social cognition and interaction training (SCIT) for outpatients with schizophrenia: a preliminary study. Psychiatry Research, 166, 141-147.

89.

Roncone, R., Falloon, I. R., Mazza, M., De Risio, A., Pollice, R., Necozione, S., et al. (2002). Is theory of mind in schizophrenia more strongly associated with clinical and social functioning than with neurocognitive deficits? Psychopathology, 35, 280-288.

90.

Roncone, R., Mazza, M., Frangou, I., De Risio. A., Ussorio, D., Tozzini. C., & Casacchia. M. (2004). Rehabilitation of theory of mind deficit in schizophrenia: A pilot study of metacognitive strategies in group treatment. Neuropsychological Rehabilitation, 14, 421-435.

91.

Sarfati, Y., Hardy-Bayle, M. C., Brunet, E., & Widlocher, D. (1999). Investigating theory of mind in schizophrenia: influence of verbalization in disorganized and nondisorganized patients. Schizophrenia Research, 37, 183-190.

92.

Schneider, D. J. (1991). Social cognition. Annual Review of Psychology, 42, 527-561.

93.

Sergi, M. J., Rassovsky, Y., Nuechterlein, K. H., & Green, M. F. (2006). Social perception as a mediator of the influence of early visual processing on functional status in schizophrenia. American Journal of Psychiatry, 163, 448-454.

94.

Sergi, M. J., Rassovsky, Y., Widmark, C., Reist, C., Erhart, S., & Braff, D. L., (2007). Social cognition in schizophrenia: relationships with neurocognition and negative symptoms. Schizophrenia Research, 90, 316-324.

95.

Silver, H., Goodman, C., Knoll, G., & Isakov, V. (2004). Brief emotion training improves recognition of facial emotions in chronic schizophrenia. A pilot study. Psychiatry Research, 128, 147-154.

96.

Spaulding, W. D., Fleming, S. K., Reed, D., Sullivan, M., Storzbach, D., & Lam, M. (1999). Cognitive functioning in schizophrenia: implications for psychiatric rehabilitation. Schizophrenia Bulletine, 25, 275-289.

97.

Sprong, M., Schothorst, P., Vos, E., Hox, J., & van Engeland, H. (2007). Theory of mind in schizophrenia: meta-analysis. British Journal of Psychiatry, 191, 5-13.

98.

Stone, V. E., Baron-Cohen, S., & Knight, R. T. (1998). Frontal lobe contributions to theory of mind. Journal of Cognitive Neuroscience, 10, 640- 656.

99.

Sullivan, K., Winner, E., & Hopfield, N. (1995). How children tell lie from joke: The role of second drder mental state attribution. British Journal of Development Psychology, 22, 974-982.

100.

Uhlhaas, P. J., Phillips, W. A., Schenkel, L. S., & Silverstein, S. M. (2006). Theory of mind and perceptual context-processing in schizophrenia. Cognitive Neuropsychiatry, 11, 416-436.

101.

Vauth, R., Rüsch, N., Wirtz, M., & Corrigan, P. W. (2004). Does social cognition influence the relation between neurocognitive deficits and vocational functioning in schizophrenia? Psychiatry Research, 128, 155-165.

102.

Wechsler, D. (1981). Wechsler Adult Intelligence Scale, Revised. New York: Psychological Corp.

103.

Wellace C. J. (1986). Functional assessment in rehabilitation. Schizophrenia Bulletin, 12, 604- 630.

104.

Wellman, H. M., Cross, D., & Watson, J. (2001). Meta-analysis of theory-of-mind development: the truth about false belief. Child Development, 72, 655-684.

105.

Whiten, A. (1999). The evolution of deep social mind in humans. In M. C. Corballis & S. E. G. Lea (Eds.), The descent of mind: Psychological perspectives on hominid evolution (pp.173-193). New York: Oxford University Press.

106.

Wimmer, H., & Perner, J. (1983). Beliefs about beliefs: representation and constraining function of wrong beliefs in young children's understanding of deception. Cognition, 13, 103- 128.

107.

Wolwer, W., Frommann, N., Halfmann, S., Piaszek, A., Streit, M., & Gaebel, W. (2005). Remediation of impairments in facial affect recognition in schizophrenia: efficacy and specificity of a new training program. Schizophrenia Research, 80, 295-303.

108.

Wykes, T., Reeder, C., Corner, J., Williams, C., & Everitt, B. (1999). The effects of neurocognitive remediation on executive processing in patients with schizophrenia. Schizophrenia Bulletin, 25, 291-307.

109.

Zanello, A., Perrig, L., & Huguelet, P. (2006). Cognitive functions related to interpersonal problem-solving skills in schizophrenic patients compared with healthy subjects. Psychiatry Research, 142, 67-78.

logo