Randomized controlled trial of Understanding Social Situations versus problem-solving training in improving social function in people with psychosis

OBJECTIVES: Poor social function in people with psychosis has been linked to impairments in social cognition and neurocognition, which in turn have been identified as promising treatment targets. We developed a novel social cognitive intervention, Understanding Social Situations (USS), that minimizes cognitive load by leveraging delivery methods common to cognitive rehabilitation. USS focuses on making good judgments about what others may be feeling and thinking, and how they might respond in various social scenarios. In the current trial, we evaluated the efficacy of USS versus an active control. METHODS: 103 Veterans with psychotic spectrum disorders were randomized to two months of USS training or a problem-solving training matched for nonspecific treatment factors. Comprehensive assessments included clinician-aided self-report social functioning, social skills performance, and pre/post/follow-up ecological momentary assessments about the extent and quality of social interactions. RESULTS: Participants in USS had significant within but not between group improvements on a clinician-aided self-report measure of social function. Social skills performance did not change for either condition. Momentary assessments revealed no change in frequency of social contacts, but those in the USS condition showed within-group improvements on comfort level during current social interactions and anticipated positive appraisals of future interactions. Those randomized to problem-solving training had significantly greater improvements in depression at post-training. CONCLUSIONS: More rigorous trials are needed evaluating the impact of social cognitive interventions on real-world social functioning. It may be particularly important to link interventions to lived social experience and to assess the quality of social interactions.