Social Cognition and Interaction Training (SCIT) for Deaf People with Schizophrenia: Preliminary Findings

Background and Purpose: Social Cognition and Interaction Training (SCIT) is a manual-based group intervention designed to improve social cognition in schizophrenia. Previous research has revealed that SCIT improves emotion perception and theory of mind, two domains of social cognition consistently related to functional outcomes. Ongoing work by this researcher and others aims to evaluate SCIT’s effectiveness in reducing such deficits so that people with schizophrenia can enjoy higher levels of social integration and independence. The purpose of this pilot study was to examine the feasibility, acceptability, and effectiveness of SCIT with deaf participants in the context of a collaborative research-clinical approach. The evaluation met the administrative goals of participating clinics and worked within the constraints of real-world clinical practice. It was hypothesized that an adapted version of SCIT would be well-tolerated due to its emphasis on social interaction, role play, and (sign language) communication.

Methods: Participants were recruited from a psychiatric center in New York. A total of six deaf persons completed the 12-week training: Three with schizophrenia and three with other psychotic disorders. The intervention was facilitated by two fluent signers (one deaf, one hearing), each of whom had worked with the population for many years. An uncontrolled, pre-post design was employed. Outcomes were evaluated in terms of symptom ratings and client satisfaction ratings; social-cognitive and cognitive outcome measures assessed emotion perception, theory of mind, visual-spatial and word memory. Pre- and post-treatment values were probed using dependent sample t-tests for each outcome variable (one-tailed, p<.10) and both with-in group and intra-individual effect sizes were estimated using Cohen's d.

Results: Client satisfaction ratings revealed a high level of acceptability and tolerance for the intervention. Statistical analyses indicated a significant reduction, from pre- to post testing, in affective symptoms (depression, suicidality, and anxiety) as well as thought disorder symptoms (unusual thought content, grandiosity, and suspiciousness) (change in mean [ΔM])=.42, p<.10, d=-1.09; ΔM=.17, p<.10, d=-1.09, respectively). Word memory ability improved significantly for all participants (ΔM=10.67, p<.10, d=.82; ΔM=3.00,P<.10, d=1.75), while a trend level reduction was apparent in levels of visual-spatial memory (ΔM=4.5, p<.12, d=.67). Among the participants with schizophrenia (n=3), large effect sizes and significant (positive) intra-individual differences in pre- and post-test scores were found for emotion perception (ΔM=5.34, P<.05 d=4.62) and theory of mind (the Hinting Task) (ΔM=3.34, p<.05, d=1.44) .

Conclusions and Implications: Deaf participants who received an adaptation of SCIT showed a significant reduction in affect and thought disorder symptoms. Social-cognitive abilities were improved only in patients with schizophrenia, supporting the idea that SCIT is particularly effective with this population. To our knowledge, this is the first study on social cognition training for deaf people and it provided preliminary evidence that SCIT can be used effectively. SCIT tasks represent highly valued activities in the deaf community and are integral to Deaf Culture. Practice implications relate directly to expanding opportunities for deaf individuals to participate in interventions, like SCIT, that broaden social interactions and create opportunities to engage with high level signers in meaningful treatment experiences.