Social cognition in schizophrenia: an NIMH workshop on definitions, assessment, and research opportunities.
ABSTRACT Social cognition has become a high priority area for the study of schizophrenia. However, despite developments in this area, progress remains limited by inconsistent terminology and differences in the way social cognition is measured. To address these obstacles, a consensus-building meeting on social cognition in schizophrenia was held at the National Institute of Mental Health in March 2006. Agreement was reached on several points, including definitions of terms, the significance of social cognition for schizophrenia research, and suggestions for future research directions. The importance of translational interdisciplinary research teams was emphasized. The current article presents a summary of these discussions.
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ABSTRACT: Background People with chronic psychosis often display theory of mind impairments that are not fully accounted for by other, more general neurocognitive deficits. In these patients, both theory of mind and neurocognitive deficits contribute to poor functioning, independently of psychotic symptoms. In young people with recent-onset psychosis, however, it is unclear the extent to which theory of mind impairment is independent of neurocognitive deficits. The primary aim of this study was to examine the evidence for specific theory of mind impairments in early psychosis. A secondary aim was to explore the relations between theory of mind, neurocognition, symptom severity, and functional outcomes.Methods Twenty-three patients who were within two years of their first psychotic episode and 19 healthy controls completed theory of mind and neurocognitive batteries. Social functioning, quality of life, and symptom severity were also assessed in patients.ResultsPatients demonstrated deficits in tasks assessing theory of mind and neurocognition relative to controls. Patients¿ deficits in theory of mind were evident even after adjusting for their deficits in neurocognition. Neither theory of mind nor neurocognition predicted social functioning or quality of life in this early psychosis sample. Severity of negative symptoms, however, was a significant predictor of both outcomes.Conclusions While a specific theory of mind impairment was evident in this early psychosis sample, severity of negative symptoms emerged as the best predictor of poor functional outcome. Further early psychosis research is needed to examine the longitudinal progression of theory of mind impairments ¿ independent of neurocognitive deficits ¿ and their impact on psychosocial function.BMC Psychiatry 12/2014; 14(1):316. · 2.24 Impact Factor
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ABSTRACT: While the role of impaired neurocognition in accounting for functional outcome in schizophrenia is generally established, the influence of social cognition on this relationship is far from clear. This study aims to explore in depth the nature of the relationship between neurocognition, social cognition and daily functioning in people with schizophrenia. Twenty-one individuals diagnosed with schizophrenia and 15 controls completed the assessment of symptom severity, neuropsychological status, social cognition (Theory of Mind and affect processing) and other functional measures. A statistical mediation model based on hierarchical regression analyses was used to establish the mediation path with significant variables. Social cognition played a mediating role between neurocognition and functioning, accounting for significant trends in incremental variance in specific functional indexes (interpersonal behavior and employment/occupation). Consequently, this study adds to the evidence underlining the importance of targeting not only social cognitive or neurocognitive functions but to combine both interventions to reveal the best daily functioning results in schizophrenia patients.Psychiatry Research 02/2015; 225(3):374-380. · 2.68 Impact Factor
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ABSTRACT: Schizophrenia is a chronic illness affecting approximately 0.5-1% of the world's population. The etiology of schizophrenia is complex, including multiple genes and contributing environmental effects that adversely impact neurodevelopment. Nevertheless, a final common result, present in many subjects with schizophrenia, is impairment of pyramidal neuron dendritic morphology in multiple regions of the cerebral cortex. In this review we summarize the evidence of reduced dendritic spine density and other dendritic abnormalities in schizophrenia, evaluate current data that informs the neurodevelopment timing of these impairments, and discuss what is known about possible upstream sources of dendritic spine loss in this illness. Copyright © 2014. Published by Elsevier Ireland Ltd.Neuroscience Letters 12/2014; · 2.06 Impact Factor
Social Cognition in Schizophrenia: An NIMH Workshop on Definitions, Assessment,
and Research Opportunities
Michael F. Green1–3, David L. Penn4, Richard Bentall5,
William T. Carpenter6,7, Wolfgang Gaebel8, Ruben
C. Gur9, Ann M. Kring10, Sohee Park11, Steven
M. Silverstein12, and Robert Heinssen13
2Department of Psychiatry and Biobehavioral Sciences, Geffen
School of Medicine at UCLA, Los Angeles, CA;3VA Greater Los
Angeles Healthcare System, Los Angeles, CA;4Department of
Psychology, University of North Carolina-Chapel Hill, NC;
5School of Psychology, University of Wales, Bangor, UK;
University of Maryland School of Medicine, Baltimore, MD;
7VISN 5 Mental Illness Research, Education, and Clinical Center,
Veterans Administration, Baltimore, MD;8Department of
Psychiatry, Heinrich-Heine-University Du ¨sseldorf, Du ¨sseldorf,
Germany;9University of Pennsylvania School of Medicine,
Philadelphia, PA;10University of California, Berkeley, CA;
11Departments of Psychology and Psychiatry, Vanderbilt Univer-
sity, Nashville, TN;12University Behavioral HealthCare and
Dentistry of New Jersey, Piscataway, NJ;13Division of Adult
Translational Research and Treatment Development, National
Institute of Mental Health, Bethesda, MD
Social cognition has become a high priority area for the
study of schizophrenia. However, despite developments
in this area, progress remains limited by inconsistent termi-
nology and differences in the way social cognition is mea-
sured. To address these obstacles, a consensus-building
meeting on social cognition in schizophrenia was held at
the National Institute of Mental Health in March 2006.
Agreement was reached on several points, including defini-
tions of terms, the significance of social cognition for
schizophrenia research, and suggestions for future research
directions. The importance of translational interdisciplin-
ary research teams was emphasized. The current article
presents a summary of these discussions.
Key words: social cognition/schizophrenia/NIMH
The term social cognition is defined in various ways, but
generally refers to the mental operations that underlie so-
cial interactions, including perceiving, interpreting, and
generating responses to the intentions, dispositions,
and behaviors of others.1–4In humans, social cognition
means people thinking and forming impressions about
people. Social cognitive processes are how we draw infer-
encesaboutother people’s beliefsand intentionsand how
we weigh social situational factors in making these infer-
ences. Over the past 15 years, clinical investigators and
behavioral scientists have increasingly employed social
cognitive constructs to explore the symptoms and inter-
personal deficits that characterize schizophrenia.5–7In-
deed, social cognition has emerged as a high priority
geoning empirical literature and increased attention in
The impetus for the present meeting on social cogni-
tion in schizophrenia arose from 2 events. First, social
cognition was seen as a key domain for consideration
during the first meeting of the NIMH-sponsored Mea-
surement and Treatment Research to Improve Cognition
in Schizophrenia (MATRICS) Initiative. Social cogni-
tion was ultimately included as 1 of the 7 domains rep-
Battery for clinical trials in schizophrenia.9,10Second, so-
cial cognition was a specific topic of discussion at the
New Approaches Conference (NAC), which was the final
meeting of the MATRICS conference series. Although
there was general agreement among NAC participants
that social cognition is a valuable construct for under-
standing the nature and disability of schizophrenia,
a number of potential obstacles were identified that could
impede progress in this area, including the lack of agree-
This article summarizes a subsequent meeting spon-
sored by the National Institute of Mental Health
‘‘Social Cognition in Schizophrenia: Basic Definitions,
Methods of Assessment, and Research Opportunities’’
was organized by Drs Green, Penn, and Heinssen and
took place in March 28–29, 2006. Participants included
the authors on this article as well as additional extramu-
ral program staff from NIMH. The main topics and dis-
cussion questions that structured the meeting are
1To whom correspondence should be addressed; UCLA Semel
Institute for Neuroscience and Human Behavior, 300 Medical
Plaza, Room 2263, Los Angeles, CA 90095-6968; tel: 310-794-
1993, fax: 310-825-6626, e-mail: email@example.com.
? The Author 2008. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved.
For permissions, please email: firstname.lastname@example.org.
Schizophrenia Bulletin Advance Access published January 8, 2008
agreement, to the extent possible, on the definitions of
terms in this area and on the significance of social cog-
nition in schizophrenia research for understanding clin-
ical symptoms and outcome and to suggest promising
research directions. The remainder of this article summa-
rizes the discussion of these topics.
Defining Social Cognition in Schizophrenia
terms that are commonly used in schizophrenia research.
Ambiguous and inconsistent terminology can complicate
communication among researchers and make it more
difficult to draw inferences across studies. As a starting
point for the discussion, participants reviewed recent
publications that suggested research in social cognition
in schizophrenia fits into the following 5 areas.8,11
1. Theory of mind. Theory of mind (also called mental
state attribution) typically involves the ability to infer
intentions, dispositions, and beliefs of others.12,13
Much of initial interest in this area focused on studies
of children and how theory of mind is acquired in
normal and abnormal development. Hence, many
measures in this area were initially developed for
use with children. Theory of mind has been extended
to schizophrenia, partly due to similarity between
aspects of social dysfunction in autism and a subgroup
of patients with schizophrenia, and following sugges-
the formation of clinical symptoms.13–16
2. Social perception. Tests of social perception assess
one’s ability to identify social roles, societal rules,
and social context.17–19In social perception tasks, par-
ticipants must process nonverbal, paraverbal, and/or
verbal cues to make inferences about complex or am-
biguous social situations. Individuals may be asked to
identify interpersonal features in a situation such as
intimacy, status, mood state, and veracity. This area
can also include ‘‘relationship perception,’’ which
refers to perception of the nature of relationships be-
tween people.20Social perception is one of the social
cognitive areas related to community functioning in
schizophrenia, and hence, may be a rational focus
for interventions designed to enhance functional
3. Social knowledge. This area refers to awareness of the
roles, rules, and goals that characterize social situa-
tions and guide social interactions.22–24Social knowl-
edge (also called social schema) can be measured with
paper and pencil tests that assess one’s awareness of
what is socially expected in different situations (eg,
in adoctor’s office vs in arestaurant). It has been stud-
ied somewhat less than the other areas in schizophre-
nia, and it overlaps with social perception; successful
social knowledge requires awareness of which cues oc-
cur typically in specific social situations (ie, social per-
ception) and how one is supposed to respond to them.
Social knowledge is viewed as an initial step and pre-
requisite for adequate social competence25and has
been targeted for intervention in some social skills
training programs for schizophrenia.26
4. Attributional bias. Attributions are causal statements;
ie, statements that either include or imply the word
‘‘because.’’ They are a very frequent type of verbal be-
havior and are found in every hundred words or so of
speech.27Unlike mental state attribution (theory of
ically infer the causes of particular positive and nega-
tive events. Attributions
questionnaires28or rated from transcripts of interac-
tions.29In research involving both psychiatric and
nonpsychiatric samples, key distinctions are typically
made between external personal attributions (ie,
causes attributed to other people), external situational
attributions (ie, causes attributed to situational fac-
tors), and internal attributions (ie, causes due to one-
self). Application of these categories to clinical
samplesreveals that individualswith persecutorydelu-
sions often attribute negative outcomes to others,
Table 1 Topics and Questions at the NIMH Workshop on Social
Cognition in Schizophrenia
Defining social cognition in schizophrenia
1. What domains of social cognition should be considered? Is
there empirical support for these domains?
2. What is the factor structure of social cognition in
schizophrenia? Are there data on factor structures in normal
3. What is the relationship of social cognition to neurocognition?
4. Can work from basic neuroscience or social psychology inform
the definitions and boundaries of social cognition in
Establishing the significance of social cognition in schizophrenia:
relationships to clinical symptoms and functional outcome
1. What is social cognition’s relationship with positive symptoms
(eg, paranoia), negative symptoms, and disorganization?
2. What is the functional significance of social cognition? Does it
behave as a mediator?
3. Social cognition and the course of schizophrenia: does it
predate the illness or occur early in the illness? Are the
impairments trait like?
Measuring social cognition in schizophrenia
1. What are the psychometric problems with current measures
when used with schizophrenia patients?
2. Should measures developed for other clinical populations (eg,
brain injury, autism) guide measurement development for
Identifying obstacles to research progress
1. What conceptual or methodological barriers must be overcome
to advance social cognition research in schizophrenia?
2. How might meaningful collaborations be developed between
social cognition researchers in schizophrenia, basic social
scientists, and cognitive neuroscientists?
M. F. Green et al.
bias.30,31Research involving persons with schizophre-
nia has also focused on hostile attributional biases or
the tendency to attribute hostile intentions to others’
5. Emotional processing. Emotional processing refers
broadly to perceiving and using emotions.33One influ-
intelligence as a set of 4 components, including identi-
fying emotions, facilitating emotions, understanding
emotions, and managing emotions.34,35This model
includes affect perception, a domain of emotion pro-
cessing that is frequently measured in schizophrenia
research.36–38Measures of emotion processing vary
broadly and include ratings of emotions that are dis-
played in faces or voices or ratings from brief vignettes
of how individuals manage, regulate, or facilitate
Although there was general agreement among meeting
participants that these 5 areas of social cognition capture
much of the research in schizophrenia, 2 important cav-
eats were mentioned. First, it was noted that boundaries
between the categories listed above are not absolute and
thereis considerableoverlapamong the terms.For exam-
ple, identifying emotions is clearly a component of emo-
tional processing but is sometimes considered to be an
aspect of theory of mind. Likewise, social knowledge
overlaps with social perception. Second, participants rec-
ognized that studies of social cognition in nonpsychiatric
samples would not be organized the same way and would
include a larger set of research topics. For example, emo-
nition in schizophrenia research, may be treated as
a separate domain from social cognition in nonclinical
studies. Other topics that are included in studies of non-
clinical social cognition include self-perception, prejudice
and stereotyping, empathy, hindsight bias, and counter-
factual thinking, among others. For the most part, these
topics have not yet been adequately addressed (or only
addressed in a preliminary way) in schizophrenia re-
search, although they may have importance for under-
standing the clinical phenomenology and outcome of
vided a reasonable organizing framework for subsequent
How to Refine and Select Domains
Given the wide range of definitions for social cognitive
that are of highest priority for future research? The group
believed that the database is early in its development and
too limited to provide firm answers at this point. How-
ever,we identified a processthat will help to organizeand
parse the social cognitive landscape in schizophrenia
research. First, if a study includes a sufficient number
of measures and an adequate number of participants,
the researchers could conduct exploratory analyses of
the factor structure of social cognition in schizophrenia.
Such analyses are not common because few studies in-
clude a range of social cognitive measures, but they
are valuable in determining the degree of commonality
among measures. Second, after exploratory analyses it
will be possible to test theoretical models with confirma-
tory analyses. Such approaches provide a strong way to
test proposed models of social cognition, illness features,
and interpersonal functioning, but they require large
samples and a clearly articulated theoretical framework
as a starting point. Third, the division of social cognitive
constructs in schizophrenia will be informed by social
and affective neuroscience that can parse social cognitive
domains based on overlapping and distinct neural cir-
cuits. Identification of separate circuits supporting social
cognition will allow clinical researchers to determine
which ones are intact or aberrant in schizophrenia.
Fourth, it will be ultimately important to develop new
rowly and precisely, that are appropriate for clinical pop-
ulations, and that can be used repeatedly in intervention
studies. Such efforts are currently underway with the
NIMH Initiative, Cognitive Neuroscience for Treatment
Research to Improve Cognition in Schizophrenia
(CNTRICS) that is mentioned below.
Establishing the Significance of Social Cognition in
Schizophrenia: Relationships to Clinical Symptoms and
It was emphasized that social cognition in schizophrenia
is studied for a variety of different goals using very dif-
ferent frameworks. Hence, the added value of social cog-
nition varies depending on the scientific question of
a research program. Four types of goals were mentioned.
One was the use of social cognition for understanding the
development of particular clinical symptoms of schizo-
phrenia. A second was social cognition’s role in explain-
ing functional outcome differences in schizophrenia. A
third was determining whether social cognitive impair-
ments are stable traits in schizophrenia or fluctuate
over time. Each of these 3 goals will be discussed in
this article. A fourth goal in cognitive neuroscience stud-
iesinschizophrenia is tousesocialcognitiveconstructs to
identify neural substrates that are potentially distinct
from those of nonsocial cognitive domains.39–45As men-
tioned below, the extent to which these processes are sep-
arate is not clear. Empirical (correlational) relationships
have been demonstrated among social cognition (theory
of mind) impairments, impaired perceptual organization,
and disorganized thinking.46–48
might be taken to suggest the existence of a common
Social Cognition in Schizophrenia
context-dependent, binding process and its disruption in
schizophrenia. Such disruption may stem from underly-
ing abnormalities in the neural circuitry and neurotrans-
mitter systems known to be involved in modulatory
(excitatory and inhibitory) interactions.49The topic of
neural substrates of social cognition was viewed as
very important for schizophrenia research but was not
a main focus of this meeting.
Using Social Cognitive Constructs to Deconstruct
Psychotic Symptoms in Schizophrenia
One goal is to understand how social cognition is in-
volved in the formation of specific clinical symptoms,
such as paranoia or thought control.13,30From this per-
spective, abnormalities in social cognition would be
viewed asclose (proximal) causesof clinical phenomenol-
ogy. For example, the tendency of individuals with para-
noia or persecutory delusions to blame others, rather
than situations for negative outcomes, may result from
a jumping to conclusions reasoning bias and difficulties
in theory of mind processes,31which in turn may be
a function of a strong need for closure and cognitive
Social Cognition and Negative Symptoms in
Relationships amongsocial cognitive constructs andneg-
ative symptoms are less clear. Participants acknowledged
that although some overlap exists between negative
symptoms and social cognition in schizophrenia, it is un-
wise to combine the constructs at this point in time. In-
deed, some of this overlap may reflect the structure of
current negative symptom rating scales that include con-
ceptually distinct areas (such as social cognition) that are
not necessarily part of the negative symptom construct.53
The consensus of the meeting was that it is more infor-
mative to study negative symptoms and social cognition
separately and to analyze relationships between them un-
til we know more about areas of convergence and diver-
gence. Confirmatory factor analyses may be helpful in
testing various structural models, and initial efforts sup-
port the distinctiveness of social cognition and negative
symptoms.54In addition, social cognitive constructs may
have value in deconstructing specific negative symptoms
such as avolition and flat affect, similar to what has been
done with paranoia, although these studies have yet to be
Along these lines, there was considerable discussion
about social motivation/social drive. Social motivation/
drive is sometimes viewed as part of a broader definition
of social cognition, but it is typically viewed as a negative
symptom of schizophrenia (eg, asociality and avolition).
At present we cannot determine whether asociality and
avolition are by-products of impaired social cognition,
or whether these deficits impact social cognitive
performance adversely. For the time being, the partici-
pants suggested that it is better to continue to view social
motivation/drive as part of the negative symptom com-
plex, but that exploring relationships with social cogni-
tive constructs is an important topic for future
research. Efforts are currently underway to validate
a new negative symptom rating scale that arose from
the NIMH-MATRICS consensus development confer-
Symptom Rating Scale, carefully evaluates asociality and
avolition, so that studies can examine the relationship be-
tween these negative symptoms that are associated with
social drive and social cognition.
Social Cognition and Functional Outcome
appear to be key determinants of daily functioning in
schizophrenia, including instrumental actions, interper-
sonal functioning, and vocational achievement.57–62A re-
cent review of the literature found consistent patterns of
association with community functioning for 2 aspects of
social cognition (emotion perception and social percep-
tion) and preliminary trends in 2 others (theory of mind
and attributional style).61At an intuitive level, it is rea-
sonable to assume that social cognitive abilities enable
subjects to interact effectively with their social environ-
ment, and that deficits in social cognition could lead to
social misperceptions, resulting in inappropriate interper-
sonal reactions or social withdrawal.5,63Beyond the rep-
licated bivariate associations, there is increasing support
from studies that have used exploratory and confirmatory
analytic approaches that suggest that social cognitive pro-
cesses act as key mediators between basic (nonsocial) cog-
nition and functional outcome.21,64–66These studies of
mediation show that social cognition has significant rela-
tionships to basic cognition on the one hand, and to com-
munity functioning on the other, and that the direct
relationships between cognition and outcome are reduced
to themodel.Inaddition,social cognitioncontributesvar-
of nonsocial cognition.60,61,67,68
Based on the studies mentioned above, it is clear that
social cognitive measures have value for understanding
outcome, above and beyond basic (nonsocial) cognition
alone. However, the meeting participants acknowledged
that there is still considerable debate regarding whether
social cognitive processes are mainly unique or are fully
overlapping with basic cognitive processes. It is safe to
conclude there is some overlap between social and
non-social cognition, so the argument is about the degree
of overlap. A confirmatory factor analysis showed that
although social and basic cognition were closely con-
nected, separating these 2 domains provided significantly
M. F. Green et al.
better model fit compared with when they were com-
bined.54Similarly, a structural equation modeling study
found that the data fit the model well when social cogni-
tion and basic cognition were separated but not when the
2 domains were combined.65A third study recently used
confirmatory factor analysis to evaluate the structure of
IQ subtests in schizophrenia.69The results supported
(labeled a social cognition factor).
Consistent with these confirmatory analyses, a recent
study found that schizophrenia and schizoaffective
patients differed on a social cognitive measure but not
basic cognitive measures.70In addition, interesting disso-
socialcognitionisrelatively preserved,whereas nonsocial
cognition is not, although the opposite pattern may be
found in individuals with high functioning autism.44
Data from neurologically impaired populations also sup-
port the idea of some independence of social and nonso-
cial cognition. For example, Parkinson’s disease patients
have demonstrated impairments in emotion perception,
making emotional faces, and emotional facial imagery,
while demonstrating intact object imagery.71Dissocia-
have also been observed in cases of neurodegenerative
discussion about degree of overlap in nonclinical samples
based on neuroimaging results. Some investigators argue
for unique neural circuits associated with social and emo-
tional processes by subtractingout comparison tasksthat
control for the nonsocial components.42,73–76However,
these conclusions are actively debated.77–79Future stud-
ify neural circuitry that is unique to social cognition
versus circuits shared with other aspects of cognition.
State vs Trait Characteristics
There is little direct evidence on the question of whether
the impairments in social cognition can be viewed as state
or trait like. Attributional bias is viewed as a proximal
determinant of psychotic symptoms, and hence, tends
to be viewed as state related. At the same time, it would
be possible for stable low-level attributional bias in at-
chosis. Other social cognitive constructs such as emotion
and social perception may be more trait like because they
have been observed in first-degree relatives of patients
with schizophrenia (although the findings are not entirely
consistent80,81) and appear to be stable across different
stages of schizophrenia and in longitudinal studies82,83
(see Penn et al11for review of state vs trait issues for emo-
tion perception and theory of mind). In addition, emerg-
ing social cognitive data on the prodromal phase of
schizophrenia will help to address whether impairment
in social cognitive processes precedes the onset of
psychotic symptoms.84,85Overall, the state vs trait
aspects of social cognition was seen as a basic question
that remains largely unanswered, but it seemed likely
to the participants that the social cognitive subdomains
will vary in this respect.
Participants thought it unreasonable to assume that so-
cial cognition could be represented as a single construct.
Few data exist, however, concerning the factor structure
far this has not been a large problem as most studies in
schizophrenia include only one measure of social cogni-
tion, although there are exceptions.54,67However, this
will become a bigger challenge for the field as more stud-
ies include multiple measures, making it necessary to in-
dicate which subdomains are being represented. Given
the current paucity of data to address this question,
the group thought there is a risk in oversimplifying the
constructs and, for the time being, it may be safer to ex-
amine measures separately and not make strong assump-
tions about common factors.
Psychometric Characteristics of Existing Measures
There was agreement that the psychometric properties of
current social cognitive measures for schizophrenia are
generally inadequate or unknown. Measurement prob-
lems are a consideration for all social cognitive domains
but appear to be especially prominent for measures of
theory of mind and attributional style. One reason for
these difficulties is the common practice of taking meas-
ures developed for a nonpsychotic population and apply-
ing them directly to schizophrenia (such as measures of
theory of mind from autism). This process tends to result
and difficulties in interpreting the meaning of scores.
For attributional style, the Internal Personal Situational
Attributions Questionnaire (IPSAQ28) was developed
to help address psychometric problems in other meas-
ures. Although the IPSAQ has shown adequate psycho-
metric properties, questions remain on how to best
quantify performance and whether it is better to use rat-
ings from subjects or rater codings of responses as the
in assessment of attributional style is that the underlying
would make them less reliable and more state like. For
example, activation of situation-relevant self-schemas
may increase the availability of internal explanations
for negative events, resulting in a pessimistic shift in at-
tributional style that may be more pronounced in clinical
groups compared with controls.87Finally, it is unclear
whether problems in attributional style are present across
Social Cognition in Schizophrenia
all social situations or only those in which intention is
ambiguous. This issue has implications for treatment.32
Thus, further work is required to investigate the mecha-
nisms involved in making causal judgments in both
healthy and clinical groups.
The group noted that good psychometrics is desirable
in any type of research, but that the requirement for
strong psychometrics in measures increases with certain
types of studies. As one starts to measure social cognition
in studies that use correlational analyses (including re-
gression analysis, path analysis, and structural equation
modeling), it is critical for measures to have adequate
range and distributional properties. Perhaps, even higher
standards apply when tests are used as outcome measures
in clinical trials, as described in the next section.
Social Cognition as an Intervention Target
Although social cognition has not been commonly used
as an endpoint for intervention studies, it is increasingly
viewed as a treatment target for both pharmacological
and nonpharmacological (psychosocial) interventions.
Social cognitive measures were included in some clinical
trials with second-generation antipsychotic medications,
and the results have not been overly encouraging.88,89So-
cial cognition will now be examined more consistently
with novel compounds for cognition enhancement due
to its inclusion as one of the domains of the MATRICS
Consensus Cognitive Battery. Regarding nonpharmaco-
logical interventions, a variety of studies have examined
short-term intervention probes for social cognition, and
longer term social cognitive training programs are start-
ing to emerge internationally.90–94The validation studies
tions are well tolerated and generally enjoyed by patients
over extended periods (typically months). The initial
results from these studies, although preliminary, strongly
suggest that social cognitive interventions can improve
performance on social cognitive outcome measures.95
In addition,somestudieshave foundthat socialcognitive
When social cognition is used as an endpoint for phar-
macological or psychosocial interventions, it is essential
that the measures are standardized, have excellent test–
retest reliability, and possess good utility as a repeated
measure. In the absence of these psychometric qualities,
it will be difficult (or require very large samples) to detect
change with treatment,9and to interpret the clinical sig-
nificance or results. Challenges in adapting measures
from cognitive and affective neuroscience for use in clin-
ical trials of schizophrenia are currently being addressed
in an ongoing series of meetings, CNTRICS, with sum-
maries of anticipated problems and possible solutions
posted on the CNTRICS Web site (http://cntrics.ucdavis.
Identifying Obstacles to Progress in this Area
Three general obstacles to research progress were identi-
fied: (1) psychometrics and measurement, (2) maturity of
the field, and (3) a lack of interdisciplinary bridges be-
tween clinical and basic researchers. The first issue (psy-
chometrics and measurement) was mentioned above, so
here we briefly mention the other 2.
Maturity of the Field
The study of social cognition in schizophrenia is far from
new.56,96,97However, there is a large disparity between
the relatively limited data-based literature on social cog-
nition in schizophrenia and the very extensive and well-
established literature on nonsocial cognition. Hence,
there is still a need for a critical mass of data on relation-
ships between social cognition and symptoms or func-
tional outcome. Similarly, there is a need for a critical
mass of researchers in this area. Despite several estab-
lished research programs in social cognition in schizo-
phrenia, it is not currently viewed as critical for social
cognitive measures to be included in performance assess-
nitive terms. The participants at this meeting expect that
social cognitive considerations will become increasingly
common, if certain interdisciplinary bridges can be built.
Lack of Bridges to Basic Scientists
The single most problematic obstacle identified was the
lack of bridges connecting schizophrenia investigators
to other scientists, including social psychologists, social
and affective neuroscientists, preclinical scientists, and
clinical trial researchers. These translational bridges
firmly established. It is common to find that paradigms
developed by basic behavioral scientists are not applica-
ble to schizophrenia samples (too long, too complex) or
to clinical trials (not easily repeated, not highly reliable).
It is also common for clinical scientists to use older ex-
perimental paradigms until newer measures are tried
and adequately adapted for use in psychopathology re-
search. Another difficulty is that basic scientists often
have more interest in discovering patterns and principles
that apply broadly as opposed to those that are limited to
specific disease states such as schizophrenia. Clearly, it is
important to find ways to improve the communication
between basic researchers and psychopathologists.
To address obstacles such as these, NIMH cosponsors
3 research announcements that foster translational part-
nerships among scientists who study basic behavioral
processes and those who study the etiology, diagnosis,
treatment, and prevention of mental and behavioral dis-
orders. PAR-06-355 (http://grants.nih.gov/grants/guide/
pa-files/PAR-06-355.html) addresses the needs of inves-
tigators in the formative stages of the collaborative
M. F. Green et al.
research process, who are just beginning to explore trans-
lational research questions and designs. PAR-06-357
html) is designed for investigators who have already ini-
tiated some collaborative partnerships but need to build
additional translational research infrastructure. Finally,
translational research question and possess sufficient pi-
lot data to warrant an R01 research project grant. Grant
support mechanisms such as these have fostered several
successful collaborations between basic behavioral scien-
tists and clinical schizophrenia researchers in other re-
partnerships exist in the areas of attention, memory,
and perception, participants expressed hope that similar
collaborations are possible between clinical and basic
science researchers with common interests in social
Identifying Key Research Topics
Social cognition in schizophrenia was confidently viewed
as an area that offers substantial prospects for discovery.
Over the course of the meeting, key research topics were
identified that were partly, or largely, unexplored. Here is
a partial listing:
? Alternative approaches to measuring social cognition
in schizophrenia, including reaction time measures
that would help resolve scaling problems, experience
sampling methods in which subjects report their activ-
ities and emotions in daily life, role plays of generated
social situations with confederates, and use of filmed
(as opposed to written) vignettes of social interactions.
? The factor structure within social cognition and be-
tween social and basic cognition.
? The degree to which social cognition impairments are
state related or trait related.
? The timing of social cognitive impairment relative to
the development of functional impairment and onset
of clinical symptoms (eg, social cognition during the
? The extent to which the social cognitive impairments
agnoses (eg, bipolar disorder) or in schizoaffective dis-
? The connection between social cognition and neural
circuits that are known to be dysfunctional in schizo-
To stimulate a translational research approach to ad-
dress these questions, the group envisioned a series of
meetings or conferences along the lines of MATRICS
and CNTRICS that would facilitate collaborations be-
tween clinical researchers and basic scientists. However,
participants believed that meetings by themselves are not
sufficient to accomplish meaningful translational re-
search in this area. The group encouraged the adoption
of a new framework for constructing the relationships
among scientists that includes such elements as extended
meeting time (eg, workshops or institutes), finding ways
to encourage pilot collaborative projects, and, if success-
ful, launching subsequent investigator initiated grant
applications of translational research.
This consensus-building meeting generated several con-
clusions. First, there was agreement on definitions of
terms used in social cognition research in schizophrenia.
Participants also noted that many potentially important
aspects of social cognition that are studied in nonclinical
samples remain understudied in schizophrenia. Second,
for deconstructing clinical symptoms and for explaining
functional outcome in schizophrenia. For these reasons,
social cognition is starting to be viewed as a reasonable
treatment target. Third, obstacles to development in this
areawere identified,includingthe relative lack of maturity
compared with research on basic neurocognition and dif-
ficulty in building bridges among scientists from related
disciplines. Fourth, the participants produced a listing
of potentially informative research directions.
The meeting also clarified important steps that can be
taken to stimulate advances in this area. The participants
suggested ways to improve assessment of key constructs
and to achieve the necessary psychometric qualities that
will allow tests to be useful across a range of samples and
research questions, including clinical trials. Although not
were envisioned that will explore interfaces between so-
cial cognition in schizophrenia and cognitive and affective
neuroscience, including human functional neuroimaging
studies and animal models of social cognition. Finally,
and perhaps most importantly, the participants empha-
sized that it takes time, energy, and resources to identify
and build bridges between scientists of different disci-
plines. As reflected by the goals ofthe NIMH mechanisms
and programs, a key step to achieving traction on these
questions will be close collaborations among social scien-
tists, neuroscientists, andclinicalresearchers. If such inter-
disciplinary bridges can be constructed, social cognition is
well poised to explain many features of schizophrenia,
from neural circuits, to clinical symptoms, to community
This article presents a summary of the discussion from
a workshop supported by the NIMH. The views
expressed are those of the authors and do not
Social Cognition in Schizophrenia
necessarily reflect the official views of the NIMH, the
National Institutes of Health, or any other branch of
the US Department of Health and Human Services.
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