Social Cognition Training for Enhancing Theory of Mind in Schizophrenia

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Social Cognition Training for Enhancing Affective

and Cognitive Theory of Mind in Schizophrenia: A
Systematic Review and a Meta-Analysis
Alessia d’Arma , Sara Isernia , Sonia Di Tella , Marco Rovaris , Annalisa Valle ,
Francesca Baglio & Antonella Marchetti
To cite this article: Alessia d’Arma , Sara Isernia , Sonia Di Tella , Marco Rovaris , Annalisa Valle ,
Francesca Baglio & Antonella Marchetti (2020): Social Cognition Training for Enhancing Affective
and Cognitive Theory of Mind in Schizophrenia: A Systematic Review and a Meta-Analysis, The
Journal of Psychology, DOI: 10.1080/00223980.2020.1818671
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THE JOURNAL OF PSYCHOLOGY
https://doi.org/10.1080/00223980.2020.1818671
Social Cognition Training for Enhancing Affective

and Cognitive Theory of Mind in Schizophrenia:
A Systematic Review and a Meta-Analysis
Alessia d’Armaa,b , Sara Iserniaa , Sonia Di Tellaa , Marco Rovarisa, Annalisa
Valleb, Francesca Baglioa , and Antonella Marchettib
a
IRCCS Fondazione Don Carlo Gnocchi; bUniversita Cattolica del Sacro Cuore
ABSTRACT ARTICLE HISTORY

People with schizophrenia disorder show the presence of a deficit in Received 30 May 2020
social cognition (SC). Several proposals of intervention for social cog- Accepted 31 August 2020
nitive deficits in schizophrenia have been raised. The present study
KEYWORDS
aimed to provide an update to the state-of-the-art of SC training
Social interaction;
in schizophrenia, with specific analysis on their efficacy on ToM, sociocognitive development;
which is deeply involved with social dysfunction in this disorder. training and development;
Furthermore, we proposed to investigate the efficacy of SC training metacognition;
both on ToM cognitive and affective components. We conducted a neuropsychology
systematic review, screening 5251 articles; 26 studies met our inclu-
sion criteria. Interventions included were very heterogeneous. To test
the efficacy of SC training on ToM domain, we conducted a meta-
analysis. Our results showed that SC multidimensional training pro-
grams have a positive effect on ToM domain, with a moderate effect
on both cognitive and affective ToM subcomponents. Future investi-
gations about which could be the best option for the enhancement
of SC in schizophrenia are needed, contributing to expanding the
state-of-the-art of SC training in this disorder.
Introduction
Social cognition (SC) refers to neuro-cognitive abilities underlying social interaction. It
is a construct that provides a broad theoretical perspective that focuses on how people
process information within social contexts (Smith & Semin, 2004). In our daily lives, SC
allows us to perceive, process, and interpret social information, enabling us to give
meaning to the actions of others to develop and maintain interpersonal relationships
(Ciampi et al., 2018).
Unfortunately, this capacity may be lost in some atypical neurodevelopmental condi-
tions, such as in the case of schizophrenia, a chronic mental disorder characterized by
disturbances in thought and interpretation of reality. According to the Diagnostic and
Statistical Manual of Mental Disorders, Fifth Edition (DSM 5; American Psychiatric
Association, 2013), we can define schizophrenia as a syndrome that affects how a
CONTACT Alessia d’Arma adarma@dongnocchi.it IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.
These authors contributed equally to this work.
Supplemental data for this article is available online at https://doi.org/10.1080/00223980.2020.1818671.
ß 2020 Taylor & Francis Group, LLC
2 A. D'ARMA ET AL.
person thinks, feels, and behaves. The principal criteria to make a diagnosis of schizo-
phrenia are the presence of positive symptoms, such as delusions, hallucinations, disor-
ganized speech, grossly disorganized or catatonic behavior, and negative symptoms such
as diminished emotional expression.
The last decade recorded an increase in scientific works focused on impairments in
SC in schizophrenia; literature demonstrated that almost all schizophrenia patients pre-
sent these kinds of deficits (Green et al., 2015). For this reason, SC impairment is con-
sidered a core feature of the disorder, and it is closely related to the impaired daily
functioning of these patients (Couture et al., 2006; Insel, 2010; Maat et al., 2012;
Mancuso et al., 2011). Furthermore, SC is associated with Quality of Life in schizophre-
nia (QoL, Maat et al., 2012). Hence, a deficit in SC may lead to several problems not
necessarily involved in the core of schizophrenia disease but somewhat related to taking
in charge of these individuals. Several models have been depicted with the aim to
describe which are the principal SC domains affected in schizophrenia disorder. Recent
studies have shown that people with schizophrenia (PwSc) present alterations in a wide
range of social skills domain. Although there is no complete consensus about the hall-
mark of these impairments, four SC domains have emerged in order to describe SC
impairments in schizophrenia: emotion recognition, social perception, attributional style,
and Theory of Mind (ToM) (Billeke & Aboitiz, 2013; Charernboon & Patumanond,
2017; Couture et al., 2006; Penn et al., 2008). Emotion recognition is the ability to rec-
ognize other people’s feelings and to discriminate their facial expression, where social
perception is defined as the awareness of cues that occurs in social situations (Barbato
et al., 2015). Attributional style refers to the characteristic tendency in which individuals
explain the causation of events (DeVylder et al., 2013). ToM instead is the specific abil-
ity of recognition and, subsequently, attribution of mental states in order to predict
future behaviors (Premack & Woodruff, 1978). Among all these domains, several pieces
of evidence are supporting the idea that ToM is particularly significant for PwSc. ToM
plays a crucial role in the social cognitive mechanisms of schizophrenia, due to the
strong relationship with thought disorder and social abilities (Br€ une et al., 2007;
Pinkham et al., 2003). It has long been thought that ToM deficit could be related to
social dysfunction in schizophrenia (Frith & Corcoran, 1996), given the specific difficul-
ties of PwSc in inferring what others intend, think, or pretend. Moreover, ToM could
have a possible role of mediator in the relationship between symptoms, neurocognitive
deficits, and functional outcome (Dimopoulou et al., 2017; Green et al., 2019;
Harrington et al., 2005, Greig et al., 2004; Schmidt et al., 2011). However, ToM deficit
in schizophrenia requires adequate debate concerning its role in the pathogenesis of the
disorder: in fact, it is not still clear whether ToM deficit is a trait marker or a state of
the disease (Bora et al., 2009; De Achaval et al., 2010; Kelemen et al., 2019; Mazza et al.,
2012; Pentaraki et al., 2012; Harrington et al., 2005). Furthermore, it remains unclear
how ToM is impaired in schizophrenia, whether it is defective or exaggerated (Br€ une,
2005). It seems that it could be associated with different types of symptoms. The com-
monly named “negative symptoms” could be associated with a defective-attribution
ToM, i.e. a low ability to interpret behavior based on mental states; whereas commonly
named “positive symptoms” could be related to the tendency to over-attribute know-
ledge and mental states to other people (Montag et al., 2012; Peyroux et al., 2019).
THE JOURNAL OF PSYCHOLOGY 3
ToM does not represent a monolithic process: recent works have been focused on the
multifaceted nature of ToM, supporting the idea of the possibility to subdivide ToM
into separable dimensions. Within the definition of attribution of mental states, we can
divide the cognitive and affective aspects of the attribution as separate processes (the
“cognitive” and “affective” ToM; Poletti et al., 2012; Shamay-Tsoory & Aharon-Peretz,
2007). The cognitive dimension is related to inferences about knowledge and beliefs
(belief about belief). In contrast, the affective dimension is responsible for the compre-
hension and representation of other’s affective mental states (belief about emotions and
feelings) in order to predict other’s behaviors based on emotions and feelings. Some
research has shown a relationship between these two ToM subcomponents and the dif-
ferent symptoms of schizophrenia: it seems that PwSc with a high level of negative
symptoms demonstrate selective impairment of the affective ToM (Shamay-Tsoory
et al., 2005), whereas patients with positive symptoms (i.e. paranoid symptoms) could
be related to an impairment in cognitive ToM (Frith, 2004). These evidences suggest
that the analysis of the dissociation between its cognitive and affective aspects must
accompany a better comprehension of the ToM deficit in schizophrenia. The existence
of these two dimensions is evidenced by different existing tests of ToM, evaluating ToM
from a cognitive (for example, false belief tasks) versus affective (e.g. the Reading the
Mind in the Eyes Test) point of view and in more or less ecological contexts, i.e. more
or less similar to real-life contexts (Scherzer et al., 2012).
In light of the impact of the SC deficits on the clinic characteristics of schizophrenia,
several proposals of intervention have been raised. Specifically, a wide range of social
cognitive interventions is currently available (Grant et al., 2017; Kurtz et al., 2016; Tan
et al., 2018).
However, to the best of our knowledge, there is no systematic review and meta-
analysis available on the SC training focused on their efficacy on the cognitive and
affective ToM domain among patients with schizophrenia. For this reason, we conduct
our research with the following purposes: (a) to provide an update to the state-of-the-
art of SC training in schizophrenia, describing them with a focus on their characteris-
tics, method of administration, and format strategies. To achieve this goal, we
conducted a systematic review of SC training currently available to treat SC deficits in
schizophrenia; (b) to assess the impact of SC training on ToM overall domain conduct-
ing a meta-analysis; (c) to assess the impact of SC training on cognitive and affective
ToM conducting two additional meta-analyses for these ToM separate domains.
Materials and Methods

Search Strategy
We conducted our research using PubMed, Wos, and PsycInfo databases.
Keywords included in the search string were the following: (“training” OR
“intervention” OR “treatment” OR “education” OR “empowerment” OR “enhancement”
OR “teach” OR “rehabilitation”) AND (“theory of mind” OR “social competences” OR
“social skills” OR “social cognition”).
We included a consistent number of keywords to avoid missing articles of our inter-
ests: in fact, some works refer to SC training using other words such as “treatment,”
4 A. D'ARMA ET AL.
“enhancement,” and “teach.” Furthermore, given our focus on training effectiveness on

the ToM domain, we specially reported “theory of mind” among other keywords related
to social cognition.
Some filters were applied where possible to conduct a more precise search. Filters
chosen were the following: (a) article types: classical article, clinical study, clinical trial,
comparative study, controlled clinical trial, journal article, multicenter study, observa-
tional study, pragmatic clinical trial, randomized controlled trial, validation studies, (b)
abstract availability, (c) publication dates ranged 2008–2020, (d) English language, (e)
ages: adult.
The search was conducted up to February 04, 2020.
We followed PRISMA guidelines for systematic reviews in our study (see Figure 1—
PRISMA flowchart).
Inclusion and Exclusion Criteria

In order to select the articles to include in this systematic review and a meta-analysis,
we adopted the following inclusion criteria:
studies on training focused on SC (in whole or part);

studies in which population target was schizophrenia and schizoaffective dis-
order; we considered these disorders among those included in the schizophrenia
spectrum disorders due to their chronic nature and their impact on the social
and/or occupational functioning. These factors justify the search for intensive
and long-lasting treatments;
studies in which the assessment included ToM instruments for the evaluation;
studies in the English language;
randomized controlled trials (RCT).
Exclusion criteria adopted were the following:
no training studies (i.e., protocol trials, review);

population target other than schizophrenia;
studies with no ToM assessment;
no RCT trials.
Data Collection, Extraction, Methodological Quality, and Risk of Bias of

Studies Assessment
After identification of the articles through the search string, two double-blinded inde-
pendent investigators dealt with the removal of the duplicates. Subsequently, articles
were screened for title and abstract. Then, the two investigators integrally read the
selected papers in order to check eligible studies for inclusion in the review. A third
investigator was consulted when needed in order to solve cases of disagreement.
To assess the methodological quality and the quantification of risk of bias of the stud-
ies selected, we used the PEDro Scale (Maher et al., 2003), a specific instruments for
Figure 1. PRISMA flowchart.
RCT in the field of the rehabilitation interventions (Alashram et al., 2019; Cotelli et al.,
2019; Yang et al., 2013). It is composed of a list of 10 items correspondent with the
evaluation criteria about the internal validity of the trial, and the presence of sufficient
statistical information to make the study interpretable; for each item, the point is only
6 A. D'ARMA ET AL.
awarded when the criterion is clearly satisfied. Hence, the sum of the 10 criteria pro-
vides a score from 1 to 10 (criteria 2–11). A further criterion (criterion 1) related to the
external validity (or “applicability” of the trial) was added (but this criterion is not
counted in the total score). Studies reaching a score ranging from 6 to 10 indicates a
high quality of the study, while a score lower than or equal to 3 is representative of a
poor-quality study. Scores from 4 to 5 pinpoint fair quality studies. Two double-blinded
independent investigators assessed the selected study attributing a score for each of
them according to this instrument).
Statistical Analysis
For the meta-analysis, we computed standardized mean difference (SMD) between
experimental condition and control groups of change from baseline to immediately
post-treatment. SMD was calculated as Hedges g with a 95% confidence interval (CI)
for each outcome measure. First, we considered ToM outcome measures for each study
(overall effect), in order to evaluate the efficacy after social cognition training on ToM
(the criteria for the selection of the single outcome are outlined in the Supplementary
material, Figure 1a). In order to provide further specific analysis, we classified measures
in affective and cognitive ToM (domain-specific effects), following the model of
Shamay-Tsoory et al. (2009) and we conducted other two separate meta-analysis for
these two dimensions. To distinguish between cognitive and affective ToM instruments,
we considered the classification proposed by the current literature.
For overall effect ToM, the mean SMD of all outcomes in each study and variance
from each study were pooled using a random-effects model. We used a random-effects
model to calculate effect sizes given the heterogeneity of the studies. The two domain-
specific effects (cognitive and affective ToM) were analyzed using a similar method. For
both effect calculations, correction for intercorrelation among outcomes was assumed at
0.7, according to procedures suggested by Rosenthal (1986). In general, positive values
suggest a more considerable improvement in the experimental group than in control
one. Effect size g can be interpreted using suggestions by Higgins et al. (2003), with
g 0.30 indicating a small, g > 0.30 a medium and g > 0.60 a large effect, respectively. I2
statistic was used with 95% CI to count the proportion of actual variance from total
observed variance (I2 values of 25%, 50%, and 75% indicate low, moderate, and large
proportions of variance from the exact effect size, Higgins et al., 2003). The publication
bias was assessed through the funnel plot, exploring studies dispersed around either side
of the mean effect size. We used “Trim and Fill” procedure (Duval & Tweedie, 2000) to
evaluate missing studies that are likely to fall to make the plot symmetrical.
Statistical analyses were computed using R software version,17 adopting the metafor
R package.
Results
Studies Included in the Systematic Review and the Meta-Analysis
Through the search string, we identified 6224 articles. Among these, 973 duplications
were excluded. We screened the remaining part of the 5251 articles for title and
abstract. After this screening, the two investigators entirely read the selected articles in
order to check eligible studies for inclusion in the review. Eighty articles were chosen
for a full reading. Twenty-six articles have met inclusion and exclusion criteria, and
they were included in this systematic review. Among these, we included 20 studies in
the meta-analysis.
Table 1 reports the main characteristics and findings of the studies selected.
Most of the studies were carried out in Europe (20 studies), more specifically in
Spain (5 studies), Italy (7 studies), Poland (2 studies), Germany (2 studies), Turkey (one
study), Norway (one study), Ireland (one study), UK (one study). A small number of
works were carried out in USA (4 studies) and Asia (2 studies). Considering all the
studies included, 1361 subjects with schizophrenia were recruited, of which 699 followed
a social cognition training when 662 subjects participated in the control group. The
mean number of the participants included in each selected studies was 52, considering
the total number of sample sizes. Participants recruited for the studies selected belong-
ing to experimental and control groups were comparable in all of the main demo-
graphic characteristics. More specifically, there were no statistically significant
differences regarding the mean age of the participants (38.44 mean age years of the
experimental group vs. 37.99 mean age years of the control group). The mean duration
of the disease was 10.88 years for the experimental group and 11.03 years for the control
group. Percentage of male subjects was 66.21 for the experimental group and 62.55 for
the control group. Table 2 shows the demographic description of the two groups. All
the studies except for two report antipsychotic drug assumption (chlorpromazine
equivalence), without any statistically significant differences between the two groups
except in one case.
Social Cognition Training: Type of Interventions

Most of the training programs included in the present review are multidomains, which
mean they target two or more SC domains. In details, with reference to SC domains
affected in schizophrenia, multidomain training targeted ToM (N ¼ 22), social percep-
tion (N ¼ 10), attributional style (N ¼ 12), and emotion recognition (N ¼ 20). One train-
ing was specifically focused on ToM.
Different types of format strategies are implemented. Due to the considerable hetero-
geneity that characterized SC training currently available for schizophrenia patients, we
rank them into groups divided by the modality of delivery, contents, and materials used
and strategic approach. We identified 8 types of groups:
Psychoeducational Approach Integrated with Behavioral and Cognitive Techniques

Programs focused on restitution and compensation methods to establish alternative
strategies of information processing and attributional style (N ¼ 3; Eack et al., 2015;
O’Reilly et al., 2019; Veltro et al., 2011).
Ecological Training: Training oriented toward a more ecological approach, enhancing
SC through the help of real-world conditions (video-clip, animated cartoon, real-life
clips, mini-games; N ¼ 7; Bechi et al., 2012, 2013, 2015; Fernandez-Gonzalo et al., 2015;
Lado-Codesido et al., 2019; Maro~ no Souto et al., 2018; Palumbo et al., 2017).
8
Table 1. Main Characteristics and Findings of the Studies Selected.

Social cognition training Control condition
Intensity, N
sessions Name, N; mean
Name, N, mean (length in age and
age (years ± minutes, (years ± standard Intensity, N; sessions
Sample size (N) standard deviation), frequency/ deviation); (length in minutes, Major findings
Author (sample type) gender (male%) week) Description gender(male%) frequency/week) Description ToM evaluation ToM in SC group
Kanie N ¼ 64 Social cognition and 22 (45.1) SCIT is made up of three Treatment as usual 22 Psychosocial treatment Hinting task No significant interaction
A. D'ARMA ET AL.
et al., [schizophrenia; interaction training modules, targeting (TAU) [not specifically programs other than between timepoint
2019 schizoaffective (SCIT) 1) emotion N ¼ 32 reported; 1] SCIT and cognitive and group in any of
disorder] N ¼ 32 perception training; (35.5 ± 9.6) remediation therapy the outcome
(35.50 ± 10.15) 2) distinguishing [62.5] measures of
[62.5] facts from guesses social cognition
and avoiding
jumping to
conclusions
3) integration
Vaskinn N ¼ 48 Training of affect N ¼ 24 Targeted manualized Treatment as usual Not specifically Individualized Movie for the There was a significant
et al., 2019 [schizophrenia; recognition (TAR) (29.9 ± 8.9) training for facial (TAU) reported antipsychotic Assessment of Social time group
schizoaffective [75] emotion N ¼ 24 medication, Cognition (MASC) interaction effect for
disorder] perception deficits (30.8 ± 8.79 psychoeducation and the ToM measure
[58.3] psychotherapy, often (MASC). Over time,
cognitive the TAR group
behavioral therapy performed better,
the TAU
group worse.
O’Reilly N ¼ 65 Cognitive remediation 56 CRT is designed to Waiting list control Not specifically Antipsychotic Reading the Mind in the No significant differences
et al., 2019 [schizophrenia training (60.3) improve cognitive group receiving reported pharmacotherapy Eyes Test (RMET) in RMET at end
schizoaffective (CRT) problems associated treatment as usual and a therapeutically of treatment
disorder] N ¼ 32 with schizophrenia (TAU) safe and secure
(42.68 ± 9.74) and schizoaffective N ¼ 33 environment
[87.5] disorder through a (39.3 ± 9.51) appropriate to the
process of learning [82] individual
known as ‘drill and patient’s needs
practice’, in addition
to explicitly teaching
meta-
cognitive strategies
Lado-Codesido N ¼ 50 Voice program 16 Computer program for Treatment as usual Not specifically Drug therapy, case Reading the Mind in the There were statistically
et al., 2019 [Schizophrenia; þ [30.2] improving prosodic N ¼ 24 reported management and Eyes Test (RMET) significant
schizoaffective treatment as usual recognition (41.20 ± 12.14) individual and group (voice test) differences in score
disorder] N ¼ 26 [54] psychotherapy not changes at RMET
(40.70 ± 12.22) focused on social between the
[50] cognitive intervention and
rehabilitation control group in
favor of Voice group.
Maro~no Souto N ¼ 60 Emotional training 12 The first four meetings Treatment as usual Not specifically Drug therapy, case Statistically significant
et al., 2018 [schizophrenia] treatment as usual [60.1] were dedicated to N ¼ 30 reported management, Faux Pas differences in change
N ¼ 30 recognizing facial (39.87 ± 6.12) individual and group Happe’s Strange scores in Faux Pas
(38.47 ± 7.88) emotions. The next [76.70] psychotherapy not Stories (not in control
eight sessions focused on social Movie for the stories), Happe’s
[80] included cognitive Assessment of Social Strange Stories (not
a short, interactive rehabilitation Cognition (MASC) in control stories),
animated cartoon. Hinting Task Hinting and in MASC
The user had to with a large
describe effect size
what happened, with
questions about
ToM, social
perception and
attributional style.
Palumbo N ¼ 10 Social Cognition 40 The training is divided Social Skills And 40 SSANIT is aimed at The Awareness of Social ANCOVA showed a
et al., 2017 [schizophrenia] Individualized [80,2] into two modules Neurocognitive [80.2] improving individual Inference Test significant treatment
Activities Lab comprising two Individualized assertiveness and (TASIT) effect on TASIT
(SoCIAL) different areas of SC: Training (SSANIT) conversation skills global score
N¼5 emotion recognition N¼5
(36.40 ± 13.1) and ToM (37.25 ± 4.2)
[not [not
specifically reported] specifically reported]
Kowalski N 31 Meta-cognitive training MCT-ToM Intervention for patients Discussion Group 8 1 Hour long discussion Reading the Mind in the Two separate MCT
et al., 2017 [schizophrenia] focused on ToM 8 diagnosed with N ¼ 10 [60.1] about current events Eyes Test (RMET) modules have an
(MCT-ToM) [60.2] schizophrenia, with (31.70 ± 4.8) exclusive influence
N¼9 MCT-JtC the highest impact [50] on the cognitive
(29.11 ± 4.43) 8 on jumping to biases they target.
Meta-cognitive [60.2] conclusions (JTC) and The ToM module
training delusions severity. had a significant and
focused on jumping The JTC subgroup exclusive impact on
to conclusions (JtC) attended a module ToM deficits, while
N ¼ 12 of metacognitive JTC was exclusively
(28 ± 5,41) training – “Jumping reduced by the JTC
[75] to Conclusions”; module at
The ToM subgroup tendency level
attended a module
of metacognitive
training—“To
empathize” version
Fisher Targeted Cognitive 70 30 Hours of general Targeted Cognitive 70 40 Hours of auditory Faux Pas No significant group
et al., 2017 N ¼ 111 Training þ Social [60.5] auditory exercises Training only [60.5] processing training differences in Faux
[schizophrenia, Cognition Training supplemented with N ¼ 54 þ 30 hours visual Pas test (test showed
schizoaffective N ¼ 57 10 hours of auditory (42.37 ± 12.65) processing training. a significant main
disorder, psychotic (44.08 ± 13.05) social cognition [64.81] Exercises targeted effect of time with
disorder (NOS)] [77.19] exercises þ 20 hours perception, attention both groups showing
of general visual and memory improvement)
exercises
supplemented with
10 hours of visual
social cognition
exercises. Exercises
targeted in the social
cognitive domains
affecting perception
and social
cue perception
(continued)
9
10
Table 1. Continued.
Intensity, N
K€other N ¼ 150 Meta-cognitive training 8 Treating cognitive biases CogPack 16 Individual computerized Reading the Mind in the MCT tend to reduce the
et al., 2017 [schizophrenia; (MCT) [60.2] in schizophrenia; N ¼ 74 [60.1] cognitive Eyes Test (RMET) amount of false
A. D'ARMA ET AL.
schizoaffective N ¼ 76 raising the patients’ (32.68 ± 9.54) remediation mental state

disorder] (36.82 ± 11.12) awareness of [66] technique targeting perceptions over
[59] possible “thinking basal neurocognitive time in comparison
traps” which are abilities such as to the control group
suspected to be selective attention or
involved in the memory functions
pathogenesis of
paranoid ideation.
Pe~na N ¼ 101 REHACOP 39 REHACOP group Occupational group 39 Occupational group Happe Stories There were significant
et al., 2016 [schizophrenia] N ¼ 52 [90.3] remediation N ¼ 49 [90.3] activities led by a differences in change
(39.87 ± 9.5) consisted of (38.13 ± 10.1) clinical psychologist. scores between
[75.5] Attention, verbal [69.2] The activities REHACOP and
memory, language, included drawing, control group in
pianification, and gardening, reading ToM, Social
Social the daily news, and Perception,
Cognition units building things from Emotional Proessing.
different materials The effect size was
(such as paper large for ToM
or wood).
Gil-Sanz N ¼ 44 Social Cognition Training 28 4 Modules: emotion Standard psychosocial 28 Social skills training, Hinting Task Significant differences in
et al., 2016 [schizophrenia] Program (PECS) [45.1] processing (1), ToM rehabilitation [45.1] psychoeducation and post treatment
N ¼ 20 and attributional N ¼ 24 life skills training measures of the
(37.05 ± 6.43) style (2), social (43.83 ± 9.77) Hinting Task for the
[40] perception (3), [66.67] social cognition
personalization (4) group compared to
patients in the
control group
Taylor N ¼ 36 Social Cognition and 16 Emotion perception (6 Treatment as usual Not specifically Not specifically reported Hinting Task ToM remained
et al., 2016 [schizophrenia Interaction Training [45.2] sessions), ToM, N ¼ 15 reported comparable
spectrum] (SCIT) attributional style, (39.20 ± 10.6) between groups.
N ¼ 21 jumping to [–]
(40.7 ± 10.3) conclusions and
[–] tolerating ambiguity
(7 sessions),
generalizing skills to
participants’ real-life
social situation
(2 sessions)
Fernandez- N ¼ 53 Neuro Personal 36 2 Modules: the cognition Nonspecific computer 36 Course focused in text 1st and 2nd order False No significant effect on
Gonzalo [paranoid Trainer—Mental [60.2] module targeted training group [60.2] editing, spreadsheet belief stories ToM measures were
et al., 2015 schizophrenia, Health attention, memory N ¼ 25 management and hinting task reading found with the NPT-
disorganized (NPT-MH) and executive creation of dynamic MH training.
schizophrenia, N ¼ 28 functions; the social (30.02 ± 7.4) presentations, the mind in the
bipolar (30.90 ± 5.90) cognition module [68] nonspecific internet eyes test
schizoaffective [60.70] targeted to emotion games, documentary
disorder] processing, theory of videos about the
mind and functioning of the
cognitive biases brain and the
human body
Bechi N ¼ 75 Social Social Social cognitive training Active Control Group 16 Newspaper ToM Picture Sequencing Significant time x group
et al., [schizophrenia] cognitive Cognitive (SCT): short videos (ACG) [60.1] discussion group Task (PST) interactions in
2015 training (SCT) Training (SCT) depicting human N ¼ 19 Picture Sequencing
N ¼ 24 12 social interactions (37.21 ± 12.45) Task total score and
(38.08 ± 10.50) [60.1]; that imply [52.63] questionnaire. Social
[66.67] Theory of recognition of Cognitive Training
Theory of Mind Mind emotions and ToM and Theory of Mind
Intervention (ToMI) Intervention abilities Intervention groups
N ¼ 32 (ToMI) improved
40.3 ± 10.33 18 Theory of Mind significantly from
[53.13] [60.2] Intervention (ToMI): pre-to-post-test in all
5 modules on ToM measures
TOT TOT cognitive and except sequencing,
N ¼ 56 15 affective ToM whereas Active
(39.21) [60.15] Control Group
[59.90] did not.
Gawe
R da N ¼ 44 Meta-cognitive 8 8 Modules targeted to Treatment As Usual Not specifically Psychoeducation, Reading the Mind in the No changes were found
et al., [schizophrenia] training þ treatment [52.5, 2] self-serving bias (1), (TAU) reported computer training, Eyes Test between groups in
2015 as usual jumping to N ¼ 21 different social (RMET) ToM deficits.
(TAU) conclusions (2.7), (51.65 ± 10.25) activities and
N ¼ 23 belief flexibility and [52.38] individual
(50.41 ± 10.79) bias against support therapy
[47.83] disconfirmatory
evidence (3.7), ToM
(4.6), cognitive over-
confidence in false
memories (5) and
depressive thinking
style (8)
Pino N ¼ 14 Emotion and ToM 24 8 Modules: eyes Problem Solving Training 24 Training on Advanced ToM task Results showed an
et al., [schizophrenia] Imitation Training [50.2] orienting attention (PST) [50.2] responsibility and Reading the Mind in improvement in ETIT
2015 (ETIT) (1.2), observation N¼7 active the Eyes Test group compared to
N¼7 and imitation of (42.25 ± 8.20) problem (RMET) the Problem Solving
(45.00 ± 16.91) facial emotional [42.6] management. Training group in
[57.14] expression (3.4), Advanced ToM task
interpretation of and in the eyes test.
mental states and
understanding of
emotional causation
(5,6) and attribution
of intentions (7.8)
Eack et al., N ¼ 28 Cognitive 45 Interactive Social Treatment As Usual Not specifically Mental health and social Hinting Task Effects on social
2015 [schizophrenia, Enhancement [90.1] Cognition (TAU) reported services (psychiatry cognitive functioning
schizoaffective Therapy Discussions; N¼9 services, case were large and

disorder] (CET) Homework reporting (34.67 ± 12.99) management, significant favoring
N ¼ 22 in class; Individual [78] individual supportive CET. The greatest
(continued)
11
12
Table 1. Continued.
Intensity, N
(39.68 ± 13.64 ‘coaching’ once therapy, vocational domains of social-
[68.00] a week rehabilitation cognitive
A. D'ARMA ET AL.
services and improvement were

community-driven understanding
substance emotions and
use treatments) managing emotions
Roberts N ¼ 66 Social cognition and 22 Combination of Treatment As Usual Not specifically Combinations of local Hinting Task The Social Cognition and
et al., [schizophrenia, interaction training [60.1] psychoeducation, (TAU) reported available services The Awareness of Interaction Training
2014 schizoaffective (SCIT) drill and repeat skill N ¼ 33 (pharmacotherapy, Social Inference Test group did not show
disorder] N ¼ 33 practice, strategy (39.40 ± 10.8) case-management, (TASIT) an advantage over
(40.00 ± 12.20) games, heuristic [66.67] individual and group Treatment As Usual
[66.70] rehearsal and psychotherapy). in improving ToM.
homework
assignments to
remediate deficits
and decrease biases
in social cognition
Bechi N ¼ 30 ToM Intervention 18 Intervention target on Newspaper Discussion 18 Newspaper discussion ToM Picture Sequencing ANOVAs showed
et al., [schizophrenia] (ToMI) (60.2) ToM; modules were Group (60.2) group Task (PST) significant
2013 þ Cognitive executed in þ Cognitive with domain-specific time group (ToMI
Remediation Therapy ascending order of Remediation Therapy computer- or ACG) interaction
(CRT) complexity (affective (CRT) aided exercises effect on PST
N ¼ 19 and cognitive ToM) outcome in favor
(37,68 ± 8,42) N ¼ 11 of ToMI
[42] (37.73 ± 15.45)
[54]
Wang N ¼ 39 Social Cognition and 20 SCIT targeted to Waitlist Not specifically Not specifically reported Reading the Mind in the Statistically significant
et al., [schizophrenia] Interaction Training [60.1] emotion perception, N ¼ 17 reported Eyes Test improvement in
2013 (SCIT) attributional style (40.88 ± 10.15) (RMET) ToM (RMET)
N ¼ 22 and Theory of [47.06]
(43.86 ± 11.65) Mind abilities
[54.55]
Tas N ¼ 45 Family-assisted Social 14 F-SCIT targeted to Social Stimulation 4 Training promoting Hinting Task RMET- F-SCIT condition
et al., [schizophrenia] Cognitive Training [65.1] emotion perception, N ¼ 26 [240, 0.3] general social Reading the Mind in revealed
2012 (F-SCIT) ToM and (34.62 ± 10.06) interaction in the Eyes Test improvement in the
N ¼ 19 attributional style [46.20] everyday life: every (RMET) revised social cognitive
(33.32 ± 11.57) patient was assigned domain of ToM
[57.90] a volunteer for (Hinting Task); a
activities (general much limited
conversation about improvement in the
patients’ daily lives, social-perceptual
visiting a cafe, domain (Eyes Test),
picture painting, whereas no
watching a comedy improvement was
movie, having a chat observed in the
afterwards in a cafe Social
and a Stimulation
feedback session. condition.
Bechi N ¼ 73 Video-based social 12 Integrated Psychological Standard Rehabilitation ToM Picture Sequencing Improvement on ToM
et al., [schizophrenia] cognitive training [60.1] Video-based social Therapy Social Program: focus on Task (PST) skills in Video-based
2012 (VB-SCT) cognitive training cognitive training 12 main community social cognitive
N ¼ 28 (VB-SCT): use of (IPT): Standard [60.1] goals of social training (VB-SCT)
(37.14 ± 10.02) short videos selected Rehabilitation abilities subprograms group with respect
[68.00] from international Treatment (SRT) – of IPT (verbal to Standard
cinema movies N ¼ 24 communication, Rehabilitation
depicting human (38 ± 8.73) social skill training Program and no
social interactions. [63] and problem treatment conditions
solving).
No Treatment
N ¼ 24
(40.20 ± 8.99) No treatment
[67]
TOT:
48
(39.1)
[65]
W€olwer & N ¼ 38 Training of Affect 12 4 Modules focused on Cognitive Remediation 12 Computer tasks of the ToM Picture Sequencing ToM performance
Frommann, [schizophrenia, recognition (TAR) [52.50, 2] discrimination of Program (CRT) [52.50, 2] software Cogpack Task (PST) improved in Training
2011 schizoaffective N ¼ 20 facial expressions of N ¼ 18 targeted to of Affect recognition
psychosis] (–) basic emotions, (–) attention, memory but not in Cognitive
[–] reasoning on the [–] and Remediation
alternative strategies executive functions. Program
in case of
uncertainty,
decoding different
intensities of
emotional
expressions and
understanding of
social scenes.
Veltro N ¼ 24 Cognitive Emotional 24 Psychoeducational Problem Solving Training 24 4 Modules focused on 1st and 2nd order False Significant interactions
et al., [schizophrenia] Rehabilitation (REC) [82.5, 1] approach integrated (PST) [82.5, 1] resolving problems: Belief Stories, in first level ToM
2011 N ¼ 12 with behavioral and N ¼ 12 it allows patients to ToM,
(38.8 ± 6.30) cognitive techniques (37.70 ± 11.16) develop solutions to Advanced ToM scale
[–] in order to teach [–] everyday problems
patients to recognize by assigning them a
events and situations role of responsibility
of everyday life. and allowing
individuals to
experience an active
management
of problems.
Mazza N ¼ 33 Emotion and ToM 24 Focus on social Problem Solving Training 24 A structured method for 1st and 2nd order False Significant interaction on
et al., 2010 [schizophrenia] Imitation Training [50.2] cognition processes (PST) [50.2] problem-solving: it Belief Stories, Advanced ToM and
(ETIT) such as empathy N ¼ 17 allows patients to Advanced ToM scale Second Level ToM
(continued)
13
14
Table 1. Continued.
Intensity, N
N ¼ 16 and ToM: (24.71 ± 2.17) develop solutions to
(24.37 ± 2.12) observation of the [–] everyday issues,
A. D'ARMA ET AL.
[–] eye direction (phase assigning them a

1), observation of role of responsibility
faces and imitation and enhancing active
of facial expression management
(phase 2), of problems
understanding of
mental states in
social situations
(phase 3) and
attribution of
intentions through
the observation of
other people’s
actions (phase 4)
Horan N ¼ 31 Social Cognition Training 12 Training targeted to Illness Self-Management 12 Teaching participants The Awareness of Social No significant
et al., 2009 [schizophrenia] (SCT) [60.2] emotion and social and Relapse [60.2] how preventing Inference Test improvement in ToM
N ¼ 15 perception (phase 1) Prevention Skills symptom relapses or (TASIT)
(50.70 ± 5.8) and social attribution (ISMRPST) minimizing their
[87.00] and ToM (phase 2) N ¼ 16 severity by focusing
(45.90 ± 7.5) on four skill areas:
[100] Identifying Warning
Signs of Relapse,
Managing Warning
Signs, Coping with
Persistent Symptoms,
Avoiding Alcohol
and Street Drugs
McDonald N ¼ 39 Social Skills Treatment 12 Targeted to social 12 Waitlist condition: The Awareness of Social No improvement on
et al., 2003 [traumatic Program (SST) [240, 1] behavior (2 hours per Waitlist condition N [240, 1] patients will receive Inference Test ToM (TASIT)
brain injury] N ¼ 13 session), social ¼ 13 treatment at the end (TASIT)
(35.5 ± 11.3) perception (one hour (35,3 ± 11.6) of the study
[76.92] per session) and [76.92]
emotional Social Group (SG) Social Group: group
adjustment (weekly N ¼ 13 social activities
individual session) (34.30 ± 11.6) (cooking, craft and
[61.54] board and
TOT ball games)
N ¼ 26
(34.8)
[69.23]
The stands for the mean value.
Table 2. Demographic Characteristics.

Illness
Number Number Men % Age (N duration (N
Sample (N total) (N average ± SD) (average) average ± SD) average ± SD)
All the studies 1361 52.23 ± 31.35 – – –
Social Cognition Group 699 26.88 ± 16.73 66.21 38.48 ± 6.31 10.88 ± 6.60
Control Group
662 25.00 ± 16.23 62.55 37.99 ± 5.52 11.03 ± 6.00
SCIT Training: Manualized cognitive-behavioral therapy using a gradual exposure

with increasingly self-relevant, challenging and ambiguous social experiences (N ¼ 5;
Kanie et al., 2019; Roberts et al., 2014; Tas et al., 2012; Taylor et al., 2016; Wang
et al., 2013).
Imitation Training: Programs based on observation and imitation of facial expression of
emotions and the display of social situations (N ¼ 2; Pino et al., 2015; Mazza et al., 2010).
Meta-Cognitive Training: Programs dedicated to reducing the hypermentalization pro-
cess typical of positive symptoms of schizophrenia (N ¼ 3; GaweR da et al., 2015; K€ other
et al., 2017; Kowalski et al., 2017).
Skill-Building Strategies: A broad range of skill-building strategies widely used in
psychiatric rehabilitation, as breaking down complex social cognitive processes into their
component skills, teaching social-behavioral skill and practicing these skills so that they
become more routinized through repeated experiences (N ¼ 1; Horan et al., 2009).
Training of Affect Recognition (TAR): Restitution and compensation method focused
on verbalization, generation of associations using situational clues and context informa-
tion, errorless learning, repetition, identification, and discrimination by reasoning and
resorting of alternative strategies (N ¼ 2; Vaskinn et al., 2019; W€
olwer & Frommann, 2011).
Discrimination of Emotions and Social Reasoning in Social Situation Contexts
Strategies: Training programs focused on emotion recognition work (discrimination of
faces, facial expressions, prosodic fluctuations, and gaze directions) and teaching how to
cope with negative reactions. Furthermore, these training programs teach the concept of
ToM, help the comprehension of ambiguous meaning language, the avoidance jumping
to conclusions, and the social norms in a cognitive-behavioral manner. Finally, these
strategies focused on the personalization of the lessons learned (N ¼ 3; Fisher et al.,
2017; Gil-Sanz et al., 2016; Pe~ na et al., 2016) (Figure 2).
In addition, several authors mixed up these different format strategies, developing
multifaceted training to maximize the outcome of different processes of SC. In fact, we
can recognize SC training combined with neurocognitive rehabilitation modules or with
modules oriented toward a more ecological approach.
Taking into account the length and the intensity of the SC training programs, we
observed that the number of sessions varied from 8 to 56 sessions, with an average of 21
sessions. The mean length of each session was 60 min (range 30–90 min). Most of the
training programs consisted of two days per week treatments, varying from one to five
weekly sessions. One study involved a family member in a family-assisted condition.
The majority of the studies analyzed present a group delivery format. Considering
sessions setting it is possible to find: group sessions (n ¼ 19); individual sessions (n ¼ 6);
combined group to “face to face” sessions (n ¼ 1). Among these, conventional “face to
face” sessions with the operator, “self” individual sessions, and computerized sessions
16 A. D'ARMA ET AL.
Figure 2. Training format strategies.
(n ¼ 5) were detected. All training programs were delivered in the clinic, some of them
(n ¼ 13) with additional work at home. Most of the training programs was led by facili-
tators such as neuropsychologists, clinical psychologists, rehabilitation therapists, and
other figures.
Various types of control groups were considered: waiting list, treatment as usual
(TAU), and active control groups (such as cognitive training, problem-solving training,
social groups, psychoeducational groups).
Tom Assessment Used in the Selected Studies

Studies selected showed high variance in the selection of ToM tests. The most used tests
were the Hinting Task Test (HT, Corcoran et al., 1995) and Reading the Mind in the
Eyes Test (RMET, Baron-Cohen et al., 2001) used in 8/26 times. The ToM Picture
Sequencing Task (PST; Br€ une, 2003) was recorded 4/26 times. Subsequently, we found
the Awareness of Social Inference Test (TASIT, McDonald et al., 2003), the Advance
ToM Scale (Blair & Cipolotti, 2000) and the False Belief Stories (1 /2 and 3 order;
Baron-Cohen, 1989; Baron-Cohen et al., 1985; Mazza et al., 2007, 2008; Rowe et al.,
2001), used 3/26 times. Lastly, we found 2/26 times the Faux Pas test (FP, Baron-Cohen
et al., 1997), the Movie for the Assessment of Social Cognition (MASC, Dziobek et al.,
2006) and the Strange Stories (SS, Happe, 1994). In Table 3, principal aims and
characteristics of these tests are exposed, focusing on the leading cognitive or affective
attribution where practicable.
Methodological Quality
Two investigators examined the methodological quality of the studies selected through
the PEDro scale. Considering all the studies, the total mean score of the PEDro scale
was 6.6 (range 5 to 8). Eligibility criteria (criterion 1) were specified in 21/26 studies. In
accordance with our inclusion criteria, all studies were randomized (26/26, criterion 2).
The allocation was concealed in 16/26 studies (criterion 3). Nearly all the studies except
two reported similarities between groups (experimental vs. control) at baseline for at
least one of the principal outcomes of the study (24/26 studies, criterion 4), and only
one study clearly reported that all subjects were blinded (1/26 studies, criterion 5). No
study specified that therapists who administered the training were blind (0/26 studies,
criterion 6), while 18/26 studies reported all raters who assessed the participants were
blinded (criterion 7). Measures of at least one key outcome were obtained from more
than 85% of the subjects in 18/26 studies (criterion 8). 19/26 studies applied an inten-
tion to treatment approach for analysis (or they have declared that all the subjects allo-
cated to the conditions have received the treatment, criterion 9). All the studies have
reported results of between-group statistical comparisons for at least one key outcome
(criterion 10). Lastly, most of the studies (except for two, 24/26 studies) provided both
point measures and measures of variability for at least one key outcome (criterion 11).
Results are exposed in Supplementary material, Table S1—PEDro scale.
Effect of SC Training on ToM Outcomes

To test the efficacy of SC training on ToM domain (overall, cognitive and affective
components) we included 20 studies in the meta-analysis. Six studies were excluded for
missing/incomplete data.
Overall Effect on ToM

The overall effect of SC training on ToM outcomes was medium and statistically signifi-
cant (g ¼ 0.53; 95% CI 0.37–0.69; p < 0.001). True heterogeneity across studies was
mildly moderate (I2 ¼ 49.86%; Q ¼ 37.85; df ¼ 19; p ¼ 0.006). The funnel plot showed a
slight asymmetry. The Trim and Fill method suggests that four studies would need to
fall to the left of the mean effect size in order to make the plot symmetric (see Figure 3—
Overall ToM—Forest Plot. For more details see Supplementary material Figure 2b—
Overall ToM—Funnel Plot).
Cognitive ToM
The assessment of cognitive ToM is reported in 15 studies. The combined effect size
was almost large and statistically significant (g ¼ 0.60; 95%CI 0.38–0.82; p < 0.001). True
heterogeneity across studies was moderate (I2 ¼ 61.19%; Q ¼ 33.94; df ¼ 14; p ¼ 0.002).
The funnel plot showed a slight asymmetry. The Trim and Fill method suggests that no
18 A. D'ARMA ET AL.
Table 3. ToM Assessment: Aims, Characteristic, and Cognitive/Affective Components.

Name of ToM task Target domain Brief description of task
Advanced Cognitive A short version of 13 comic stories, each accompanied by two
ToM Scale questions: the comprehension question “Was it true, what X said?,”
and the justification question “Why did X say that?”. The 13 story-
types included Lie, White Lie, Contrary
Emotion, Joke, Pretend, Misunderstanding, Double Bluff.
False Belief Task Cognitive Reading and comprehension of false belief stories. Assessment of first/
second/third-order ToM competences.
Faux Pas test Cognitive and Recognition of the embarrassing situations in faux pas’ stories. The test
Affective provides scores for five variables: faux pas detection, understanding
inappropriateness, intentions, and belief and empathy.
Hinting Task Test Cognitive Understanding of the direct speech and infer the mental state of one
character or answer the ToM questions.
Movie for the Cognitive and A short film in which patient must answer a series of questions
Assessment of Affective regarding the ToM and emotional content depicted in social
Social Cognition interactions
Reading the Mind in Affective ToM ToM task containing 36 male and female eyes pictures with 4 answers
the Eyes Test multiple choices for each item. Patients had to infer mental states
through gaze choosing one of the four possible answers.
Strange Stories Cognitive Stories containing Lie, White Lie, Joke, Pretend, Misunderstanding,
Persuade, Appearance/Reality, Contrary Emotions, Figure of Speech,
Sarcasm, Forget, Double Bluff, and utterances. In each of the stories,
the character says something that should not be interpreted literally.
The participant is asked to explain why the characters said what
they said.
The Awareness Cognitive Videotape measure of ToM that contains 16 scenes with two or three
of Social method actors appearing in each one. After presentation of each
Inference Test scene, subjects respond to questions about the characters’
communicative intentions, their emotional state, whether they want
the literal or non-literal meaning of their message to be believed,
their beliefs and knowledge about the situation.
The ToM Picture Cognitive Six cartoon picture stories depicting scenarios where characters
Sequencing Task cooperate, deceives a second character and cooperating to deceive a
third. In the Sequencing task, measure of non-verbal ToM processing
four cards was presented, the participants were asked order them in
a logical sequence of events. In addition, a ToM questionnaire was
administered to the subjects to test their ability to appreciate the
mental states of the characters involved in the cartoon stories. The
questions referred to the mental states of the characters according
to different levels of complexity and included first to third false
belief questions, questions involving the understanding of cheating
detection and two reality questions, basically included to rule out
major attention problems.
additional studies would be requested to make the plot symmetric (see Figure 4—
Cognitive ToM—Forest Plot. For more details see Supplementary material Figure 3c—
Cognitive ToM—Funnel Plot).
Affective ToM
The assessment of affective ToM is reported in seven studies. The combined effect size
was medium and statistically significant (g ¼ 0.42; 95% CI 0.17–0.67; p < 0.001). True
heterogeneity across studies was low (I2 ¼ 34.94%; Q ¼ 8.41; df ¼ 6; p ¼ 0.210). The fun-
nel plot shows a substantial symmetry. The Trim and Fill method suggests that no fur-
ther studies are needed in order to make the plot symmetric (see Figure 5—Affective
ToM—Forest Plot. For more details see Supplementary material Figure 4d—Affective
ToM—Funnel Plot).
Figure 3. Overall ToM forest plot.
Figure 4. Cognitive ToM—forest plot.
Discussion
In the present systematic review and meta-analysis, we focused on SC training for
schizophrenia, and we tested the effect of these training programs on the overall ToM
domain and its separate affective and cognitive sub-components. While literature docu-
mented the efficacy of SC training on ToM overall domain in schizophrenia (Kurtz &
Richardson, 2012), only a few single works have focused on their efficacy on ToM
affective and cognitive subprocesses considered separately (Bechi et al., 2013; Pino
et al., 2015).
Through the systematic review, we found 26 SC training to enhance the ToM
domain. This number demonstrates that SC deficits in ToM domain are well recognized
in schizophrenia and, therefore, psychosocial support for this population is also oriented
toward training to treat these issues. The number of 26 studies is quite substantial,
considering that SC and ToM are fields that have only recently gained interest in the
evaluation and rehabilitation of the adult people. Let us bear in mind that SC and
20 A. D'ARMA ET AL.
Figure 5. Affective ToM—forest plot.
ToM are always being studied in neurodevelopmental psychology and have only
recently been identified as a possible target for the research in adult atypical condi-
tions, as adult neurodevelopmental disorders (Ashman et al., 2017), people in chronic
neurodegenerative conditions (Isernia et al., 2019; Rossetto et al., 2018), adult people
with other psychiatric disorders (Edel et al., 2017), and also in normal aging (Castelli
et al., 2010; Cavallini et al., 2015; Kalokerinos et al., 2015; Moran et al., 2012; Rosi
et al., 2016).
Most of the studies selected were from Europe, with a limited number of studies car-
ried in American (4 studies) and the Asian continent (2 studies). This could limit our
findings’ generalizability, given that SC is influenced in multiple ways by culture (Chiu
et al., 2013). Hence, it is unknown if all characteristics of SC training developed in
Europe can be successfully applied in other cultural contexts.
Concerning the format delivery of SC training, our systematic review found that the
average intensity of these programs is 21 sessions, with a mean length of 60 min two
days per week sessions. This result represents a possible answer to the lack of the guide-
lines about the modality of the delivery in the cognitive rehabilitation for schizophrenia
(timing and duration, frequency of participation in the program, intensity of the train-
ing sessions) as literature has so far shown, focusing on the need to examine minimally
necessary and sufficient dosage and frequency for treatment gains (Barlati et al., 2013;
Reddy et al., 2014).
As we expected, the mean age of pwSc included in these studies was 38 years with a
mean length of disease of 11 years, reflecting the current data about the onset of the dis-
ease (DSM 5, American Psychiatric Association, 2013). This result is in line with the
previous meta-analysis of Kurtz et al. (2012), in which it is demonstrated that samples
with a younger mean age were most likely to generalize the effects of social cognitive
training on general symptoms. Furthermore, the majority of these were male pwSc, in
line with recent studies reporting a higher percentage of male than female pwSc in the
gender prevalence (McGrath & Scott, 2006).
Referring to the strategies used to implement SC training, studies included varying
from programs targeted only SC deficits to broader training programs that target vari-
ous dimensions of the illness. Of the eight strategies identified, only three have been
manualized: the SCIT program (Roberts et al., 2015), the MetaCognitive training
(Moritz & Woodward, 2007), and the TAR program (Frommann et al., 2003). Our
results evidenced that sometimes a neurocognitive training was combined with SC
training. The combination with a cognitive rehabilitation program could be related to
the evidence supporting the relationship between cognitive functions and social cogni-
tion in schizophrenia, even if the correlation is not clear and requires further debate
(Chan et al., 2018; Deckler et al., 2018). Moreover, some SC training programs are
carried with computerized sessions. Over recent years the introduction of computerized
systems becomes more widespread. The possibility to use technologies lets to carry
more individualized rehabilitation, allowing trainers to tailor the intervention, to man-
age different levels of complexity of the materials proposed in order to better respond
to the different levels of deficits showed by PwSc. Other particularly promising strategies
for structuring ToM training that are increasingly effective and personalized concern the
introduction of a more ecological approach. As we observed in this study, 7/26 training
have an ecological footprint. This fact is reflected in a different choice of materials seek-
ing to use a methodology as close as possible to the real-life situations, increasing the
generalizability of the results obtained. This ecological approach could be helpful to face
the challenges of the real-world context effectively and to overcome the limits of stand-
ard materials. This aspect is present also in the problem of the ToM measures, that
often are not very sensitive in detecting an SC impairment in a clinical population (as
highlighted in Scherzer et al., 2012) and are not able to differentiate between types of
error responses (as supported in Montag et al., 2012). We have not found any Virtual
Reality (VR) or telerehabilitation solutions in our systematic review, methods that are
already present in other fields of rehabilitation, like cognitive rehabilitation or integrated
rehabilitation for neurological disorders (Di Tella et al., 2020; Dobkin & Dorsch, 2017;
Isernia et al., 2019; Maggio et al., 2019).
Some approaches integrate cognitive and behavioral techniques (psychoeducational
approach, SCIT training, skill-building strategies, discrimination of emotions and social
reasoning in social situation contexts strategies), where others propose a more neuro-
psychological approach (TAR) or a strictly-cognitive approach (meta-cognitive training).
Another context is represented by the Imitation Training, characterized by a more phe-
nomenological approach (it is based on the mirror neurons theory). This heterogeneity
in terms of strategy and approaches could be related to the currently existing models
that describe SC in schizophrenia (as highlighted in the introduction part).
The analysis through the Pedro Scale showed that the overall methodological quality
of studies was high (6.6 mean score). This result marks continuous growth in the field
of SC research since previous systematic reviews highlighting the weakness of the meth-
odology of these studies (Grant et al., 2017). This weakness is probably due to the high
number of pilot interventions in the past, which is related to the fact that the field of
SC interventions is relatively young. The studies’ high methodological quality let us esti-
mate our reported effect sizes in a reasonably reliable way.
Regarding the SC domains targeted, results show that most of the SC training pro-
grams included do not selectively target ToM skills, but rather incorporate ToM into
multitasking interventions. Only three studies chose ToM as a single target of interven-
tion, both conducted by the same group (Bechi et al., 2012, 2013, 2015). Furthermore,
22 A. D'ARMA ET AL.
training programs are very heterogeneous in terms of strategy, delivery format, contents,
and materials implemented.
Despite different types of interventions implemented and the different SC domains
targeted, through our first meta-analysis we found a moderate effect on the ToM overall
domain, in line with the previous literature on schizophrenia (Kurtz & Richardson,
2012). Our results show that enhancing SC in the schizophrenia population has positive
effects in terms of ToM efficacy.
As evidenced in the following two meta-analyses the effect is also confirmed dissoci-
ating the affective and the cognitive components of ToM, with a substantial effect on
cognitive ToM and a moderate effect on affective ToM.
“Overall,” SC training are hence useful as a form of “secondary prevention,” due
to the already known impact of SC deficits in PwSc daily life. However, ToM plays a
key role in the social disfunction of PwSc due to its relationship with specific symp-
toms and quality of life (Maat et al., 2012). Our results confirm the differences
between cognitive and affective components of ToM also in training programs aimed
to improve SC, not explicitly focused on ToM abilities, opening up some relevant
reflections on the implementation of this competence in PwSc. So far, the tested
training has been far-reaching, making no distinction between cognitive and affective
ToM, and they have been applied indiscriminately to patients with positive and negative
symptoms. In line with the promotion of “personalized medicine” (Hamburg & Collins,
2010), the recent approach to treat diseases based on each person’s unique characteristics,
we think that structure and propose specific ToM training to the patients on the base on
their symptoms would be advantageous. If the intention is tailoring SC training on the
specific deficits of PwSc, it could be interesting the investigation on which type of ToM
deficit PwSc present, thus examining whether it is a situation of ToM over-attribution or
defective-attribution. By estimating this type of ToM impairment, it will be possible to
evaluate whether it is necessary to focus on cognitive or affective aspects of ToM, prob-
ably obtaining more positive results. In the future, following this latest trends in rehabili-
tation research increasingly oriented toward personalized and individualized medicine, we
believe it could be more useful to propose more specific training based on precise deficits
presented by the person treated, in order to strengthen the results already exceeded from
“overall” SC training, with the most substantial possible effect on the ToM domain. This
could save time and resources. What was saved in terms of time and resources must be
reinvested in the clear identification of the SC and ToM domains in deficit.
The broad range of different strategies currently available to enhance SC in schizo-
phrenia could help in the construction of personalized training, also from a methodo-
logical point of view. In line with the indication of personalized care already widespread
in psychiatry (Arean, 2012; Dimidjian & McCauley, 2016) and specifically in schizo-
phrenia (Candida et al., 2016), to be able to respond to the need of more personalized
interventions it could be interesting to examine if the use of a method or another has
an impact of cognitive and affective ToM subcomponents.
The importance of focusing on ToM cognitive and affective components is linked
to the specific characterization of ToM competence in PwSc. It is possible to distin-
guish in fact an over-attribution ToM deficit and a defective-attribution of ToM def-
icit (Frith, 2004; Peyroux et al., 2019; Bliksted et al., 2019). In the first case, patients
show the tendency to over attribute knowledge and mental states to other people,
even unrealistically and disconnected from reality, whereas in the second case, they
cannot interpret behavior basing on mental states. Furthermore, the ToM over-attri-
bution is related to the cognitive subcomponent (Frith, 2004), that according to
Peyroux and colleagues predicts positive symptoms (Peyroux et al., 2019); at the same
time, we can find in PwSc an impairment in the affective subcomponent that could be
a predictor of negative symptoms (Shamay-Tsoory et al., 2005), probably due to a
defective-attribution of ToM (Frith, 2004; Peyroux et al., 2019). Furthermore, it has
been considered that schizophrenia brings itself a heavy economic burden, not only
for pwSc but also for their families, other caregivers, and the wider society (Chong
et al., 2016). Indeed, it is estimated that approximately 20 million people in the world
are affected by this chronic and severe mental disorder (Vos et al., 2017). Hence, both
the social and economic impacts associated with schizophrenia are substantial.
Treating this illness in its clinical manifestations strictly related to social functioning
and developing new rehabilitation research lines provides innovative treatment
options for clinicians. It could also have a positive repercussion on healthcare costs
(both psychological/social and economic ones). Along with the already well-known
medical antipsychotic treatment, the identification and the treatment of SC deficits
could help to restore acceptable social functioning (Penaherrera & Duarte, 2016),
thereby decreasing their need for further support measures.
Some limitations to the current findings should be noted. First, the overall sample of
26 studies was small, and the number of studies included in the meta-analysis for each
of the outcome ToM domains was even smaller. This limit is due to the fact that we
selected only RCT trials, with the purpose of conducting a precise analysis. In addition,
sometimes the lack of some information, as specific outcome measures and measures of
variability, have limited the number of studies that could be investigated in the meta-
analysis, possibly influencing the variation of the effect size.
Furthermore, ToM measures used were mainly heterogeneous: in fact, the tasks pro-
posed differ concerning the ToM component evaluated (cognitive vs. affective) and
with respect to how ecological they are. As this study demonstrates, the effectiveness
of SC training on both ToM components in different contexts suggests the importance
for the future of building a specific ToM assessment battery for patients with schizo-
phrenia with the same characteristics of symptoms, capable of recognizing all the dif-
ferent levels of ToM deficit (over and defective attribution of ToM/cognitive and
affective ToM). Having a specific ToM battery could make sure that the results of dif-
ferent training studies can be effectively compared, as highlighted in Tan et al. (2018).
The creation of a specific standard ToM assessment battery for these patients could
also overcome the problem of the weakness of the psychometric properties of ToM
measures, recognized by the literature on this construct (Livingston et al., 2019).
Conclusions
An extensive array of SC training is available for the treatment of SC deficits in schizo-
phrenia. Our results suggest that these trainings are effective on the ToM domain,
which plays a key role in the symptoms exhibited by the pwSc. The effect is detectable
24 A. D'ARMA ET AL.
not only for ToM overall domain but also for its cognitive and affective components,
related to positive and negative symptoms exhibited by these patients. In light of this,
in the future it would be desirable to design training increasingly tailored to meet the
different needs and specific deficits of pwSC. In this way, it might be possible to obtain
a more effective impact on the specific difficulties handled by PwSc, with a decisive
reduction of time and resources. This might affect not only the attenuation of the symp-
tomatology but also the daily functioning of PwSc, due to the notorious consequences
of SC deficits on social dysfunction.
Author notes
Alessia d’Arma completed a Master of Science Degree in Psychology at the University of Turin
(Italy) and she is currently completing her PhD course in “Science of the Person and Education”
at the Universita Cattolica del Sacro Cuore (Milan, Italy). She is also researcher at the IRCCS
Don Gnocchi Foundation ONLUS, Milan (Italy). Her main research fields of interest are: Social
Cognition and Theory of Mind, chronic and neurodegenerative disease, rehabilitation, neuro-
psychology, lifestyle and quality of life in chronic diseases.
Sara Isernia graduated from the University of Pavia (Italy) in Psychology, she obtained a PhD in
Science of the person and Education from Universita Cattolica del Sacro Cuore (Italy). Currently,
she is researcher at the IRCCS Don Gnocchi Foundation ONLUS, Milan (Italy). Her main
research fields of investigation are: social cognition in typical and atypical development, rehabili-
tation, digital health, neurodegenerative diseases, chronicity.
Sonia Di Tella completed a Master Degree in Cognitive Neuroscience and Psychological
Rehabilitation at Universita degli Studi di Roma “La Sapienza” in Rome (Italy), a Postgraduate
Degree in Clinical Neuropsychology at Universita Europea di Roma, Istituto Skinner in Rome
(Italy) and PhD in Psychology at the Catholic University of the Sacred Heart in Milan (Italy).
Student visitor at the Department of Neuroscience, University of Sheffield, Royal Hallamshire
Hospital Sheffield and at the Sheffield Institute for Translational Neuroscience (SITraN) (United
Kingdom, UK). She is currently Neuroscientific research collaborator at the I.R.C.C.S. Don Carlo
Gnocchi Foundation, Centro Avanzato di Diagnostica e Terapia Riabilitativa (CADiTeR) in
Milan (Italy). Her Skils and expertise are Clinical and experimental Neuropsychology, Functional
Neuroimaging, and Neuropsychological Rehabilitation. She is also winner of a Scholarship
financed by “Crespi Spano Foundation”, on the topic “Functional Recovery in the neurodegenera-
tive diseases” and Member of the Italian Society of Neuropsychology (SINP) from 2018
to present.
Marco Rovaris achieved the degree in Medicine in 1990 with full marks cum laude and com-
pleted his training in Neurology in 1994 at the University of Milan. Between 1994 and 1995 he
spent a fellowship period at the Institute of Neurology in London (UK), participating to clinical
activity and research studies focused on the use of MRI in the diagnosis and monitoring of mul-
tiple sclerosis. Between 1996 and 2008 he worked as a registrar in neurology and researcher at
the Multiple Sclerosis Centre and Rehabilitation Unit of the Scientific Institute San Raffaele in
Milan. In 2004 he received the Rita Levi Montalcini award from the Italian MS Foundation,
thanks to his studies on multiple sclerosis. Since 2008 he has been working at the Scientific
Institute Fondazione Don Carlo Gnocchi in Milan, where he is the head of the Multiple Sclerosis
Centre and Inpatient Rehabilitation Unit. He is contract professor at the University of Milan and
member of the Italian Neurological Society. He has authored or co-authored more than 250 full
papers on peer-reviewed journals.
Annalisa Valle is researcher in Developmental and Educational Psychology at the Faculty of
Educational Sciences, Department of Psychology, Universita Cattolica del Sacro Cuore, Milano.
Member of the Research Unit on Theory of Mind, main interests: Theory of mind development
in a life-span perspective. Irony understanding in children. Financial education, Emotional devel-
opment in children and adolescents. Mentalization in a life-span perspective.
Francesca Baglio is Neurologist, senior scientist and P.I. in projects related to the development
and application of new models of care in both adults and developmental age, with particular
attention to integrated care models applied to neurorehabilitation settings. She has implemented
and sperimented integrated multimodal rehabilitation interventions for non communicable dis-
eases such as Alzheimer’s and Parkinson’s Disease. Finally, she is an expert in the use of
advanced neuroimaging techniques in the evaluation of rehabilitation outcomes in clinical set-
tings. Currently, she is the Research Coordinator of Center of Advanced Diagnostics, Therapy
and Rehabilitation (CADiTeR) at Fondazione Don Carlo Gnocchi-Scientific Institute of Milan.
Antonella Marchetti is Full Professor of Psychology of Development and Psychology of
Education at the Universita Cattolica del Sacro Cuore (UCSC) in Milan (Italy), Director of the
Research Unit on Theory of Mind, Coordinator of the PhD Programme in Sciences of the
Person and Education, Vice-President of the Italian Association of Psychology, ISSBD Executive
Committee member and ISSBD Regional Coordinator for Italy, member of the scientific
Committee of FEDUF (Foundation for the Financial Education and Saving). Her research inter-
ests are in: Theory of Mind development from infancy to the elderly, decision-making, Theory of
Mind in HRI. Antonella Marchetti graduated in Philosophy at the University of Genoa and took
her specialization in Psychology at UCSC, she also obtained her PhD in Psychology from the
University of Pavia. Antonella Marchetti published more than 270 scientific contributes, consist-
ing in papers, book chapters, books and edited books. She took part to numerous international
and national conferences.
ORCID
Alessia d’Arma http://orcid.org/0000-0002-4855-4577
Sara Isernia http://orcid.org/0000-0002-0849-3984
Sonia Di Tella http://orcid.org/0000-0002-2248-5120
Francesca Baglio http://orcid.org/0000-0002-6145-5274
Antonella Marchetti http://orcid.org/0000-0001-9985-0539
References
Alashram, A. R., Annino, G., Padua, E., Romagnoli, C., & Mercuri, N. B. (2019). Cognitive
rehabilitation post traumatic brain injury: A systematic review for emerging use of virtual real-
ity technology. Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of
Australasia, 66, 209–219. https://doi.org/10.1016/j.jocn.2019.04.026
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(DSM-5V R ). American Psychiatric Pub.
Arean, P. A. (2012). Personalizing behavioral interventions: The case of late-life depression.

Neuropsychiatry, 2(2), 135–145. https://doi.org/10.2217/npy.12.15
Ashman, R., Banks, K., Philip, R. C., Walley, R., & Stanfield, A. C. (2017). A pilot randomised
controlled trial of a group based social skills intervention for adults with autism spectrum dis-
order. Research in Autism Spectrum Disorders, 43-44, 67–75. https://doi.org/10.1016/j.rasd.2017.
08.001
Barbato, M., Liu, L., Cadenhead, K. S., Cannon, T. D., Cornblatt, B. A., McGlashan, T. H.,
Perkins, D. O., Seidman, L. J., Tsuang, M. T., Walker, E. F., Woods, S. W., Bearden, C. E.,
Mathalon, D. H., Heinssen, R., & Addington, J. (2015). Theory of mind, emotion recognition
and social perception in individuals at clinical high risk for psychosis: Findings from the
NAPLS-2 cohort. Schizophrenia Research. Cognition, 2(3), 133–139. https://doi.org/10.1016/j.
scog.2015.04.004
26 A. D'ARMA ET AL.
Barlati, S., Deste, G., De Peri, L., Ariu, C., & Vita, A. (2013). Cognitive remediation in schizo-
phrenia: Current status and future perspectives. Schizophrenia Research and Treatment, 2013,
156084. https://doi.org/10.1155/2013/156084
Baron-Cohen, S. (1989). The autistic child’s theory of mind: A case of specific developmental
delay. Journal of Child Psychology and Psychiatry, 30(2), 285–297. https://doi.org/10.1111/j.
1469-7610.1989.tb00241.x
Baron-Cohen, S., Jolliffe, T., Mortimore, C., & Robertson, M. (1997). Another advanced test of
theory of mind: Evidence from very high functioning adults with autism or Asperger syn-
drome. Journal of Child Psychology and Psychiatry, 38(7), 813–822. https://doi.org/10.1111/j.
1469-7610.1997.tb01599.x
Baron-Cohen, S., Leslie, A. M., & Frith, U. (1985). Does the autistic child have a “theory of mind”.
Cognition, 21(1), 37–46. https://doi.org/10.1016/0010-0277(85)90022-8
Baron-Cohen, S., Wheelwright, S., Hill, J., Raste, Y., & Plumb, I. (2001). The “Reading the Mind
in the Eyes” Test revised version: A study with normal adults, and adults with Asperger syn-
drome or high-functioning autism. Journal of Child Psychology and Psychiatry, 42(2), 241–251.
https://doi.org/10.1017/S0021963001006643
Bechi, M., Spangaro, M., Bosia, M., Zanoletti, A., Fresi, F., Buonocore, M., Cocchi, F.,
Guglielmino, C., Smeraldi, E., & Cavallaro, R. (2013). Theory of Mind intervention for outpa-
tients with schizophrenia. Neuropsychological Rehabilitation, 23(3), 383–400. https://doi.org/10.
1080/09602011.2012.762751
Bechi, M., Bosia, M., Spangaro, M., Buonocore, M., Cocchi, F., Pigoni, A., Piantanida, M.,
Guglielmino, C., Bianchi, L., Smeraldi, E., & Cavallaro, R. (2015). Combined social cognitive
and neurocognitive rehabilitation strategies in schizophrenia: Neuropsychological and psycho-
pathological influences on Theory of Mind improvement. Psychological Medicine, 45(15),
3147–3157. https://doi.org/10.1017/S0033291715001129
Bechi, M., Riccaboni, R., Ali, S., Fresi, F., Buonocore, M., Bosia, M., Cocchi, F., Smeraldi, E., &
Cavallaro, R. (2012). Theory of mind and emotion processing training for patients with schizo-
phrenia: Preliminary findings. Psychiatry Research, 198(3), 371–377. https://doi.org/10.1016/j.
psychres.2012.02.004
Billeke, P., & Aboitiz, F. (2013). Social cognition in schizophrenia: From social stimuli processing
to social engagement. Frontiers in Psychiatry, 4, 4. https://doi.org/10.3389/fpsyt.2013.00004
Blair, R. J., & Cipolotti, L. (2000). Impaired social response reversal: A case of acquired sociop-
athy. Brain, 123(6), 1122–1141. https://doi.org/10.1093/brain/123.6.1122
Bliksted, V., Frith, C., Videbech, P., Fagerlund, B., Emborg, C., Simonsen, A., Roepstorff, A., &
Campbell-Meiklejohn, D. (2019). Hyper- and hypomentalizing in patients with first-episode
schizophrenia: fMRI and behavioral studies. Schizophrenia Bulletin, 45(2), 377–385. https://doi.
org/10.1093/schbul/sby027
Bora, E., Y€ ucel, M., & Pantelis, C. (2009). Theory of mind impairment: A distinct trait-marker
for schizophrenia spectrum disorders and bipolar disorder? Acta Psychiatrica Scandinavica,
120(4), 253–264. https://doi.org/10.1111/j.1600-0447.2009.01414.x
Br€
une, M. (2003). Theory of mind and the role of IQ in chronic disorganized schizophrenia.
Schizophrenia Research, 60(1), 57–64. https://doi.org/10.1016/S0920-9964(02)00162-7
une, M. (2005). “Theory of mind” in schizophrenia: A review of the literature. Schizophrenia
Br€
Bulletin, 31(1), 21–42. https://doi.org/10.1093/schbul/sbi002
Br€
une, M., Abdel-Hamid, M., Lehmk€amper, C., & Sonntag, C. (2007). Mental state attribution,
neurocognitive functioning, and psychopathology: What predicts poor social competence in
schizophrenia best? Schizophrenia Research, 92(1–3), 151–159. https://doi.org/10.1016/j.schres.
2007.01.006
Candida, M., Campos, C., Monteiro, B., Rocha, N. B. F., Paes, F., Nardi, A. E., & Machado, S.
(2016). Cognitive-behavioral therapy for schizophrenia: An overview on efficacy, recent trends
and neurobiological findings. MedicalExpress (S~ao Paulo, online), 3(5), M160501. https://doi.
org/10.5935/MedicalExpress.2016.05.01
Castelli, I., Baglio, F., Blasi, V., Alberoni, M., Falini, A., Liverta-Sempio, O., Nemni, R., &
Marchetti, A. (2010). Effects of aging on mindreading ability through the eyes: An fMRI study.
Neuropsychologia, 48(9), 2586–2594. https://doi.org/10.1016/j.neuropsychologia.2010.05.005
Cavallini, E., Bianco, F., Bottiroli, S., Rosi, A., Vecchi, T., & Lecce, S. (2015). Training for gener-
alization in Theory of Mind: A study with older adults. Frontiers in Psychology, 6, 1123.
https://doi.org/10.3389/fpsyg.2015.01123
Chan, J. Y., Ng, S. S., Lo, A. W., Chan, F. S., Leung, T. K., Kwok, J. W., Chow, L. W. L., Tam,
V. M. C., & Yiu, C. Y. (2018). Correlation of neuro-cognition and social cognition of people
with schizophrenia. International Journal of Psychology & Behavior Analysis, 4(1), 139. https://
doi.org/10.15344/2455-3867/2018/139
Charernboon, T., & Patumanond, J. (2017). Social cognition in schizophrenia. Mental Illness,
9(1), 16–19. https://doi.org/10.4081/mi.2017.7054
Chiu, C-y., Ng, S., & Au, E. W. M. (2013). Culture and social cognition. Oxford University Press.
https://10.1093/oxfordhb/9780199730018.013.0037
Chong, H. Y., Teoh, S. L., Wu, D. B. C., Kotirum, S., Chiou, C. F., & Chaiyakunapruk, N. (2016).
Global economic burden of schizophrenia: A systematic review. Neuropsychiatric Disease and
Treatment, 12, 357–373. https://doi.org/10.2147/NDT.S96649
Ciampi, E., Uribe-San-Martin, R., Vasquez, M., Ruiz-Tagle, A., Labbe, T., Cruz, J. P., Lillo, P.,
Slachevsky, A., Reyes, D., Reyes, A., & Carcamo-Rodrıguez, C. (2018). Relationship between
social cognition and traditional cognitive impairment in progressive multiple sclerosis and pos-
sible implicated neuroanatomical regions. Multiple Sclerosis and Related Disorders, 20, 122–128.
https://doi.org/10.1016/j.msard.2018.01.013
Corcoran, R., Mercer, G., & Frith, C. D. (1995). Schizophrenia, symptomatology and social infer-
ence: Investigating “theory of mind” in people with schizophrenia. Schizophrenia Research,
17(1), 5–13. https://doi.org/10.1016/0920-9964(95)00024-G
Cotelli, M., Manenti, R., Brambilla, M., Gobbi, E., Ferrari, C., Binetti, G., & Cappa, S. F. (2019).
Cognitive telerehabilitation in mild cognitive impairment, Alzheimer’s disease and frontotem-
poral dementia: A systematic review. Journal of Telemedicine and Telecare, 25(2), 67–79.
https://doi.org/10.1177/1357633X17740390
Couture, S. M., Penn, D. L., & Roberts, D. L. (2006). The functional significance of social cogni-
tion in schizophrenia: A review. Schizophrenia Bulletin, 32(Suppl 1), S44–S63. https://doi.org/
10.1093/schbul/sbl029
De Achaval, D., Costanzo, E. Y., Villarreal, M., Jauregui, I. O., Chiodi, A., Castro, M. N., Fahrer,
R. D., Leiguarda, R. C., Chu, E. M., & Guinjoan, S. M. (2010). Emotion processing and theory
of mind in schizophrenia patients and their unaffected first-degree relatives. Neuropsychologia,
48(5), 1209–1215. https://doi.org/10.1016/j.neuropsychologia.2009.12.019
Deckler, E., Hodgins, G. E., Pinkham, A. E., Penn, D. L., & Harvey, P. D. (2018). Social cognition
and neurocognition in schizophrenia and healthy controls: Intercorrelations of performance
and effects of manipulations aimed at increasing task difficulty. Frontiers in Psychiatry, 9, 356.
https://doi.org/10.3389/fpsyt.2018.00356
DeVylder, J. E., Ben-David, S., Kimhy, D., & Corcoran, C. M. (2013). Attributional style among
youth at clinical risk for psychosis. Early Intervention in Psychiatry, 7(1), 84–88. https://doi.
org/10.1111/j.1751-7893.2012.00347.x
Di Tella, S., Pagliari, C., Blasi, V., Mendozzi, L., Rovaris, M., & Baglio, F. (2020). Integrated tele-
rehabilitation approach in multiple sclerosis: A systematic review and meta-analysis. Journal of
Telemedicine and Telecare, 26(7–8), 385–399. https://doi.org/10.1177/1357633X19850381
Dimidjian, S., & McCauley, E. (2016). Modular, scalable, and personalized: priorities for behav-
ioral interventions for adolescent depression. Clinical Psychology: Science and Practice, 23(1),
58–61. https://doi.org/10.1111/cpsp.12142
Dimopoulou, T., Tarazi, F. I., & Tsapakis, E. M. (2017). The clinical role of theory of mind in
schizophrenia: A comprehensive review. Avid Science.
Dobkin, B. H., & Dorsch, A. K. (2017). The evolution of personalized behavioral intervention
technology: Will it change how we measure or deliver rehabilitation? Stroke, 48(8), 2329–2334.
https://doi.org/10.1161/STROKEAHA.117.016620
28 A. D'ARMA ET AL.
Duval, S., & Tweedie, R. (2000). Trim and fill: A simple funnel-plot-based method of testing and
adjusting for publication bias in meta-analysis. Biometrics, 56(2), 455–463. https://doi.org/10.
1111/j.0006-341x.2000.00455.x
Dziobek, I., Fleck, S., Kalbe, E., Rogers, K., Hassenstab, J., Brand, M., Kessler, J., Woike, J. K.,
Wolf, O. T., & Convit, A. (2006). Introducing MASC: A movie for the assessment of social
cognition. Journal of Autism and Developmental Disorders, 36(5), 623–636. https://doi.org/10.
1007/s10803-006-0107-0
Eack, S. M., Hogarty, S. S., Greenwald, D. P., Litschge, M. Y., McKnight, S. A., Bangalore, S. S.,
Pogue-Geile, M. F., Keshavan, M. S., & Cornelius, J. R. (2015). Cognitive Enhancement
Therapy in substance misusing schizophrenia: Results of an 18-month feasibility trial.
Schizophrenia Research, 161(2–3), 478–483. https://doi.org/10.1016/j.schres.2014.11.017
Edel, M. A., Raaff, V., Dimaggio, G., Buchheim, A., & Br€ une, M. (2017). Exploring the effective-
ness of combined mentalization-based group therapy and dialectical behaviour therapy for
inpatients with borderline personality disorder—A pilot study. The British Journal of Clinical
Psychology, 56(1), 1–15. https://doi.org/10.1111/bjc.12123
Fernandez-Gonzalo, S., Turon, M., Jodar, M., Pousa, E., Rambla, C. H., Garcıa, R., & Palao, D.
(2015). A new computerized cognitive and social cognition training specifically designed for
patients with schizophrenia/schizoaffective disorder in early stages of illness: A pilot study.
Psychiatry Research, 228(3), 501–509. https://doi.org/10.1016/j.psychres.2015.06.007
Fisher, M., Nahum, M., Howard, E., Rowlands, A., Brandrett, B., Kermott, A., Woolley, J., &
Vinogradov, S. (2017). Supplementing intensive targeted computerized cognitive training with
social cognitive exercises for people with schizophrenia: An interim report. Psychiatric
Rehabilitation Journal, 40(1), 21–32. https://doi.org/10.1037/prj0000244
Frith, C. D. (2004). Schizophrenia and theory of mind. Psychological Medicine, 34(3), 385–389.
https://doi.org/10.1017/S0033291700035601
Frith, C. D., & Corcoran, R. (1996). Exploring ’theory of mind’ in people with schizophrenia.
Psychological Medicine, 26(3), 521–530. https://doi.org/10.1017/s0033291700035601
Frommann, N., Streit, M., & W€ olwer, W. (2003). Remediation of facial affect recognition impair-
ments in patients with schizophrenia: A new training program. Psychiatry Research, 117(3),
281–284. https://doi.org/10.1016/S0165-1781(03)00039-8
GaweR da, Ł., KreR z_ ołek, M., Olbrys, J., Turska, A., & Kokoszka, A. (2015). Decreasing self-reported
cognitive biases and increasing clinical insight through meta-cognitive training in patients with
chronic schizophrenia. Journal of Behavior Therapy and Experimental Psychiatry, 48, 98–104.
https://doi.org/10.1016/j.jbtep.2015.02.002
Gil-Sanz, D., Fernandez-Modamio, M., Bengochea-Seco, R., Arrieta-Rodrıguez, M., & Perez-
Fuentes, G. (Fall 2016). Efficacy of the social cognition training program in a sample of outpa-
tients with schizophrenia. Clinical Schizophrenia & Related Psychoses, 10(3), 154–162. https://
doi.org/10.3371/1935-1232.10.3.154
Grant, N., Lawrence, M., Preti, A., Wykes, T., & Cella, M. (2017). Social cognition interventions
for people with schizophrenia: A systematic review focussing on methodological quality and
intervention modality. Clinical Psychology Review, 56, 55–64. https://doi.org/10.1016/j.cpr.2017.
06.001
Green, M. F., Horan, W. P., & Lee, J. (2019). Nonsocial and social cognition in schizophrenia:
Current evidence and future directions. World Psychiatry: Official Journal of the World
Psychiatric Association, 18(2), 146–161. https://doi.org/10.1002/wps.20624
Green, M. F., Horan, W. P., & Lee, J. (2015). Social cognition in schizophrenia. Nature Reviews.
Neuroscience, 16(10), 620–631. https://doi.org/10.1038/nrn4005
Greig, T. C., Bryson, G. J., & Bell, M. D. (2004). Theory of mind performance in schizophrenia:
Diagnostic, symptom, and neuropsychological correlates. The Journal of Nervous and Mental
Disease, 192(1), 12–18. https://doi.org/10.1097/01.nmd.0000105995.67947.fc
Hamburg, M. A., & Collins, F. S. (2010). The path to personalized medicine. The New England
Journal of Medicine, 363(4), 301–304. https://doi.org/10.1056/NEJMp1006304
Happe, F. G. (1994). An advanced test of theory of mind: Understanding of story characters’
thoughts and feelings by able autistic, mentally handicapped, and normal children and adults.
Journal of Autism and Developmental Disorders, 24(2), 129–154. https://doi.org/10.1007/

BF02172093
Harrington, L., Siegert, R., & McClure, J. (2005). Theory of mind in schizophrenia: A critical
review. Cognitive Neuropsychiatry, 10(4), 249–286. https://doi.org/10.1080/13546800444000056
Higgins, J. P., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring inconsistency in
meta-analyses. British Medical Journal (Clinical Research Edition), 327(7414), 557–560. https://
doi.org/10.1136/bmj.327.7414.557
Horan, W. P., Kern, R. S., Shokat-Fadai, K., Sergi, M. J., Wynn, J. K., & Green, M. F. (2009).
Social cognitive skills training in schizophrenia: An initial efficacy study of stabilized outpa-
tients. Schizophrenia Research, 107(1), 47–54. https://doi.org/10.1016/j.schres.2008.09.006
H., Choi, J., Hun Kim, J., Lee, J., & Green, M. F. (2009). Social cognition training for individuals
with schizophrenia: A review of targeted interventions. Clinical Psychopharmacology and
Neuroscience, 7(2), 29–38.
Insel, T. R. (2010). Rethinking schizophrenia. Nature, 468(7321), 187–193. https://doi.org/10.
1038/nature09552
Isernia, S., Baglio, F., d’Arma, A., Groppo, E., Marchetti, A., & Massaro, D. (2019). Social mind
and long-lasting disease: Focus on affective and cognitive theory of mind in multiple sclerosis.
Frontiers in Psychology, 10, 218. https://doi.org/10.3389/fpsyg.2019.00218
Isernia, S., Pagliari, C., Jonsdottir, J., Castiglioni, C., Gindri, P., Gramigna, C., Palumbo, G., Salza,
M., Molteni, F., & Baglio, F, HEAD study group (2019). Efficiency and patient-reported out-
come measures from clinic to home: The human empowerment aging and disability program
for digital-health rehabilitation. Frontiers in Neurology, 10, 1206. https://doi.org/10.3389/fneur.
2019.01206
Kalokerinos, E. K., von Hippel, W., & Henry, J. D. (2015). Social cognition and aging. In N.
Pachana (Ed.), Encyclopedia of geropsychology (pp. 1–7). https://doi.org/10.1007/978-981-287-
080-3_2-1.
Kanie, A., Kikuchi, A., Haga, D., Tanaka, Y., Ishida, A., Yorozuya, Y., Matsuda, Y., Morimoto,
T., Fukuoka, T., Takazawa, S., Hagiya, K., Ozawa, S., Iwata, K., Ikebuchi, E., Ikebuchi, T.,
Roberts, D. L., & Hagiya, K. (2019). The feasibility and efficacy of social cognition and inter-
action training for outpatients with schizophrenia in Japan: A multicenter randomized clinical
trial. Frontiers in Psychiatry, 10, 589. https://doi.org/10.3389/fpsyt.2019.00589
Kelemen, O., Mattyassy, A., & Keri, S. (2019). Improvement of theory of mind in schizophrenia:
A 15-year follow-up study. Psychology, 1(1), 420–428. https://doi.org/10.3390/psych1010032
K€other, U., Vettorazzi, E., Veckenstedt, R., Hottenrott, B., Bohn, F., Scheu, F., Pfueller U.,
Roesch-Ely D. & Moritz, S. (2017). Bayesian analyses of the effect of metacognitive training on
social cognition deficits and overconfidence in errors. Journal of Experimental Psychopathology,
8(2), 158–174. https://doi.org/10.5127/jep.054516
Kowalski, J., Pankowski, D., Lew-Starowicz, M., & Gawęda, Ł. (2017). Do specific metacognitive
training modules lead to specific cognitive changes among patients diagnosed with schizophrenia?
A single module effectiveness pilot study. Psychosis, 9(3), 254–259. https://doi.org/10.1080/
17522439.2017.1300186
Kurtz, M. M., Gagen, E., Rocha, N. B., Machado, S., & Penn, D. L. (2016). Comprehensive treat-
ments for social cognitive deficits in schizophrenia: A critical review and effect-size analysis of
controlled studies. Clinical Psychology Review, 43, 80–89. https://doi.org/10.1016/j.cpr.2015.09.
003
Kurtz, M. M., & Richardson, C. L. (2012). Social cognitive training for schizophrenia: A meta-
analytic investigation of controlled research. Schizophrenia Bulletin, 38(5), 1092–1104. https://
doi.org/10.1093/schbul/sbr036
Lado-Codesido, M., Perez, C. M., Mateos, R., Olivares, J. M., & Caballero, A. G. (2019).
Improving emotion recognition in schizophrenia with “VOICES”: An on-line prosodic self-
training. PLoS One, 14(1), e0210816. https://doi.org/10.1371/journal.pone.0210816
Livingston, L. A., Carr, B., & Shah, P. (2019). Recent advances and new directions in measuring
theory of mind in autistic adults. Journal of Autism and Developmental Disorders, 49(4),
1738–1744. https://doi.org/10.1007/s10803-018-3823-3
30 A. D'ARMA ET AL.
Maggio, M. G., Maresca, G., De Luca, R., Stagnitti, M. C., Porcari, B., Ferrera, M. C., Galletti, F.,
Casella, C., Manuli, A., & Calabr o, R. S. (2019). The growing use of virtual reality in cognitive
rehabilitation: Fact, fake or vision? A scoping review. Journal of the National Medical
Association, 111(4), 457–463. https://doi.org/10.1016/j.jnma.2019.01.003
Maat, A., Fett, A. K., & Derks, E, & Group Investigators. (2012). Social cognition and quality of
life in schizophrenia. Schizophrenia Research, 137(1–3), 212–218. https://doi.org/10.1016/j.
schres.2012.02.017
McDonald, S., Flanagan, S., Rollins, J., & Kinch, J. (2003). TASIT: A new clinical tool for assess-
ing social perception after traumatic brain injury. The Journal of Head Trauma Rehabilitation,
18(3), 219–238. https://doi.org/10.1097/00001199-200305000-00001
McGrath, J., & Scott, J. (2006). Urban birth and risk of schizophrenia: A worrying example of
epidemiology where the data are stronger than the hypotheses. Epidemiology and Psychiatric
Sciences, 15(4), 243–246. https://doi.org/10.1017/S1121189X00002104
Maher, C. G., Sherrington, C., Herbert, R. D., Moseley, A. M., & Elkins, M. (2003). Reliability of
the PEDro scale for rating quality of randomized controlled trials. Physical Therapy, 83(8),
713–721. https://doi.org/10.1093/ptj/83.8.713
Mancuso, F., Horan, W. P., Kern, R. S., & Green, M. F. (2011). Social cognition in psychosis:
Multidimensional structure, clinical correlates, and relationship with functional outcome.
Schizophrenia Research, 125(2–3), 143–151. https://doi.org/10.1016/j.schres.2010.11.007
Maro~
no Souto, Y., Vazquez Campo, M., Dıaz Llenderrozas, F., Rodrıguez Alvarez, M., Mateos,
R., & Garcıa Caballero, A. (2018). Randomized clinical trial with e-MotionalTrainingV R 1.0 for
social cognition rehabilitation in schizophrenia. Frontiers in Psychiatry, 9, 40. https://doi.org/

10.3389/fpsyt.2018.00040
Mazza, M., Costagliola, C., Di Michele, V., Magliani, V., Pollice, R., Ricci, A., Di Giovanbattista,
E., Roncone, R., Casacchia, M., & Galzio, R. J. (2007). Deficit of social cognition in subjects
with surgically treated frontal lobe lesions and in subjects affected by schizophrenia. European
Archives of Psychiatry and Clinical Neuroscience, 257(1), 12–22. https://doi.org/10.1007/s00406-
006-0676-0
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(4), 254–263. https://doi.org/10.1159/000128324
Mazza, M., Lucci, G., Pacitti, F., Pino, M. C., Mariano, M., Casacchia, M., & Roncone, R. (2010).
Could schizophrenic subjects improve their social cognition abilities only with observation and
imitation of social situations? Neuropsychological Rehabilitation, 20(5), 675–703. https://doi.
org/10.1080/09602011.2010.486284
Mazza, M., Pollice, R., Pacitti, F., Pino, M. C., Mariano, M., Tripaldi, S., Casacchia, M., &
Roncone, R. (2012). New evidence in theory of mind deficits in subjects with chronic schizo-
phrenia and first episode: Correlation with symptoms, neurocognition and social function.
Rivista di Psichiatria, 47(4), 327–336. https://doi.org/10.1708/1139.12561
Montag, C., Neuhaus, K., Lehmann, A., Kr€ uger, K., Dziobek, I., Heekeren, H. R., Heinz, A., &
Gallinat, J. (2012). Subtle deficits of cognitive theory of mind in unaffected first-degree rela-
tives of schizophrenia patients. European Archives of Psychiatry and Clinical Neuroscience,
262(3), 217–226. https://doi.org/10.1007/s00406-011-0250-2
Moran, J. M., Jolly, E., & Mitchell, J. P. (2012). Social-cognitive deficits in normal aging. The
Journal of Neuroscience: The Official Journal of the Society for Neuroscience, 32(16), 5553–5561.
https://doi.org/10.1523/JNEUROSCI.5511-11.2012
Moritz, S., & Woodward, T. S. (2007). Metacognitive training for schizophrenia patients (MCT):
A pilot study on feasibility, treatment adherence, and subjective efficacy. German Journal of
Psychiatry, 10(3), 69–78.
O’Reilly, K., Donohoe, G., O’Sullivan, D., Coyle, C., Corvin, A., O’Flynn, P., O’Donnell, M.,
Galligan, T., O’Connell, P., & Kennedy, H. G. (2019). A randomized controlled trial of cogni-
tive remediation for a national cohort of forensic patients with schizophrenia or schizoaffective
disorder. BMC Psychiatry, 19(1), 27. https://doi.org/10.1186/s12888-019-2018-6
Palumbo, D., Mucci, A., Piegari, G., D’Alise, V., Mazza, A., & Galderisi, S. (2017). SoCIAL -
training cognition in schizophrenia: A pilot study. Neuropsychiatric Disease and Treatment,
13, 1947–1956. https://doi.org/10.2147/NDT.S136732
Pe~
na, J., Ibarretxe-Bilbao, N., Sanchez, P., Iriarte, M. B., Elizagarate, E., Garay, M. A., Gutierrez,
M., Iribarren, A. & Ojeda, N. (2016). Combining social cognitive treatment, cognitive remedi-
ation, and functional skills training in schizophrenia: a randomized controlled trial. npj
Schizophrenia, 2(1), 1–7. https://doi.org/10.1038/npjschz.2016.37
Penaherrera, C. A., & Duarte, M. C. (2016). Schizophrenia and social cognition: A review of con-
cepts and treatment options. Journal of Socialomics, 05(02), 2167–0358. https://doi.org/10.4172/
2167-0358.1000150
Penn, D. L., Sanna, L. J., & Roberts, D. L. (2008). Social cognition in schizophrenia: An overview.
Schizophrenia Bulletin, 34(3), 408–411. https://doi.org/10.1093/schbul/sbn014
Pentaraki, A. D., Stefanis, N. C., Stahl, D., Theleritis, C., Toulopoulou, T., Roukas, D., Kaliora,
S. C., Chatzimanolis, I., Smyrnis, N., Russell, T., Kravariti, E., & Murray, R. M. (2012). Theory
of mind as a potential trait marker of schizophrenia: A family study. Cognitive
Neuropsychiatry, 17(1), 64–89. https://doi.org/10.1080/13546805.2011.568289
Peyroux, E., Prost, Z., Danset-Alexandre, C., Brenugat-Herne, L., Carteau-Martin, I., Gaudelus,
B., Jantac, C., Attali, D., Amado, I., Graux, J., Houy-Durand, E., Plasse, J., & Franck, N.
(2019). From “under” to “over” social cognition in schizophrenia: Is there distinct profiles of
impairments according to negative and positive symptoms? Schizophrenia Research. Cognition,
15, 21–29. https://doi.org/10.1016/j.scog.2018.10.001
Pinkham, A. E., Penn, D. L., Perkins, D. O., & Lieberman, J. (2003). Implications for the neural
basis of social cognition for the study of schizophrenia. American Journal of Psychiatry,
160(5), 815–824. https://doi.org/10.1176/appi.ajp.160.5.815
Pino, M. C., Pettinelli, M., Clementi, D., Gianfelice, C., & Mazza, M. (2015). Improvement in
cognitive and affective theory of mind with observation and imitation treatment in subjects
with schizophrenia. Clinical Neuropsychiatry, 12(3), 64–72.
Poletti, M., Enrici, I., & Adenzato, M. (2012). Cognitive and affective Theory of mind in neuro-
degenerative diseases: Neuropsychological, neuroanatomical and neurochemical levels.
Neuroscience and Biobehavioral Reviews, 36(9), 2147–2164. https://doi.org/10.1016/j.neubiorev.
2012.07.004
Premack, D., & Woodruff, G. (1978). Does the chimpanzee have a theory of mind? Behavioral
and Brain Sciences, 1(4), 515–526. https://doi.org/10.1017/S0140525X00076512
Reddy, L. F., Horan, W. P., Jahshan, C., & Green, M. F. (2014). Cognitive remediation for schizo-
phrenia: A review of recent findings. Current Treatment Options in Psychiatry, 1(2), 121–133.
https://doi.org/10.1007/s40501-014-0011-8
Roberts, D. L., Combs, D. R., Willoughby, M., Mintz, J., Gibson, C., Rupp, B., & Penn, D. L.
(2014). A randomized, controlled trial of Social Cognition and Interaction Training (SCIT) for
outpatients with schizophrenia spectrum disorders. The British Journal of Clinical Psychology,
53(3), 281–298. https://doi.org/10.1111/bjc.12044
Roberts, D. L., Penn, D. L., & Combs, D. R. (2015). Social cognition and interaction training
(SCIT): Group psychotherapy for schizophrenia and other psychotic disorders, clinician guide.
Oxford University Press.
Rosenthal, R. (1986). Meta-analytic procedures for social science research (pp. 148). Sage
Publications.
American Medical Research Association. (1986). Educational researcher (Vol. 15, pp. 18–20).
American Medical Research Association. https://doi.org/10.2307/1175262
Rosi, A., Cavallini, E., Bottiroli, S., Bianco, F., & Lecce, S. (2016). Promoting theory of mind in
older adults: Does age play a role? Aging & Mental Health, 20(1), 22–28. https://doi.org/10.
1080/13607863.2015.1049118
Rossetto, F., Castelli, I., Baglio, F., Massaro, D., Alberoni, M., Nemni, R., Shamay-Tsoory, S., &
Marchetti, A. (2018). Cognitive and affective theory of mind in mild cognitive impairment and
Parkinson’s disease: Preliminary evidence from the Italian version of the yoni task.
Developmental Neuropsychology, 43(8), 764–780. https://doi.org/10.1080/87565641.2018.1529175
32 A. D'ARMA ET AL.
Rowe, A. D., Bullock, P. R., Polkey, C. E., & Morris, R. G. (2001). “Theory of mind” impairments
and their relationship to executive functioning following frontal lobe excisions. Brain: A
Journal of Neurology, 124(Pt 3), 600–616. https://doi.org/10.1093/brain/124.3.600
Scherzer, P. B., Leveille, E., Achim, A., Boisseau, E., & Stip, E. (2012). A study of theory of mind
in paranoid schizophrenia: A theory or many theories? Frontiers in Psychology, 3, 432. https://
doi.org/10.3389/fpsyg.2012.00432
Schmidt, S. J., Mueller, D. R., & Roder, V. (2011). Social cognition as a mediator variable
between neurocognition and functional outcome in schizophrenia: Empirical review and new
results by structural equation modeling. Schizophrenia Bulletin, 37(suppl 2), S41–S54. https://
doi.org/10.1093/schbul/sbr079
Shamay-Tsoory, S. G., & Aharon-Peretz, J. (2007). Dissociable prefrontal networks for cognitive
and affective theory of mind: A lesion study. Neuropsychologia, 45(13), 3054–3067. https://doi.
org/10.1016/j.neuropsychologia.2007.05.021
Shamay-Tsoory, S. G., Aharon-Peretz, J., & Perry, D. (2009). Two systems for empathy: A double
dissociation between emotional and cognitive empathy in inferior frontal gyrus versus ventro-
medial prefrontal lesions. Brain: A Journal of Neurology, 132(Pt 3), 617–627. https://doi.org/10.
1093/brain/awn279
Shamay-Tsoory, S. G., Tomer, R., Berger, B. D., Goldsher, D., & Aharon-Peretz, J. (2005).
Impaired “affective theory of mind” is associated with right ventromedial prefrontal damage.
Cognitive and Behavioral Neurology: Official Journal of the Society for Behavioral and Cognitive
Neurology, 18(1), 55–67. https://doi.org/10.1097/01.wnn.0000152228.90129.99
Smith, E. R., & Semin, G. R. (2004). Socially situated cognition: Cognition in its social context.
Advances in Experimental Social Psychology, 36, 57–121. https://doi.org/10.1016/S0065-
2601(04)36002-8
Tan, B. L., Lee, S. A., & Lee, J. (2018). Social cognitive interventions for people with schizophre-
nia: A systematic review. Asian Journal of Psychiatry, 35, 115–131. https://doi.org/10.1016/j.ajp.
2016.06.013
Tas, C., Danaci, A. E., Cubukcuoglu, Z., & Br€ une, M. (2012). Impact of family involvement on
social cognition training in clinically stable outpatients with schizophrenia - A randomized
pilot study. Psychiatry Research, 195(1–2), 32–38. https://doi.org/10.1016/j.psychres.2011.07.031
Taylor, R., Cella, M., Csipke, E., Heriot-Maitland, C., Gibbs, C., & Wykes, T. (2016). Tackling
social cognition in schizophrenia: A randomized feasibility trial. Behavioural and Cognitive
Psychotherapy, 44(3), 306–317. https://doi.org/10.1017/S1352465815000284
Vaskinn, A., Løvgren, A., Egeland, M. K., Feyer, F. K., Østefjells, T., Andreassen, O. A., Melle, I.,
& Sundet, K. (2019). A randomized controlled trial of training of affect recognition (TAR) in
schizophrenia shows lasting effects for theory of mind. European Archives of Psychiatry and
Clinical Neuroscience, 269(5), 611–620. https://doi.org/10.1007/s00406-019-00997-z
Veltro, F., Mazza, M., Vendittelli, N., Alberti, M., Casacchia, M., & Roncone, R. (2011). A com-
parison of the effectiveness of problem solving training and of cognitive-emotional rehabilita-
tion on neurocognition, social cognition and social functioning in people with schizophrenia.
Clinical Practice and Epidemiology in Mental Health, 7, 123–132. https://doi.org/10.2174/
1745017901107010123
Vos, T., Abajobir, A. A., Abate, K. H., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abdulkader,
R. S., Abdulle, A. M., Abebo, T. A., Abera, S. F., Aboyans, V., Abu-Raddad, L. J., Ackerman,
I. N., Adamu, A. A., Adetokunboh, O., Afarideh, M., Afshin, A., Agarwal, S. K., Aggarwal, R.,
… Murray, C. J. L. (2017). Global, regional, and national incidence, prevalence, and years
lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: A systematic
analysis for the Global Burden of Disease Study 2016. The Lancet, 390(10100), 1211–1259.
https://doi.org/10.1016/S0140-6736(16)31678-6
Wang, Y., Roberts, D. L., Xu, B., Cao, R., Yan, M., & Jiang, Q. (2013). Social cognition and inter-
action training for patients with stable schizophrenia in Chinese community settings.
Psychiatry Research, 210(3), 751–755. https://doi.org/10.1016/j.psychres.2013.08.038
W€olwer, W., & Frommann, N. (2011). Social-cognitive remediation in schizophrenia:

Generalization of effects of the Training of Affect Recognition (TAR). Schizophrenia Bulletin,
37(suppl 2), S63–S70. https://doi.org/10.1093/schbul/sbr071
Yang, N. Y., Zhou, D., Chung, R. C., Li, C. W., & Fong, K. N. (2013). Rehabilitation interven-
tions for unilateral neglect after stroke: A systematic review from 1997 through 2012. Frontiers
in Human Neuroscience, 7, 187. https://doi.org/10.3389/fnhum.2013.00187

Social Cognition Training for Enhancing Theory of Mind in Schizophrenia

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Social Cognition Training for Enhancing Affective

ABSTRACT ARTICLE HISTORY

Materials and Methods

“enhancement,” and “teach.” Furthermore, given our focus on training effectiveness on

Inclusion and Exclusion Criteria

studies on training focused on SC (in whole or part);

Exclusion criteria adopted were the following:

no training studies (i.e., protocol trials, review);

Data Collection, Extraction, Methodological Quality, and Risk of Bias of

Figure 1. PRISMA flowchart.

Social Cognition Training: Type of Interventions

Psychoeducational Approach Integrated with Behavioral and Cognitive Techniques

Table 1. Main Characteristics and Findings of the Studies Selected.

schizoaffective N ¼ 76 raising the patients’ (32.68 ± 9.54) remediation mental state

schizoaffective Therapy Discussions; N¼9 services, case were large and

services and improvement were

[–] eye direction (phase assigning them a

Table 2. Demographic Characteristics.

SCIT Training: Manualized cognitive-behavioral therapy using a gradual exposure

Figure 2. Training format strategies.

Tom Assessment Used in the Selected Studies

Effect of SC Training on ToM Outcomes

Overall Effect on ToM

Table 3. ToM Assessment: Aims, Characteristic, and Cognitive/Affective Components.

Figure 3. Overall ToM forest plot.

Figure 4. Cognitive ToM—forest plot.

Figure 5. Affective ToM—forest plot.

Arean, P. A. (2012). Personalizing behavioral interventions: The case of late-life depression.

Journal of Autism and Developmental Disorders, 24(2), 129–154. https://doi.org/10.1007/

social cognition rehabilitation in schizophrenia. Frontiers in Psychiatry, 9, 40. https://doi.org/

W€olwer, W., & Frommann, N. (2011). Social-cognitive remediation in schizophrenia:

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