Cognitive enhancement therapy improves emotional intelligence in early course schizophrenia: Preliminary effects

Abstract

This research examined the preliminary effects of Cognitive Enhancement Therapy (CET) on social cognition in early course schizophrenia, using an objective, performance-based measure of emotional intelligence. Individuals in the early course of schizophrenia were randomly assigned to either CET (n = 18) or Enriched Supportive Therapy (n = 20), and assessed at baseline and after 1 year of treatment with the Mayer–Salovey–Caruso Emotional Intelligence Test. A series of analyses of covariance showed highly significant (p = .005) and large (Cohen's d = .96) effects favoring CET for improving emotional intelligence, with the most pronounced improvements occurring in patients' ability to understand and manage their own and others' emotions. These findings lend preliminary support to the previously documented benefits of CET on social cognition in schizophrenia, and suggest that such benefits can be extended to patients in the early course of the illness.

Introduction

Despite the introduction of novel antipsychotic agents, many individuals with schizophrenia continue to suffer from marked social disability and diminished functional capacity (Thaker and Carpenter, 2001). Research over the past several decades has increasingly pointed to the important role cognitive deficits play in maintaining poor functional outcomes in schizophrenia (Green, 1996). In particular, research has consistently shown neurocognitive deficits in attention, working memory, and executive function to be linked with poor community functioning and social adjustment (Green et al., 2000). Recently, cognitive deficits associated with the processing and interpretation of social and emotional information have also been noted as important potential contributors to poor functional outcome in schizophrenia (Green et al., 2005, Penn et al., 1997). Several cross-sectional studies have found that these deficits in social cognition are related to poor social and behavioral outcomes (Brune, 2005, Corrigan and Toomey, 1995, Mueser et al., 1996), and indicated that such relationships exist, to some degree, independent of deficits in neurocognition (Penn et al., 1996, Vauth et al., 2004). Unfortunately, to date, effective treatments to address social-cognitive deficits in schizophrenia have been sparse.

Cognitive Enhancement Therapy (CET; Hogarty and Greenwald, 2006) is an integrated, developmental approach to the remediation of neurocognitive and social-cognitive deficits in schizophrenia. Recently we described comprehensive and enduring effects of CET in a randomized-controlled trial of 121 chronically ill (on average 15 years) persons with schizophrenia, treated for 2 years and followed-up 1 year post-treatment (Hogarty et al., 2004, Hogarty et al., in press). Employing highly reliable composites, broadly defined measures of social cognition demonstrated the largest behavioral improvement over time. However, legitimate concerns existed not only with our definition and measure of social cognition, but also its objective assessment by non-blind clinical raters. In preparation for a new trial among early course patients (ill for less than 8 years), we again surveyed the literature on the measurement of social cognition. Although the literature is replete with widely varying definitions of social cognition (Wyer and Srull, 1994), the field has increasingly moved to a better elaboration of the mental processes that are known to support interpersonal functioning, such as emotional processing, social processing, social context appraisal, theory of mind and attributional styles (Pinkham et al., 2003), to name a few. Central to these social-cognitive processes is the ability to process, understand, and manage emotion, commonly referred to as emotional intelligence (Mayer and Salovey, 1997). The Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT; Mayer et al., 2003) provides objective, performance and ability-based assessments of emotional intelligence, that are largely independent of personality traits and self-report attributions. This unique instrument has been included in our ongoing studies of CET and has also been recently recommended by the NIMH-MATRICS project (Green et al., 2005).

We now examine whether previous beneficial effects of CET on social cognition can be identified using the MSCEIT, and extended to individuals in the early course of schizophrenia. Previous reports have shown CET to be effective at improving deficits in social-cognition among more chronic patients (Hogarty et al., 2004, Hogarty et al., in press). The neurodevelopmental framework upon which CET is based suggests that the treatment should be particularly effective at improving adjustment and forestalling social deterioration among patients early in the course of the illness, through facilitating the development of the social-cognitive processes that underly appropriate adult socialization closer to the developmental period when these processes emerge among healthy individuals (Hogarty and Flesher, 1999). Furthermore, patients early in the course of their illness are thought to have continuing brain plasticity (Keshavan and Hogarty, 1999). This might facilitate the ability of patients to benefit from a disorder-relevant treatment designed to improve social and neurocognitive deficits, and lead to a better long-term functional outcome.