Human interactions are complex, and can lead to their share of disappointment. It may happen, for example, that a loved one does not respond to our distress or our joy as we might expect. Communication accidents happen!
Psychiatry, however, teaches us that if these accidents multiply with the same person, the reason could lie less with a lack of good intentions on the part of our interlocutor than with an alteration of their social cognition.
A growing number of studies are indeed establishing a relationship between social cognition and different psychiatric conditions. Behaviors that are self-evident for most people, such as showing concern for someone who expresses sadness, may be absent for some.
For some, even a basic situation or interaction can give rise to an erroneous interpretation, and incidentally to inappropriate or inappropriate behavior. The multiplication of these types of errors may be due to an impairment in the individual of a central cognitive skill in this area: social cognition.
It mainly concerns the ability to decode emotions as well as understand the beliefs and intentions of the people around us. Determining whether this cognitive skill is affected by an illness or psychiatric disorder is therefore essential, since it is then possible to respond adequately to the problems encountered, and thus limit its harmful effects.
An emerging field of research
Assistant Professor of Psychiatry at McGill University, I conduct research on psychiatric disorders in order to study cognitive disorders, their impacts and their possible solutions. In this regard, my work is part of an increasingly important field of research which is interested in the relationships that exist between disorders of social cognition and mental health disorders such as depression, bipolar disorder or schizophrenia. In all these pathologies, impairments of different degrees of social cognition have been observed.
The various signs that may indicate impaired social cognition should be taken seriously. This attack not only affects an individual’s understanding of the world, but also disrupts communication with people in their daily lives.
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It is possible to spot these signs when interpreting a real-life situation or a fiction that you have just watched. How is it, for example, that we are the only one who has not understood the implication of the main character of our favorite series or the double meaning of a comment during a discussion between colleagues?
An impact on daily life
A literature review carried out a few years ago with colleagues showed links between impairments in social cognition in people living with bipolar disorder and the level of functioning in everyday life. In other words, the more social cognition is impaired, the less likely the individual will be to function well on a daily basis.
Since then, our work and that of other teams have shown that these disorders are an intermediary between cognitive problems (e.g. memory) and clinical symptoms. Indeed, memory is frequently affected in pathologies such as schizophrenia and certain forms of bipolar disorder.
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These attacks occur early in the course of the disease and are associated with a loss of motivation, withdrawal or difficulty expressing one’s emotions. Impairments of social cognition, such as difficulty identifying one’s emotions and those of others, understanding oneself and others, would be at the center of this process. By understanding this, treatment options can be proposed.
Improve your cognitive skills
Several proposals have been developed to support and improve these skills.
Some interventions will, for example, offer exercises working on social cognition and memory. It may then be a question, for the patient, of correctly recognizing the emotions expressed by another person, or even, by correctly interpreting the beliefs or intentions of others, of achieving an adequate reading of more complex situations.
Other interventions will allow the patient to become aware of the way he thinks by integrating social cognition. An exercise can present a story in which the motivations of the characters only appear gradually.
For example, a young girl offers chocolates to an elderly lady who thanks her with a smile. Once the girl leaves, the lady expresses disgust then throws the box in the trash. The young girl returns after a few months with a new box of chocolates. The questions will then focus on the young girl’s beliefs and the reaction she can expect from the elderly lady.
This type of exercise, of increasing complexity, helps the individual to gradually become aware of their own difficulties, then to find strategies that can provide solutions. Such a program, initially developed for schizophrenia, has shown its effectiveness and is now recommended for several psychiatric disorders. For schizophrenia, a recent meta-analysis showed sustained improvement over one year in symptoms, self-esteem and functioning.
Most of these programs are done in the presence of a therapist, in a caring environment. The role-play, through practical exercises, then allows people living with social cognition disorders to introduce this learning into their daily lives. Indeed, interventions that support social cognition involve quickly using the strategies proposed in everyday life so that they are useful and maintained over time.
Accessibility to improve
Many efforts are being made to ensure that this type of support can benefit a wider audience, particularly using digital tools. For example, since the pandemic, our team has proposed videoconference groups for people suffering from severe mental health problems as part of a research project. People who participated in these interventions found it feasible and satisfying in this form and their well-being improved.
For loved ones of a person living with a mental health disorder, better knowledge and understanding of these processes is also useful. It is indeed important that these loved ones understand that they are not dealing with a person with bad intentions, who deliberately seeks to hurt them or misinterpret them, but with a person in suffering.
Schizophrenia being one of the pathologies which causes the most incomprehension for families, programs aimed at improving intra-family communication exist (e.g. Profamily) and can support the maintenance and quality of relationships, even if they do not specifically aim social cognition.
Social cognition is a field that has generated a lot of research and clinical work in order to understand its mechanisms and enable the recovery of people living with a mental health disorder. There is still a lot of work to be done to adjust to each individual situation, but the progress is very real.
