Training the Mind to Feel: A New Approach Accelerates Recovery in Schizophrenia
- Lidi Garcia
- 4 minutes ago
- 4 min read
Schizophrenia affects not only logical thinking but also how a person understands and relates to others. Research shows that successful recovery depends heavily on social cognition, especially the ability to interpret emotions and intentions. The study analyzed 102 patients and showed that improving these skills can help people live with more autonomy and stability. Training the brain to better understand human behavior is, therefore, one of the keys to a functional life in schizophrenia.
Research conducted over nearly three decades shows that people with schizophrenia face significant challenges not only in psychiatric symptoms but also in their cognitive abilities, that is, in the mental functions that involve thinking, understanding, remembering, and interacting socially.
These challenges, both neurological and social, are one of the main barriers to recovery and a return to a functional life.
Therefore, scientists have developed programs called "cognitive remediation," which are sets of mental exercises and training aimed at improving both "pure" cognition (such as memory, attention, planning, and reasoning) and social cognition (the ability to understand the emotions, intentions, and behaviors of other people).
This approach has shown promising results, especially when applied in the early stages of schizophrenia, a crucial time to prevent the disease from worsening and to reduce long-term disability.
Previous studies, conducted with people in more chronic stages of schizophrenia, have shown an interconnection between rational and social thinking. Simply put: basic cognitive functions, such as memory and attention, affect how a person understands and reacts socially; and this social cognition, in turn, strongly influences the ability to maintain a functional life, such as working, studying, and relating to others.
On average, people with schizophrenia have cognitive performance that is about two standard deviations below the average of people without the disease, which means a marked difference in skills such as memory, reasoning, and learning.
Social cognition difficulties, such as recognizing emotions or interpreting gestures and intentions, are about one standard deviation below the average. Both types of deficit contribute to difficulty in maintaining daily life and stable relationships.
Research since the late 1990s has indicated that, although neurocognition (basic mental functions) and social cognition are related, they are distinct brain functions. In a large analysis of over 2,600 patients, it was observed that social cognition has a greater impact on people's practical lives than neurocognition.
More recent studies, including over 3,700 patients in the early stages of schizophrenia, have confirmed this relationship: the more impaired social cognition, the worse the functional outcomes, such as employment, social relationships, and autonomy.
To better understand this mechanism, researchers developed a mediating model, a form of analysis that shows how one factor indirectly influences another. In this model, neurocognition affects social cognition, which in turn affects functional outcome. Thus, the impact of reasoning and memory on practical life largely occurs through a person's social and emotional capacity.
A recent study tested this hypothesis with 102 outpatients, all in the early years of the illness. Three dimensions were evaluated:
Neurocognition, which includes memory, attention, and reasoning;
Social cognition, which encompasses skills such as empathy and interpretation of intentions;
Functional outcome, which refers to the ability to live independently and interact socially.
The researchers used a statistical method called path analysis, which allows them to measure how one factor influences another directly and indirectly.
The results showed that, in fact, social cognition mediates the relationship between reasoning and daily functioning, confirming the hypothesis. Among the various social skills tested, only one, called social inference (the ability to deduce what others think or feel), played a truly decisive role.
That is, the study indicates that the impact of cognitive deficits on the daily lives of people with schizophrenia occurs, in part, because these difficulties impair how they understand and respond to others. Thus, improving social cognition, especially social inference, may be one of the most promising paths to functional recovery.
These findings reinforce the importance of comprehensive cognitive rehabilitation programs that include not only memory and attention training, but also the development of social and emotional skills.
READ MORE:
Social cognition as a mediator between neurocognition and functional outcome in early course schizophrenia
Anju Kotwani, Jessica A. Wojtalik, Douglas D. Gunzler, Matthew J. Smith, Wilson J. Brown, Rochanne L. Honarvar, Martha Sajatovic, Matcheri S. Keshavan, and Shaun M. Eack
Psychiatry Research, Volume 351, September 2025, 116594
Abstract:Â
Social cognition is an established mediator between neurocognition and functional outcome in schizophrenia, but there is limited evidence for this model specifically in the early course, which is a critical window for intervention to reduce long-term disability. This study aimed to test the social cognition mediator model in the early course of schizophrenia and identify social cognitive subdomains that may have stronger indirect effects on the relationship between neurocognition and functional outcome. This secondary analysis utilized baseline cognitive and functional outcome data from a cognitive remediation trial for outpatients with early course schizophrenia (N = 102). A path analysis approach was used to compute mediation of social cognition (mediator; composite index and subdomain scores) on the relationship between neurocognition (predictor; composite index) and functional outcome (outcome; composite index). Significant positive associations were observed between neurocognition, social cognition, and functional outcome. As previously observed, the mediation effect of the social cognition composite was significant (p = 0.042). Of the seven social cognitive subdomains, only social inference (p < 0.001) emerged as a significant mediator. Reverse mediation models (mediator; neurocognition) were non-significant. Results suggest that the impact of cognition on functional outcome in the early course occurs, in part, through the impact of neurocognition on social cognition, which subsequently influences functional outcome. In addition, social inference is possibly an important treatment target of functional recovery in the early course of the condition, highlighting a potential future research direction. These findings further support the provision of comprehensive cognitive remediation approaches to facilitate functional recovery.