S231. A NETWORK META-ANALYSIS ON SOCIAL COGNITION TRAINING FOR PEOPLE WITH PSYCHOTIC DISORDER: RELATIVE EFFICACY, MODERATORS, AND LONG-TERM EFFECTS

BACKGROUND: Social cognitive deficits are common in people with a psychotic disorder, and may play an important role in social dysfunction. Social cognition training (SCT) has emerged in the past two decades as a way to improve social cognition through strategy training and repeated practice. Several reviews and meta-analyses have indicated that SCT improves social cognition, but several important questions remain. This meta-analysis addresses three of these questions: METHODS: Search results from clinical databases were systematically reviewed by two independent raters. SCTs from included publications were categorized according to their focus (targeted or broad-based) and their inclusion of CRT (with or without). Network meta-analysis was used, since it allows for comparison of more than two treatments, and comparison of any chosen pair of interventions - even those not directly investigated in the literature. It estimates the treatment effect by inference from a network of evidence (i.e., effectAB = effectAC – effectBC), and combines this indirect evidence with original comparisons to estimate treatment effects. For each treatment arm, a pre-post effect size was determined and pairwise comparisons for each combination of study arms were calculated. With network meta-analysis, all SCTs were compared to treatment as usual (the chosen reference group). Meta-regression was used to evaluate the moderating effects of study (methodological quality, total intervention time, use of groups, static/dynamic measures, inclusion of CRT) and participant (age, illness duration, medication dose, gender) characteristics. Follow-up efficacy was investigated using multivariate meta-analysis. RESULTS: Compared to TAU, emotion perception was improved most by targeted SCT without CRT (Cohen’s d=.68) and broad-based SCT without CRT (d=.46). All treatments improved social perception (active control, d=.98, targeted SCT with and without CRT, d=1.36 and d=1.38, broad-based SCT with and without CRT, d=1.35 and d=1.45). Only broad-based SCT without CRT improved ToM (d=.42) more than TAU. Social functioning was significantly improved only by broad-based SCT (without CRT, d=.82, with CRT, d=.41). None of the SCTs significantly improved attribution, general social cognition and psychotic symptoms, compared to TAU. Individual SCT worked better for emotion perception, but SCT in a group was more effective for social functioning. A higher percentage of male participants in a study predicted worse outcomes on functioning and psychotic symptoms. At follow-up, a moderate effect on social functioning (d=.66) was found, but not on psychotic symptoms. Social cognition could not be investigated quantitatively at follow-up due to insufficient data, but qualitative analysis suggested persisting effects. DISCUSSION: While targeted SCT is the most effective for emotion perception and social perception, broad-based SCT produced the best overall outcomes. Using CRT did not enhance SCT effects. Our results suggest that (particularly broad-based approaches to) SCT produce generalized, enduring effects, but more methodologically sound research is necessary to investigate key questions that remain, especially regarding mechanisms of treatment. 1) Which type of social cognition training (targeted or broad-based, with or without cognitive remediation therapy - CRT) is the most effective for improvement of social cognition and functioning? 2) Which characteristics of studies and participants moderate the efficacy of SCT? 3) Do effects of SCT persist over time?