Trajectories of Emotion Recognition Training in Virtual Reality and Predictors of Improvement for People with a Psychotic Disorder

Meta-analyses have found that social cognition training (SCT) has large effects on the emotion recognition ability of people with a psychotic disorder. Virtual reality (VR) could be a promising tool for delivering SCT. Presently, it is unknown how improvements in emotion recognition develop during (VR-)SCT, which factors impact improvement, and how improvements in VR relate to improvement outside VR. Data were extracted from task logs from a pilot study and randomized controlled trials on VR-SCT (n = 55). Using mixed-effects generalized linear models, we examined the: (a) effect of treatment session (1-5) on VR accuracy and VR response time for correct answers; (b) main effects and moderation of participant and treatment characteristics on VR accuracy; and (c) the association between baseline performance on the Ekman 60 Faces task and accuracy in VR, and the interaction of Ekman 60 Faces change scores (i.e., post-treatment - baseline) with treatment session. Accounting for the task difficulty level and the type of presented emotion, participants became more accurate at the VR task (b = 0.20, p &lt; 0.001) and faster (b = -0.10, p &lt; 0.001) at providing correct answers as treatment sessions progressed. Overall emotion recognition accuracy in VR decreased with age (b = -0.34, p = 0.009); however, no significant interactions between any of the moderator variables and treatment session were found. An association between baseline Ekman 60 Faces and VR accuracy was found (b = 0.04, p = 0.006), but no significant interaction between difference scores and treatment session. Emotion recognition accuracy improved during VR-SCT, but improvements in VR may not generalize to non-VR tasks and daily life.</p

The role of the social support system in work participation among young people with an autism spectrum disorder

SamenvattingArbeid is een van de belangrijkste manieren van participeren in de samenleving. Voor mensen met een autismespectrumstoornis (ASS) is arbeidsparticipatie echter minder vanzelfsprekend. Zij ondervinden moeite bij het vinden en behouden van werk. Een ondersteunende sociale omgeving waarin arbeid een belangrijk aspect vormt, verhoogt de kans op het vinden en behouden van werk.MethodeDe rol van het sociaal steunsysteem (SSS) richting arbeidsparticipatie bij deze doelgroep is in dit onderzoek onderzocht. De participanten zijn afkomstig van het longitudinaal onderzoek ‘Catching Up?!’. Alle participanten (N = 29), met een leeftijd tussen 20 en 26 jaar, zijn middels de ADOS-2 getest op (sub)klinische symptomen van ASS. Waaruit twee groepen zijn ontstaan; een groep met ASS (n = 14), de andere groep met subklinische symptomen van ASS (n = 15). Er zijn semigestructureerde interviews afgenomen waarbij is ingegaan op verschillende aspecten van arbeidsparticipatie, waaronder de sociale omgeving.ResultatenUit de resultaten komt naar voren dat individuen met ASS profijt lijken te hebben van een goed ondersteunend SSS. Voor beide groepen werkt het bevorderlijk wanneer het SSS hen van adviezen en tips voorziet. De groep participanten met ASS lijkt meer steun te behoeven van het SSS, voornamelijk in de bemiddeling richting een mogelijk nieuwe werkgever. Verder blijkt dat er behoefte bestaat aan meer begeleiding/steun gericht op het verbeteren van communicatieve vaardigheden.DiscussieOm gerichtere uitspraken te kunnen doen, specifiek gericht op het sociaal steunsysteem, is verder onderzoek noodzakelijk. De resultaten van dit onderzoek zijn afkomstig van een overkoepelend onderzoek; ‘Catching Up?!’, waardoor specificatie richting het sociaal steunsysteem beperkt is. Daarbij is er weinig onderzoek verricht naar specifiek dit onderwerp.Abstract Work is one of the most important ways of participating in society. However, work participation is less obvious for people with an autism spectrum disorder (ASD). They find difficulty in finding and keeping work. A supportive social environment in which work is an important aspect increases the chances of finding and retaining work. Method The role of the social support system (SSS) in relation to work participation in this target group was investigated in this study. The participants are from the longitudinal research 'Catching Up ?!'. All participants (N = 29), aged between 20 and 26 years, have been tested for (sub) clinical signs of ASD by means of the ADOS-2. From which two groups arose; a group with ASD (n = 14), the other group with subclinical symptoms of ASD (n = 15). Semi-structured interviews were conducted in which various aspects of labor participation, including the social environment, were discussed. Results The results show that individuals with ASD seem to benefit from a well-supportive SSS. For both groups it works well when the SSS provides them with advice and tips. The group of participants with ASD seems to need more support from the SSS, mainly in the mediation towards a possible new employer. Furthermore, there appears to be a need for more guidance / support aimed at improving communication skills. Discussion In order to be able to make more specific statements, specifically aimed at the social support system, further research is necessary. The results of this research come from an overarching research; 'Catching Up ?!', so that specification towards the social support system is limited. In addition, little research has been done on this subject specifically

The role of self-efficacy in work participation of people with ASD

SamenvattingArbeidsparticipatie is voor mensen met een autismespectrumstoornis (ASS) nietvanzelfsprekend. Slechts 25 tot 30 procent heeft een betaalde baan (Holwerda, van de Klink, de Boer, Groothoff &amp; Brouwer, 2013; Shattuck et al., 2012). Dit onderzoek richt zich op de rol van de eigeneffectiviteitsverwachting bij arbeidsparticipatie van individuen met ASS. Bij de participanten (19 t/m26 jaar) zijn de ADOS-2 en een semigestructureerd interview afgenomen om de data te verzamelen. De scores van de ADOS-2 resulteerden in wel of geen ASS classificatie. Tijdens het semigestructureerde interview staan de ervaringen van de participant die invloed hebben op maatschappelijke participatie centraal. Uit dit onderzoek komt naar voren dat als rolmodellen (metname ouders) een positieve houding hebben ten opzichte van werk, de kans groter is dat een individu met ASS een hogere eigen-effectiviteitsverwachting heeft. Tevens gaan de participanten in dit onderzoek uit van hun eigen capaciteiten en niet van hun valkuilen. Dit betekend dat de eigeneffectiviteitsverwachting positief beïnvloed wordt, door de successen en vaardigheden die de participanten beheersen en in veel mindere mate negatief beïnvloed wordt door de gefaalde situaties en vaardigheden welke zij niet beheersen. Tevens zorgt een negatieve bekrachtiging nauwelijks voor eennegatieve invloed op de eigen-effectiviteitsverwachting. Individuen met een ASS diagnose lijken een hogere eigen-effectiviteitsverwachting te hebben dan individuen met subklinische symptomen van ASS. Tot slot, kan vanwege het feit dat het concept, eigen-effectiviteitsverwachting, niet als zodanig gemeten is, niet geconcludeerd worden of de eigen-effectiviteitsverwachting invloed heeft op arbeidsparticipatie.Participating in the workforce is not obvious for people with an autism spectrum disorder (ASD). Only 25 to 30 percent have paid jobs (Holwerda, van de Klink, de Boer, Groothoff &amp; Brouwer, 2013, Shattuck et al., 2012). This research focuses on the role of self-efficacy in the work participation of individuals with ASD. Among the participants (19 to 26 years) the ADOS-2 as well as a semi-structured interview has been conducted to collect the data. The ADOS-2 scores were used to determine if participants were placed in the ASD classification or not. The semi-structured interview focuses on the experiences of the participants that have influence on their daily social participation.The semi-structured interview data provides more detailed insight on how the participant experienced aspect that influences social participation. This research shows a higher chance of self-efficacy of individuals with ASD if their role models (especially parents) have a positive attitude towards work. In addition, the participants in this study exerted their own strengths and not their weaknesses. This means that the self-efficacy of the participants is influenced positively by their successes and skills that they control, and only are influenced to a lower extent negatively by their failures and skills that they do not control. The negative reinforcement also, hardly causes a negative influence of the selfefficacy. Individuals with an ASD diagnosis seem to have a higher self-efficacy compared to the individuals with subclinical symptoms of ASD. Finally, since the concept, of self-efficacy, is not measured as such, it cannot be concluded whether the self-efficacy influences work participation

Histories of Social Functioning and Mental Healthcare in Severely Dysfunctional Dual-Diagnosis Psychiatric Patients

Abstract Disengagement from mental health services is a major obstacle to the treatment of homeless dual-diagnosis patients (i.e., those with severe mental illness and substance-use disorder). A subgroup of these patients is considered to be treatment resistant and we aim to explore whether patients’ reasons for disengagement may stem from negative experiences in their lives and treatment histories. This retrospective, explorative study examined the medical files of 183 severely dysfunctional dual-diagnosis patients who had been admitted involuntarily to a new specialized clinic for long-term treatment. Most patients shared common negative experiences with respect to childhood adversities, low school achievement, high levels of unemployment, discontinuity of care, and problems with the judicial system. The lifetime histories of treatment-resistant, severely dysfunctional dual-diagnosis patients showed a common pattern of difficulties that may have contributed to treatment resistance and disengagement from services. If these adversities are targeted, disengagement may be prevented and outcome improved

Improving cognition in severe mental illness by combining cognitive remediation and transcranial direct current stimulation:study protocol for a pragmatic randomized controlled pilot trial (HEADDSET)

Background A fundamental challenge for many people with severe mental illness (SMI) is how to deal with cognitive impairments. Cognitive impairments are common in this population and limit daily functioning. Moreover, neural plasticity in people with SMI appears to be reduced, a factor that might hinder newly learned cognitive skills to sustain. The objective of this pilot trial is to investigate the effects of cognitive remediation (CR) on cognitive and daily functioning in people dependent on residential settings. In addition, transcranial direct current stimulation (tDCS) is used to promote neural plasticity. It is expected that the addition of tDCS can enhance learning and will result in longer-lasting improvements in cognitive and daily functioning. Methods This is a pragmatic, triple-blinded, randomized, sham-controlled, pilot trial following a non-concurrent multiple baseline design with the participants serving as their own control. We will compare (1) CR to treatment as usual, (2) active/sham tDCS+CR to treatment as usual, and (3) active tDCS+CR to sham tDCS+CR. Clinical relevance, feasibility, and acceptability of the use of CR and tDCS will be evaluated. We will recruit 26 service users aged 18 years or older, with a SMI and dependent on residential facilities. After a 16-week waiting period (treatment as usual), which will serve as a within-subject control condition, participants will be randomized to 16 weeks of twice weekly CR combined with active (N = 13) or sham tDCS (N = 13). Cognitive, functional, and clinical outcome assessments will be performed at baseline, after the control (waiting) period, directly after treatment, and 6-months post-treatment. Discussion The addition of cognitive interventions to treatment as usual may lead to long-lasting improvements in the cognitive and daily functioning of service users dependent on residential facilities. This pilot trial will evaluate whether CR on its own or in combination with tDCS can be a clinically relevant addition to further enhance recovery. In case the results indicate that cognitive performance can be improved with CR, and whether or not tDCS will lead to additional improvement, this pilot trial will be extended to a large randomized multicenter study. Trial registration Dutch Trial Registry NL7954. Prospectively registered on August 12, 2019

Clinical, societal and personal recovery in schizophrenia spectrum disorders across time:States and annual transitions

BACKGROUND: Recovery in schizophrenia is a complex process, involving clinical, societal and personal recovery. Until now, studies analysed these domains separately, without examining their mutual relations and changes over time. AIMS: This study aimed to examine different states of recovery and transition rates between states. METHOD: The Pharmacotherapy Monitoring and Outcome Survey (2006–2017) yearly assesses patients with schizophrenia in the Northern Netherlands. Data from 2327 patients with one up to 11 yearly measurements on clinical, societal and personal recovery were jointly analysed with a mixture latent Markov model (MLMM). RESULTS: The selected MLMM had four states that differed in degree and pattern of recovery outcomes. Patients in state 1 were least recovered on any domain (16% of measurements), and partly recovered in states 2 (25%; featured by negative symptoms) and 3 (21%; featured by positive symptoms). Patients in state 4 (38%) were most recovered, except for work, study and housekeeping. At the subsequent measurement, the probability of remaining in the same state was 77–89%, transitioning to a better state was 4–12% and transitioning to a worse state was 4–6%; no transitions occurred between states 1 and 4. Female gender, shorter illness duration and less schizophrenia were more prevalent in better states. CONCLUSIONS: Quite a high recovery rate was present among a substantial part of the measurements (38%, state 4), with a high probability (89%) of remaining in this state. Transition rates in the other states might increase to a more favourable state by focusing on adequate treatment of negative and positive symptoms and societal problems

F105. Measuring Empathy in Schizophrenia: The Empathic Accuracy Task and Its Correlation With Other Empathy Measures

Background Empathy is a complex interpersonal process thought to be impaired in individuals with schizophrenia spectrum disorders. Past studies have mainly used questionnaires or performance-based tasks with static cues to measure cognitive and affective empathy. In contrast, we used an Empathic Accuracy Task (EAT) designed to capture the more dynamic aspects of empathy by using video clips in which perceivers continuously judge emotionally charged stories of various targets. We compared individuals with schizophrenia to healthy controls on the EAT and assessed correlations among the EAT and three other commonly used empathy tasks. Methods Patients (n=92) and healthy controls (n=42) matched for age and education, completed the EAT, the Interpersonal Reactivity Index, the Questionnaire of Cognitive and Affective Empathy and the Faux Pas task. Differences between groups were analyzed and correlations were calculated between empathy measurement instruments. Results The groups differed in EAT performance, with controls outperforming patients. A moderating effect was found for the emotional expressivity of the target: while both patients and controls scored low when judging targets with low expressivity, controls performed better than patients with more expressive targets. Though there were also group differences on the cognitive and affective empathy questionnaires (with lower scores for patients in comparison to controls), EAT performance did not correlate with questionnaire scores. Reduced empathy performance did not seem to be part of a generalized cognitive deficit, as differences between patients and controls on general cognition was not significant. Discussion Individuals with schizophrenia benefit less from the emotional expressivity of other people than controls, which contributes to their impaired empathic accuracy. The lack of correlation between the EAT and the questionnaires suggests a distinction between self-report empathy and actual empathy performance. To explore empathic difficulties in real life, it is important to use instruments that take the interpersonal perspective into account