Randomized Controlled Trial of Social Cognition Training and Therapeutic Alliance Focused Therapy for Persons With Severe Mental Illness
Phase: NA
Conditions: Mental Disorders
Sponsor: Bar-Ilan University, Israel

March 2024
 
 
 
 
Randomized controlled trail of social cognition interaction training 
and a therapeutic alliance focused therapy among persons with 
Schizophrenia. 
 
Clinicaltrial. gov ID NCT02380885 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

March 2024
 
 
Scientific background 
Schizophrenia is associated with impairments in both interpersonal and intrapersonal 
functioning, which in turn, hinders quality of life (QoL). These impairments are so extensive that 
various clinicians and researchers view them as a major feature of schizophrenia characterized 
by difficulties in understanding the social environment and the individual's place within it (Penn, 
Corrigan, Bentall, Racenstein, & Newman, 1997; Stanghellini, 2000). These impairments are 
relatively non-responsive to antipsychotic medications (Bellack, Schooler, & Marder, 2004) and 
are reported by patients as their greatest unmet need (Coursey, Keller, & Farrell, 1995; 
Middelboe et al., 2001). One strong mediator of social functioning impairments in schizophrenia 
is disturbance in social cognition (i.e., the cognitive processes that underlie social interaction; 
Couture, Penn, & Roberts, 2006; Brüne, Abdel-Hamid, Lehmkämper, & Sonntag, 2007). The 
growing recognition of the devastating impact of social cognition deficits in schizophrenia, have 
generated attempts to develop interventions that target social cognition as a means to improve 
social functioning and QoL. One such intervention is Social Cognition and Interaction Training 
(SCIT; Roberts, Penn, & Combs, 2006). SCIT is a manualized, group-based intervention that has 
demonstrated efficacy in improving social cognition and social functioning in both inpatient and 
outpatient samples (Combs et al., 2007a; Combs et al., 2009b; Roberts & Penn, 2009; Roberts, 
Penn, Labate, Margolis, & Sterne, 2010). SCIT was developed to address the three core domains 
of social cognition that are disrupted in schizophrenia: emotion perception, theory of mind, and 
attributional style. The major theoretical assumption underlying SCIT is that schizophrenia is 
associated with a number of social cognitive distortions and impairments. These include 
jumping to conclusions (Garety, Hemsley, & Wessely, 1991), attribution bias (Bentall, 1994), as 
well as problems with Theory of Mind (ToM; Frith,1992) and emotion perception. Because these 
cognitive impairments are linked to the mental operations underlying social interactions, such 
as the human ability and capacity to perceive the intentions and dispositions of others (Brothers, 
1990), they interfere with social QoL and functioning. 
The proposed study assessed both the theoretical assumptions and the effectiveness of the SCIT 
intervention with persons diagnosed with schizophrenia. The SCIT intervention emphasizes a 
set of techniques designed to ameliorate the social cognitive deficiencies and biases to promote 
change. Accordingly, this study will assess both potential mediating processes, such as emotion 
perception and ToM, that are thought to be limited and distorted by schizophrenia, as well as 
social functioning and QoL. To test whether any positive change can be attributed specifically 
to SCIT, we compared its impact to a different intervention, called Therapeutic Alliance Focused 
Therapy (TAFT). TAFT is based on the system of observing family therapy alliance 
(Friedlander, Escudero, & Heatherington, 2006) and focuses on the therapeutic alliance . Both 
interventions (experimental groups) were compared to control group of treatment as usual 
(TAU). 
 
Method 
Research Setting  
The current randomized controlled trial (RCT) was an intervention study that assessed the 
effectiveness of SCIT versus TAFT in a psychiatric community setting in Israel (Clinicaltrial. 
gov ID NCT02380885). Data were collected between the years 2014 and 2018. Previous studies 

March 2024
 
 
derived from this larger project were conducted on the basis of baseline partial samples of the 
current study (25, 26). Approval for the study was obtained from the ethics committee of the 
Department of Psychology at Bar-Ilan University, as well as from two psychiatric hospital 
committees. After receiving a detailed explanation of the study, all research participants 
provided written informed consent. Data were collected by an experienced mental health 
practitioner who was trained to administer.  
Statistical Analysis: 
Analyses were computed using Predictive Analytics SoftWare (PASW, Version 25.0). To test 
whether the groups differed in their baseline scores on the scales and whether there were 
differences between participants who did and did not complete Time 2 assessments, two-way 
ANOVAs were performed. To examine improvement in the outcomes (SQoL, FEIT, Faux Pas 
task, SSPA, and AIHQ), mixed repeated measures ANOVAs were used with time (pre, post) and 
group (SCIT, TAFT, and TAU) as factors. A mixed repeated-measures ANOVA allows for an 
examination of the extent to which participants improved over time regardless of group, as well 
as whether they improved significantly more over time in one group versus the other (group–
time interaction). To assess the overall effect sizes, partial eta squared (ηp 2 ) was computed with 
ηp 2 = .01 indicating small, ηp 2 = .059 medium, and ηp 2 = .138 large effects (37). In case of a 
significant effect, a paired two-sample t test was conducted for each group comparing preand 
post-results. Effect sizes of paired tests were reported with Cohen’s d (37) with d = .2, indicating 
small; d = .5, medium; and d = .8 large effects. To examine whether the therapeutic alliance was 
associated with the change in the research variables, we performed a multiple regression, with 
the difference in each variable (difference between time 1 and time 2) as the dependent variable, 
and group (0-SCIT, 1-TAFT) and the four dimensions of the therapeutic as the independent 
variables.