JMIR Publications

ABSTRACT

Background:

Social cognitive impairments are prevalent in schizophrenia spectrum disorder (SSD) and have detrimental effects on functioning. Cognitive remediation (CR) has shown its efficacy to improve social cognitive impairments, though the transfer of these skills to daily life and the personalization of these interventions remain challenging. RC2S is a CR created in France combining learning of strategies and practice using paper and pencil exercises and digital relational simulations with avatars. This program was designed as an in-person intervention and is only available in French.

Objective:

The current project aims to culturally adapt RC2S in French Canadian and in North American English and to assess the feasibility, acceptability, safety and implementation of a remote version in people with SSD. An exploratory objective is to assess the preliminary effect of remote RC2S on goal attainment, social cognition, and psychosocial outcomes.

Methods:

A pre-post quasi-experimental design with mixed methods will be used. First, the translation and the cultural adaptation in North American English and French Canadian of RC2S is presented. Then, twenty-four participants aged 18 years or older with a diagnosis of SSD, presenting with a subjective or an objective impairment in social cognition will be included to receive RC2S. In addition, five therapists will be included as research participants to assess their perspective on the program. Participants with SSD will undergo a baseline remote assessment for social cognition, clinical symptoms, and functioning. They will then start remote RC2S for 24 biweekly individual one-hour sessions with a therapist. Following the case formulation and goal setting, participants will complete personalized paper-pencil exercises to develop strategies and integrative digital relational simulations during which they will help the avatar Tom navigate through a variety of social contexts and relationships. The last two sessions are dedicated to transfer to daily life. All participants will complete in-session questionnaires assessing therapeutic alliance, motivation, acceptability, feasibility and implementation. Following the intervention, participants with SSD will repeat the same assessment as baseline. Descriptive statistics will be used to summarize data about acceptability, feasibility, safety and implementation. To assess the preliminary effect of RC2S, an intention-to-treat approach will be used with linear mixed models for repeated measures with fixed effects of time.

Results:

From August to December 2021, our team adapted and translated RC2S in North American English and French-Canadian. Recruitment and data collection started in January 2022, with 14 participants included so far. The study is expected to be completed in August 2024.

Conclusions:

Improving social cognitive impairments is an important target in SSD to promote functional recovery. Using digital technologies to address these impairments, and deliver the intervention is a promising approach to increase the ecological validity of CR and access to the intervention. Clinical Trial: ClinicalTrials.gov registration identifier: NCT05017532