Periodic Reporting for period 1 - SOCIAbLE (Social Cognitive Interventions following Adverse early Life Experiences)
Période du rapport: 2023-09-01 au 2025-02-28
Mental health disorders affect ~20% of the world’s population and explain one in five years lived with all-cause disability. The total costs of mental health problems are estimated at more than 4% of GDP (more than €600 billion) across the 27 EU countries and the United Kingdom. Among the identified causal factors, childhood trauma and other adverse childhood experiences (including physical/emotional neglect or abuse, domestic violence, parental alcoholism, and parental loss due to bereavement or separation is associated with a four-fold increase in risk for mental health.
Adult mental health therapies typically target the emotional consequences of childhood adversity (i.e. anxiety and mood difficulties), while failing to address its cognitive consequences (reduced general cognitive ability, memory, executive function, and social cognition). This is important because cognitive difficulties strongly predict social and occupational function/disability in mental health disorders. In particular, social cognition - the cognitive processes that underpin our ability to understand others’ thoughts and feelings so as to navigate the social world – strongly predicts both current and future levels of functioning, even after accounting for clinical symptom severity. The development of treatments targeting cognitive deficits associated with childhood trauma has been held back by the fact that, until recently, the mechanisms by which adversity impacts on cognition have been poorly understood.
SOCIAbLE exploits a highly novel treatment target identified by my recently completed ERC funded work. My ERC-funded ‘iRELATE’ study has led to significant advances in understanding the neurocognitive effects of childhood trauma.
The objectives of this research are (1) to target a novel cognitive pathway between early adversity and poor social function that is associated with mental health disorders but not addressed in current treatments. It does so by targeting the cognitive causes of those deficits that are not targeted in current clinical practice (2) it harnesses latest VR technology to simulate social interaction, an innovation that has enormous potential for translation into clinical use given its targeting of a major currently untreated cause of disability using a low-cost and scalable intervention.
Adult mental health therapies typically target the emotional consequences of childhood adversity (i.e. anxiety and mood difficulties), while failing to address its cognitive consequences (reduced general cognitive ability, memory, executive function, and social cognition). This is important because cognitive difficulties strongly predict social and occupational function/disability in mental health disorders. In particular, social cognition - the cognitive processes that underpin our ability to understand others’ thoughts and feelings so as to navigate the social world – strongly predicts both current and future levels of functioning, even after accounting for clinical symptom severity. The development of treatments targeting cognitive deficits associated with childhood trauma has been held back by the fact that, until recently, the mechanisms by which adversity impacts on cognition have been poorly understood.
SOCIAbLE exploits a highly novel treatment target identified by my recently completed ERC funded work. My ERC-funded ‘iRELATE’ study has led to significant advances in understanding the neurocognitive effects of childhood trauma.
The objectives of this research are (1) to target a novel cognitive pathway between early adversity and poor social function that is associated with mental health disorders but not addressed in current treatments. It does so by targeting the cognitive causes of those deficits that are not targeted in current clinical practice (2) it harnesses latest VR technology to simulate social interaction, an innovation that has enormous potential for translation into clinical use given its targeting of a major currently untreated cause of disability using a low-cost and scalable intervention.
Using a virtual reality (VR) environment, the benefits of a social cognitive intervention wwas investigated. Using a repeated measures design, individuals (n=25) exposed to childhood trauma (based on self-report) who met the eligibility criteria received a 8 session social cognitive training intervention, delivered via VR and facilitated by a psychologist. The benefits of this intervention (SOCIAbLE) was assessed in terms of changes on measures of cognition, social cognition, and social functioning. This approach builds on previous cognitive remediation studies that my group have carried by targeting here the effects of childhood trauma and by do so using VR delivery system.
The initial phase of this work included (a) identifying a suitable VR programming platform and (b) adapting a social cognitive intervention for use. The VR platform used was Engage VR (https://engagevr.io/(s’ouvre dans une nouvelle fenêtre)) that allowed us to develop a number of scenarios for use, including a café, a medical clinic, a lecture hall and an office suite. The social cognitive training platform was adapted from the Social Cognition and Interaction Training (SCIT) platform designed by David Roberts and David Penn. Participants completed a range of clinical, cognitive, and social functioning measures, at baseline, 6 weeks, 12 weeks and 24 weeks. Participants also completed qualitative feedback based on their experiences.
The cognitive intervention (SOCIAbLE) targeted aspects of social cognition, including emotion recognition and social attributions. This work begins by focusing on facial emotion recognition, before considering video vignette highlighting different approaches to social attribution (e.g. assigning 'blame' for negative events to self, others or situational factors). This is based on the rationale that training targeting specific aspects of social cognition (e.g. emotional recognition, theory of mind) results in benefits to the trained social cognitive function but these then need to be generalized to social settings in order for benefits to accrue. These scenarios were presented in a blended format using both in session and in VR contexts, with the opportunity to apply the skills taught presented during roleplay in the VR setting. The sessions lasted for between 40-50 mins provided during 8 weekly sessions.
The initial phase of this work included (a) identifying a suitable VR programming platform and (b) adapting a social cognitive intervention for use. The VR platform used was Engage VR (https://engagevr.io/(s’ouvre dans une nouvelle fenêtre)) that allowed us to develop a number of scenarios for use, including a café, a medical clinic, a lecture hall and an office suite. The social cognitive training platform was adapted from the Social Cognition and Interaction Training (SCIT) platform designed by David Roberts and David Penn. Participants completed a range of clinical, cognitive, and social functioning measures, at baseline, 6 weeks, 12 weeks and 24 weeks. Participants also completed qualitative feedback based on their experiences.
The cognitive intervention (SOCIAbLE) targeted aspects of social cognition, including emotion recognition and social attributions. This work begins by focusing on facial emotion recognition, before considering video vignette highlighting different approaches to social attribution (e.g. assigning 'blame' for negative events to self, others or situational factors). This is based on the rationale that training targeting specific aspects of social cognition (e.g. emotional recognition, theory of mind) results in benefits to the trained social cognitive function but these then need to be generalized to social settings in order for benefits to accrue. These scenarios were presented in a blended format using both in session and in VR contexts, with the opportunity to apply the skills taught presented during roleplay in the VR setting. The sessions lasted for between 40-50 mins provided during 8 weekly sessions.
All n=25 participants have now completed their 8 sessions and thus, 200 individual therapy sessions were provided. All participants also provided detailed qualitative feedback at the end of the 10 sessions. All baseline and 6-week data collection is complete and has been analysed using a repeated-measures ANOVA. This analysis indicated benefits across clinical, cognitive, and social and occupational functioning measures. Participation in the intervention was association with (1) reductions in anxiety and mood as measured by the GAD7 and PhQ9, (2) increased performance on measures of social cognition, (3) improved scores on a measure of social interaction, and (4) improvements on measures of social and occupational function. In particular, the SOFAS (d = .76), SIAS (d = -.75) AIHQ (d = -.52) RETM (d = 0.71) and BLERT (d = 0.85) all demonstrated improvement from baseline to six weeks that were moderate to high in terms of effect sizes. Further analyses of this data is ongoing. Based on the analysis to date, our hypotheses that our VR intervention targeting social cognition in adults exposed to childhood adversity and trauma would be associated with benefits to both cognition and social and occupational functioning appears to have been supported based on the data currently available.