Development and validation of an internet based treatment program for impairments in social cognition and competence following acquired brain injury

Status:

completed 03/2023

Aims:

The primary goal of the project was to develop and evaluate a novel, internet-based therapy for impairments of social cognition and social competence for adults with traumatic brain injury (TBI). Social cognition is an umbrella term broadly comprising all cognitive and emotional processes within social interactions. Sociocognitive dysfunction has been related to problems in social and vocational functioning, independently of cognitive dysfunction.

Activities/Methods:

Following a systematic literature review which specifically confirmed the lack of well-evaluated internet-based programs for the treatment of sociocognitive dysfunction in neurological disorders (Lohaus et al., 2022), a novel, internet-based therapy program "Program for the treatment of limitations of social cognitions and competences of the Ruhr-University Bochum" (SoCoBo), has been developed. Three modules aim at improving the capacity to recognize the emotions of other individuals (module 1: emotion recognition), to assume the cognitive and affective perspective of others (module 2: perspective taking) and to solve social problems adequately and effectively (module 3: social problem solving). In each module, psychoeducation about the targeted sociocognitive subcomponents, their potential impairments, implications for everyday life and potential compensation strategies is intertwined with exercises (involving photographies, videos, audio plays).

Based on response feedback provided in the exercises, patients have the opportunity to review whether they are able to apply what they have learned during psychoeducation. In a pilot study involving 50-52 healthy older participants (Rogalla et al., resubmitted in a revised version), good feasibility, acceptance and high satisfaction with content and structure has been demonstrated for the program. In total, 64 patients with TBI were included into the main randomized controlled trial (Lohaus et al., in prep.). In internet-based sessions from home, the experimental group (EG) worked for a total duration of at least 12 weeks 4 times per week for approximately 30 minutes under the remote supervision of a therapist (biweekly telephone contacts according to a standardized protocol in addition to availability per e-mail) with the newly developed program SoCoBo. In a control group (CG) of TBI patients, a standardized program ("RehaCom"/Hasomed) for remediation treatment of cognitive dysfunction in attention, memory and executive dysfunction was used with the same frequency and intensity. Also, psychoeducation about the trained cognitive functions and therapist support was implemented in a comparable way as in the experimental group. All patients were administered a comprehensive pre-post assessment with standardized neuropsychological instruments for the assessment of a number of relevant outcome measures, particularly in the area of social cognition and social skills.

Results:

Currently, 27 individuals with TBI in the EG and 15 in the CG (in total 21 following TBI in a work context) have completed their respective trials. Consistent with our hypotheses, the EG, but not the CG, showed specific improvements in the ability to recognize emotions in faces (but not voices or dynamic films). However, there were no obvious improvements in social problem solving probably suggesting that such complex behavior needs practise in real life in addition to the online exercises. The increase in empathy in the EG was additionally associated with increased life satisfaction at the time of post-interventional assessment. Exploratory additional analyses suggest that SoCoBo treatment might also be associated with potential reduction in depressive symptoms. Cognitive performance in attention, memory or executive functions did not improve significantly, neither in the EG nor in the CG.

Conclusions: The current results confirm a specific efficacy of the newly developed internet-based therapy program SoCoBo with regard to improvements in facial affect recognition and self-rated empathy. Based on the literature it can be expected that these skills crucially affect social and vocational rehabilitation.

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