King's College London

What is social functioning, and why is it important in the understanding and treatment of psychosis?

A decline in social functioning is a hallmark of psychosis and is evident across the psychosis continuum. We define social functioning as someone’s interactions with the world around them, and the ability to fulfil their role in work, social activities and relationships.

A decline in social functioning often emerges before the onset of psychosis and typically develops long-standing difficulties. No study to date has summarised the existing evidence base regarding social functioning interventions in psychosis, nor have they synthesised the factors associated with high or low social functioning in psychosis.

Researchers from the IoPPN at King's conducted a systematic review to provide a summary of all the existing literature regarding social functioning interventions in psychosis, as well as factors that can be used to identify high or low social functioning in psychosis. This then fed into a proposed cognitive model of social functioning in psychosis.

How was the research conducted?

65 studies were eligible for inclusion in the review. Across the studies it was found that physical exercise, art therapy, social recovery therapy, social skills training, virtual reality, online programs, and psychosocial interventions improved social functioning and reduced both positive and negative symptoms of psychosis.

Factors associated with low social functioning in psychosis included self-perception (how clients view themselves), symptoms (social anxiety, depression, positive and negative symptoms), emotion (how aware someone is of their emotions and how able they are to regulate their emotions), cognition (negative thoughts about performance and negative beliefs about themselves), social cognition (ability to understand the thoughts, intentions, and behaviours of others), and behaviours (motivation and avoidance).

Factors associated with high social functioning in psychosis included emotional awareness, acceptance of emotions, positive affect, cognitive reappraisal, positive performance beliefs, and adaptive coping. A number of factors were associated with high or low social functioning in psychosis, which highlights important clinical intervention targets for devising novel social functioning interventions.

What next?

Within this paper, researchers have developed the Cognitive Model of Social Functioning in Psychosis, which could help the development of personalised formulations and targeted interventions in cognitive-behavioural therapy (CBT) for psychosis to enhance social functioning in this group.

Want to know more? 

The full paper by M. Vinu and Anna Georgiades, Social Functioning Interventions in Psychosis: A Systematic Review can be found in Clinical psychology & psychotherapy, 32(3), e70090. https://doi.org/10.1002/cpp.70090