Is the Cognitive Remediation of Social Cognition (RC2S) program useful to improve social cognition and functional outcomes in people with schizophrenia? A randomized controlled trial.

Abstract

Objective: Difficulties in social interactions are a core characteristic of schizophrenia spectrum disorders. They are often linked to impairments in social cognition, including emotion recognition, social perception, theory of mind, and attributional style. The RC2S program (cognitive remediation of social cognition) aims to address these deficits through individualized interventions. This study is the first controlled randomized trial to compare RC2S with RECOS (Remédiation Cognitive pour la Schizophrénie ou un trouble associé), a neurocognitive remediation program, to evaluate their respective impacts. Method: Fifty-one outpatients with schizophrenia were randomized into RC2S (n = 25) or RECOS (n = 26) groups. The primary outcome was a measure of attributional biases, with secondary outcomes including symptom severity, social functioning, and cognitive measures. Assessments were conducted at baseline (T1), posttreatment (T2), and 3 month follow-up (T3). Results: Both groups improved significantly in social cognition and neurocognition, with no overall between-group differences. Yet only the RC2S group showed a significant reduction in hostile attribution bias from T1 to T2, a domain where many social cognitive trainings falter. RC2S also produced faster gains in negative symptoms and one area of social functioning. RECOS showed stronger effects on positive symptoms and certain neurocognitive measures. Both programs enhanced functional outcomes, though the trajectories of change differed. Conclusions and Implications for Practice: While the results highlight RC2S's potential, the small sample size, high dropout rate, and low baseline levels of hostility bias limit the generalizability and interpretability of these findings. Future research should refine RC2S, use more sensitive assessments, and explore broader applications. (PsycInfo Database Record (c) 2026 APA, all rights reserved).