Social Functioning Interventions in Psychosis: A Systematic Review

Objective

A decline in social functioning is a hallmark of psychosis and is evident across the psychosis continuum. However, 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.

Method

A systematic review was conducted to summarise the extant literature regarding social functioning interventions in psychosis.

Results

Sixty-five studies were eligible for inclusion. Physical exercise, art therapy, social recovery therapy, social skills training, virtual reality, online programmes 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 (self-esteem, self-efficacy, internalised stigma), symptoms (social anxiety, depression, positive and negative symptoms), emotion (reduced emotional awareness/regulation, emotional suppression, negative affect), cognition (appraisals, negative self-beliefs, dependency and enmeshment schema, negative self-statements, defeatist performance beliefs, metacognitive beliefs), social cognition (ToM, neurocognition) and behaviours (motivation, social relatedness, 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.

Conclusions

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. The cognitive model of social functioning in psychosis could facilitate the development of personalised and idiosyncratic formulations and targeted interventions in CBTp to enhance social functioning in psychosis.