Introduction.
Over the past twenty years, cognitive disorders in schizophrenia have been extensively studied. Cognitive impairments have the greatest impact patient’s functioning in everyday life (Green, 1996). Indeed, getting a job and keeping it are skills that will depend on the cognitive functions of the patient with schizophrenia (Franck, 2014). More accurately, social cognition disorders are considered as determinants of interpersonal and socio-professional functioning (Fett and al., 2011). Social cognition refers to the set of competencies peer relations and consist mainly of knowledge and social perception, emotions, the theory of mind or the ability to attribute mental states to others. Moreover, based on Brune’s work in 2005, the theory of mind is related to socialization disorders.
Consequently, programs of cognitive remediation are used in order to reduce the impact of deficits in daily life. The cognitive remediation technique used here is the ToMRemed program, who targets the theory of mind in the ability to attribute intentions to others.
Method.
The program that the researchers used is based on the work of the Versailles team directed by Hardy-Baylé. They deduced that there are two distinctive features in schizophrenic patients : they have a specific disorder in attribution of others’ intentions, in their type of attack and in their intensity ; and they have a disorder in the processing of contextual elements. The researcher’s team concluded a model to understand deficits in theory of mind in schizophrenic patients taking into account these two previous defects. The lack of contextual information processing leads to the difficulty of attributing an intention in the context where it is implicit, leading to a misunderstanding of the other’s intention and a feeling of persecution and anxiety, with an avoidance of social situations manifested by a social withdrawal.
The objective of the study is to show the value of the technique used, the ToMRemed program, for patients with schizophrenia in a Day Care Center. They were seven patients recruited, who have been diagnosted with schizophrenia. They all had a pharmacological treatment and they all had attribution’s disorders. Thus, the authors selected ten movie clips from French films, with intentional exchanges. These extracts represent situations of everyday life. For each video, two or three questions about the characters’ intentions are asked to the subject and there are five possible answers.
Results and discussion.
The present study was not intended to provide quantitative results. Therefore, the results are succinct. However, it is possible to prove its effectiveness by a multicenter study for the same program that the authors carried out later, with 110 patients (Bazin and al., 2016).
For exploratory purposes, this study demonstrated the results of the program. Indeed, in an everyday life situation, in the Day Care Center where the intervention took place, when the conversational situation seemed poorly understood, the professionals took again the situation experienced with the patient. It consisted to analyze it in the same way that during the procedure followed in workshops : search for alternative hypotheses to explain the person’s intention in the situation lived. In addition, after the program was completed, the Center observed that patients were more opened to others, less withdrawned and they felt less persecuted.
This technique seems to be relevant to help schizophrenic patients with theirs difficulties in the attribution of others’ intentions. However, two factors seem important to consider : self-awareness and the consequences in everyday life.
Conclusion.
ToMRemed is a cognitive remediation technique that seems relevant for schizophrenic patients in order to improve their ability to treat intentional mental states dynamically and as in their everyday life. It is essential to train professionals to this technique of care in institutions. It still has to be proven that patients will be able to practice the techniques learned over the long term.
