A tablet-based intervention to manipulate social cognitive bias in schizophrenia

Interventions to decrease cognitive bias in schizophrenia have yielded limited benefit. One reason may be that people receive insufficient rehearsal applying debiasing skills while biases are actively affecting their thinking. The authors designed Mary/Eddie/Bill-internet (MEBi) to (1) teach debiasing skills to people with schizophrenia, (2) activate biases during training sessions, and (3) provide daily in-home rehearsal of debiasing skills using tablet computer interface. In this proof-of-concept trial, 28 adults with schizophrenia used the MEBi tablet “app” for one month. Fourteen completed a version of MEBi including only the debiasing skills, and 10 completed a version including a bias activation component. Participants completed pretest and posttest measures of social cognition and social functioning. Results showed that participants in both groups adhered to the intervention and learned the debiasing skills. Participants who were only taught the debiasing skills showed significant improvements in social cognitive bias, accuracy, and self-reported social functioning relative to participants who also received the bias-activation manipulation—who showed worsening social cognitive bias. Results suggest that it is feasible to affect social cognition in schizophrenia through in-home tablet-based training. However, more metacognitive training is needed to help people apply debiasing techniques when bias is activated.