Digital Social Cognition Training Enhancing Social Cognition in Patients With Schizophrenia: A Systematic Review and...

Social cognition deficits, such as impaired emotion recognition, theory of mind (ToM), and empathy are central to schizophrenia-spectrum disorders and predict poor functional outcomes. Conventional therapies often lack scalability. Technology-based social cognition training (TBSCT), using computerized, web-based, or virtual reality (VR) formats, offers an accessible and adaptive solution.

Following PRISMA guidelines (PROSPEROCRD420251021242), databases including Embase, MEDLINE, Cochrane, CINAHL, Web of Science, and PsycArticles were searched up to May 2025. Eligible randomized or quasi-experimental studies involved adults with schizophrenia-spectrum disorders receiving TBSCT targeting emotion recognition, ToM, or empathy. Methodological quality was assessed using Joanna Briggs Institute tools. Random-effects meta-analyses estimated pooled effect sizes (Hedges' g), with subgroup analyses by technology type, clinical setting, and intervention focus.

Twenty-one studies (17 in meta-analysis) met inclusion criteria. TBSCT significantly enhanced facial emotion recognition (FER; g = 0.92, p < 0.001) and showed a small effect on ToM (g = 0.22, p = 0.05); empathy improved pre-post (g = 0.58, p = 0.04). FER benefits were strongest in web-based (g = 1.35), followed by VR (g = 0.87) and computerized programs (g = 0.75). ToM gains were significant only among outpatients. Methodological quality was moderate to high, with mild, transient adverse effects and comparable dropout rates (risk difference = -0.03, p = 0.21).

TBSCT effectively improves social cognition, particularly emotion recognition in schizophrenia-spectrum disorders. The interventions are safe, feasible, and scalable, supporting clinical implementation. Future studies should examine long-term efficacy and optimize engagement across diverse psychiatric populations.