Gonzalez-Ortega et al. (Reference Gonzalez-Ortega, Gonzalez-Pinto, Alberich, Echeburua, Bernardo, Cabrera and Selva2019) examined the longitudinal relationship between social cognition, cognitive reserve and functional outcomes in 192 patients with first episode psychosis. They found that social cognition mediated the relationship between cognitive reserve (assessed using estimates of premorbid IQ, years of education and employment attainment) and functional outcome (using the functional assessment short test) at 2 years follow-up. As social cognition did not mediate the same relationship at baseline, these findings suggest that social cognition is a primary factor specific to the long-term functional outcomes of individuals after experiencing first-episode psychosis. While the relationship between non-social cognitive functioning and functional outcome in first episode psychosis has been known for some time (Fett et al., Reference Fett, Viechtbauer, Dominguez, Penn, Van Os and Krabbendam2011), this study provided important evidence on the need for social cognition to be included within the rehabilitative framework of recovery following first episode psychosis in order to maximise functional outcome.
Social cognition refers to the mental processes which govern one's ability to perceive, interpret and react to social information within their environment (Green et al., Reference Green, Penn, Bentall, Carpenter, Gaebel, Gur and Heinssen2008; Penn, Corrigan, Bentall, Racenstein, & Newman, Reference Penn, Corrigan, Bentall, Racenstein and Newman1997). Through the understanding of thoughts, feelings and intentions of others, it underlies our social behaviour and capacity to form meaningful and reciprocal relationships. A cohesive definition of social cognition within psychotic disorders research came from a consensus meeting by the NIMH for social cognition in schizophrenia (Green et al., Reference Green, Penn, Bentall, Carpenter, Gaebel, Gur and Heinssen2008). The organisational framework separated social cognition into five distinct areas: (1) Theory of Mind, the ability to attribute intentions, mental states and beliefs of others; (2) Social perception, the ability to understand social roles, rules and context based on nonverbal, verbal and environmental cues; (3) Social knowledge, the ability to adapt and guide one's behaviour to the environment by understanding rules and expectations within the social context; (4) Attributional bias, the inferences and errors made when individuals evaluate the cause of internal, external and situational behaviours and events and (5) Emotional processing, the capacity to identify, understand, facilitate and regulate emotions. While alternative models exist (Adolphs, Reference Adolphs2010; Green, Horan, & Lee, Reference Green, Horan and Lee2019; Lieberman, Reference Lieberman2007; Pinkham et al., Reference Pinkham, Penn, Green, Buck, Healey and Harvey2014; Saxe, Reference Saxe2006) and additional factors are typically involved, such as emotional empathy (Lieberman, Reference Lieberman2007), these frameworks nevertheless propose that social cognition is a multi-dimensional construct that consists of several related yet dissociated domains.
In the article by Gonzalez-Ortega et al. (Reference Gonzalez-Ortega, Gonzalez-Pinto, Alberich, Echeburua, Bernardo, Cabrera and Selva2019), the authors used the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT; Mayer & Salovey, Reference Mayer and Salovey2007) as a proxy of social cognition. They specifically used the ‘understanding emotions’ and ‘managing emotions’ subtests together with an overall score for emotional intelligence. However, the use of the MSCEIT does not entirely examine or encapsulate the diversity of processes underlying social cognition. The MSCEIT examines the ability to identify, perceive, understand and manage emotions (Mayer & Salovey, Reference Mayer and Salovey2007). Consequently, in the absence of additional measures of social cognitive abilities, we propose that the findings of Gonzalez-Ortega et al. (Reference Gonzalez-Ortega, Gonzalez-Pinto, Alberich, Echeburua, Bernardo, Cabrera and Selva2019) are best interpreted within the context within the emotional processing arm of social cognition, rather than social cognition as a general latent structure. As such, this would suggest that emotional processing mediates the relationship between cognitive reserve and functional outcome at 2-years follow-up for those with first episode psychosis. When viewed within this context, it makes sense that emotional processing is a mediator of the longitudinal outcomes. It serves that those better able to identify, manage and regulate their emotions would have greater resources to cope with the negative outcomes that occur after a significant life stressor (rather than at baseline). It may be that other factors within the broader umbrella of social cognition may mediate the relationship between cognitive reserve and functional outcomes at baseline, particularly given that those with first-episode psychosis demonstrate difficulties with the other social cognitive abilities of mentalising (Achim, Ouellet, Roy, & Jackson, Reference Achim, Ouellet, Roy and Jackson2012), and theory of mind and social perception (Healey, Bartholomeusz, & Penn, Reference Healey, Bartholomeusz and Penn2016).
While emotional intelligence (or rather, emotional processing) fits within the broader content of social cognition, these terms are not synonymous and researchers should critically examine the tools employed in their studies to identify what aspects of social cognition are being measured. We propose that researchers need to examine multiple facets of social cognition in those with first-episode psychosis (Pinkham, Harvey, & Penn, Reference Pinkham, Harvey and Penn2018), in conjunction with measures of emotional processing, in order to fully identify the unique contribution of each domain to cognitive and functional outcomes. This will be important for predicting recovery trajectories and to identify which specific social cognitive factors are requisite for appropriate intervention.
