Comparing traditional, computerised and virtual reality assessments of social cognition in schizophrenia: A within-subjects multimodal approach

Abstract Social cognition is significantly impacted in people with schizophrenia and can be assessed using various methods including traditional (paper-and-pencil) tasks, computer tasks, and Virtual Reality (VR) assessments. The current study investigated whether these different approaches to social cognitive assessment, with a particular focus on theory of mind (ToM), could consistently and sensitively identify differences between individuals with schizophrenia and controls within the same sample. We hypothesised that participants with schizophrenia would perform less well than controls across all assessment methods. We additionally measured brain changes associated with social cognition during the ToM computer task using electroencephalography (EEG). Our results revealed that the schizophrenia group performed less well than the control group in ToM across all assessment approaches. They also performed less well on traditional measures of social knowledge and on VR measures emotion recognition. Additionally, event-related potential (ERP) amplitudes were reduced in people with schizophrenia compared to controls across brain regions linked to ToM. Our findings suggest that these different modes of social cognitive assessment are all sensitive to detecting differences in ToM abilities, with VR in particular showing strongest effect sizes. Implications of the findings on future protocol development are discussed. Competing Interest Statement KEH was a past founder of Resonance Therapeutics. PBF has received reimbursement for educational activities from Otsuka Australia Pharmaceutical Pty Ltd and equipment for research from Brainsway Ltd. Clinical Trial ACTRN12621001649808 Funding Statement KG was supported by a Monash University Departmental Scholarship, an Australian Government Research Training Program (RTP) Scholarship and an Epworth HealthCare Capacity Building Grant. KEH was supported by a National Health and Medical Research Council (NHMRC) fellowship (1135558). PBF is supported by an MHMRC Leadership Award. ATH was supported by and Alfred Deakin Postdoctoral Research Fellowship. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Monash Health Human Research Ethics Committee gave ethical approval for this work. Monash University Human Research Ethics Committee, Alfred Health and Epworth HealthCare provided governance approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes Author emails: bernadette.fitzgibbon{at}anu.edu.au (B.Fitzgibbon), a.hill{at}deakin.edu.au (A.Hill), paul.fitzgerald{at}anu.edu.au (P.Fitzgerald), caroline.gurvich{at}monash.edu (C.Gurvich), khoy{at}bionicsinstitute.org (K.Hoy) Data Availability All data produced in the present study are available upon reasonable request to the authors.