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Schizophrenia Research and Treatment
Volume 2017, Article ID 7203871, 15 pages
Research Article

Improving Theory of Mind in Schizophrenia by Targeting Cognition and Metacognition with Computerized Cognitive Remediation: A Multiple Case Study

1École de Psychologie, Université Laval, Québec, QC, Canada G1V 0A6
2Centre de Recherche de l’Institut Universitaire en Santé Mentale de Québec, Québec, QC, Canada G1J 2G3
3Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
4Département de Psychiatrie et Neurosciences, Faculté de Médecine, Université Laval, Québec, QC, Canada G1V 0A6

Correspondence should be addressed to Amélie M. Achim; ac.lavalu.demf@mihca.eilema

Received 1 August 2016; Accepted 15 December 2016; Published 26 January 2017

Academic Editor: Nakao Iwata

Copyright © 2017 Élisabeth Thibaudeau et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Schizophrenia is associated with deficits in theory of mind (ToM) (i.e., the ability to infer the mental states of others) and cognition. Associations have often been reported between cognition and ToM, and ToM mediates the relationship between impaired cognition and impaired functioning in schizophrenia. Given that cognitive deficits could act as a limiting factor for ToM, this study investigated whether a cognitive remediation therapy (CRT) that targets nonsocial cognition and metacognition could improve ToM in schizophrenia. Four men with schizophrenia received CRT. Assessments of ToM, cognition, and metacognition were conducted at baseline and posttreatment as well as three months and 1 year later. Two patients reached a significant improvement in ToM immediately after treatment whereas at three months after treatment all four cases reached a significant improvement, which was maintained through 1 year after treatment for all three cases that remained in the study. Improvements in ToM were accompanied by significant improvements in the most severely impaired cognitive functions at baseline or by improvements in metacognition. This study establishes that a CRT program that does not explicitly target social abilities can improve ToM.