The feasibility and clinical benefits of improving facial affect recognition impairments in schizophrenia: Systematic review and meta-analysis

People diagnosed with schizophrenia have significant difficulty accurately recognising emotions expressed by others. This may generate anomalous experiences which, if misinterpreted, could contribute to experiences of social defeat, psychotic symptoms and reduced social functioning. It remains unclear whether this impairment is responsive to non-pharmacological intervention, or what the effect of modifying it is. We did a systematic review and meta-analysis to examine whether and to what extent facial affect recognition impairments can be improved by psychological intervention and, if so, whether this leads to improvements in psychotic symptoms and social functioning. A total of 8 randomised controlled trials (RCTs) consisting of 300 participants were included. Focused yet brief psychological interventions led to very large improvements in facial affect recognition ability in psychosis [k = 8, N = 300, g = 1.26, 95% Confidence Interval (CI) 0.92, 1.60, I2 41%]. Early evidence suggests this may cause large improvements in social functioning (k = 3, N = 109, g = 0.98, 95% CI 0.37, 1.36, I2 38%), but not psychotic symptoms. Facial affect recognition difficulties in schizophrenia are highly responsive to psychological interventions designed to improve them, and there is early evidence that this may lead to large gains in social functioning for this group – but not symptoms. A large-scale high-quality RCT with longer-term follow-up period is now required to overcome the limitations of the existing evidence.