A friend sees another friend, she’s put on a little bit of weight, and the friend says, ‘When is your baby due?’ Of course, she’s not pregnant. Sound familiar?
Making a social faux pas every now and again is one thing, but to constantly misread social situations and facial expressions can profoundly affect your everyday life. This is the case for many people who have the debilitating symptoms of mental illness such as schizophrenia or bipolar disorder.
‘If you could imagine that if you were hearing voices, your attention, your concentration will be impacted, like carrying on a conversation with somebody with headphones in,’ says clinical psychologist Alana Dobie. ‘One of the premises of relationships in general is to really be there with another person, so if you are distracted it makes it really impossible … having an auditory hallucination can really impair our relationships in the present. Also, if one feels paranoid or persecuted as well, that’s likely to influence or flavour the way we interpret social situations.’
Dr Melissa Green, associate professor in the School of Psychiatry at the University of New South Wales, points out that in a recent national survey of people with psychosis, the number one problem they were reporting was that they were lonely, socially isolated, and felt their quality of life was just not up to scratch. Research is also showing that cognitive deficits in attention and memory can affect a person’s ability to function both socially and in the workplace, she says.
‘So we really think that by providing rehabilitation of these skills we can impact the daily lives of people with psychosis,’ says Dr Green.
Drawing on the increasing realisation that brains are plastic and can physically change and grow, given the right conditions, a new Brain Training Centre has recently opened at St Vincent’s Mental Health Program in Sydney. It’s co-ordinated by Dr Green. The centre is open daily and clients can train on computer programs when they come in for their mental health appointments. The centre has drawn on international evidence to select the best brain training programs available to improve cognitive skills in attention, memory and social understanding.
‘I’m only 19 but I’ve been through a lot for a 19-year-old,’ says Rhukhankin. ‘I’ve been on the wrong side of the law and I’ve had problems with social things, family problems.’
‘I’ve used too many drugs, to be honest, it just ruined everything in my life; I lost my family, I lost my friends, I saw people get hurt … and I thought I’m either going to sit here and end up homeless living on the street [or] I’m going to do something with my life, come to the hospital and get the help from the mental health team. This was just an extra program to help my memory and the speed of my brain and intelligence, ways of talking to people, reading people … You know, I’m probably lucky to be alive, and this is really important for me because I want to get a proper job and I want to have a normal life.’
Rhukhankin’s favourite brain training game is Hawkeye, which he says is sharpening his attention and visual memory – but , it’s the games that improve social cognition that have made a real difference to the way he’s relating to people.
‘This program has already helped me reconnect with my mum,’ he says. ‘Sometimes Mum could say something to me two years ago and I’d blow it out of proportion … and by doing this, it has helped me gain knowledge of how I read her face and her actions and the words she says and what they mean, not just jumping to conclusions. It’s focusing on things that are really important.’
Dr Pamela Marsh from Macquarie University developed the program at the brain training centre, focusing on social cognition. Her motivation grew from her personal experience of being the carer of her mentally ill son, Damien.
At the same time as caring for her son, Dr Marsh has herself lived with mental illness. She was diagnosed with depression, then borderline personality disorder and finally chronic post-traumatic stress as a result of experiences earlier in her life. Over recent years she’s also juggled a PhD focusing on the social cognitive difficulties she’s observed in her son, particularly the ways he reads emotions in others.
‘In terms of reading faces, even though I didn’t have the training at the time, I found myself when he was really little actually saying to him, “Damien, look at my face, I’m joking, I’m smiling, see, this is a smile.” I found myself on an implicit level explaining things like that to him.’
‘As a child growing up, he didn’t get on with other people very well. He was aggressive quite often, and now he’s socially isolated, he is not understanding what other people mean when they say things, or thinking that another person is out to deliberately do something to him.’
The program Dr Marsh has developed is called So Cog. It’s a socially interactive training program which includes a number of different types of games. Not all of them are computer based, such as the So Cog social trivia board game. After throwing a dice, you move around the board, and depending on what square you land on, you are presented with multiple choice questions about social situations involving ambiguous humour, deception and what she calls ‘oops’ moments or faux pas.
‘We have language-based stories because often what happens with schizophrenia, the sorts of difficulties are with non-literal speech, so if somebody uses sarcasm or irony or a figure of speech, it can be very difficult sometimes for people with schizophrenia to understand what that means because they will interpret that literally,’ she says.
‘Deception can also be difficult to understand. So we try to talk about the difference between what are white lies and what are great big whoppers. So for instance you might tell a white lie when you want to save somebody’s feelings about something, maybe that’s okay.’
It’s still early days to assess this type of brain training program, but one of the studies Dr Marsh has done shows that even after one month of remediating facial expression recognition with a simple computerised tool, improvements have been observed. And there is some quite uplifting anecdotal evidence.
Nineteen-year-old Nikita Rhukhankin has been attending the brain training centre at St Vincent’s Hospital for several weeks now, and he’s noticing some changes in himself which are making things a bit easier.
‘It’s been a lot easier for me to read faces and people’s expressions,’ he says. ‘I can take things as a joke and I can take things seriously, but I’ve been able to read things better than I used to. I could just jump to a conclusion, thinking that was what that person meant, but by doing this it helps you understand, because you need to be able to understand that sometimes it’s not always against you, I mean, the whole world’s not against you.’
Dr Marsh has also had some great feedback from other carers of people with mental illness who’ve done brain training.
‘One of the mums came up to me and she actually said, “my son did your program,” And she told me that he had hugged her for the first time ever since being ill,’ she says.
‘That was about probably the most awesome moment and reinforcing for me why I’m doing this research.’
In recent years, there has been a shift in the way the medical profession and society at large are seeing recovery from mental illness. Dr. Green says interventions like brain training are an important and exciting part of that change.
‘There has been a lot of effort by the pharmaceutical companies over the past 10 or so years to try to develop drugs that impact the cognitive disabilities, and at this stage nothing is working,’ she says.
‘That is one of the main reasons why it is being increasingly acknowledged that these psychosocial interventions are necessary as adjunct treatments. They are improving cognition in a way that the medication just cannot do.’
This article first appeared on ‘ABC’ on 9 May 2014.