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

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.