Department of Humanities and Life Sciences, University School for Advanced Studies IUSS Pavia, Italy.
School of Psychology, Vita-Salute San Raffaele University, Milan, Italy; Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy.
J Commun Disord. 2022 May-Jun;97:106196. doi: 10.1016/j.jcomdis.2022.106196. Epub 2022 Feb 2.
Language and communication disruptions in schizophrenia are at the center of a large body of investigation. Yet, the remediation of such disruptions is still in its infancy. Here we targeted what is known to be one of the most damaged language domains in schizophrenia, namely pragmatics, by conducting a pragmatics-centered intervention with a randomized controlled trial design and assessing also durability and generalization. To the best of our knowledge, this is the first study with these characteristics.
Inspired by the Gricean account of natural language use, we tailored a novel treatment addressing the pragmatics of communication (PragmaCom) and we tested its efficacy in a sample of individuals with schizophrenia randomized to the experimental group or to an active control group. The primary outcome with respect to the efficacy of the PragmaCom was measured by changes in pragmatic abilities (as evaluated with the global score of the Assessment of Pragmatic Abilities and Cognitive Substrates test) from baseline to 12 weeks and at 3-month follow-up. The secondary outcome was measured by changes in metaphor comprehension, abstract thinking, and global functioning from baseline to 12 weeks and at 3-month follow-up.
Relative to the control group, at post-test the PragmaCom group showed greater and enduring improvement in global pragmatic skills and in metaphor comprehension. At follow-up, these improvements persisted and the PragmaCom exerted beneficial effects also on functioning.
Despite the limited sample size, we believe that these findings offer initial yet encouraging evidence of the possibility to improve pragmatic skills with a theoretically grounded approach and to obtain durable and clinically relevant benefits. We argue that it is time that therapeutic efforts embrace communicative dysfunctions in order to improve illness outcome.
精神分裂症患者的语言和交流障碍是大量研究的核心。然而，这些障碍的矫正仍处于起步阶段。在这里，我们通过一项具有随机对照试验设计的以语用学为中心的干预措施，针对精神分裂症中已知受损最严重的语言领域之一——语用学，进行了研究，并评估了其持久性和泛化性。据我们所知，这是具有这些特征的第一项研究。
受格赖斯自然语言使用理论的启发，我们设计了一种新的治疗方法，旨在解决交流的语用学问题（PragmaCom），并在一组随机分配到实验组或活动对照组的精神分裂症患者中测试了其疗效。关于 PragmaCom 疗效的主要结果是通过从基线到 12 周和 3 个月随访时评估语用能力的变化（使用评估语用能力和认知基质测试的综合评分来评估）来衡量的。次要结果是通过从基线到 12 周和 3 个月随访时评估隐喻理解、抽象思维和整体功能的变化来衡量的。
与对照组相比，在测试后，PragmaCom 组在整体语用技能和隐喻理解方面表现出更大且持久的改善。在随访时，这些改善持续存在，并且 PragmaCom 对功能也产生了有益的影响。
尽管样本量有限，但我们认为这些发现提供了初步但令人鼓舞的证据，表明通过基于理论的方法有可能改善语用技能，并获得持久和临床相关的益处。我们认为，现在是治疗努力应该包括交流障碍，以改善疾病结果的时候了。
