A remote and avatar-based approach for social cognitive impairments in psychotic disorders: A Canadian adaptation of RC2S.

BACKGROUND: Social cognition is a core impairment in psychotic disorders and is strongly associated with functional outcomes. Although social cognitive training is effective, challenges remain regarding skill generalization and accessibility. This study aimed to develop culturally adapted French- and English-Canadian versions of RC2S and to assess the feasibility and acceptability of remote delivery. METHODS: Fourteen individuals with a psychotic disorder were assessed at baseline, offered 24 twice-weekly RC2S sessions with a therapist over 12 weeks, and reassessed post-intervention. Motivation and therapeutic alliance were assessed through intra-session questionnaires. RC2S uses a personalized approach targeting social cognition and combines pen-and-paper exercises with digital relational simulations using avatars to promote skill transfer. Feasibility and acceptability were examined descriptively and paired-samples t-tests assessed exploratory pre-post changes. RESULTS: All participants who initiated RC2S met the predefined completion criterion (≥50% of sessions), and all completed at least 75% of planned sessions (mean = 20.9). Acceptability was high for cultural adaptation, ease of use, and remote interaction (all>4.1/5), although ratings were lower for the RC2S interface (mean = 3.75/5). Motivation and therapeutic alliance remained high throughout the intervention (MUSIC>5.1;WAI > 4.3). Therapist support, perceived benefits, and remote accessibility were key facilitators. The largest exploratory pre-post changes occurred in therapist-administered goal attainment and functional impact measures. Findings from independently administered measures were more mixed, although a large change was observed for theory of mind. CONCLUSIONS: Findings support the feasibility and acceptability of remotely delivered, culturally adapted RC2S. Exploratory outcomes were mixed, requiring confirmation in a randomized trial with independent, blinded outcome assessment.