Technology-based social cognition training improved facial emotion recognition and empathy in adults with schizophrenia-spectrum disorders.

INTRODUCTION: Social cognition deficits, such as impaired emotion recognition, theory of mind (ToM), and empathy are central to schizophrenia-spectrum disorders and predict poor functional outcomes. Conventional therapies often lack scalability. Technology-based social cognition training (TBSCT), using computerized, web-based, or virtual reality (VR) formats, offers an accessible and adaptive solution. METHODS: Following PRISMA guidelines (PROSPEROCRD420251021242), databases including Embase, MEDLINE, Cochrane, CINAHL, Web of Science, and PsycArticles were searched up to May 2025. Eligible randomized or quasi-experimental studies involved adults with schizophrenia-spectrum disorders receiving TBSCT targeting emotion recognition, ToM, or empathy. Methodological quality was assessed using Joanna Briggs Institute tools. Random-effects meta-analyses estimated pooled effect sizes (Hedges' g), with subgroup analyses by technology type, clinical setting, and intervention focus. RESULTS: Twenty-one studies (17 in meta-analysis) met inclusion criteria. TBSCT significantly enhanced facial emotion recognition (FER; g = 0.92, p < 0.001) and showed a small effect on ToM (g = 0.22, p = 0.05); empathy improved pre-post (g = 0.58, p = 0.04). FER benefits were strongest in web-based (g = 1.35), followed by VR (g = 0.87) and computerized programs (g = 0.75). ToM gains were significant only among outpatients. Methodological quality was moderate to high, with mild, transient adverse effects and comparable dropout rates (risk difference = -0.03, p = 0.21). CONCLUSION: TBSCT effectively improves social cognition, particularly emotion recognition in schizophrenia-spectrum disorders. The interventions are safe, feasible, and scalable, supporting clinical implementation. Future studies should examine long-term efficacy and optimize engagement across diverse psychiatric populations.