Are the effects of cognitive remediation therapy (CRT) durable? Results from an exploratory trial in schizophrenia.
BACKGROUND
This paper investigates the durability of the effects of cognitive remediation therapy (CRT). In a randomised control trial, CRT was compared with a control therapy (intensive occupational therapy activities), matched for length of therapist contact. The main three cognitive outcomes, (i) number of categories achieved on the Wisconsin Card Sort Test, (ii) age-scaled score on the Digit Span subtest of the WAIS-R, and (iii) mean number of moves on the Tower of London test, were chosen because they are known to be problematic in schizophrenia. In addition, a wide variety of other outcomes (symptoms, social functioning, self-esteem and cognition) were assessed. At the end of treatment, CRT conferred a benefit to people with schizophrenia in cognition and self-esteem [Schizophr. Bull. 25 (1999) 291]. This study investigates these outcomes 6 months after the therapies were withdrawn.


METHODS
Participants were assessed at baseline, posttreatment and 6-month follow-up (n=17 for the CRT group; n=16 for the control therapy group). In addition to the functioning measures, data on use of services and cost of therapy were collected.


RESULTS
The effects of CRT on cognition were still apparent at follow-up, particularly in the memory domain. When these cognitive improvements reached a criterion threshold, there were also improvements in social behaviour and symptoms. The gains made in self-esteem disappeared following the withdrawal of therapy. The economic analysis showed overall reductions in the care packages of both patient groups but there was a significant increase in day-care costs for patients who have received CRT. This additional use of day care may confer further advantages to the CRT group, such as improved social functioning and quality of life.


CONCLUSIONS
The overall results of this first trial of a novel CRT approach have produced encouraging results which merit further investigation.
Department of Psychology, Institute of Psychiatry, De Crespigny Park, SE5 8AF, London, UK. t.wykes@iop.kcl.ac.uk
Til
T
Wykes
Clare
C
Reeder
Clare
C
Williams
Julia
J
Corner
Christopher
C
Rice
Brian
B
Everitt
D000293:Adolescent; D000328:Adult; D003072:Cognition Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D003631:Day Care, Medical; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D009788:Occupational Therapy; D010043:Outcome and Process Assessment, Health Care; D011340:Problem Solving; D012073:Remedial Teaching; D012153:Retention, Psychology; D012559:Schizophrenia / Q000175:diagnosis / Q000628:therapy*; D012565:Schizophrenic Psychology