title: A randomized, controlled trial of computer-assisted cognitive remediation for schizophrenia.
abstract: OBJECTIVE
  There is considerable interest in cognitive remediation for schizophrenia, but its essential components are still unclear. The goal of the current study was to develop a broadly targeted computer-assisted cognitive remediation program and conduct a rigorous clinical trial in a large group of schizophrenia patients.
  
  
  METHODS
  Sixty-nine people with schizophrenia or schizoaffective disorder were randomly assigned to 36 sessions of computer-assisted cognitive remediation or an active control condition. Remediation broadly targeted cognitive and everyday performance by providing supportive, graduated training and practice in selecting, executing, and monitoring cognitive operations. It used engaging computer-based cognitive exercises and one-on-one training. A total of 61 individuals (34 in remediation group, 27 in control group) engaged in treatment, completed posttreatment assessments, and were included in intent-to-treat analyses. Primary outcomes were remediation exercise metrics, neuropsychological composites (episodic memory, working memory, attention, executive functioning, and processing speed), and proxy measures of community functioning.
  
  
  RESULTS
  Regression modeling indicated that performance on eight of 10 exercise metrics improved significantly more in the remediation condition than in the control condition. The mean effect size, favoring the remediation condition, was 0.53 across all 10 metrics. However, there were no significant benefits of cognitive remediation on any neuropsychological or functional outcome measure, either immediately after treatment or at the 3-month follow-up.
  
  
  CONCLUSIONS
  Cognitive remediation for people with schizophrenia was effective in improving performance on computer exercises, but the benefits of training did not generalize to broader neuropsychological or functional outcome measures. The evidence for this treatment approach remains mixed.
authors.affiliation: Mental Illness Research, Education and Clinical Center, VISN 5, VA Medical Center, Suite 6A (BT/MIRECC), 10 North Greene St., Baltimore, MD 21201, USA. dwight.dickinson@va.gov
authors.forename: Dwight
authors.initials: D
authors.lastname: Dickinson
authors.forename: Wendy
authors.initials: W
authors.lastname: Tenhula
authors.forename: Sarah
authors.initials: S
authors.lastname: Morris
authors.forename: Clayton
authors.initials: C
authors.lastname: Brown
authors.forename: Jason
authors.initials: J
authors.lastname: Peer
authors.forename: Katrina
authors.initials: K
authors.lastname: Spencer
authors.forename: Lan
authors.initials: L
authors.lastname: Li
authors.forename: James M
authors.initials: JM
authors.lastname: Gold
authors.forename: Alan S
authors.initials: AS
authors.lastname: Bellack
mesh_terms: D003071:Cognition; D003072:Cognition Disorders / Q000534:rehabilitation / Q000628:therapy*; D003194:Computer-Assisted Instruction; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000534:rehabilitation / Q000628:therapy; D012044:Regression Analysis; D012559:Schizophrenia / Q000534:rehabilitation / Q000628:therapy*; D012565:Schizophrenic Psychology