title: Is cognitive adaptation training (CAT) compensatory, restorative, or both?
abstract: Cognitive adaptation training (CAT) is a psychosocial treatment incorporating environmental supports including signs, checklists to bypass the cognitive deficits of schizophrenia. Our objective was to examine the association between CAT, functional outcomes, and cognitive test performance (cognition). The two research questions were as follows: 1) Does cognition mediate the effect of CAT intervention on functional outcome? 2) Does CAT impact cognitive test performance? A total of 120 participants with schizophrenia were randomized to one of three treatments: 1) CAT (weekly for 9months; monthly thereafter), 2) generic environmental supports (given to participants on clinic visits to promote adaptive behavior), or 3) treatment as usual (TAU). Assessments of cognition and functional outcome were conducted at baseline, 9 and 24months. Mediation analyses and mixed effects regression were conducted. Mediation analyses revealed that during the initial 9months, the direct path from treatment group to functional outcome on the primary measure was positive and highly significant. CAT significantly improved functional outcome compared to the other treatments. However, paths involving cognition were negligible. There was no evidence that cognition mediated improvement in functional outcomes. At 24months, cognition improved more in CAT compared to other treatment groups. The test for cognition mediating improvement in functional outcomes was not significant at this time point. However, improvement in functional outcome led to better performance on cognitive testing. We concluded that improvement in cognition is not a necessary condition for improvement in functional outcome and that greater engagement in functional behavior has a positive impact on cognition.
authors.affiliation: Department of Psychiatry, UPL, University of Texas Health Science Center, San Antonio, TX 78229, United States. Electronic address: Fredrick@uthscsa.edu.
authors.forename: Megan M
authors.initials: MM
authors.lastname: Fredrick
authors.affiliation: Department of Psychiatry, NWC 13.132, University of Texas Health Science Center, San Antonio, TX 78229, United States. Electronic address: mintz@uthscsa.edu.
authors.forename: Jim
authors.initials: J
authors.lastname: Mintz
authors.affiliation: Department of Psychiatry, UPL, University of Texas Health Science Center, San Antonio, TX 78229, United States. Electronic address: RobertsD5@uthscsa.edu.
authors.forename: David L
authors.initials: DL
authors.lastname: Roberts
authors.affiliation: Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX 78229, United States. Electronic address: MaplesN@uthscsa.edu.
authors.forename: Natalie J
authors.initials: NJ
authors.lastname: Maples
authors.affiliation: Department of Psychiatry, School of Medicine, University of Texas Health Science Center, San Antonio, TX 78229, United States. Electronic address: Sonalisarkar@yahoo.com.
authors.forename: Sonali
authors.initials: S
authors.lastname: Sarkar
authors.affiliation: Department of Psychiatry, NWC 13.132, University of Texas Health Science Center, San Antonio, TX 78229, United States. Electronic address: Lix3@uthscsa.edu.
authors.forename: Xueying
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Psychiatry, UPL, University of Texas Health Science Center, San Antonio, TX 78229, United States. Electronic address: VELLIGAND@uthscsa.edu.
authors.forename: Dawn I
authors.initials: DI
authors.lastname: Velligan
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D003071:Cognition; D015928:Cognitive Behavioral Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010045:Outpatients; D012559:Schizophrenia / Q000628:therapy*; D012565:Schizophrenic Psychology; D012944:Social Support; D016896:Treatment Outcome
keywords: Cognitive; Cognitive adaptation training; Environmental supports; Functional outcomes; Functioning; Schizophrenia; Treatment