title: Group cognitive remediation for schizophrenia: Exploring the role of therapist support and metacognition.
abstract: OBJECTIVE
  Cognitive remediation (CR) is a therapy targeting cognitive difficulties in psychiatric disorders. We recently develop a novel CR program for people with psychosis with a focus on metacognitive skills individually supported by a therapist. This study aims to assess the acceptability and feasibility of implementing CR in small groups where therapist support is shared amongst service users.
  
  
  METHODS
  Control group design with non-randomized group allocation.
  
  
  METHODS
  Twenty-five service users with a diagnosis of schizophrenia participated. Ten received group CR and 15 individual CR (i.e., one therapist for each service user). Both therapy formats were supported by one therapist. Participants were assessed before and after therapy with neuropsychological tests assessing different cognitive domains, self-assessed cognitive complaints, and psychotic symptoms. Treatment satisfaction questionnaires and therapist's session ratings were also collected for group CR.
  
  
  RESULTS
  Dropout rate was 20% for both methods. Session attendance was 74% for group CR and 86% for individual CR. Service users evaluated positively group CR and considered it helpful; therapists rated this delivery format feasible. Exploratory analysis suggested that the two methods have similar effects on cognition. After therapy, service users showed improvements in recall memory, reduced negative symptoms, and reported fewer cognitive complains.
  
  
  CONCLUSIONS
  It is feasible and acceptable for people with schizophrenia to take part in small CR therapy groups. The reduced therapist contact compared to individual therapy was well tolerated and may help sustain independent work. The small group format allows therapists to spend sufficient time to support the use of metacognitive strategies.
  
  
  CONCLUSIONS
  CR small groups are feasible and acceptable for service users and therapists. Therapist support can be shared. Metacognitive-based CR can improve cognition and may benefit awareness and negative symptoms.
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
authors.forename: Matteo
authors.initials: M
authors.lastname: Cella
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Reeder
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
authors.forename: Til
authors.initials: T
authors.lastname: Wykes
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D000067489:Metacognition; D009483:Neuropsychological Tests; D017060:Patient Satisfaction; D024382:Professional Role / Q000523:psychology; D011615:Psychotherapy, Group / Q000379:methods*; D012559:Schizophrenia / Q000628:therapy*; D012565:Schizophrenic Psychology; D016896:Treatment Outcome
keywords: awareness; cognition; cognitive remediation; group therapy; memory; metacognition; psychosis; schizophrenia