Action-based cognitive remediation for individuals with serious mental illnesses: Effects of real-world simulations and goal setting on functional and vocational outcomes.
Cognitive remediation programs often have larger effects on cognition compared with everyday outcomes. We compared changes across cognitive, functional competence, and vocational domains in 2 cognitive remediation programs.



A sequential enrollment, nonrandom design with 50 individuals with serious mental illnesses (psychotic and mood disorders) from a community vocational rehabilitation program. Action-Based Cognitive Remediation (ABCR), a new program that combines traditional cognitive training techniques with simulated workplace situations and goal setting for engaging with cognitively demanding activities (N = 24; 19 completers) was compared with traditional cognitive remediation (tCR; N = 26; 15 completers). Both groups met twice-weekly for 2-hr sessions over 10 weeks. Repeated measures analysis of variance was used to examine effects pre- and posttreatment and 10 weeks after treatment. Univariate analysis of variance and chi-square tests were used to compare work outcomes 6 months after intervention.



Significantly more ABCR participants (83%) were retained in the intervention compared with tCR (57%) and reported greater increases in perceived competence with cognitively challenging tasks (η2 = .23). ABCR effects were significantly larger than tCR on functional competence (η2 = .53), with smaller, nonsignificant differences in social cognition (η2 = .14) and neurocognition (η 2 = .16). ABCR participants were marginally more likely to be competitively employed (68.4% vs. 40%) and, among those employed, ABCR participants experienced less job-related stress (η2 = .37).



Cognitive rehabilitative programs for serious mental illness that rely on computer-based training for neuroplasticity should ensure opportunities for active skill development and therapist-supported techniques to overcome challenges with generalizing cognitive effects to everyday outcomes. (PsycINFO Database Record
Department of Psychology, Queen's University.
Christopher R
CR
Bowie
Department of Psychology, Queen's University.
Michael
M
Grossman
Department of Psychology, Queen's University.
Maya
M
Gupta
Department of Psychology, Queen's University.
Katherine
K
Holshausen
Department of Psychology, Queen's University.
Michael W
MW
Best
D000328:Adult; D000072466:Cognitive Remediation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000534:rehabilitation*; D017063:Outcome Assessment, Health Care; D012050:Rehabilitation, Vocational; D012559:Schizophrenia / Q000534:rehabilitation*; D013813:Therapy, Computer-Assisted