Cognitive remediation for individuals with psychosis: efficacy and mechanisms of treatment effects.
The popularity of cognitive remediation (CR) interventions for individuals with psychosis is in part based on the well-established link between cognition and functioning and the assumption that by targeting cognition, function can improve. While numerous trials have reported CR's efficacy, it is still not considered an evidence-based treatment. Importantly, little is known about the mechanisms through which it may affect functioning.



In this study, we evaluated CR's proximal and distal effects, and examined potential mechanisms. A total of 75 individuals with psychotic disorders were randomized to a combination of strategy-based and drill-and-practice CR or wait-list control, with assessments of training task performance, neurocognition, functional capacity, symptoms and functioning conducted at baseline, end of the 2-month intervention, and 2-month follow-up.



Compared with treatment as usual, CR was associated with large post-training improvements on training tasks targeting attention, visuospatial memory, and verbal learning and memory, with persisting group differences at the 2-month follow-up. These generalized to mostly large improvements on neuropsychological measures targeting visuospatial memory, verbal learning and memory, delayed verbal memory and verbal working memory. While there were no CR-associated improvements on measures of functional capacity, symptoms, or a self-report measure of independent living skills, there was an effect on an interviewer-rated measure of functioning (Quality of Life Scale), which appeared primarily driven by the Intrapsychic Foundations subscale. Finally, for those randomized to CR, there were significant, medium-sized correlations between training task improvement, neuropsychological improvement and functioning measures.



This suggests a complex, multifactorial relationship between CR, and cognitive and functional change.
VA Connecticut Healthcare System and Yale University School of Medicine,Psychology Service (116B),950 Campbell Avenue,West Haven, CT,USA.
J M
JM
Fiszdon
Department of Psychology,Korea University,Seoul,Republic of Korea.
K H
KH
Choi
VA Connecticut Healthcare System and Yale University School of Medicine,Psychology Service (116B),950 Campbell Avenue,West Haven, CT,USA.
M D
MD
Bell
The Institute of Living at Hartford Hospital,200 Retreat Avenue,Hartford, CT,USA.
J
J
Choi
Rutgers University - Robert Wood Johnson Medical School Department of Psychiatry and University Behavioral Health Care,151 Centennial Avenue,Piscataway, NJ,USA.
S M
SM
Silverstein
D000203:Activities of Daily Living; D000328:Adult; D001288:Attention; D000072466:Cognitive Remediation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory; D008875:Middle Aged; D009483:Neuropsychological Tests; D011618:Psychotic Disorders / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D012559:Schizophrenia / Q000503:physiopathology / Q000534:rehabilitation*; D012565:Schizophrenic Psychology; D065852:Spatial Memory; D013647:Task Performance and Analysis; D014706:Verbal Learning
Cognitive remediation; functioning; mediation; psychosis; schizophrenia