SUMMARY Schizophrenia patients suffer from severe cognitive deficits, such as impaired reality monitoring. Reality monitoring is the ability to distinguish the source of internal experiences from outside reality. During reality monitoring tasks, schizophrenia patients make errors identifying “I made it up” items, and even during accurate performance, they show abnormally low activation of the medial prefrontal cortex (mPFC), a region that supports self-referential cognition. We administered 80 hours of computerized training of cognitive processes to schizophrenia patients and found improvement in reality monitoring that correlated with increased mPFC activity. In contrast, patients in a computer games control condition did not show any behavioral or neural improvements. Notably, recovery in mPFC activity after training was associated with improved social functioning six months later. These findings demonstrate that a serious behavioral deficit in schizophrenia, and its underlying neural dysfunction, can be improved by well-designed computerized cognitive training, resulting in better quality of life.

Previous research has shown that people solve insight or creative problems better when in a positive mood (assessed or induced), although the precise mechanisms and neural substrates of this facilitation remain unclear. We assessed mood and personality variables in 79 participants before they attempted to solve problems that can be solved by either an insight or an analytic strategy. Participants higher in positive mood solved more problems, and specifically more with insight, compared with participants lower in positive mood. fMRI was performed on 27 of the participants while they solved problems. Positive mood (and to a lesser extent and in the opposite direction, anxiety) was associated with changes in brain activity during a preparatory interval preceding each solved problem; modulation of preparatory activity in several areas biased people to solve either with insight or analytically. Analyses examined whether (a) positive mood modulated activity in brain areas showing responsivity during preparation; (b) positive mood modulated activity in areas showing stronger activity for insight than noninsight trials either during preparation or solution; and (c) insight effects occurred in areas that showed mood-related effects during preparation. Across three analyses, the ACC showed sensitivity to both mood and insight, demonstrating that positive mood alters preparatory activity in ACC, biasing participants to engage in processing conducive to insight solving. This result suggests that positive mood enhances insight, at least in part, by modulating attention and cognitive control mechanisms via ACC, perhaps enhancing sensitivity to detect non-prepotent solution candidates.

A total of 50 hours of neuroplasticity-based computerized cognitive training appears sufficient to drive improvements in verbal learning/memory and cognitive control that endure 6 months beyond the intervention, but a higher "dose" and more "broad-spectrum" training may be necessary to drive enduring gains in processing speed and global cognition. Training-induced cognitive improvement is related to enhanced functioning at 6 months. These data suggest that (1) higher and "broader" doses of cognitive training may confer the most benefits for schizophrenia patients; (2) the posttraining period opens a critical window for aggressive adjunctive psychosocial rehabilitation.