A new generation computerised metacognitive cognitive remediation programme for schizophrenia (CIRCuiTS): a randomised controlled trial

Abstract

BackgroundCognitive remediation (CR) is a psychological therapy, which improves cognitive and social functioning in people with schizophrenia. It is now being implemented within routine clinical services and mechanisms of change are being explored. We designed a new generation computerised CR programme, CIRCuiTS (Computerised Interactive Remediation of Cognition – a Training for Schizophrenia), to enhance strategic and metacognitive processing, with an integrated focus on the transfer of cognitive skills to daily living. This large trial tested its feasibility to be delivered in therapist-led and independent sessions, and its efficacy for improved cognitive and social functioning.MethodsA two arm single blind randomised superiority trial comparing CIRCuiTS plus treatment-as-usual (TAU) with TAU alone in 93 people with a diagnosis of schizophrenia. Cognitive, social functioning and symptom outcomes were assessed at pre- and post-therapy and 3 months later.Results85% adhered to CIRCuiTS, completing a median of 28 sessions. There were significant improvements in visual memory at post-treatment (p = 0.009) and follow-up (p = 0.001), and a trend for improvements in executive function at post-treatment (p = 0.056) in favour of the CIRCuiTS group. Community function was also differentially and significantly improved in the CIRCuiTS group at post-treatment (p = 0.003) but not follow-up, and was specifically predicted by improved executive functions.ConclusionsCIRCuiTS was beneficial for improving memory and social functioning. Improved executive functioning emerges as a consistent predictor of functional gains and should be considered an important CR target to achieve functional change. A larger-scale effectiveness trial of CIRCuiTS is now indicated.

Nonsocial and social cognition in schizophrenia: current evidence and future directions

“…Similarly, there are currently at least four different psychotherapies for schizophrenia that all include the term “metacognition” in their titles, as well as metacognitively‐oriented cognitive remediation and social skills training. Yet, these programs look rather different.…”

The nuts and bolts of Cognitive Remediation: Exploring how different training components relate to cognitive and functional gains

“…Strategy use is also thought to be important to boost not only cognitive performance, but also functioning levels as strategy use can be generalised to other tasks. Some CR programs have linked the importance of strategy use to the development of metacognitive skills (Reeder et al, 2017;Reeder et al, 2016;Tsapekos et al, 2017).…”

“…The advent of computerised CR has simplified how we record task practice as this information is, in many cases, easily retrievable from the CR software. In the CIRCuiTS software (Reeder et al, 2017) used in our recent studies it is also possible to consider other therapy components such as use of strategies.…”

Trial implementation of CIRCuiTS cognitive remediation therapy for people with schizophrenia in Orange, New South Wales

“…Many with these diagnoses experience cognitive impairments, which underpin significant difficulties with functioning in everyday tasks, poor rates of participation in employment and difficulties with relationships . A number of international studies including systematic reviews have identified the effectiveness of cognitive remediation therapies (CRT) . Current Royal Australian and New Zealand College of Psychiatrists practice guidelines recommend CRT …”

“…The Advanced Journey provides similar tasks of greater difficulty and further opportunities to apply therapeutic strategies. International research showed CIRCuiTS was feasible, acceptable and effective in improving functioning …”