A Multisite, Randomized Controlled Clinical Trial of Computerized Cognitive Remediation Therapy for Schizophrenia

Abstract

The effectiveness of cognitive remediation therapy (CRT) for the neuropsychological deficits seen in schizophrenia is supported by meta-analysis. However, a recent methodologically rigorous trial had negative findings. In this study, 130 chronic schizophrenic patients were randomly assigned to computerized CRT, an active computerized control condition (CC) or treatment as usual (TAU). Primary outcome measures were 2 ecologically valid batteries of executive function and memory, rated under blind conditions; other executive and memory tests and a measure of overall cognitive function were also employed. Carer ratings of executive and memory failures in daily life were obtained before and after treatment. Computerized CRT was found to produce improvement on the training tasks, but this did not transfer to gains on the primary outcome measures and most other neuropsychological tests in comparison to either CC or TAU conditions. Nor did the intervention result in benefits on carer ratings of daily life cognitive failures. According to this study, computerized CRT is not effective in schizophrenia. The use of both active and passive CCs suggests that nature of the control group is not an important factor influencing results.

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

“…We did not include an active control condition: a lack of agreement regarding what constitutes specific v . non-specific effects of CR, combined with evidence that active computerised CR controls may not be effective (Gomar et al 2015 ), made it difficult to justify public funding support for an additional control treatment arm.…”

Alpha‐band desynchronization reflects memory‐specific processes during visual change detection

“…By contrast, others have conceptualized α/β‐ERD as serving a more generalized “gating” function, passing task‐relevant information through the visual stream for further processing when it is desynchronized and suppressing task‐irrelevant information when it is highly synchronized (Handel, Haarmeier, & Jensen, ; Jensen & Mazaheri, ; Poch, Valdivia, Capilla, Hinojosa, & Campo, ; Zumer, Scheeringa, Schoffelen, Norris, & Jensen, ). Such a gating mechanism would be considered a function that is necessary, but not sufficient, for WM storage, and, indeed, some studies have demonstrated that α/β‐ERD is elicited in response to visual stimuli during a task with no explicit memory component at all (e.g., Banerjee, Snyder, Molholm, & Foxe, ; Foster et al, ; Gomar et al, ; Handel et al, ; Ichihara‐Takeda et al, ; Roijendijk, Farquhar, van Gerven, Jensen, & Gielen, ). These observations suggest the possibility that α/β‐ERD reflects engagement of earlier more generalized visual processes, such as perceptual encoding or modulation of attention.…”

Cognitive-behavioral rehabilitation vs. treatment as usual for bipolar patients: study protocol for a randomized controlled trial

“…However, when testing its efficacy, restrictive settings are often utilized [24], which brings criticism for creating low ecological validity (i.e. the individual shows improvement in a specific task, but does not transfer it into their daily lives); consequently, new approaches are being proposed rather focusing on daily tasks [18].…”