Cognitive, creative, functional, and clinical symptom improvements in schizophrenia after an integrative cognitive remediation program: a randomized controlled trial

Abstract

This study analyzed the effectiveness of an integrative cognitive remediation program (REHACOP) in improving neurocognition, social cognition, creativity, functional outcome, and clinical symptoms in patients with schizophrenia. In addition, possible mediators predicting improvement in functional outcomes were explored. The program combined cognitive remediation with social cognitive training and social and functional skill training over 20 weeks. The sample included 94 patients, 47 in the REHACOP group and 47 in the active control group (occupational activities). Significant differences were found between the two groups in change scores of processing speed, working memory, verbal memory (VM), inhibition, theory of mind, emotion processing (EP), figural creative strengths, functional competence, disorganization, excitement, and primary negative symptoms. A mediational analysis revealed that changes in VM, inhibition, and EP partially explained the effect of cognitive remediation on functional competence improvement. This study provides initial evidence of the effect of integrative cognitive remediation on primary negative symptoms and creativity.

Advances in Cognitive Remediation Training in Schizophrenia: A Review

“…Out of the 26 studies included, two included a paper-and-pencil format that had dropout rates of 0 [ 9 ] and 8 [ 15 ]. Twenty-three studies included a computerized CRT program with dropout rates ranging from 0 to 53 [ 7 , 8 , 10 , 11 , 12 , 13 , 14 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. One study compared paper-and-pencil and computerized CRT to one another and had 9 total dropouts [ 25 ].…”

“…Both group and individual formats implementing CRT were found from our search. Of the 26 articles, nine studies used an individual format [ 7 , 11 , 12 , 13 , 14 , 23 , 24 , 29 , 31 ] and 17 used a group format [ 8 , 9 , 10 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 25 , 26 , 27 , 28 , 30 , 32 ]. One study [ 22 ] had participants complete homework exercises in their own homes, but the CRT program itself was implemented in a group outpatient setting.…”

“…While participants were partaking in the cognitive exercises, therapists guided the process by asking questions aimed at enhancing metacognition and information processing. Such a strategy-based approach was implemented in several other studies that included performance feedback, encouragement to practice new strategies in future sessions, and compensatory strategies relevant to the individual’s needs [ 9 , 15 , 16 , 22 , 26 , 28 , 30 , 31 , 32 ]. One study allotted 10 min before and after each CRT session for participants to socially interact and share learning strategies [ 25 ].…”

“…Two studies combined CRT with a social cognition training program called MRIGE and compared it to CRT alone, showing significant improvements in emotion perception, emotion recognition, and greater gains in neurocognition as compared to CRT alone [ 10 , 21 ]. Three studies [ 15 , 19 , 30 ] utilized a cognitive CRT program, REHACOP, which combined cognitive remediation, social cognitive intervention, and functional skills training all embedded within the computerized software. The authors found significant improvements in social cognition, neurocognition, and functioning in the REHACOP group as compared to the control [ 15 , 19 , 30 ].…”

“…Three studies [ 15 , 19 , 30 ] utilized a cognitive CRT program, REHACOP, which combined cognitive remediation, social cognitive intervention, and functional skills training all embedded within the computerized software. The authors found significant improvements in social cognition, neurocognition, and functioning in the REHACOP group as compared to the control [ 15 , 19 , 30 ]. Kurtz et al (2015) augmented a social skills training program with CRT and found significant improvements in attention, working memory, and social functioning, specifically in empathy [ 17 ].…”