Cognitive Enhancement Therapy for Early-Course Schizophrenia: Effects of a Two-Year Randomized Controlled Trial

Abstract

Objective The early application of cognitive rehabilitation may afford long-term functional benefits to patients with schizophrenia. This study examined the two-year effects of an integrated neurocognitive and social-cognitive rehabilitation program, cognitive enhancement therapy (CET), on cognitive and functional outcomes in early course schizophrenia. Method Early course outpatients (mean illness duration = 3.19±2.24 years) with schizophrenia or schizoaffective disorder were randomly assigned to CET (n = 31) or enriched supportive therapy (EST) (n = 27), an illness management intervention utilizing psychoeducation and applied coping strategies, and treated for 2 years. Multivariate composite indexes of cognitive, social adjustment, and symptomatology domains were derived from assessment batteries administered annually by computer-based tests and raters not blind to treatment assignment. Results Of the 58 patients randomized and treated, 49 and 46 completed 1 and 2 years of treatment, respectively. Intent to treat analyses showed significant differential effects favoring CET on social cognition, cognitive style, social adjustment, and symptomatology composites during the first year of treatment. After two years, moderate effects (d = .46) were observed favoring CET at enhancing neurocognitive function. Strong differential effects (d > 1.00) on social cognition, cognitive style, and social adjustment composites remained at year 2, and also extended to measures of symptomatology, particularly negative symptoms. Conclusions CET appears to be an effective approach to the remediation of cognitive deficits in early schizophrenia that may help reduce disability among this population. The remediation of such deficits should be an integral component of early intervention programs treating psychiatrically stable schizophrenia outpatients.

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“…This has led to an increased focus on the need to enhance social recovery (Fowler et al 2009) especially educational and vocational aspects (Fraser et al 2006;Killackey et al 2006;) through the combination of effective psychosocial interventions with well-managed medication. There is also an increasing focus on targeted cognitive remediation and to limit the degree of cognitive decline that is often found as illness progresses (Wykes et al 2007;Eack et al 2009). …”

Can computer-assisted cognitive remediation improve employment and productivity outcomes of patients with severe mental illness? A meta-analysis of prospective controlled trials

“…In other studies, patients with CACR showed improvement in work quality and work habit (Lee, 2013), but not work affinity, ability to obtain and maintain a job, or interpersonal relationships (Eack et al, 2009Cavallaro et al, 2009). …”

“…Five studies used Cogpack (Marker, 1987e2007) software, 3 studies used CogRehab (Bracy, 1995) software, and 1 study combined different softwares, including CogRehab þ Sci-Learn (Scientific Learning Corporation, 2003). The quality of included trials was generally good, as seven trials (McGurk et al, 2005;Bell et al, 2008;Eack et al, 2009Eack et al, , 2011Lindenmayer et al, 2008;McGurk et al, 2009;Vauth et al, 2005;Sayaka et al, 2014) were rated as 4e5, and two trials (Bell et al, 2005;Tan and King, 2013) scored as 6e7 (Table 1). Five studies included 24 h of computerbased cognitive exercises.…”

“…First, neurocognitive enhancement therapy (NET) (Bell et al, 2005(Bell et al, , 2008 combined computer-based cognitive exercise, feedback support groups and weekly social processing groups, to enhance the neurocognitive skills. Second, cognitive enhancement therapy (CET) (Eack et al, 2009(Eack et al, , 2011 aimed to address social cognitive and neurocognitive deficits in schizophrenia, the program combined computerized cognitive training exercises with weekly social cognitive group therapy. Third, the thinking skills for work program (McGurk et al, 2005) included facilitator-based computer cognitive exercises, and teaching compensatory strategies to minimize the effects of cognitive impairment in work.…”

The potential of nicotinic enhancement of cognitive remediation training in schizophrenia

“…CET has been shown to produce moderate to large effect sizes on neurocognition, processing speed, as well as social cognition and adjustment in PSZ (Hogarty et al, 2004;Eack et al, 2009). Robust and sustained improvements in executive function and working memory were also reported by Bell and colleagues (Bell et al, 2001(Bell et al, , 2007, who added 26 weeks, up to 5 h/week, of performance-adaptive computerized exercises of attention, memory, executive function, and dichotic listening, as well as weekly social processing group meetings to vocational rehabilitation programs.…”