Cognitive remediation for schizophrenia: An expert working group white paper on core techniques

Bowie, Christopher R.; Bell, Morris D.; Fiszdon, Joanna M.; Johannesen, Jason; Lindenmayer, Jean Pierre; McGurk, Susan R.; Medalia, Alice; Penadés, Rafael; Saperstein, Alice M.; Twamley, Elizabeth W.; Ueland, Torill; Wykes, Til

doi:10.1016/j.schres.2019.10.047

Cited by 143 publications

(139 citation statements)

References 23 publications

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“…It is likely that other mechanisms or “active therapy ingredients” may be also be instrumental. Reports suggested that some of these may be related to therapist contact and suggest that CR also capitalizes on basic psychological therapy skills and should be considered a form of psychological therapy …”

Section: Mechanisms To Maximize Transfer Of Gains To Daily Lifesupporting

confidence: 90%

Do we really need a “new” cognitive therapy for bipolar disorder? Paradigm refinements and treatment mechanisms for cognitive remediation

et al. 2020

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Although more pronounced during mood episodes, widespread cognitive deficits also persist after symptom remission for a significant proportion of individuals with bipolar disorder (BD). These cognitive difficulties limit recovery and are strongly associated with a wide range of functional goals such as employment and interpersonal relationships. This mounting evidence of the importance of cognitive functions now requires action if we are to improve recovery outcomes for the long-term. Cognitive Remediation (CR), originally developed to treat people with a diagnosis of schizophrenia, has recently emerged as a potential treatment option to promote functional recovery by targeting cognitive difficulties in people with BD. Numerous controlled trials have established the efficacy of CR paradigms for people with schizophrenia and these provide a basisfor CR programs to be tested in other mental health conditions also characterized by cognitive difficulties. | HE TEROG ENEIT Y OF COG NITIVE D IFFICULTIE S IN PEOPLE WITH B DAdopting CR paradigms from schizophrenia appears reasonable for BD research when considering the similarities in the cognitive profiles across schizophrenia and BD. However, there are also differences between these two populations and appropriately adjusting treatment manuals could improve treatment outcomes. For example, whereas most patients with schizophrenia experience severe cognitive impairment across many cognitive domains, there are subgroups of BD patients presenting with discrete cognitive problems while others remain cognitively intact.Profile differences might result from differing developmental trajectories and illness progression among patient subgroups.Unlike in schizophrenia, where cognitive impairment is predominantly associated with neurodevelopmental factors, the longitudinal course of cognitive dysfunction for some people with BD seems to involve neurodevelopmental (eg, early-life premorbid deficits) and for others neuroprogressive (eg, effect of manic episodes) factors. 1 Thus, it is unclear whether we can just provide the same therapy paradigms developed for schizophrenia to people with BD or whether adaptations of CR paradigms are needed to account for the distinct characteristics of different BD subgroups.

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Section: Mechanisms To Maximize Transfer Of Gains To Daily Lifesupporting

confidence: 90%

Do we really need a “new” cognitive therapy for bipolar disorder? Paradigm refinements and treatment mechanisms for cognitive remediation

et al. 2020

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“…The efficacy of CACR in the treatment of people with schizophrenia is extensively displayed in literature and CACR has the advantage of being motivating, adjustable, and economical (3,14). The meta-analysis of Grynszpan, Perbal (5) concludes that treatment effects on cognitive domains that were explicitly targeted by CACR do not differ from those domains that were not.…”

Section: Discussionmentioning

confidence: 99%

“…After baseline assessment the patients were randomly assigned to one of the three treatment conditions. Core techniques for cognitive remediation for schizophrenia were used during the study (14). The results of the cognitive pre-testing and the associated effects of cognitive deficits on mental health and everyday functioning were communicated and explained to the subjects during an individual therapy session before starting CACR.…”

Section: Interventionmentioning

confidence: 99%

“…The low training frequency of most previous studies is of special relevance, since intensity and frequency of CACR seem important for specific treatment effects (13,14). Possibly, low dosed CACR might early on lead to general cognitive improvements, whereas specific cognitive treatment effects require high frequent, intense CACR, and appear only after a sufficient number of training sessions.…”

Section: Introductionmentioning

confidence: 99%

“…We conducted a three-group randomized, controlled, repeated measure study where patients received 1) TAU, 2) trained their individual three main cognitive impairments (I-CACR), or 3) trained all six measured cognitive domains (G-CACR) 4 days in a week. Following current recommendation on CACR for schizophrenia intense drill and practice CACR was combined with a weekly transfer session including problem solving and transfer to real world functioning (14). Neuropsychological functioning as well as psychopathology and functional outcome were assessed both at baseline and after 5 weeks of high frequent CACR.…”

Section: Introductionmentioning

confidence: 99%

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Computer-Assisted Cognitive Remediation in Schizophrenia: Efficacy of an Individualized vs. Generic Exercise Plan

et al. 2020

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Computer-assisted cognitive remediation (CACR) is an economical, adjustable, and effective treatment for individuals with schizophrenia. The current randomized controlled study examined whether an individualized or generic exercise plan in CACR is superior in patients with multiple cognitive deficits compared to treatment-as-usual (TAU). Fifty-nine inpatients diagnosed with schizophrenia were randomly assigned to 1) TAU, 2) TAU plus an individualized exercise plan in CACR, or 3) TAU plus a generic exercise plan in CACR. Neuropsychological performance, psychopathology, and functional outcome were assessed at baseline and post-treatment. The results show a medium to large training effect for all neuropsychological performance measures. Contrary to our expectations the neuropsychological improvement over time did not differ between groups. Self-reported depression, global level of functioning, and activity and participation functioning showed a significant improvement from baseline to post-treatment. However no further group, time, or interaction effects for other psychopathology and functional outcome could be demonstrated. Possible implications for clinical use of CACR and future studies are discussed.

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Factors Associated With Real-Life Functioning in Persons With Schizophrenia in a 4-Year Follow-up Study of the Italian Network for Research on Psychoses

et al. 2021

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IMPORTANCEThe goal of schizophrenia treatment has shifted from symptom reduction and relapse prevention to functional recovery; however, recovery rates remain low. Prospective identification of variables associated with real-life functioning domains is essential for personalized and integrated treatment programs. OBJECTIVE To assess whether baseline illness-related variables, personal resources, and context-related factors are associated with work skills, interpersonal relationships, and everyday life skills at 4-year follow-up. DESIGN, SETTING, AND PARTICIPANTSThis multicenter prospective cohort study was conducted across 24 Italian university psychiatric clinics or mental health departments in which 921 patients enrolled in a cross-sectional study were contacted after 4 years for reassessment. Recruitment of community-dwelling, clinically stable persons with schizophrenia was conducted from March 2016 to December 2017, and data were analyzed from January to May 2020.MAIN OUTCOMES AND MEASURES Psychopathology, social and nonsocial cognition, functional capacity, personal resources, and context-related factors were assessed, with real-life functioning as the main outcome. Structural equation modeling, multiple regression analyses, and latent change score modeling were used to identify variables that were associated with real-life functioning domains at follow-up and with changes from baseline in these domains. RESULTSIn total, 618 participants (427 male [69.1%]; mean [SD] age, 45.1 [10.5] years) were included. Five baseline variables were directly associated with real-life functioning at follow-up: neurocognition with everyday life (β, 0.274; 95% CI, 0.207-0.341; P < .001) and work (β, 0.101; 95% CI, 0.005-0.196; P = .04) skills; avolition with interpersonal relationships (β, −0.126; 95% CI, −0.190 to −0.062; P < .001); positive symptoms with work skills (β, −0.059; 95% CI, −0.112 to −0.006; P = .03); and social cognition with work skills (β, 0.185; 95% CI, 0.088-0.283; P < .001) and interpersonal functioning (β, 0.194; 95% CI, 0.121-0.268; P < .001). Multiple regression analyses indicated that these variables accounted for the variability of functioning at follow-up after controlling for baseline functioning. In the latent change score model, higher neurocognitive abilities were associated with improvement of everyday life (β, 0.

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Cognitive remediation for schizophrenia: An expert working group white paper on core techniques

Cited by 143 publications

References 23 publications

Do we really need a “new” cognitive therapy for bipolar disorder? Paradigm refinements and treatment mechanisms for cognitive remediation

Do we really need a “new” cognitive therapy for bipolar disorder? Paradigm refinements and treatment mechanisms for cognitive remediation

Computer-Assisted Cognitive Remediation in Schizophrenia: Efficacy of an Individualized vs. Generic Exercise Plan

Factors Associated With Real-Life Functioning in Persons With Schizophrenia in a 4-Year Follow-up Study of the Italian Network for Research on Psychoses

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