Development and Pilot Testing of a Novel Compensatory Cognitive Training Intervention for People with Psychosis

Abstract

The cognitive deficits of schizophrenia have a profound impact on everyday functioning and level of community integration for affected individuals. Cognitive training (CT) interventions may help improve these impairments. We developed and pilot tested a 12-week, group based CT intervention that focused on compensatory strategies and habit learning. Participants were randomly assigned to CT plus standard pharmacotherapy or standard pharmacotherapy (SP) alone and were assessed at baseline, three months (i.e., post-intervention), and at six months. Effect sizes were calculated comparing change in the CT group with change in the SP group. CT had medium to large positive effects on attention, learning, memory, executive functioning, functional capacity, negative symptoms, and subjective quality of life. Most effects became stronger at follow-up, but the effect on negative symptoms was not maintained. Immediately post-treatment, compared with SP subjects, CT participants reported fewer cognitive problems and greater use of cognitive strategies; many of these effects were maintained, but were generally weaker, at six-month follow-up. The initial effect sizes for this compensatory CT intervention suggest that it holds promise for improving cognitive performance, functional capacity, negative symptoms, and quality of life. It is proposed that CT emphasizing habit learning may result in long term changes in ability to function independently in the community.

Expectancy-Value Theory in Persistence of Learning Effects in Schizophrenia: Role of Task Value and Perceived Competency

“…Compared with a standard arithmetic learning task without learning cue manipulations, increasing IM for the learning task by manipulating social contexts-linking the task to personal goals and providing experiences of enjoyment, control, and mastery-led to improvements in selfcompetency and learning at the end of training. 20 Helping patients understand the value of a training activity by linking it to their personal goals and proceeding with the training in a way that provides them with experiences of enjoyment, control, and mastery is both consistent with the philosophy of recovery-based approaches 39 and supported by the data presented here.…”

Development of the Supported Employment, Comprehensive Cognitive Enhancement, and Social Skills program for adults on the autism spectrum: Results of initial study

“…To this end, it is critical that an intervention be developed in a way that attends to the needs of the population and service system from the onset and be tested within community settings. An example of a cognitive enhancement intervention developed and tested within supported employment services for SMI is Compensatory Cognitive Training (CCT; Mendella et al, 2015; Twamley et al, 2008, 2012). CCT teaches compensatory cognitive strategies as a way of improving executive functions by developing new cognitive habits that are needed in work and daily living through group instruction and real-life practice activities.…”

Cognitive Remediation in Schizophrenia

“…Certain remediation programs focus specifically on metacognitive or social skill strategies integrated into the training tasks themselves to promote generalization (Roder et al 2006;Wykes et al 2007a). Interestingly, although a number of studies that incorporate these generalization techniques into cognitive remediation programs have shown modest efficacy in improving functional outcomes (Bell et al 2007b;Hodge et al 2008, McGurk et al 2007aMedalia et al 2001;Twamley et al 2008), there is no empirical literature to date that validates the individual contribution of these generalization techniques as a means to promote functional gains from cognitive remediation. That is, at this point it is not known whether generalization techniques themselves are efficacious, drill and practice remediation training by itself is insufficient to change functional abilities, or remediation and generalization procedures mutually provide a synergic functional advantage.…”