Family-directed cognitive adaptation pilot: Teaching cognitive adaptation to families of individuals with schizophrenia

Abstract

Cognitive deficits are a major determinant of functional outcome in schizophrenia. A promising treatment involves teaching individuals to use cognitive adaptation strategies to minimize the functional impact of cognitive difficulties. We developed Family Directed Cognitive Adaptation (FCA) to train caregivers to help their relatives with schizophrenia use cognitive adaptations to improve living skills. The goal of this open pilot trial was to examine the feasibility of FCA. Ten adults with schizophrenia, each with at least one relative, participated in FCA and were evaluated at baseline, post-treatment, and 6-month follow-up. Domains assessed included adaptive functioning, psychiatric symptoms, school/work involvement, hospitalizations, family burden, and treatment satisfaction. Participants reported high levels of satisfaction with FCA, and all families completed the 16-session intervention. Relatives reported reduced burden at termination and follow-up. No participants were hospitalized during the treatment or follow-up period, and rates of work/school involvement increased from 30% at baseline to 50% at the end of treatment and follow-up. Individuals improved in negative symptoms and adaptive functioning over the course of treatment, but these gains were not maintained. This pilot provides preliminary support for the acceptability and feasibility of FCA, and points to the need to address the maintenance of treatment gains after termination.

Cognitive Impairment in Schizophrenia: Description and Cognitive Familiar Endophenotypes. A Review of the Literature

“…Among the very few family intervention programs we can mention the Family-Directed Cognitive Adaptation (FCA). This program is designed to teach patients and family members the neurocognitive problems associated with schizophrenia; how to develop compensation strategies to minimize their impact on family and daily functioning; and teach families how to implement adaptive strategies to solve problems [144,145].…”

“…In a second pilot application of the program to a larger sample [145], the aspects considered most useful by relatives were: "Learning about cognitive deficits related to schizophrenia" and "learning about the specific cognitive strengths and difficulties of my relative" and patients considered: "Learning about my strengths and cognitive difficulties"and "learning strategies to overcome cognitive difficulties". This pilot study suggests that it may have helped family members to better understand the nature of cognitive challenges, which may have reduced feelings of irritation or guilt and with them the family burden.…”

“…It can be concluded that, in addition to inquiring into the ways of application of specific programs to treat cognitive deficits from the family framework (there are few programs yet, and despite having apparent good results, are still pending on a further study), the simple fact of giving knowledge about the symptomatology of schizophrenia is not always enough for parents to adopt attitudes of understanding towards the symptoms of their children. As pointed out by Friedman-Yakoobian et al [145], rehabilitation and intervention should be oriented to improve the daily needs of each patient and it cannot be ignored the fact that many of these patients live with their families. Even when they live far away, relatives usually get involved in trying to give support (financial, emotional, etc.…”

Cognitive Remediation Program for Family Caregivers in Schizophrenia (CIRCUS): Study of the Effectiveness of a Guided AND WEB-BASED Compensatory Cognitive Remediation: A Randomized Pilot Study

“…The manual guides the family and their loved one to build SMART (Speci c, Measurable, Achievable, Realistic, and Timely) goals and to use compensatory tools to counter functional di culties associated the disease encountered in daily living. Two small randomized studies showed improvements in community functioning and a signi cant decline of the caregiver-burden [2,27]. Consequently, these preliminary results indicate that raising families' awareness of the compensatory approach could reduce the caregiver's burden and reduce their loved one's di culties with minimal professional help.…”

“…To overcome these limitations, two groups of researchers [2,27] developed CAT for family, a manualized intervention who helps families throughout all different steps for achieving their relative's goals [27]. The manual guides the family and their loved one to build SMART (Speci c, Measurable, Achievable, Realistic, and Timely) goals and to use compensatory tools to counter functional di culties associated the disease encountered in daily living.…”