Implementation and preliminary outcomes of cognitive enhancement therapy for serious mental illness in an outpatient mental health program

Abstract

Background: Although numerous evidence-based treatments for serious mental illnesses (SMI) exist, the majority are not widely utilized in clinical settings. Cognitive enhancement therapy (CET) has been tested in randomized trials; however, knowledge regarding implementation and outcomes in naturalistic environments is scarce. Aims: The current study is an uncontrolled, observational study describing implementation and pre- to post-outcomes of CETCleveland®, a community-based version of CET in an outpatient mental health program in the United States. Method: We included n = 34 diverse individuals with SMI. Data include qualitative implementation information and participant outcomes, including measures of cognition, symptoms, satisfaction and adherence. Results: Overall, participant satisfaction was positive, and adherence was comparable with previous studies. Implementation information includes training, clinician and setting characteristics, and barriers and solutions. Preliminary outcomes showed that participants significantly improved in areas of neurocognition and symptoms. Conclusions: Overall, our results demonstrated successful early implementation of CET in a diverse, outpatient mental health program and provided preliminary support for the clinical utilization of CET. We hope these results will promote further access to CET and other evidence-based psychiatric rehabilitation programs in community clinics.

Social Cognition and Other Determinants of Perceived Social Support in Individuals With Serious Mental Illness

“…Fifty-nine participants were included in this secondary analysis from data collected as part of a community-based Cognitive Enhancement Therapy (CET) program at a public, urban academic-affiliated medical center in the Midwest from 2016 to 2018 (for details see Faith et al, 2022). All participants provided written informed consent, and the study procedures were approved by University of Missouri institutional review board before data collection.…”

Therapeutic alliance in a cognitive rehabilitation programme for people with serious mental illness: A qualitative analysis

“…These included four bachelor's level clinicians, two master's level clinicians, two psychiatrists, two nurses and one music therapist. More details about CET training in this study are published elsewhere (Faith et al, 2022).…”

“…A qualitative CET interview was conducted after the completion of the CET programme and was originally created from a previous study analysing implementation of CET (Faith et al, 2022). The perception of CET interview is a semi-structured interview to examine participant's subjective satisfaction and perceptions of CET.…”

The use of implementation science to close the research-to-treatment gap for cognitive impairment in psychosis

“…This finding supports results of previous consumer-led research that showed cognitive remediation was acceptable and valued from the perspective of people with schizophrenia ( Rose et al, 2008 ), and quality assurance data from US Psychiatric Centres, which showed a high level of satisfaction among people with serious mental illness receiving cognitive remediation as part of treatment ( Medalia et al, 2019b ). Another study of cognitive enhancement therapy for people with serious mental illness (88.3% schizophrenia-spectrum diagnosis) explicitly described implementation strategies, including external training and tele-observation ( Faith et al, 2022 ). Authors of that study also reported on treatment adoption by patients, including measures of satisfaction and retention, but did not include any clinician-completed implementation measures, making it unclear how clinicians viewed the appropriateness of cognitive remediation or the implementation strategies used.…”