The Effects of Neurocognitive Remediation on Executive Processing in Patients With Schizophrenia

Abstract

Approaches to cognitive remediation have differed across studies. Most of the larger studies have concentrated on group treatments designed without the benefit of recent laboratory-based studies. The current study describes a randomized trial of an intensive cognitive remediation program involving individual daily sessions of 1 hour for up to 3 months. It targets executive functioning deficits (cognitive flexibility, working memory, and planning) that are known to be problematic in people with schizophrenia. Procedural learning, as well as the principles of errorless learning, targeted reinforcement, and massed practice, was the basis of the intervention. The program was compared with an alternative therapy (intensive occupational therapy) to control for some of the effects of therapeutic contact. Some improvements in cognition followed both therapies. A differential effect in favor of cognitive remediation therapy was found for tests in the cognitive flexibility and the memory subgroups. There was a trend for those receiving atypical antipsychotic medication to benefit more from cognitive remediation for tests of cognitive flexibility. Although there were no consistent changes in symptoms or social functioning between groups, if improvement in cognitive flexibility tasks reached a threshold then there is some evidence that social functioning improved, even over the short duration of the trial. In addition, cognitive remediation differentially improved self-esteem. This study supports the view that cognitive remediation can reduce cognitive deficits and that this reduction may affect social outcome, at least in the short term.

Cognitive rehabilitation of the updating sub-component of working memory in schizophrenia: A case study

“…This is not in accordance with the only two studies (Wykes et al, 1999(Wykes et al, , 2003, two studies that included the same participants) that had previously examined this question, which found that a cognitive rehabilitation programme had a positive effect on self-esteem. Wykes et al (1999) note that this observed beneficial effect may be due, at least in part, to the fact that patients were able to perceive their increased performance thanks to the use of such techniques as errorless learning. It is important to note that Wykes et al (2003) observed that the improvement in self-esteem at the post-treatment assessment had disappeared at the follow-up (6 months post-therapy).…”

“…Moreover, a significant decrease in negative symptoms (social withdrawal and apathy) was observed after the entire cognitive rehabilitation programme. Several earlier studies have also found a relationship between working memory deficits and negative symptoms (e.g., Reeder et al, 2004;Twamley, Palmer, Jeste, Taylor, & Heaton, 2006) and others have observed the beneficial effect of a cognitive rehabilitation programme on negative symptoms (e.g., Cochet et al, 2006;Medalia, Dorn, & WatrasGans, 2000;Wykes, Reeder, Corner, Williams, & Everitt, 1999;Wykes et al, 2003). Nevertheless, the mechanisms underlying the beneficial effects of a cognitive rehabilitation programme on (negative) symptom severity have not been directly examined in the scientific literature, although Greenwood, Landau, and Wykes (2005) provided an interesting account of the possible mechanisms involved in interactions between negative symptoms and cognition in predicting community functioning.…”

Development of an Abbreviated Schizophrenia Quality of Life Scale Using a New Method

“…The importance of the QLS in assessing outcome in schizophrenia research has also been highlighted by the observed relation between neurocognitive impairment and psychosocial status (Green, 1996;Buchanan et al, 1994;Medalia et al, 1998;Wykes et al, 1999).…”

Errorless learning and memory performance in schizophrenia

“…The goal of the remedial approach is to improve social functioning, and to some extent clinical symptoms, by attempting to ameliorate cognitive deficits (Wykes et al, 1999).…”