What Predicts a Good Response to Cognitive Remediation Interventions?

Abstract

Cognitive remediation is a behavioral intervention designed to improve cognition in people who have suffered a decline in neuropsychological functioning. The application of cognitive remediation for people with schizophrenia has become increasingly popular. In this article we attempt to determine what factors moderate outcome in cognitive remediation. This issue is of primary concern, as the efficacy of treatments largely depends on the appropriate selection of individuals and treatment methodologies that are most likely to yield gains. Three databases were examined, dividing the samples into participants who showed or did not show a marked improvement from baseline to posttest. We examined patient, illness, and treatment factors that might affect treatment response. Whereas certain patient and treatment variables did differentiate "Improvers" from "Nonimprovers," illness factors were the least likely to influence treatment outcome. Treatment intensity, type of cognitive remediation program, and therapist qualifications were identified as key treatment variables. Patient levels of motivation for treatment and baseline sets of work habits were also important moderators. While the issue of treatment intensity appears to be especially salient, there is evidence that to some extent patient and treatment variables intertwine to produce a positive response to cognitive remediation.

Social cognition mediates illness-related and cognitive influences on social function in patients with schizophrenia-spectrum disorders

“…4,6 Model 2 indicates that both cognition and, in particular, social cognition are relevant targets for intervention. Interventions at the cognitive level [36][37][38] could have an impact on both cognition and social cognition. Additionally, this model confirms that social cognition has unique relations to functional outcome over and above those explained by cognition.…”

Attentional-shaping as a means to improve emotion perception deficits in schizophrenia

“…First, given the lack of clear improvement in social behaviors, it may be possible to increase the strength of the training by having the person complete the attentional-shaping condition several times a week or for longer periods of time. It is important to determine the correct "dose" or intensity of the treatment that may lead to more consistent changes in social functioning (Brekke et al, 2007;Medalia and Richardson, 2005). Currently, we are enhancing the shaping intervention by adding more faces which will allow repeated administration of the intervention.…”

Predictors for Improvement of Problem-Solving during Cognitive Remediation for Patients with Schizophrenia

“…The few studies conducted vary considerably in outcome measures and training interventions. Overall, there is some evidence that even severe cognitive impairment at baseline does not preclude gains through cognitive remediation (Medalia & Richardson, 2005). A recent study has even reported stronger improvement for patients with lower baseline cognitive performance and symptom severity during a compensatory cognitive training intervention (Twamley, Burton, & Vella, 2011).…”