Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-22T21:24:33.242Z Has data issue: false hasContentIssue false
  • English
  • Français

Cognitive remediation for individuals with psychosis: efficacy and mechanisms of treatment effects

Published online by Cambridge University Press:  08 September 2016

J. M. Fiszdon ,
K. H. Choi ,
M. D. Bell ,
J. Choi  and
S. M. Silverstein
J. M. Fiszdon*
Affiliation:
VA Connecticut Healthcare System and Yale University School of Medicine, Psychology Service (116B), 950 Campbell Avenue, West Haven, CT, USA
K. H. Choi
Affiliation:
Department of Psychology, Korea University, Seoul, Republic of Korea
M. D. Bell
Affiliation:
VA Connecticut Healthcare System and Yale University School of Medicine, Psychology Service (116B), 950 Campbell Avenue, West Haven, CT, USA
J. Choi
Affiliation:
The Institute of Living at Hartford Hospital, 200 Retreat Avenue, Hartford, CT, USA
S. M. Silverstein
Affiliation:
Rutgers University – Robert Wood Johnson Medical School Department of Psychiatry and University Behavioral Health Care, 151 Centennial Avenue, Piscataway, NJ, USA
*
*Address for correspondence: J. M. Fiszdon, VA Connecticut Healthcare System, Psychology Service (116B), 950 Campbell Avenue, West Haven, CT 06516, USA. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The popularity of cognitive remediation (CR) interventions for individuals with psychosis is in part based on the well-established link between cognition and functioning and the assumption that by targeting cognition, function can improve. While numerous trials have reported CR's efficacy, it is still not considered an evidence-based treatment. Importantly, little is known about the mechanisms through which it may affect functioning.

Method

In this study, we evaluated CR's proximal and distal effects, and examined potential mechanisms. A total of 75 individuals with psychotic disorders were randomized to a combination of strategy-based and drill-and-practice CR or wait-list control, with assessments of training task performance, neurocognition, functional capacity, symptoms and functioning conducted at baseline, end of the 2-month intervention, and 2-month follow-up.

Results

Compared with treatment as usual, CR was associated with large post-training improvements on training tasks targeting attention, visuospatial memory, and verbal learning and memory, with persisting group differences at the 2-month follow-up. These generalized to mostly large improvements on neuropsychological measures targeting visuospatial memory, verbal learning and memory, delayed verbal memory and verbal working memory. While there were no CR-associated improvements on measures of functional capacity, symptoms, or a self-report measure of independent living skills, there was an effect on an interviewer-rated measure of functioning (Quality of Life Scale), which appeared primarily driven by the Intrapsychic Foundations subscale. Finally, for those randomized to CR, there were significant, medium-sized correlations between training task improvement, neuropsychological improvement and functioning measures.

Conclusions

This suggests a complex, multifactorial relationship between CR, and cognitive and functional change.

Keywords

Cognitive remediationfunctioningmediationpsychosisschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 16 , December 2016 , pp. 3275 - 3289
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bell, M, Bryson, G, Greig, T, Corcoran, C, Wexler, BE (2001). Neurocognitive enhancement therapy with work therapy: effects on neuropsychological test performance. Archives of General Psychiatry 58, 763–768.Google Scholar
Bell, MD, Fiszdon, JM, Bryson, GJ (2009). Attention training in schizophrenia: differing responses to similar tasks. Journal of Psychiatric Research 43, 490–496.Google Scholar
Bell, MD, Greig, T, Kaplan, E, Bryson, G (1997). WCST dimensions in schizophrenia: factorial, predictive and divergent validity. Journal of Experimental and Clinical Neuropsychology 19, 933–941.Google Scholar
Bell, MD, Lysaker, PH, Beam-Goulet, JL, Milstein, RM, Lindenmeyer, JP (1994). Five-component model of schizophrenia: assessing the factorial invariance of the Positive and Negative Syndrome Scale. Psychiatry Research 52, 295–303.Google Scholar
Blom, G (1958). Statistical Estimates and Transformed Beta-variables. Wiley: New York.Google Scholar
Boot, WR, Simons, DJ, Stothart, C, Stutts, C (2013). The pervasive problem with placebos in psychology why active control groups are not sufficient to rule out placebo effects. Perspectives on Psychological Science 8, 445–454.CrossRefGoogle Scholar
Bowie, CR, Leung, WW, Reichenberg, A, McClure, MM, Patterson, TL, Heaton, RK, Harvey, PD (2008). Predicting schizophrenia patients’ real-world behavior with specific neuropsychological and functional capacity measures. Biological Psychiatry 63, 505–511.Google Scholar
Bracy, O (1995). CogReHab Software. Psychological Software Services: Indianapolis, IN.Google Scholar
Delahunty, A, Morice, R (1993). The Frontal Executive Program. A Neurocognitive Rehabilitation Program for Schizophrenia, revised edn. New South Wales Department of Health: Albury, NSW, Australia.Google Scholar
Delis, DC, Kramer, JH, Kaplan, E, Ober, BA (2000). California Verbal Learning Test, 2nd edn, Adult Version Manual. Psychological Corporation: San Antonio, TX.Google Scholar
Dickinson, D, Tenhula, W, Morris, S, Brown, C, Peer, J, Spencer, K, Li, L, Gold, JM, Bellack, AS (2010). A randomized, controlled trial of computer-assisted cognitive remediation for schizophrenia. American Journal of Psychiatry 167, 170–180.Google Scholar
Dixon, LB, Dickerson, F, Bellack, AS, Bennett, M, Dickinson, D, Goldberg, RW, Lehman, A, Tenhula, WN, Calmes, C, Pasillas, RM, Peer, J, Kreyenbuhl, J; Schizophrenia Patient Outcomes Research Team (PORT) (2010). The 2009 Schizophrenia PORT psychosocial treatment recommendations and summary statements. Schizophrenia Bulletin 36, 48–70.Google Scholar
Farreny, A, Aguado, J, Ochoa, S, Haro, JM, Usall, J (2013). The role of negative symptoms in the context of cognitive remediation for schizophrenia. Schizophrenia Research 150, 58–63.CrossRefGoogle ScholarPubMed
Fiszdon, JM, Choi, J, Goulet, J, Bell, MD (2008). Temporal relationship between change in cognition and change in functioning in schizophrenia. Schizophrenia Research 105, 105–113.Google Scholar
Franck, N, Duboc, C, Sundby, C, Amado, I, Wykes, T, Demily, C, Launay, C, Le Roy, V, Bloch, P, Willard, D, Todd, A, Petitjean, F, Foullu, S, Briant, P, Grillon, ML, Deppen, P, Verdoux, H, Bralet, MC, Januel, D, Riche, B, Roy, P; Members of Cognitive Remediation Network, Vianin, P (2013). Specific vs general cognitive remediation for executive functioning in schizophrenia: a multicenter randomized trial. Schizophrenia Research 147, 68–74.Google Scholar
Green, MF (1996). What are the functional consequences of neurocognitive deficits in schizophrenia? American Journal of Psychiatry 153, 321–330.Google ScholarPubMed
Green, MF, Kern, RS, Heaton, RK (2004). Longitudinal studies of cognition and functional outcome in schizophrenia: implications for MATRICS. Schizophrenia Research 72, 41–51.Google Scholar
Grynszpan, O, Perbal, S, Pelissolo, A, Fossati, P, Jouvent, R, Dubal, S, Perez-Diaz, F (2011). Efficacy and specificity of computer-assisted cognitive remediation in schizophrenia: a meta-analytical study. Psychological Medicine 41, 163–173.Google Scholar
Heaton, R (1981). The Wisconsin Card Sorting Test Manual. Psychological Assessment Resources, Inc.: Odessa, FL.Google Scholar
Heinrichs, DW, Hanlon, TE, Carpenter, WT Jr. (1984). The Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome. Schizophrenia Bulletin 10, 388–398.Google Scholar
Kay, SR, Fiszbein, A, Opler, LA (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261–276.Google Scholar
Krabbendam, L, Aleman, A (2003). Cognitive rehabilitation in schizophrenia: a quantitative analysis of controlled studies. Psychopharmacology 169, 376–382.Google Scholar
Kurtz, MM (2012). Cognitive remediation for schizophrenia: current status, biological correlates and predictors of response. Expert Reviews in Neurotherapeutics 12, 813–821.CrossRefGoogle ScholarPubMed
Kurtz, MM, Moberg, PJ, Gur, RC, Gur, RE (2001). Approaches to cognitive remediation of neuropsychological deficits in schizophrenia: a review and meta-analysis. Neuropsychology Review 11, 197–210.CrossRefGoogle ScholarPubMed
Kurtz, MM, Seltzer, JC, Shagan, DS, Thime, WR, Wexler, BE (2007). Computer-assisted cognitive remediation in schizophrenia: what is the active ingredient? Schizophrenia Research 89, 251–260.Google Scholar
Kurtz, MM, Wexler, BE, Fujimoto, M, Shagan, DS, Seltzer, JC (2008). Symptoms versus neurocognition as predictors of change in life skills in schizophrenia after outpatient rehabilitation. Schizophrenia Research 102, 303–311.Google Scholar
Lezak, MD (1983). Neuropsychological Assessment, 2nd edn. Oxford University Press: New York.Google Scholar
Loong, J (1991). The Manual for the Continuous Performance Test. Wang Neuropsychological Laboratory: San Louis Obispo, CA.Google Scholar
McGurk, SR, Twamley, EW, Sitzer, DI, McHugo, GJ, Mueser, KT (2007). A meta-analysis of cognitive remediation in schizophrenia. American Journal of Psychiatry 164, 1791–1802.Google Scholar
Nakagami, E, Xie, B, Hoe, M, Brekke, JS (2008). Intrinsic motivation, neurocognition, and psychosocial functioning in schizophrenia: testing mediator and moderator effects. Schizophrenia Research 105, 95–104.Google Scholar
National Institute for Health and Care Excellence (2014). Psychosis and Schizophrenia in Adults: Prevention and Management, NICE Guidelines CG178 (https://www.nice.org.uk/guidance/cg178)Google Scholar
Osterreith, PA (1944). Le test de copie d'une figure complexe (Copying test of a complex figure). Archives de Psychologie 30, 206–356.Google Scholar
Patterson, TL, Goldman, S, McKibbin, CL, Hughs, T, Jeste, DV (2001 a). UCSD Performance-Based Skills Assessment: development of a new measure of everyday functioning for severely mentally ill adults. Schizophrenia Bulletin 27, 235–245.Google Scholar
Patterson, TL, Lacro, J, McKibbin, CL, Moscona, S, Hughs, T, Jeste, DV (2002). Medication Management Ability Assessment: results from a performance-based measure in older outpatients with schizophrenia. Journal of Clinical Psychopharmacology 22, 11–19.Google Scholar
Patterson, TL, Moscona, S, McKibbin, CL, Davidson, K, Jeste, DV (2001 b). Social Skills Performance Assessment among older patients with schizophrenia. Schizophrenia Research 48, 351–360.Google Scholar
Penades, R, Catalan, R, Puig, O, Masana, G, Pujol, N, Navarro, V, Guarch, J, Gasto, C (2010). Executive function needs to be targeted to improve social functioning with cognitive remediation therapy (CRT) in schizophrenia. Psychiatry Research 177, 41–45.CrossRefGoogle ScholarPubMed
Pilling, S, Bebbington, P, Kuipers, E, Garety, P, Geddes, J, Martindale, B, Orbach, G, Morgan, C (2002). Psychological treatments in schizophrenia: II. Meta-analyses of randomized controlled trials of social skills training and cognitive remediation. Psychological Medicine 32, 783–791.Google Scholar
Rass, O, Forsyth, JK, Bolbecker, AR, Hetrick, WP, Breier, A, Lysaker, PH, O'Donnell, BF (2012). Computer-assisted cognitive remediation for schizophrenia: a randomized single-blind pilot study. Schizophrenia Research 139, 92–98.Google Scholar
Reeder, C, Harris, V, Pickles, A, Patel, A, Cella, M, Wykes, T (2014). Does change in cognitive function predict change in costs of care for people with a schizophrenia diagnosis following cognitive remediation therapy? Schizophrenia Bulletin 40, 1472–1481.Google Scholar
Reeder, C, Newton, E, Frangou, S, Wykes, T (2004). Which executive skills should we target to affect social functioning and symptom change? A study of a cognitive remediation therapy program. Schizophrenia Bulletin 30, 87–100.Google Scholar
Reeder, C, Smedley, N, Butt, K, Bogner, D, Wykes, T (2006). Cognitive predictors of social functioning improvements following cognitive remediation for schizophrenia. Schizophrenia Bulletin 32 (Suppl. 1), S123–S131.Google Scholar
Roder, V, Mueller, DR, Schmidt, SJ (2011). Effectiveness of integrated psychological therapy (IPT) for schizophrenia patients: a research update. Schizophrenia Bulletin 37, S71–S79.Google Scholar
Schinka, JA, Velicer, WF, Weiner, IB (2003). Handbook of Psychology, Vol. 2. Research Methods in Psychology. Wiley: Hoboken, NJ.Google Scholar
Schmidt, SJ, Mueller, DR, Roder, V (2011). Social cognition as a mediator variable between neurocognition and functional outcome in schizophrenia: empirical review and results by structural equation modeling. Schizophrenia Bulletin 37 (Suppl. 2), S41–S54.Google Scholar
Schwartz, KA, Buchel, C (2015). Cognition and the placebo effect – dissociating subjective perception and actual performance. PLOS ONE 10, e0130492.Google Scholar
Silverstein, SM, Spaulding, WD, Menditto, AA (2006). Schizophrenia: Advances in Evidence-based Practice. Hogrefe & Huber: Cambridge, MA.Google Scholar
Silverstein, SM, Wong, M-H, Solak, BA, Smith, TE, Wilkniss, SM, Landa, Y, Goicochea, C, Carpiniello, K, Uhlhaas, P, Schenkel, L, Savitz, A (2005). Effectiveness of a two-phase cognitive rehabilitation intervention for severely impaired schizophrenia patients. Psychological Medicine 35, 829–837.Google Scholar
Smith, TE, Hull, JW, Goodman, M, Hedayat-Harris, A, Willson, DF, Israel, LM, Munich, RL (1999). The relative influences of symptoms, insight, and neurocognition on social adjustment in schizophrenia and schizoaffective disorder. Journal of Nervous and Mental Disease 187, 102–108.Google Scholar
Spaulding, WD, Reed, D, Sullivan, M, Richardson, C, Weiler, M (1999). Effects of cognitive treatment in psychiatric rehabilitation. Schizophrenia Bulletin 25, 657–676.CrossRefGoogle ScholarPubMed
Tippens, KM, Purnell, JQ, Gregory, WL, Connelly, E, Hanes, D, Oken, B, Calabrese, C (2014). Expectancy, self-efficacy, and placebo effect of a sham supplement for weight loss in obese adults. Journal of Evidence-based Complementary and Alternative Medicine 19, 181–188.Google Scholar
Tolman, AW, Kurtz, MM (2012). Neurocognitive predictors of objective and subjective quality of life in individuals with schizophrenia: a meta-analytic investigation. Schizophrenia Bulletin 38, 304–315.Google Scholar
Twamley, EW, Jeste, DV, Bellack, AS (2003). A review of cognitive training in schizophrenia. Schizophrenia Bulletin 29, 359–382.Google Scholar
Vita, A, Deste, G, De Peri, L, Barlati, S, Poli, R, Cesana, BM, Sacchetti, E (2013). Predictors of cognitive and functional improvement and normalization after cognitive remediation in patients with schizophrenia. Schizophrenia Research 150, 51–57.Google Scholar
Wallace, CJ, Liberman, RP, Tauber, R, Wallace, J (2000). The Independent Living Skills Survey: a comprehensive measure of the community functioning of severely and persistently mentally ill individuals. Schizophrenia Bulletin 26, 631–658.CrossRefGoogle ScholarPubMed
Wechsler, D (1987). The Wechsler Memory Scale–Revised. Psychological Corporation: New York.Google Scholar
Wechsler, D (1997). WAIS-III Manual: Wechsler Adult Intelligence Scale-III. Psychological Corporation: San Antonio, TX.Google Scholar
Wechsler, D (1999). Wechsler Abbreviated Scale of Intelligence (WASI-III) Manual. Psychological Corporation: San Antonio, TX.Google Scholar
Wykes, T, Huddy, V, Cellard, C, McGurk, SR, Czobor, P (2011). A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. American Journal of Psychiatry 168, 472–485.Google Scholar
Wykes, T, Reeder, C, Corner, J, Williams, C, Everitt, B (1999). The effects of neurocognitive remediation on executive processing in patients with schizophrenia. Schizophrenia Bulletin 25, 291–307.Google Scholar
Wykes, T, Reeder, C, Huddy, V, Taylor, R, Wood, H, Ghirasim, N, Kontis, D, Landau, S (2012). Developing models of how cognitive improvements change functioning: mediation, moderation and moderated mediation. Schizophrenia Research 138, 88–93.Google Scholar
Supplementary material: File

Fiszdon supplementary material

Tables S1-S5

Download Fiszdon supplementary material(File)
File 305.7 KB