Cognitive remediation therapy in schizophrenia

TLDR

Cognitive difficulties are common in schizophrenia and predict poorer long‑term functioning. The study aims to assess whether cognitive remediation therapy improves cognitive deficits in schizophrenia. In a single‑blind RCT, 85 participants received 40 sessions of cognitive remediation or usual care, with working memory, flexibility, and planning assessed at baseline, 14 weeks, and 40 weeks. Cognitive remediation produced sustained gains in working memory (d≈0.34) and suggested flexibility gains, with memory gains predicting better social functioning, and was cost‑effective with minimal additional cost.

Abstract

Background Cognitive difficulties are prevalent in people with a diagnosis of schizophrenia and are associated with poor long-term functioning. Aims To evaluate the effectiveness of cognitive remediation therapy on cognitive difficulties experienced by people with schizophrenia. Method Participants with a diagnosis of schizophrenia, a social behaviour problem and a cognitive difficulty ( n =85) were randomised to 40 sessions of cognitive remediation or treatment as usual in a single-blind randomised controlled trial. Working memory, cognitive flexibility and planning, were measured at weeks 0, 14 and 40. Results There were durable improvements in working memory (advantage 1.33 points, 95% CI 0.43–2.16, standardised effect size 0.34) as well as an indication of improvement in cognitive flexibility. Memory improvement predicted improvement in social functioning. Costs were lower in the cognitive remediation group following therapy but rose at follow-up. However, cost-effectiveness analyses showed that improvements in memory were achieved at little additional cost. Conclusions Cognitive remediation therapy is associated with durable improvements in memory, which in turn are associated with social functioning improvements in people with severe mental illness.