What Predicts a Good Response to Cognitive Remediation Interventions?

TLDR

Cognitive remediation is a behavioral intervention aimed at improving cognition in individuals with neuropsychological decline, its use has grown in schizophrenia, yet its success hinges on selecting the right patients and methods. This article seeks to identify factors that moderate outcomes in cognitive remediation. The authors reviewed three databases, categorizing participants as improvers or non‑improvers, and examined patient, illness, and treatment variables that might influence response. They found that treatment intensity, program type, therapist qualifications, patient motivation, and baseline work habits were key moderators, while illness factors had little influence, and that these variables interact to produce positive responses.

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.