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Wykes T, Bowie CR, Cella M. Thinking About the Future of Cognitive Remediation Therapy Revisited: What Is Left to Solve Before Patients Have Access? Schizophr Bull 2024:sbae075. [PMID: 38780191 DOI: 10.1093/schbul/sbae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
In our previous paper on the Future of Cognitive Remediation published more than 10 years ago, we envisaged an imminent and wide implementation of cognitive remediation therapies into mental health services. This optimism was misplaced. Despite evidence of the benefits, costs, and savings of this intervention, access is still sparse. The therapy has made its way into some treatment guidance, but these documents weight the same evidence very differently, causing confusion, and do not consider barriers to implementation. This paper revisits our previous agenda and describes how some challenges were overcome but some remain. The scientific community, with its commitment to Open Science, has produced promising sets of empirical data to explore the mechanisms of treatment action. This same community needs to understand the specific and nonspecific effects of cognitive remediation if we are to provide a formulation-based approach that can be widely implemented. In the last 10 years we have learned that cognitive remediation is not "brain training" but is a holistic therapy that involves an active therapist providing motivation support, and who helps to mitigate the impact of cognitive difficulties through metacognition to develop awareness of cognitive approaches to problems. We conclude that, of course, more research is needed but, in addition and perhaps more importantly at this stage, we need more public and health professionals' understanding of the benefits of this therapy to inform and include this approach as part of treatment regimens.
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Affiliation(s)
- Til Wykes
- Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Matteo Cella
- Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Cella M, Parri L, Wang K, Quinn R, Oyeleye O, Jin H, Wykes T. Evaluating remote delivery of cognitive remediation in people with psychosis. Schizophr Res 2024; 267:367-372. [PMID: 38631111 DOI: 10.1016/j.schres.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 03/12/2024] [Accepted: 04/01/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Cognitive Remediation (CR) is an evidence-based therapy targeting cognitive difficulties in people with psychosis to promote functional recovery, but it is rarely implemented routinely. To reach more individuals, CR is beginning to be delivered remotely, but there is limited evidence to support the acceptability of this method. AIMS To evaluate the acceptability and feasibility of remote therapist-supported CR in people with psychosis and estimate its cost and potential benefits. METHODS A case-series with all participants assessed before and after therapy with measures of personal goal attainment (main outcome), cognition, functioning and symptoms. Acceptability was assessed with post-therapy interviews. Feasibility was assessed using proportions and confidence intervals on pre-specified parameters. Indication of benefits was assessed with exploratory analyses comparing baseline and post-therapy scores on the pre-specified outcomes. The cost of providing remote CR was assessed from both healthcare and societal perspectives. RESULTS Twenty-nine participants started therapy with two dropping out; on average participants attended 25.5 sessions. Interviews suggested that remote CR had good acceptability and led to perceived benefits. Significant and large improvements were observed on goal attainment. Cost analyses suggest that remote CR has the same health care cost as face-to-face therapy but a lower societal cost. CONCLUSIONS Our results support the use of remote CR in psychosis services as an alternative delivery modality. This method may improve adherence, attendance and be more convenient for service users. Possible barriers such as poor digital literacy or appropriate device ownership should be addressed before starting therapy.
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Affiliation(s)
- Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; South London and the Maudsley NHS Trust, UK.
| | - Lois Parri
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Kang Wang
- King's Health Economics (KHE), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | | | - Huajie Jin
- King's Health Economics (KHE), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; South London and the Maudsley NHS Trust, UK
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Øie MB, Haugen I, Stubberud J, Øie MG. Effects of Goal Management Training on self-efficacy, self-esteem, and quality of life for persons with schizophrenia spectrum disorders. Front Psychol 2024; 15:1320986. [PMID: 38515967 PMCID: PMC10955763 DOI: 10.3389/fpsyg.2024.1320986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/26/2024] [Indexed: 03/23/2024] Open
Abstract
Persons with schizophrenia often show executive dysfunction assessed with both subjective (self-report) and objective (neuropsychological tests) measures. In a recent randomized controlled trial (RCT), subjective executive functioning in everyday life was improved following Goal Management Training (GMT). The aim of the current study is to investigate the potential of GMT to improve secondary well-being outcomes from that RCT, including self-esteem, self-efficacy, and quality of life in persons with schizophrenia spectrum disorders. Since well-being is frequently lower in persons with schizophrenia compared to healthy individuals, further knowledge about well-being as an outcome after cognitive remediation may have implications for clinical treatment. Sixty-five participants were randomly assigned to GMT (n = 31) or a waiting list control condition (n = 34). Assessments were conducted at baseline (T1), immediately after the intervention (T2-5 weeks), and at six-month follow-up (T3). Measures included the Rosenberg Self-Esteem Scale, the Perceived Quality of Life Scale, and the General Self-Efficacy Scale. Results were analyzed using a linear mixed model analysis for repeated measures. There were no significant effects of GMT on self-esteem or quality of life. Only the GMT group showed a significant increase in self-efficacy that was most evident at six months follow-up, F(1, 34) = 10.71, p = 0.002, d = 0.71. Improved self-efficacy was found to correlate significantly with a reduction in perceived executive dysfunction in an exploratory post hoc analysis. Our findings demonstrate the potential of GMT in improving self-efficacy in schizophrenia Clinical trial registration:https://clinicaltrials.gov, NCT03048695.
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Affiliation(s)
| | - Ingvild Haugen
- Research Division, Innlandet Hospital Trust, Brumunddal, Norway
| | - Jan Stubberud
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Merete Glenne Øie
- Department of Psychology, University of Oslo, Oslo, Norway
- Research Division, Innlandet Hospital Trust, Brumunddal, Norway
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van Duin D, Winter LD, Kroon H, Veling W, van Weeghel J. Associations between learning principles of cognitive remediation and cognitive and vocational outcomes in early psychosis-an exploratory analysis of RCT data. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-11. [PMID: 37178165 DOI: 10.1080/23279095.2023.2199935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Background: Most cognitive remediation (CR) programs are based on multiple scientific learning principles. The role of those learning principles in the beneficial effects of CR is poorly understood. A better understanding of such underlying mechanisms is important to further tailor the intervention and to learn about optimal contexts.Method: An explorative secondary analysis was conducted of data from a randomized controlled trial (RCT) comparing the effects of Individual Placement and Support (IPS) with and without CR. The present study evaluated how CR learning principles of "massed practice," "errorless learning," "strategy use" and "therapist contribution" (therapist fidelity) were associated with cognitive and vocational outcomes within 26 participants in this RCT who were treatment exposed.Results: Cognitive gains after CR were positively associated with "massed practice" and "errorless learning." Negative associations were found with "strategy use" and "therapist fidelity." No direct relationship was found between CR principles and vocational outcomes.Conclusions: Results tentatively suggest that CR is most effective and efficient with a good balance between sufficient intensity, of more than 200 tasks, and a limited duration of the training up to 20 h, using tasks that remain both challenging and rewarding, being applied in a context that facilitates real-life practice.
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Affiliation(s)
- Daniëlle van Duin
- Phrenos Center of Expertise, Utrecht, the Netherlands
- Trimbos Institute, Utrecht, the Netherlands
- Tilburg School of Social and Behavioral Sciences, Tilburg, the Netherlands
| | | | - Hans Kroon
- Trimbos Institute, Utrecht, the Netherlands
- Tilburg School of Social and Behavioral Sciences, Tilburg, the Netherlands
| | - Wim Veling
- University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jaap van Weeghel
- Phrenos Center of Expertise, Utrecht, the Netherlands
- Tilburg School of Social and Behavioral Sciences, Tilburg, the Netherlands
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Altman RAE, Tan EJ, Rossell SL. Factors Impacting Access and Engagement of Cognitive Remediation Therapy for People with Schizophrenia: A Systematic Review. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:139-151. [PMID: 36448242 PMCID: PMC9974655 DOI: 10.1177/07067437221129073] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
OBJECTIVES Neurocognitive deficits are central in schizophrenia. Cognitive remediation has proven effective in alleviating these deficits, with medium effect sizes. However, sizeable attrition rates are reported, with the reasons still uncertain. Furthermore, cognitive remediation is not part of routine mental health care. We conducted a systematic review to investigate factors that influence access and engagement of cognitive remediation in schizophrenia. METHODS We systematically searched the PubMed, Web of Science, and PsycINFO databases for peer-reviewed articles including a cognitive remediation arm, access, and engagement data, and participants with schizophrenia spectrum disorders aged 17-65 years old. Duplicates and studies without a distinct cognitive remediation component, protocol papers, single case studies, case series, and reviews/meta-analyses were excluded. RESULTS We included 67 studies that reported data on access and engagement, and extracted quantitative and qualitative data. Access data were limited, with most interventions delivered on-site, to outpatients, and in middle- to high-income countries. We found a median dropout rate of 14.29%. Only a small number of studies explored differences between dropouts and completers (n = 5), and engagement factors (n = 13). Dropouts had higher negative symptomatology and baseline self-efficacy, and lower baseline neurocognitive functioning and intrinsic motivation compared to completers. The engagement was positively associated with intrinsic motivation, self-efficacy, perceived usefulness, educational level, premorbid intelligence quotient, baseline neurocognitive functioning, some neurocognitive outcomes, and therapeutic alliance; and negatively associated with subjective cognitive complaints. Qualitative results showed good acceptability of cognitive remediation, with some areas for improvement. CONCLUSIONS Overall, access and engagement results are scarce and heterogeneous. Further investigations of cognitive remediation for inpatients, as well as remote delivery, are needed. Future clinical trials should systematically explore attrition and related factors. Determining influential factors of access and engagement will help improve the implementation and efficacy of cognitive remediation, and thus the recovery of people with schizophrenia.
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Affiliation(s)
- Rosalie Ariane Eva Altman
- Centre for Mental Health, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Eric Josiah Tan
- Centre for Mental Health, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
- Department of Mental Health, St Vincent's Hospital, Melbourne, Australia
| | - Susan Lee Rossell
- Centre for Mental Health, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
- Department of Mental Health, St Vincent's Hospital, Melbourne, Australia
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Burns AMN, Erickson DH. Adding Cognitive Remediation to Employment Support Services: A Randomized Controlled Trial. Psychiatr Serv 2023; 74:222-228. [PMID: 36065580 DOI: 10.1176/appi.ps.202100249] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Individual placement and support (IPS) is an evidence-based strategy that helps individuals with mental illness obtain and maintain competitive employment. Despite the approach's overall success, almost half of IPS clients do not find work. Impairment in cognitive abilities may hamper employment and limit the benefits from rehabilitation services such as IPS. This randomized controlled trial aimed to assess the effects of adding cognitive remediation therapy (CRT) for IPS clients who had difficulties finding employment. METHODS At 14 mental health centers in Canada, 97 clients who had not found work after 3 months of receiving IPS services were recruited. Consenting clients were randomly assigned to either continue IPS alone or receive CRT added to IPS. The CRT used the Thinking Skills for Work protocol, a 12-week program that included computerized cognitive exercises along with coping strategies for managing cognitive challenges. RESULTS Participants completed on average 10 of 12 individual training sessions in coping strategies and 12 of 24 computerized training sessions. The addition of CRT to IPS resulted in significantly more participants working at the 3-month (odds ratio [OR]=2.83, 95% confidence interval [CI]=1.22-6.60) and 9-month follow-ups (OR=2.91, 95% CI=1.27-6.65). Participants who received CRT worked more hours and earned more in wages than those receiving IPS alone over the 9-month follow-up period. Both groups showed significantly improved cognitive outcomes at the 3-month follow-up, with no time × group interaction. CONCLUSIONS Cognitive remediation, especially skills training in coping and compensatory strategies, improves employment outcomes among individuals who do not show an early benefit of using IPS services.
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Affiliation(s)
- Amy M N Burns
- Department of Psychiatry, University of British Columbia, Vancouver, Canada (both authors); Department of Psychiatry, Royal Columbian Hospital (Burns), and Fraser Health Early Psychosis Intervention Program (Erickson), New Westminster, British Columbia, Canada
| | - David H Erickson
- Department of Psychiatry, University of British Columbia, Vancouver, Canada (both authors); Department of Psychiatry, Royal Columbian Hospital (Burns), and Fraser Health Early Psychosis Intervention Program (Erickson), New Westminster, British Columbia, Canada
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Faith LA, Howie JH, Blanco E, Jarvis SP, Rempfer MV. Therapeutic alliance in a cognitive rehabilitation programme for people with serious mental illness: A qualitative analysis. Psychol Psychother 2022; 95:958-969. [PMID: 35810321 DOI: 10.1111/papt.12412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 06/12/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Therapeutic alliance is an important element of evidence-based treatments for people diagnosed with a serious mental illness. Cognitive enhancement therapy (CET) is an efficacious cognitive rehabilitation programme that emphasizes coach-participant relationships. The purpose of this study was to examine experiences of therapeutic alliance among CET participants. DESIGN We used an exploratory qualitative approach. METHODS Semi-structured interviews were conducted with 24 participants diagnosed with a serious mental illness. Interview transcripts were analysed by three independent coders using thematic analysis. RESULTS Four themes related to therapeutic alliance emerged: (1) positive regard; (2) collaboration; (3) authenticity; (4) negative alliance. CONCLUSIONS Findings suggest that therapeutic alliance is an important component of CET that bolsters the learning environment and ensures a positive group experience. Our qualitative analyses contribute greater understanding of how strong therapeutic relationships impact people with serious mental illnesses participating in evidence-based treatments beyond psychotherapy context.
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Affiliation(s)
- Laura A Faith
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.,Department of Psychology, The University of Missouri, Kansas City, Missouri, USA
| | - J Hunter Howie
- Department of Psychology, The University of Missouri, Kansas City, Missouri, USA
| | - Emily Blanco
- Department of Psychology, The University of Missouri, Kansas City, Missouri, USA
| | - Stephen P Jarvis
- University Health Behavioral Health, Kansas City, Missouri, USA.,University of Missouri School of Medicine, Kansas City, Missouri, USA
| | - Melisa V Rempfer
- Department of Psychology, The University of Missouri, Kansas City, Missouri, USA
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Sauvé G, Buck G, Lepage M, Corbière M. Minds@Work: A New Manualized Intervention to Improve Job Tenure in Psychosis Based on Scoping Review and Logic Model. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:515-528. [PMID: 34331191 DOI: 10.1007/s10926-021-09995-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 06/13/2023]
Abstract
Introduction A significant proportion of people experiencing psychosis are unemployed, despite a strong desire to work. Current supported employment programs appear effective in helping them obtain employment, yet job tenure remains an arduous challenge. The objective of this study was to review the literature and model the results to inform the development of a new manualized group psychosocial intervention-'Minds@Work'-aimed specifically at improving job tenure in psychosis. Methods The study was registered on the Open Science Framework platform ( https://osf.io/he68z ). The literature was searched in Medline, Embase, PsycInfo and Cochrane Library databases for studies examining predictors of job tenure in psychosis and existing occupational psychosocial interventions. Data were extracted using a pre-established form and synthesized using logic models. Results A total of 94 studies were included and their findings were modeled using different categories: intervention typologies, mechanisms of action, predictors of job tenure, outcomes and contextual factors. The 'Minds@Work' program was built based on these modeled findings and aimed to target specific predictors of job tenure while addressing some of the limitations of existing interventions. The program uses evidence-based techniques and is divided into 9 modules covering 4 themes: positive psychology (motivation, character strengths, self-compassion), neurocognitive remediation (attention, memory, problem-solving), cognitive biases training (jumping to conclusions, defeatists beliefs, theory of mind, attributional styles) and socioemotional coping skills (emotion regulation, communication). Conclusions Once validated, this new program is meant to be used either as a stand-alone intervention or integrated in supported employment initiatives, by employment specialists or healthcare workers.
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Affiliation(s)
- Geneviève Sauvé
- Department of Psychology, Université du Québec À Montréal, 100 Sherbrooke West, Montreal, QC, H2X 3P2, Canada
| | - Gabriella Buck
- Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Martin Lepage
- Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Marc Corbière
- Centre de Recherche de L'Institut Universitaire en Santé Mentale de Montréal, 7331 Hochelaga, Montreal, QC, H1N 3V2, Canada.
- Department of Education - Career Counselling, Université du Québec À Montréal, Pavilion N, 1205 Saint-Denis, Montreal, QC, H2X 3R9, Canada.
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Seccomandi B, Agbedjro D, Keefe RS, Galderisi S, Fiszdon J, Mucci A, Wykes T, Cella M. Evaluating how treatment adherence influences cognitive remediation outcomes. Behav Res Ther 2022; 158:104186. [DOI: 10.1016/j.brat.2022.104186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 11/02/2022]
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Bourke E, Barker C, Fornells-Ambrojo M. Systematic review and meta-analysis of therapeutic alliance, engagement, and outcome in psychological therapies for psychosis. Psychol Psychother 2021; 94:822-853. [PMID: 33569885 DOI: 10.1111/papt.12330] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/16/2021] [Indexed: 01/07/2023]
Abstract
AIM The moderate association between therapeutic alliance (TA) and psychological therapy outcome is well established. Historically, the field has not focused on people with a severe mental illness. This is the first review to conduct a meta-analysis of associations between TA and therapeutic engagement as well as outcome in psychological therapy for psychosis. ELIGIBILITY CRITERIA Eligible studies conducted a quantitative investigation of the relationship between TA during a psychological therapy and outcome at a subsequent time-point. METHOD A systematic review examined the relationship between TA and engagement as well as outcome measures within psychological therapy for psychosis. Correlational meta-analyses using an aggregate random effects model were conducted. RESULTS Twenty-four studies were eligible for inclusion (n = 1,656) of which 13 were included in the meta-analyses. Client- and therapist-rated TA were associated with engagement in therapy (rclient (c) = 0.36, p = .003; rtherapist (t) = 0.40, p = .0053). TA was also associated with reduction in global (rc = 0.29, p = .0005; rt = 0.24, p = .0015) and psychotic symptoms (rc = 0.17, p = .0115; rt = 0.30, p = .0003). The systematic review identified no evidence or limited evidence for a relationship between TA during therapy and depression, substance use, physical health behaviours, global as well as social functioning, overall mental health recovery, and self-esteem at follow-up. Although number of studies was small, TA was related to a reduced risk of subsequent hospitalization in 40% of analyses (across two studies) and improved cognitive outcome in 50% of analyses (across three studies). CONCLUSIONS The observed TA-therapy engagement and TA-outcome associations were broadly consistent with those identified across non-psychotic diagnostic groups. Well-powered studies are needed to investigate the relationship between TA and process as well as outcome in psychological therapy for psychosis specifically. PRACTITIONER POINTS This is the first review to conduct a meta-analytic synthesis of the association between therapeutic alliance (TA) and both engagement and change in outcome in psychological therapies for psychosis. TA (as rated by therapist and client) was associated with the extent of therapeutic engagement as well as reduction in global mental health symptoms and psychotic symptoms. The significant associations between TA and engagement as well as change in outcome identified in the current review are broadly consistent with those observed across non-psychotic diagnostic groups. We consider factors that could impact upon the dynamic and potentially interdependent relationships between TA and therapeutic techniques, including attachment security and severity of paranoid ideation.
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Affiliation(s)
- Emilie Bourke
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Chris Barker
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Miriam Fornells-Ambrojo
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Haugen I, Stubberud J, Ueland T, Haug E, Øie MG. Executive dysfunction in schizophrenia: Predictors of the discrepancy between subjective and objective measures. SCHIZOPHRENIA RESEARCH-COGNITION 2021; 26:100201. [PMID: 34189060 PMCID: PMC8217703 DOI: 10.1016/j.scog.2021.100201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 01/10/2023]
Abstract
This study aimed to investigate what characterizes individuals with schizophrenia who experience more or less subjective executive dysfunction in everyday life compared to objective executive performance on neuropsychological tests. Sixty-six participants with broad schizophrenia spectrum disorders completed a comprehensive assessment of executive function. Discrepancies between performance on neuropsychological tests (objective) and an extensive self-report questionnaire (subjective) of central executive functions (inhibition, shifting and working memory) were calculated. Higher level of self-efficacy was the best predictor of experiencing fewer subjective cognitive complaints compared to objective performance, followed by higher levels of disorganized symptoms. Depressive symptoms did not predict discrepancy between subjective and objective executive function. Higher estimated IQ predicted greater subjective working memory difficulties in everyday life despite better objective performance. Results may aid clinicians in the assessment and remediation of cognitive impairment. Low self-efficacy may identify individuals who are not able to utilize their potential executive functions in daily life. Interventions aimed at fostering self-efficacy ought to be included in cognitive remediation for these individuals. Disorganized symptoms could prove useful in identifying individuals who are in need of cognitive remediation for executive dysfunction, despite that they overestimate their skills. These individuals may benefit from efforts to increase insight into cognitive dysfunction.
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Affiliation(s)
- Ingvild Haugen
- Research Division, Innlandet Hospital Trust, P.O. Box 104, 2381 Brumunddal, Norway
- Department of Psychology, University of Oslo, P.O. Box 1094, 0317 Oslo, Norway
- Corresponding author at: Research Division, Innlandet Hospital Trust, P.O. Box 104, 2381 Brumunddal, Norway.
| | - Jan Stubberud
- Department of Psychology, University of Oslo, P.O. Box 1094, 0317 Oslo, Norway
- Department of Research, Lovisenberg Diaconal Hospital, P.O. Box 4970, Nydalen, 0440 Oslo, Norway
| | - Torill Ueland
- Department of Psychology, University of Oslo, P.O. Box 1094, 0317 Oslo, Norway
- Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Postboks 4956, Nydalen, 0424 Oslo, Norway
| | - Elisabeth Haug
- Research Division, Innlandet Hospital Trust, P.O. Box 104, 2381 Brumunddal, Norway
| | - Merete Glenne Øie
- Research Division, Innlandet Hospital Trust, P.O. Box 104, 2381 Brumunddal, Norway
- Department of Psychology, University of Oslo, P.O. Box 1094, 0317 Oslo, Norway
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Browne J, Wright AC, Berry K, Mueser KT, Cather C, Penn DL, Kurtz MM. The alliance-outcome relationship in individual psychosocial treatment for schizophrenia and early psychosis: A meta-analysis. Schizophr Res 2021; 231:154-163. [PMID: 33866260 DOI: 10.1016/j.schres.2021.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 02/04/2023]
Abstract
The therapeutic alliance, or client-provider relationship, has been associated with better treatment engagement and outcomes for persons with schizophrenia-spectrum disorders (SSDs) and early psychosis in some studies, but not others. We conducted a meta-analysis of the research on alliance in SSDs and early psychosis across a range of interventions and outcomes. Parallel literature searches were conducted in PubMed and PsycINFO databases for articles between inception and 6/11/2020. English-language studies were included if they evaluated the relationship between alliance and a prospective outcome (treatment engagement, medication adherence, functioning, or total, positive, negative, or depressive symptoms) in an individual clinical treatment for SSDs/early psychosis and contained analyzable data. Correlations and partial correlations were meta-analyzed with random effects models to calculate mean across-study correlations and to carry out subsequent homogeneity and moderator variable analyses. Fourteen studies consisting of 2968 participants that assessed six outcomes across six psychosocial treatments were included. Results indicated that better client-rated (r = 0.20) and other-rated (i.e., provider- or observer-rated; r = 0.25) alliance were associated with better treatment engagement. Treatment type and sample race/ethnicity, but not age, gender, or timing of alliance rating moderated the association between other-rated alliance and engagement. Further, better other-rated alliance was related to improvements in positive (r = -0.14) and negative (r = -0.22) symptoms. A strong therapeutic alliance is important for both engaging clients with SSDs and early psychosis in treatment and facilitating improvements in positive and negative symptoms. Delivery and monitoring of treatments for this population should include assessment of the therapeutic alliance from multiple perspectives.
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Affiliation(s)
- Julia Browne
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA.
| | - Abigail C Wright
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Katherine Berry
- School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA; Department of Occupational Therapy and Psychological, Boston University, Boston, MA, USA; Department of Brain Sciences, Boston University, Boston, MA, USA
| | - Corinne Cather
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Australian Catholic University, School of Behavioural and Health Sciences, VIC, Australia
| | - Matthew M Kurtz
- Department of Psychology and Neuroscience and Behavior, Wesleyan University, Middletown, CT, USA
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Sedgwick O, Hardy A, Newbery K, Cella M. A systematic review of adherence to group interventions in psychosis: do people attend? Psychol Med 2021; 51:707-715. [PMID: 33860743 DOI: 10.1017/s0033291721000404] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Evidence supports the use of group therapy for symptom reduction and improving functioning in people with psychosis. However, research guidelines highlight the importance of establishing the feasibility of interventions. Adherence is an important indicator of feasibility and an essential step in supporting the development of the evidence base for group interventions. This review aims to estimate adherence, and possible barriers and facilitators, to psychotherapeutic groups in people with psychosis. METHODS Embase, Ovid MEDLINE and PsycINFO databases were searched for cross-referencing terms related to group therapy and psychosis. Studies were assessed against inclusion criteria and methodological quality was evaluated. Data wasextracted from each paper including the average session attendance, demographic, clinical, study and therapy-related characteristics and the impact of these on adherence levels evaluated. RESULTS Fifty-nine original research papers were included, reporting on 52 independent studies which consisted of 66 therapy groups comprised of 2109 participants. Average adherence was 76.4% (s.d. = 17.4). Adherence was improved by receiving incentives and was higher in participants of older age. Study sample size was inversely associated with adherence levels. Study quality was variable with approximately 61.5% found to be at risk of bias. The results support the feasibility of group therapy and suggest that adherence in people with psychosis is not dissimilar to those for people experiencing common mental health difficulties. These findings, alongside efficacy evidence, support the use of group interventions in people with psychosis but also highlight the need for further high-quality research on the efficacy for these approaches.
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Affiliation(s)
- Ottilie Sedgwick
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, LondonSE5 8AF, UK
- South London & Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, KentBR3 3BX, UK
| | - Amy Hardy
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, LondonSE5 8AF, UK
- South London & Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, KentBR3 3BX, UK
| | - Katie Newbery
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, LondonSE5 8AF, UK
- South London & Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, KentBR3 3BX, UK
| | - Matteo Cella
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, LondonSE5 8AF, UK
- South London & Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, KentBR3 3BX, UK
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Progress in Schizophrenia Research and Treatment. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:440-442. [PMID: 33343257 PMCID: PMC7725148 DOI: 10.1176/appi.focus.18310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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López-Navarro E, Del Canto C, Mayol A, Fernández-Alonso O, Reig J, Munar E. Does mindfulness improve inhibitory control in psychotic disorders? A randomized controlled clinical trial. Int J Clin Health Psychol 2020; 20:192-199. [PMID: 32994792 PMCID: PMC7501450 DOI: 10.1016/j.ijchp.2020.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/01/2020] [Indexed: 01/10/2023] Open
Abstract
Background/Objective: Impaired Inhibitory Control (IC) is a core feature of psychotic disorders and is related with impaired social functioning in people experiencing psychosis. Despite research showing the benefits of mindfulness over IC in the general population, no study has assessed its effects on IC in psychoses. The aim of our study was to assess the effectiveness of a mindfulness-based intervention combined with integrated rehabilitation treatment in a sample of people diagnosed of psychotic disorders. Method: Fifty-six patients diagnosed with psychotic disorder were recruited and randomly allocated either to integrated rehabilitation treatment or integrated rehabilitation treatment enhanced with 26 mindfulness group sessions. Measures comprised PANSS interview, MAAS scale, and Stroop Color Word Test (SCWT). The primary outcome variable was the performance in the non-congruent trials of the SCWT. Results: There were no differences between groups at baseline. At post-treatment patients allocated to mindfulness group increased their scores in non-congruent trials of SCWT and in MAAS. At post-treatment mindfulness group scored higher than integrated rehabilitation treatment in MAAS. Conclusions: Data suggest that mindfulness added to integrated rehabilitation treatment may improve IC in psychosis. Results are convergent with prior works about the effect of mindfulness over cognitive performance in general population.
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Affiliation(s)
- Emilio López-Navarro
- EvoCog Group, University of Balearic Islands, IFISC, Associated Unit to CSIC, Spain
- Corresponding author: EvoCog Group, Department of Psychology, AMAS Building, University of Balearic Islands, Carretera de Valldemossa km 7.5, Palma de Mallorca 07122, Balearic Islands, Spain.
| | - Cristina Del Canto
- Department of Psychiatry, Son Llàtzer Hospital, Balearic Health Service, Spain
| | - Antoni Mayol
- UCR Serralta Community Rehabilitation Centre, Balearic Health Service, Spain
| | | | - Josep Reig
- EvoCog Group, University of Balearic Islands, IFISC, Associated Unit to CSIC, Spain
| | - Enric Munar
- EvoCog Group, University of Balearic Islands, IFISC, Associated Unit to CSIC, Spain
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Allott K, Steele P, Boyer F, de Winter A, Bryce S, Alvarez-Jimenez M, Phillips L. Cognitive strengths-based assessment and intervention in first-episode psychosis: A complementary approach to addressing functional recovery? Clin Psychol Rev 2020; 79:101871. [DOI: 10.1016/j.cpr.2020.101871] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 05/14/2020] [Accepted: 05/24/2020] [Indexed: 12/14/2022]
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17
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Tan S, Zhu X, Fan H, Tan Y, Yang F, Wang Z, Zhao Y, Fan F, Guo J, Li Z, Quan W, Wang X, Reeder C, Zhou D, Zou Y, Wykes T. Who will benefit from computerized cognitive remediation therapy? Evidence from a multisite randomized controlled study in schizophrenia. Psychol Med 2020; 50:1633-1643. [PMID: 31298171 PMCID: PMC7408576 DOI: 10.1017/s0033291719001594] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 06/05/2019] [Accepted: 06/14/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND Computerized cognitive remediation therapy (CCRT) is generally effective for the cognitive deficits of schizophrenia. However, there is much uncertainty about what factors mediate or moderate effectiveness and are therefore important to personalize treatment and boost its effects. METHOD In total, 311 Chinese inpatients with Diagnostic and Statistical Manual of Mental Disorders-IV schizophrenia were randomized to receive CCRT or Active control for 12 weeks with four to five sessions per week. All participants were assessed at baseline, post-treatment and 3-month follow-up. The outcomes were cognition, clinical symptoms and functional outcomes. RESULTS There was a significant benefit in the MATRICS Consensus Cognitive Battery (MCCB) total score for CCRT (F1,258 = 5.62; p = 0.02; effect size was 0.27, 95% confidence interval 0.04-0.49). There were no specific moderators of CCRT improvements. However, across both groups, Wisconsin Card Sort Test improvement mediated a positive effect on functional capacity and Digit Span benefit mediated decreases in positive symptoms. In exploratory analyses younger and older participants showed cognitive improvements but on different tests (younger on Symbol Coding Test, while older on the Spatial Span Test). Only the older age group showed MSCEIT benefits at post-treatment. In addition, cognition at baseline negatively correlated with cognitive improvement and those whose MCCB baseline total score was around 31 seem to derive the most benefit. CONCLUSIONS CCRT can improve the cognitive function of patients with schizophrenia. Changes in cognitive outcomes also contributed to improvements in functional outcomes either directly or solely in the context of CCRT. Age and the basic cognitive level of the participants seem to affect the cognitive benefits from CCRT.
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Affiliation(s)
- Shuping Tan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing100096, P.R. China
| | - Xiaolin Zhu
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing100096, P.R. China
| | - Hongzhen Fan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing100096, P.R. China
| | - Yunlong Tan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing100096, P.R. China
| | - Fude Yang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing100096, P.R. China
| | - Zhiren Wang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing100096, P.R. China
| | - Yanli Zhao
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing100096, P.R. China
| | - Fengmei Fan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing100096, P.R. China
| | - Junhua Guo
- Beijing Anding Hospital of Capital Medical University, Beijing100088, P.R. China
| | - Zhanjiang Li
- Beijing Anding Hospital of Capital Medical University, Beijing100088, P.R. China
| | - Wenxiang Quan
- Institute of Mental Health, Peking University, Beijing100191, P.R. China
| | - Xiangqun Wang
- Institute of Mental Health, Peking University, Beijing100191, P.R. China
| | - Clare Reeder
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, LondonSE5 8AF, UK
| | - Dongfeng Zhou
- Institute of Mental Health, Peking University, Beijing100191, P.R. China
| | - Yizhuang Zou
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing100096, P.R. China
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, LondonSE5 8AF, UK
- South London and Maudsley NHS Foundation Trust
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18
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Allott K, van-der-EL K, Bryce S, Parrish EM, McGurk SR, Hetrick S, Bowie CR, Kidd S, Hamilton M, Killackey E, Velligan D. Compensatory Interventions for Cognitive Impairments in Psychosis: A Systematic Review and Meta-Analysis. Schizophr Bull 2020; 46:869-883. [PMID: 32052837 PMCID: PMC7345816 DOI: 10.1093/schbul/sbz134] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Cognitive compensatory interventions aim to alleviate psychosocial disability by targeting functioning directly using aids and strategies, thereby minimizing the impact of cognitive impairment. The aim was to conduct a systematic review and meta-analysis of cognitive compensatory interventions for psychosis by examining the effects on functioning and symptoms, and exploring whether intervention factors, study design, and age influenced effect sizes. METHODS Electronic databases (Ovid Medline, PsychINFO) were searched up to October 2018. Records obtained through electronic and manual searches were screened independently by two reviewers according to selection criteria. Data were extracted to calculate estimated effects (Hedge's g) of treatment on functioning and symptoms at post-intervention and follow-up. Study quality was assessed using Cochrane Collaboration's risk of bias tool. RESULTS Twenty-six studies, from 25 independent randomized controlled trials (RCTs) were included in the meta-analysis (1654 participants, mean age = 38.9 years, 64% male). Meta-analysis revealed a medium effect of compensatory interventions on functioning compared to control conditions (Hedge's g = 0.46, 95% CI = 0.33, 0.60, P < .001), with evidence of relative durability at follow-up (Hedge's g = 0.36, 95% CI = 0.19, 0.54, P < .001). Analysis also revealed small significant effects of cognitive compensatory treatment on negative, positive, and general psychiatric symptoms, but not depressive symptoms. Estimated effects did not significantly vary according to treatment factors (ie, compensatory approach, dosage), delivery method (ie, individual/group), age, or risk of bias. Longer treatment length was associated with larger effect sizes for functioning outcomes. No evidence of publication bias was identified. CONCLUSION Cognitive compensatory interventions are associated with robust, durable improvements in functioning in people with psychotic illnesses.
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Affiliation(s)
- Kelly Allott
- Orygen, Parkville, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia,To whom correspondence should be addressed; 35 Poplar Road, Parkville, VIC, 3052, Australia; tel: +3 9966 9423, e-mail:
| | - Kristi van-der-EL
- Orygen, Parkville, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Shayden Bryce
- Orygen, Parkville, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Emma M Parrish
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, CA
| | - Susan R McGurk
- Department of Occupational Therapy, Center for Psychiatric Rehabilitation, Boston University, Boston, MA
| | - Sarah Hetrick
- Orygen, Parkville, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia,Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | | | - Sean Kidd
- Department of Psychiatry, University of Toronto, Toronto, Ontario, ON, Canada
| | - Matthew Hamilton
- Orygen, Parkville, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Eoin Killackey
- Orygen, Parkville, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Dawn Velligan
- Department of Psychiatry, University of Texas Health Science Centre, San Antonio, TX
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Can Cognitive Remediation in Groups Prevent Relapses?: Results of a 1-Year Follow-up Randomized Controlled Trial. J Nerv Ment Dis 2020; 208:362-370. [PMID: 32053567 DOI: 10.1097/nmd.0000000000001146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
International guidelines define relapse prevention for schizophrenia patients as a key therapeutic aim. However, approximately 80% to 90% of schizophrenia patients experience further symptom exacerbation after the first episode. The purpose of this study was to investigate whether group integrated neurocognitive therapy (INT), a cognitive remediation approach, reduces relapse rates in schizophrenia outpatients. INT was compared with treatment as usual (TAU) in a randomized controlled trial. Fifty-eight stabilized outpatients participated in the study with 32 allocated to the INT group and 26 to the TAU group. A test battery was used at baseline, posttreatment at 15 weeks, and a 1-year follow-up. Relapse rates were significantly lower in the INT condition compared with TAU during therapy as well as at follow-up. The relapse rate after therapy was associated with significant reductions in negative and general symptoms, improvements in functional outcome, and overall cognition. Out of these variables, negative symptoms were identified to show the strongest association with relapses after therapy. The primary outcome of this study suggests that INT can prevent relapses in schizophrenia outpatients.
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20
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Tsapekos D, Seccomandi B, Mantingh T, Cella M, Wykes T, Young AH. Cognitive enhancement interventions for people with bipolar disorder: A systematic review of methodological quality, treatment approaches, and outcomes. Bipolar Disord 2020; 22:216-230. [PMID: 31610086 DOI: 10.1111/bdi.12848] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Patients with bipolar disorder (BD) suffer from cognitive deficits across several domains. The association between cognitive performance and psychosocial functioning has led to the emergence of cognition as a treatment target. OBJECTIVE This study reviews the existing literature on cognitive enhancement interventions for people with BD, focusing on different treatment approaches and methodological quality. METHODS We conducted a systematic search following the PRISMA guidelines. Sample characteristics and main outcomes for each study and treatment characteristics for each approach were extracted. Study quality was assessed using the Clinical Trials Assessment Measure (CTAM) and Cochrane Collaboration's Risk of Bias tool by independent raters. RESULTS Eleven articles reporting data from seven original studies were identified encompassing 471 participants. Two treatment approaches were identified, cognitive and functional remediation. For controlled studies, methodological quality was modest (average CTAM score = 60.3), while the overall risk of bias was considered moderate. Beneficial effects on cognitive or functional outcomes were reported in the majority of studies (91%), but these findings were isolated and not replicated across studies. Key methodological limitations included small sample sizes, poor description of randomization process, high attrition rates, and participant exclusion from the analysis. CONCLUSIONS Findings are promising but preliminary. Quality studies were few and mostly underpowered. Heterogeneity in sample characteristics, outcome measures, and treatment approaches further limit the ability to generalize findings. Adequately powered trials are required to replicate initial findings, while moderators of treatment response and mechanisms of transfer need to be explored.
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Affiliation(s)
- Dimosthenis Tsapekos
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Benedetta Seccomandi
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tim Mantingh
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
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21
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Cella M, Price T, Corboy H, Onwumere J, Shergill S, Preti A. Cognitive remediation for inpatients with psychosis: a systematic review and meta-analysis. Psychol Med 2020; 50:1062-1076. [PMID: 32349802 DOI: 10.1017/s0033291720000872] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Cognitive difficulties are common in people with psychosis and associated with considerable disability. Cognitive remediation (CR) can reduce the burden of cognitive difficulties and improve functioning. While mental health care has predominantly shifted to the community, people with greater illness severity and complexity, and those with poor response to treatment and concomitant greater cognitive difficulties, continue to receive inpatient care. The aim of this study is to review and evaluate the acceptability and efficacy of CR for inpatients with psychosis. A systematic search was used to identify randomized controlled trials of CR for inpatients with psychosis. Demographic and clinical information was extracted by independent raters together with therapy outcomes. Study quality was assessed using the Cochrane Collaboration Risk of Bias Assessment tool. Standardized mean change for cognitive and functional outcomes was calculated using Hedges's g and used to infer therapy effects with meta-analysis. Twenty studies were identified considering 1509 participants. Results from random-effect models suggested that CR was effective in improving processing speed (g = 0.48), memory (g = 0.48) and working memory (g = 0.56). While there was an indication of improvements in the levels of vocational, social and global functioning, these were less reliable. On average, 7% of participants dropped-out of treatment. Studies methodological quality was moderate. CR is an acceptable intervention for inpatients with psychosis and can lead to significant cognitive improvements. Evidence for improvement in functioning requires more robust and converging evidence. Future research should extend the evaluation of inpatient CR to subsequent post-discharge community functioning and further need for care.
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Affiliation(s)
- Matteo Cella
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Tom Price
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Holly Corboy
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- University College Dublin (UCD), Belfield, Dublin 4, Ireland
| | - Juliana Onwumere
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- National Psychosis Unit, Bethlem Hospital, South London and Maudsley NHS Trust, UK
| | - Sukhi Shergill
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- National Psychosis Unit, Bethlem Hospital, South London and Maudsley NHS Trust, UK
| | - Antonio Preti
- Centro Medico Genneruxi, Cagliari, Italy
- Center for Liaison Psychiatry and Psychosomatics, University Hospital, University of Cagliari, Cagliari, Italy
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22
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Thomas M, Rusten K. Trial implementation of CIRCuiTS cognitive remediation therapy for people with schizophrenia in Orange, New South Wales. Aust J Rural Health 2020; 27:463-468. [PMID: 31663213 DOI: 10.1111/ajr.12578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 09/01/2019] [Accepted: 09/10/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Many people with schizophrenia experience cognitive impairments and current practice guidelines recommend cognitive remediation therapy. This implementation trial examined aspects of feasibility, acceptability and outcomes of the computerised interactive remediation of cognition-interactive training for schizophrenia cognitive remediation therapy program in our local context. DESIGN A longitudinal design was utilised with participants providing outcome data at commencement of the computerised interactive remediation of cognition-interactive training for schizophrenia program, completion and at follow-up 3 months later. SETTING Our trial was conducted in the inpatient and community mental health contexts within the New South Wales regional city of Orange, between January 2017 and December 2018. PARTICIPANTS Fifty-three adult volunteers commenced the computerised interactive remediation of cognition-interactive training for schizophrenia program and participated in this trial. Forty-five participants were currently admitted to psychiatric rehabilitation inpatient units at Bloomfield hospital, and eight were referred by Orange Community Mental Health Service. MAIN OUTCOME MEASURE(S) Participants completed measures of cognitive functioning (repeatable battery for the assessment of neuropsychological status), functional independence (Adaptive Behaviour Assessment Scales 3) and Goal attainment scaling. RESULTS Most participants reported they liked computerised interactive remediation of cognition-interactive training for schizophrenia therapy and made excellent progress towards their goals. Those who completed the program made significant gains in the domains of attention, memory and independence in key aspects of daily living. Gains in functional independence were sustained for a small sample following program completion. CONCLUSION This implementation trial showed the computerised interactive remediation of cognition-interactive training for schizophrenia cognitive remediation therapy program was feasible, acceptable and contributed to strong outcomes in both the inpatient and community contexts. Efforts are in progress to translate the computerised interactive remediation of cognition-interactive training for schizophrenia program, and future research will focus on longer term outcomes, cost-benefit analyses and the experiences of participants and therapists.
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Affiliation(s)
- Matt Thomas
- Bloomfield Hospital, Orange, NSW, Australia.,School of Psychology, Charles Sturt University, Bathurst, NSW, Australia
| | - Kim Rusten
- Bloomfield Hospital, Orange, NSW, Australia
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Saperstein AM, Jones BD, Hansen MC, Medalia A. The cognitive training version of the MUSIC® model of motivation inventory: A follow-up validity study. Schizophr Res 2020; 216:516-519. [PMID: 31924371 PMCID: PMC8054066 DOI: 10.1016/j.schres.2019.12.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/21/2019] [Accepted: 12/20/2019] [Indexed: 11/17/2022]
Abstract
Further validation of the MUSIC® Model of Motivation Inventory (MMI) for use in Cognitive Remediation (CR) for schizophrenia is needed. The MMI was compared to the Intrinsic Motivation Inventory - Schizophrenia Research and Perceived Competency Scale following early treatment exposure in a CR clinical trial. MMI Usefulness, Success, and Interest scales were significantly correlated with corresponding comparison scales. The MMI was not correlated with pre-morbid cognitive ability. Higher expectancy for success and perceived usefulness were significantly associated with greater intensity of session attendance. Results support the convergent, divergent, and predictive validity of the MMI for CR research and clinical use.
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Affiliation(s)
- Alice M Saperstein
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, United States.
| | - Brett D Jones
- Virginia Tech, School of Education, 310B War Memorial Hall, Blacksburg, VA 24061, United States.
| | - Marie C Hansen
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, United States.
| | - Alice Medalia
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York-Presbyterian, 1051 Riverside Drive, New York, NY 10032, United States.
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De Vito AN, Ahmed M, Mohlman J. Cognitive Enhancement Strategies to Augment Cognitive-Behavioral Therapy for Anxiety and Related Disorders: Rationale and Recommendations for Use With Cognitively Healthy Older Adults. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2019.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Miley K, Hadidi N, Kaas M, Yu F. Cognitive Training and Remediation in First-Episode Psychosis: A Literature Review. J Am Psychiatr Nurses Assoc 2019; 26:542-554. [PMID: 31578909 PMCID: PMC7863980 DOI: 10.1177/1078390319877952] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND: Neurocognitive and social cognitive impairments are core characteristics of psychotic disorders, which are present in the first episode of psychosis (FEP) and strongly predict poor social functioning. Addressing cognitive impairments through cognitive training and remediation (CTR) may be a crucial component of recovery-oriented treatment. AIMS: The objectives of this review were to (1) evaluate the CTR theoretical basis and intervention components and (2) examine the effects of CTR on cognition and social functioning in FEP. METHOD: A combined search of Ovid Medline, Embase, and Psych Info databases was conducted using keywords. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Quality and risk of bias were assessed using established instruments. RESULTS: Ten randomized controlled trials were included in this review and had an overall fair to poor quality. CTR interventions in FEP utilize a range of theoretical backgrounds, with most including a focus on higher order cognitive processes. Varied doses and intervention components are used. All but one study found improvements in at least one cognitive domain. Global cognition, verbal learning, and memory and executive function were most commonly improved. Three studies found an effect on a range of functional outcomes. CONCLUSIONS: A broad range of CTR interventions have promising effects for addressing cognitive impairments in FEP. Evidence of functional impact is less consistent. Further research is needed in FEP on CTR targeting sensory and perceptual processes, and to identify CTR intervention targets and treatment components that will lead to robust improvements in cognition and functioning.
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Affiliation(s)
- Kathleen Miley
- Kathleen Miley, MSN, PMHNP-BC, University of Minnesota, Minneapolis, MN, USA
| | - Niloufar Hadidi
- Niloufar Hadidi, PhD, APRN, University of Minnesota, Minneapolis, MN, USA
| | - Merrie Kaas
- Merrie Kaas, PhD, PMHCNS-BC, University of Minnesota, Minneapolis, MN, USA
| | - Fang Yu
- Fang Yu, PhD, GNP-BC, University of Minnesota, Minneapolis, MN, USA
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Seccomandi B, Tsapekos D, Newbery K, Wykes T, Cella M. A systematic review of moderators of cognitive remediation response for people with schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2019; 19:100160. [PMID: 31828023 PMCID: PMC6889639 DOI: 10.1016/j.scog.2019.100160] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/14/2019] [Accepted: 08/17/2019] [Indexed: 01/08/2023]
Abstract
Background There is evidence that cognitive remediation (CR) is moderately effective in improving cognitive and functional difficulties in people with schizophrenia. However, there is still a limited understanding of what influence different treatment responses. Aim To identify moderators influencing CR response in people with schizophrenia. Methods This systematic review follows PRISMA guidelines. Searches were conducted up to January 2019 on PubMed and PsychInfo to identify randomized controlled trials of CR reporting analyses of moderators of treatment response. All papers were assessed for methodological quality and information on sample size, intervention and control condition, moderators, outcomes, effect of moderator on outcomes and demographic characteristics from each study was extracted and critically summarised. Results Thirty-six studies were included, considering 2737 participants. Study participants consisted on average of people in their late-thirties, mostly men, with over 10 years of illness. The review identified moderators that could be grouped into five categories: demographics, biological, cognitive and functional, psychological, and illness-related characteristics. The assessment of methodological quality showed that many studies had a high risk of bias. Conclusions There was no high-quality replicated evidence which identifies reliable moderators of CR response. Many moderators were not replicated or presented in single, underpowered studies. Studies also investigated moderators independently despite their potential to overlap (e.g. age and education). Future research should concentrate on evaluating, with sound studies, the role moderators may play in affecting CR treatment response. This information can inform who will benefit most from the therapy and help to improve the benefits of CR.
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Affiliation(s)
- Benedetta Seccomandi
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Dimosthenis Tsapekos
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Katie Newbery
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.,South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London SE5 8AZ, UK
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.,South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London SE5 8AZ, UK
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.,South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London SE5 8AZ, UK
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Reser MP, Slikboer R, Rossell SL. A systematic review of factors that influence the efficacy of cognitive remediation therapy in schizophrenia. Aust N Z J Psychiatry 2019; 53:624-641. [PMID: 31177813 DOI: 10.1177/0004867419853348] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Cognitive remediation therapy is a moderately effective intervention for ameliorating cognitive deficits in individuals with schizophrenia-related disorders. With reports of considerable variability in individual response to cognitive remediation therapy, we need to better understand factors that influence cognitive remediation therapy efficacy to realise its potential. A systematic review was conducted to identify and evaluate predictors of cognitive outcome. METHODS An electronic database search was conducted identifying peer-reviewed articles examining predictors of cognitive response to cognitive remediation therapy. RESULTS A total of 40 articles accounting for 1681 cognitive remediation therapy participants were included; 81 distinct predictors of cognitive response were identified. Data synthesis and discussion focused on 20 predictors examined a minimum three times in different studies. Few of the examined predictors of cognitive outcome following cognitive remediation therapy were significant when examined through systematic review. A strong trend was found for baseline cognition, with reasoning and problem solving and working memory being strongly predictive of within-domain improvement. Training task progress was the most notable cross-domain predictor of cognitive outcome. CONCLUSION It remains unclear why a large proportion of participants fail to realise cognitive benefit from cognitive remediation therapy. However, when considering only those variables where a majority of articles reported a statistically significant association with cognitive response to cognitive remediation therapy, three stand out: premorbid IQ, baseline cognition and training task progress. Each of these relates in some way to an individual's capacity or potential for change. There is a need to consolidate investigation of potential predictors of response to cognitive remediation therapy, strengthening the evidence base through replication and collaboration.
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Affiliation(s)
- Maree P Reser
- 1 Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Reneta Slikboer
- 1 Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Susan L Rossell
- 1 Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.,2 Psychiatry, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
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Ermakova AO, Gileadi N, Knolle F, Justicia A, Anderson R, Fletcher PC, Moutoussis M, Murray GK. Cost Evaluation During Decision-Making in Patients at Early Stages of Psychosis. COMPUTATIONAL PSYCHIATRY (CAMBRIDGE, MASS.) 2019; 3:18-39. [PMID: 30931393 PMCID: PMC6436576 DOI: 10.1162/cpsy_a_00020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 08/13/2018] [Indexed: 11/29/2022]
Abstract
Jumping to conclusions during probabilistic reasoning is a cognitive bias reliably observed in psychosis and linked to delusion formation. Although the reasons for this cognitive bias are unknown, one suggestion is that psychosis patients may view sampling information as more costly. However, previous computational modeling has provided evidence that patients with chronic schizophrenia jump to conclusions because of noisy decision-making. We developed a novel version of the classical beads task, systematically manipulating the cost of information gathering in four blocks. For 31 individuals with early symptoms of psychosis and 31 healthy volunteers, we examined the numbers of "draws to decision" when information sampling had no, a fixed, or an escalating cost. Computational modeling involved estimating a cost of information sampling parameter and a cognitive noise parameter. Overall, patients sampled less information than controls. However, group differences in numbers of draws became less prominent at higher cost trials, where less information was sampled. The attenuation of group difference was not due to floor effects, as in the most costly block, participants sampled more information than an ideal Bayesian agent. Computational modeling showed that, in the condition with no objective cost to information sampling, patients attributed higher costs to information sampling than controls did, Mann-Whitney U = 289, p = 0.007, with marginal evidence of differences in noise parameter estimates, t(60) = 1.86, p = 0.07. In patients, individual differences in severity of psychotic symptoms were statistically significantly associated with higher cost of information sampling, ρ = 0.6, p = 0.001, but not with more cognitive noise, ρ = 0.27, p = 0.14; in controls, cognitive noise predicted aspects of schizotypy (preoccupation and distress associated with delusion-like ideation on the Peters Delusion Inventory). Using a psychological manipulation and computational modeling, we provide evidence that early-psychosis patients jump to conclusions because of attributing higher costs to sampling information, not because of being primarily noisy decision makers.
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Affiliation(s)
- Anna O. Ermakova
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, East London NHS Foundation Trust, London, UK
| | - Nimrod Gileadi
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Franziska Knolle
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Azucena Justicia
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- Hospital del Mar Medical Research Institute, CIBERSAM, Barcelona, Spain
| | - Rachel Anderson
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Paul C. Fletcher
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Michael Moutoussis
- Wellcome Centre for Human Neuroimaging and Max Planck Centre for Computational Psychiatry and Ageing, University College London, London, UK
| | - Graham K. Murray
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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29
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Barlati S, Deste G, Galluzzo A, Perin AP, Valsecchi P, Turrina C, Vita A. Factors Associated With Response and Resistance to Cognitive Remediation in Schizophrenia: A Critical Review. Front Pharmacol 2019; 9:1542. [PMID: 30687100 PMCID: PMC6335346 DOI: 10.3389/fphar.2018.01542] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/17/2018] [Indexed: 01/06/2023] Open
Abstract
Cognitive impairment is a central feature of schizophrenia and has shown to play a crucial role in the psychosocial function of the disorder. Over the past few years, several cognitive remediation (CR) interventions have been developed for schizophrenia, whose effectiveness has also been widely demonstrated by systematic reviews and meta-analysis studies. Despite these evidences, many questions remain open. In particular, the identification of CR response predictors in patients with schizophrenia is still a topic with equivocal findings and only a few studies have looked for the relationship between CR response or resistance and the biological, socio-demographic, clinical and cognitive features in schizophrenia. The current knowledge on positive or negative response predictors to CR treatment in schizophrenia include: age, duration of illness, premorbid adjustment, baseline cognitive performance, intrinsic motivation, hostility, disorganized symptoms, neurobiological reserve, genetic polymorphisms, the amounts of antipsychotics, the type of CR, etc. The aim of this review is to identify neurobiological, psychopathological, cognitive, and functional predictors of CR response or resistance in schizophrenia, taking into account both cognitive and functional outcome measures. The information obtained could be very useful in planning integrated and personalized interventions, also with a better use of the available resources.
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Affiliation(s)
- Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giacomo Deste
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy
| | - Alessandro Galluzzo
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy
| | - Anna Paola Perin
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Valsecchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Cesare Turrina
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Palumbo D, Mucci A, Giordano GM, Piegari G, Aiello C, Pietrafesa D, Annarumma N, Chieffi M, Cella M, Galderisi S. The Efficacy, Feasibility And Acceptability Of A Remotely Accessible Use Of CIRCuiTS, A Computerized Cognitive Remediation Therapy Program For Schizophrenia: A Pilot Study. Neuropsychiatr Dis Treat 2019; 15:3103-3113. [PMID: 31814722 PMCID: PMC6853079 DOI: 10.2147/ndt.s221690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/29/2019] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION The Computerized Interactive Remediation of Cognition - Training for Schizophrenia (CIRCuiTS) is a form of cognitive remediation therapy developed to target neurocognitive and metacognitive deficits of people with schizophrenia, which have a detrimental impact on real-life functioning. The English version of CIRCuiTS demonstrated good acceptability and feasibility. A recent randomized controlled trial provided evidence that the program improves memory and functioning, and that the impact on functional outcome is mediated by metacognition. The next steps in the development of CIRCuiTS include both: 1) the translation and adaptation of the program in different cultural settings; and 2) the demonstration of feasibility, acceptability and effectiveness of a standardized method to administer CIRCuiTS remotely. PURPOSE To implement the CIRCuiTS Italian version and to assess acceptability, feasibility and efficacy of a standardized method to administer CIRCuiTS remotely. METHODS Participants were assessed at baseline and received up to 40 CIRCuiTS therapy sessions, three times a week, for about 1 hr over a three-month period. Participants were reassessed post-treatment. RESULTS The program demonstrated good feasibility and high acceptability when assessed by the number of dropouts and evaluation of patients' satisfaction. Participants improved in learning, speed of processing, working memory and executive control. They showed a reduction in disorganization and improvement in self-esteem, functional capacity, and real-life functioning. CONCLUSION In this study, a standardized protocol for using CIRCuiTS from home was implemented. The first set of data showed in the paper is encouraging. The proposed procedure could lead to a dropout reduction while maintaining the efficacy of the program.
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Affiliation(s)
- Davide Palumbo
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Giuseppe Piegari
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Carmen Aiello
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Daria Pietrafesa
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Nicola Annarumma
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Marcello Chieffi
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Matteo Cella
- Institute of Psychiatry, Psychology and Neuroscience (ioppn), King's College London, London, UK
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
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31
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Bryce SD, Lee SJ, Ponsford JL, Lawrence RJ, Tan EJ, Rossell SL. The impact of intrinsic motivation on session attendance and reliable cognitive improvement in cognitive remediation in schizophrenia. Schizophr Res 2018; 202:354-360. [PMID: 29935884 DOI: 10.1016/j.schres.2018.06.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 03/09/2018] [Accepted: 06/10/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Cognitive remediation (CR) is considered a potentially effective method of improving cognitive function in people with schizophrenia. Few studies, however, have explored the role of intrinsic motivation on treatment utilization or training outcomes in CR in this population. This study explored the impact of task-specific intrinsic motivation on attendance and reliable cognitive improvement in a controlled trial comparing CR with a computer game (CG) playing control. METHODS Forty-nine participants with schizophrenia or schizoaffective disorder, allocated to 10 weeks of group-based CR (n = 25) or CG control (n = 24), provided complete outcome data at baseline. Forty-three participants completed their assigned intervention. Cognition, psychopathology and intrinsic motivation were measured at baseline and end-treatment. Regression analyses explored the relative contribution of baseline motivation and other clinical factors to session attendance as well as the association of baseline and change in intrinsic motivation with the odds of reliable cognitive improvement (calculated using reliable change indices). RESULTS Baseline reports of perceived program value were the only significant multivariable predictor of session attendance when including global cognition and psychiatric symptomatology. The odds of reliable cognitive improvement significantly increased with greater improvements in program interest and value from baseline to end-treatment. Motivational changes over time were highly variable between participants. CONCLUSION Task-specific intrinsic motivation in schizophrenia may represent an important patient-related factor that contributes to session attendance and cognitive improvements in CR. Regular evaluation and enhancement of intrinsic motivation in cognitively enhancing interventions may optimize treatment engagement and the likelihood of meaningful training outcomes.
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Affiliation(s)
- S D Bryce
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia; Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, VIC, Australia.
| | - S J Lee
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia; Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, VIC, Australia; Department of Psychiatry, Alfred Health, Melbourne, VIC, Australia
| | - J L Ponsford
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia; Monash-Epworth Rehabilitation Research Centre, Richmond, VIC, Australia
| | - R J Lawrence
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia; Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, VIC, Australia
| | - E J Tan
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, VIC, Australia; Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia; Psychiatry, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - S L Rossell
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, VIC, Australia; Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia; Psychiatry, St Vincent's Hospital, Fitzroy, VIC, Australia
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32
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Wykes T, Joyce E, Velikonja T, Watson A, Aarons G, Birchwood M, Cella M, Dopson S, Fowler D, Greenwood K, Johnson S, McCrone P, Perez J, Pickles A, Reeder C, Rose D, Singh S, Stringer D, Taylor M, Taylor R, Upthegrove R. The CIRCuiTS study (Implementation of cognitive remediation in early intervention services): protocol for a randomised controlled trial. Trials 2018; 19:183. [PMID: 29544551 PMCID: PMC5856221 DOI: 10.1186/s13063-018-2553-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/08/2018] [Indexed: 11/10/2022] Open
Abstract
Background Cognitive problems in people with schizophrenia predict poor functional recovery even with the best possible rehabilitation opportunities and optimal medication. A psychological treatment known as cognitive remediation therapy (CRT) aims to improve cognition in neuropsychiatric disorders, with the ultimate goal of improving functional recovery. Studies suggest that intervening early in the course of the disorder will have the most benefit, so this study will be based in early intervention services, which treat individuals in the first few years following the onset of the disorder. The overall aim is to investigate different methods of CRT. Methods This is a multicentre, randomised, single-blinded, controlled trial based in early intervention services in National Health Service Mental Health Trusts in six English research sites. Three different methods of providing CRT (intensive, group, and independent) will be compared with treatment as usual. We will recruit 720 service users aged between 16 and 45 over 3 years who have a research diagnosis of non-affective psychosis and will be at least 3 months from the onset of the first episode of psychosis. The primary outcome measure will be the degree to which participants have achieved their stated goals using the Goal Attainment Scale. Secondary outcome measures will include improvements in cognitive function, social function, self-esteem, and clinical symptoms. Discussion It has already been established that cognitive remediation improves cognitive function in people with schizophrenia. Successful implementation in mental health services has the potential to change the recovery trajectory of individuals with schizophrenia-spectrum disorders. However, the best mode of implementation, in terms of efficacy, service user and team preference, and cost-effectiveness is still unclear. The CIRCuiTS trial will provide guidance for a large-scale roll-out of CRT to mental health services where cognitive difficulties impact recovery and resilience. Trial registration ISRCTN, ISRCTN14678860, Registered on 6 June 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2553-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK. .,South London & Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK.
| | - Eileen Joyce
- UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Tjasa Velikonja
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Andrew Watson
- UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Gregory Aarons
- University of California, San Diego, 9500 Gilman Dr. (0812), La Jolla, CA, 92093-0812, USA
| | - Max Birchwood
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Sue Dopson
- Saïd Business School, University of Oxford, Park End Street, Oxford, OX1 1HP, UK
| | - David Fowler
- Psychology Department, University of Sussex, Brighton, Sussex, BN1 9RH, UK
| | - Kathy Greenwood
- Sussex Partnership NHS Foundation Trust and University of Sussex, Sussex House, Falmer, Brighton, BN1 9RH, UK
| | - Sonia Johnson
- Division of Psychiatry, UCL, Mental Health Sciences Unit, 2nd Floor Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, UK
| | - Paul McCrone
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Jesus Perez
- Cambridge & Peterborough NHS Foundation Trust, CAMEO, Block 7 Ida Darwin, Fulbourn Hospital, Cambridge, CB2 5EE, UK
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Clare Reeder
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Diana Rose
- Health Services and Population Research Department, Institute of Psychology, Psychiatry and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Swaran Singh
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Dominic Stringer
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Matthew Taylor
- South London & Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | - Rumina Taylor
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Rachel Upthegrove
- College of Medical and Dental Sciences, University of Birmingham, 25 Vincent Drive, Birmingham, B15 2F, UK
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