Combined Cognitive Remediation and Functional Skills Training for Schizophrenia: Effects on Cognition, Functional Competence, and Real-World Behavior

Department of Psychiatry, University of California, San Diego, San Diego, California, United States
American Journal of Psychiatry (Impact Factor: 12.3). 05/2012; 169(7). DOI: 10.1176/appi.ajp.2012.11091337
Source: PubMed

ABSTRACT OBJECTIVE: Cognitive remediation is an efficacious treatment for schizophrenia and, when used within broader psychosocial treatments, improves transfer to real-world behavior change. The authors examined whether cognitive remediation effectively generalizes to functional competence and real-world functioning as a standalone treatment and when combined with a functional skills treatment. METHOD: Outpatients with schizophrenia (N=107) were randomly assigned to receive cognitive remediation, functional adaptation skills training, or combined treatment, with cognitive remediation preceding functional skills training. Clinical symptoms, neurocognition, social competence, functional competence, and case-manager-rated real-world behavior were assessed at baseline, at end of treatment, and at a 12-week durability assessment. RESULTS: Neurocognition improved, with durable effects, after cognitive remediation but not after functional skills training. Social competence improved both with functional skills training and with combined treatment but not with cognitive remediation alone. Improvements in functional competence were greater and more durable with combined treatment. Cognitive remediation alone did not produce significant improvements in real-world behavior, but when combined with functional skills training, statistically significant improvements from baseline to end of treatment and follow-up were observed in community or household activities and work skills. Number-needed-to-treat analyses suggest that as few as three cases are required for treatment to induce a meaningful improvement in functional skills. CONCLUSIONS: In a short intervention, cognitive remediation produced robust improvements in neurocognition. Generalization to functional competence and real-world behavior was more likely when supplemental skills training and cognitive remediation were combined.

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    • "r time ( McGurk et al . 2007 ; Wykes et al . 2011 ) . Although a comprehensive review of this literature is beyond the scope of this paper , we focus on a recently completed ran - domized clinical trial of a combined neurocognitive ? skill - based intervention for schizophrenia as an exemplar of the potential for combined intervention approaches . Bowie et al . ( 2012 ) evaluated the effects of a computerized neurocognitive intervention , a skill - based intervention , and combined neuro - cognitive ? skill - based intervention for adults with schizo - phrenia . The 12 - week neurocognitive intervention included computer - based cognitive exercises and therapist support in developing , implementing ,"
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    ABSTRACT: Attention-deficit/hyperactivity disorder (ADHD) is a prevalent and chronic mental health condition that often results in substantial impairments throughout life. Although evidence-based pharmacological and psychosocial treatments exist for ADHD, effects of these treatments are acute, do not typically generalize into non-treated settings, rarely sustain over time, and insufficiently affect key areas of functional impairment (i.e., family, social, and academic functioning) and executive functioning. The limitations of current evidence-based treatments may be due to the inability of these treatments to address underlying neurocognitive deficits that are related to the symptoms of ADHD and associated areas of functional impairment. Although efforts have been made to directly target the underlying neurocognitive deficits of ADHD, extant neurocognitive interventions have shown limited efficacy, possibly due to misspecification of training targets and inadequate potency. We argue herein that despite these limitations, next-generation neurocognitive training programs that more precisely and potently target neurocognitive deficits may lead to optimal outcomes when used in combination with specific skill-based psychosocial treatments for ADHD. We discuss the rationale for such a combined treatment approach, prominent examples of this combined treatment approach for other mental health disorders, and potential combined treatment approaches for pediatric ADHD. Finally, we conclude with directions for future research necessary to develop a combined neurocognitive + skill-based treatment for youth with ADHD.
    Clinical Child and Family Psychology Review 08/2014; 17(4). DOI:10.1007/s10567-014-0171-5 · 4.75 Impact Factor
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    • "Although the effectiveness of clinician-facilitated role-play training in vocational rehabilitation has received minimal empirical attention (Salyers et al, 2004), several interventions have been developed as supplements to enhance SE, including cognitive remediation, cognitive behavioral therapy, performance feedback, and developing work skills (Bell et al, 2003; Bell et al, 2008; Bowie Virtual Reality 4 et al, 2012; Lysaker et al, 2009; McGurk et al, 2005; Mueser et al, 2005). As such, perhaps SE or other vocational services can be enhanced by supplementing them with an evidenced-based approach to job interview training. "
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    ABSTRACT: Services are available to help support existing employment for individuals with psychiatric disabilities; however, there is a gap in services targeting job interview skills that can help obtain employment. We assessed the feasibility and efficacy of Virtual Reality Job Interview Training (VR-JIT) in a randomized controlled trial. Participants were randomized to VR-JIT (n = 25) or treatment-as-usual (TAU) (n = 12) groups. VR-JIT consisted of 10 hours of simulated job interviews with a virtual character and didactic online training. The participants attended 95% of laboratory-based training sessions and found VR-JIT easy to use and felt prepared for future interviews. The VR-JIT group improved their job interview role-play performance (p ≤ 0.05) and self-confidence (p ≤ 0.05) between baseline and follow-up as compared with the TAU group. VR-JIT performance scores increased over time (R = 0.65). VR-JIT demonstrated initial feasibility and efficacy at improving job interview skills and self-confidence. Future research may help clarify whether this intervention is efficacious in community-based settings.
    Journal of Nervous & Mental Disease 08/2014; 202:659-667. DOI:10.1097/NMD.0000000000000187 · 1.69 Impact Factor
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    • "Cognitive science assumes that skills development can occur at any age and can help advance or restore the brain's capacity for improving cognitive or social performance [14]. Learning in a properly stimulating environment can help the patient to capitalize on brain malleability and improve functioning [15]. In this context, cognitive remediation attempts to improve and/or restore cognitive functioning using a range of approaches. "
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    ABSTRACT: Objectives. This study is aimed to review the current scientific literature on cognitive remediation in schizophrenia. In particular, the main structured protocols of cognitive remediation developed for schizophrenia are presented and the main results reported in recent meta-analyses are summarized. Possible benefits of cognitive remediation in the early course of schizophrenia and in subjects at risk for psychosis are also discussed. Methods. Electronic search of the relevant studies which appeared in the PubMed database until April 2013 has been performed and all the meta-analyses and review articles on cognitive remediation in schizophrenia have been also taken into account. Results. Numerous intervention programs have been designed, applied, and evaluated, with the objective of improving cognition and social functioning in schizophrenia. Several quantitative reviews have established that cognitive remediation is effective in reducing cognitive deficits and in improving functional outcome of the disorder. Furthermore, the studies available support the usefulness of cognitive remediation when applied in the early course of schizophrenia and even in subjects at risk of the disease. Conclusions. Cognitive remediation is a promising approach to improve real-world functioning in schizophrenia and should be considered a key strategy for early intervention in the psychoses.
    12/2013; 2013:156084. DOI:10.1155/2013/156084
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