Joanna M Fiszdon

• Ph.D.
• Professor (Associate) at Yale University

Background Psychotic spectrum disorders (PSD) are associated with poor social function. In this study, we investigate which of two different types of 2-month long training courses is more effective in improving day-to-day interactions and quality of life. Methods/design Participants with psychotic spectrum disorders will be randomly assigned to on...

Group-based Metacognitive Reflection and Insight Therapy (MERITg) is the group application of Metacognitive Reflection and Insight Therapy (MERIT), an evidence-based, integrative, recovery-oriented intervention to enhance insight and understanding of oneself and others in individuals with serious mental illness (SMI). MERITg may offer therapeutic i...

While cognitive remediation therapy (CRT) and compensatory strategy training both have large literature bases supporting their efficacy on both proximal and distal outcomes, the research base on stand-alone cognitive training (CT) is smaller and less consistent, with little information about factors associated with better outcomes. In this study, w...

Given the relationship between social cognition and functional outcome in schizophrenia, a number of social cognitive interventions have been developed, including Social Cognition Interaction Training (SCIT), a group-based, comprehensive, manualized intervention. In the current trial, we examined SCIT efficacy as well as potential moderators of tre...

Metacognitive reflection and insight therapy (MERIT) is an integrative individual psychotherapy which aims to improve metacognition and insight in people with serious mental illness. In response to limitations of MERIT and the growing clinical demand for new cost-effective group psychotherapies, we developed a group-based MERIT intervention (MERITg...

Metacognitive reflection and insight therapy (MERIT) is an one-on-one intervention that targets insight with the aim to help people with serious mental illness develop more integrated ideas about themselves and others in order to respond to their psychological and social challenges more adaptively. There is a growing body of evidence on MERIT’s eff...

Background While there is increasing support for the efficacy of psychosocial interventions for people with SMI, the real-world effectiveness of such treatments is diminished by lack of motivation for treatment, leading to poor treatment engagement/dropout. We sought to evaluate the efficacy of motivational interviewing (MI) in improving attendance...

Background There is evidence that Cognitive Remediation (CR) is an efficacious approach to reduce cognitive and functioning difficulties in people with schizophrenia. However, there is still a limited understanding of what influences different treatment responses. Treatment adherence has been suggested as one factor but has not been investigated sy...

Individuals with psychotic disorders have deficits in metacognition. Thirty-four adults with schizophrenia were randomized to 2 months of metacognitive training (MCT) or a healthy living skills control group. All participants were enrolled in a work therapy program, followed by a supported employment program. Assessments were conducted at baseline,...

Purpose This study reviewed the current state of discourse and social communication interventions in traumatic brain injury (TBI) to provide clinically focused guidance about treatment efficacy, treatment approaches by TBI severity, treatment components, and treatment outcome measures. Method Searches were conducted in five electronic databases an...

Background While Cognitive Remediation (CR) is effective in reducing cognitive and functioning difficulties in people with schizophrenia, there is variability in treatment response. Previous research suggested that participants' age may be a significant moderator of CR response. Aim To examine the impact of participants' age on CR outcomes. Metho...

Background IQ and IQ decline are considered risk factors for poor prognosis in people with a diagnosis of schizophrenia. However, it is still not clear if, at least in part, IQ and IQ decline influence long-term outcomes via a negative effect on interventions. Aim To identify whether current IQ, estimated premorbid IQ, or IQ decline moderate the r...

Objective In a previous report on a randomized clinical trial of a 3-month program of Cognitive Remediation Therapy (CRT) augmented by Work Therapy (WT) compared with WT alone for older veterans with substance use disorder (SUD), we reported significantly greater improvements at six-month follow-up on neurocognitive outcomes of working memory and e...

Cognitive remediation is now widely recognized as an effective treatment for cognitive deficits in schizophrenia. Its effects are meaningful, durable, and related to improvements in everyday functional outcomes. As with many therapies, the evolution of cognitive remediation has resulted in treatment programs that use a variety of specific technique...

On average, cognitive remediation (CR) is effective in improving cognitive function in individuals with psychosis, though there is considerable variability in treatment response. No consensus has emerged to date about the potential influence of patient and illness characteristics on CR efficacy. In the current analyses, we examined baseline demogra...

Background Metacognitive capacity is the awareness and understanding of one’s own thought processes and how they influence behaviors (Lysaker et al., 2005). Deficits in metacognition in people with psychosis represent a significant barrier to benefiting from psychosocial treatments such as work therapy (Lysaker et al., 2010). Therapies that target...

Background Thought to be essential for daily functioning, prospective memory (PM) deficits were found in both adults with established psychosis (Schizophrenia; SCZ) and younger adults recently diagnosed with SCZ (First Episode Psychosis; FEP). Examined further, time-based PM appeared to be more impaired than event-based PM, which may contribute tow...

Background Physical exercise (PE) is a safe, non-stigmatizing, and side-effect free intervention that has the potential to mitigate neurocognitive dysfunction in psychosis, as well as reduce anxiety and paranoia. Developing and promoting PE programs for people with SMI in the community where participants cannot be paid to participate requires an in...

Background Current computerized cognitive training (CT) programs adjust difficulty level solely using a correct or incorrect response. This is the sole method of titrating difficulty because there is only one avenue of input. This is an inherent weakness in how learning is gauged since a correct or incorrect response only conveys one part of the st...

The link between cognition and functioning in schizophrenia is well established, and there is a large body of research supporting the efficacy of cognitive remediation (CR) for improving cognitive function in individuals with psychosis. In recent years, the focus of CR research has shifted to better understanding how these interventions work, and f...

Emerging research highlights the potential cognitive benefits of physical exercise (PE) programs for schizophrenia (SCZ). The few recent efficacy studies that examined augmenting cognitive training (CT) with PE suggest superior effects of the combination. The next step is to consider strategies to enhance adherence in real-world settings if this ty...

Music has been demonstrated to improve cognitive test performance in neuropsychiatric populations. However, the impact of music on cognitive training effects, and the importance of music preference, has yet to be studied. This is an essential oversight because many cognitive training programs play music in the background. We sought to determine if...

Cognitive impairment affects more than half of persons with multiple sclerosis (PwMS), and it is associated with difficulties in multiple aspects of daily functioning. There is a growing body of literature that has explored the use of cognitive-focused interventions in PwMS, which aim to improve cognition-related function through drill and practice...

We sought to evaluate the influence of demographic, symptom, functional and cognitive factors on task-specific motivation, as well as improvement in task-specific motivation that occurs in response to motivational interviewing. In the absence of any intervention, better task-specific motivation was associated with higher perceived competence and lo...

Background Cognitive deficits are common in people with schizophrenia and have a negative impact on functioning. Cognitive Remediation (CR) is an effective approach to reduce the burden of cognitive difficulties however there are individual differences in therapy response. Previous research suggests that participants age may be a significant modera...

The Social Attribution Task-Multiple Choice (SAT-MC) tests the ability to extract social themes from viewed object motion. This form of animacy perception is thought to aid the development of social inference, but appears impaired in schizophrenia. The current study was undertaken to examine psychometric equivalence of two forms of the SAT-MC and t...

This study introduces a computerized clinical decision-support tool, the Fluid Outpatient Rehabilitation Treatment (FORT), that incorporates individual and ever-evolving patient needs to guide clinicians in developing and updating treatment decisions in real-time. In this proof-of-concept feasibility pilot, FORT was compared against traditional tre...

Social cognition represents an important treatment target, closely linked to everyday social function. While a number of social cognitive interventions have recently been developed, measures used to evaluate these treatments are only beginning to receive psychometric scrutiny. Study goals were to replicate recently-published psychometrics for sever...

Background: While numerous trials have reported on the efficacy of cognitive remediation (CR), it is still not considered an evidence-based treatment and very little is known about mechanisms through which it may exert effects on functioning, as well as what variables predict a positive treatment response. In the current study, we evaluated both pr...

Background: Social cognitive deficits play an important role in social functioning in adults with established psychosis (schizophrenia), young adults recently diagnosed with schizophrenia in the last 2 years (first episode psychosis; FEP), and teenagers at clinical high risk for developing psychosis (CHR). In particular, the ability to infer other...

Study Goals: Evaluate psychometric validity of commonly used social cognition measures in schizophrenia research.

Defeatist beliefs and amotivation are prominent obstacles in vocational rehabilitation for people with serious mental illnesses (SMI). The CBT-based Indianapolis Vocational Intervention Program (IVIP) was specifically designed to reduce defeatist beliefs related to work functioning. In the current study, we examined the impact of IVIP on defeatist...

Background: The popularity of cognitive remediation (CR) interventions for individuals with psychosis is in part based on the well-established link between cognition and functioning and the assumption that by targeting cognition, function can improve. While numerous trials have reported CR's efficacy, it is still not considered an evidence-based t...

Objective: Among individuals at clinical high risk (CHR) for psychosis, processing speed (PS) has been related to social and role functioning regardless of conversion to schizophrenia. This information processing dysfunction is a gateway to broader behavioral deficits such as difficulty executing social behaviors. We examined the feasibility of im...

Background: Adults with serious mental illness (SMI) may struggle with expectations of failure in vocational rehabilitation. These expectations can be global and trait-like or performance-specific and related to ability. Aims: To date, it has not been examined whether global or performance-specific defeatist beliefs are related to functional outcom...

Objectives: In this proof-of-concept trial, we examined the feasibility and preliminary efficacy of Understanding Social Situations (USS), a new social-cognitive intervention that targets higher level social-cognitive skills using methods common to neurocognitive remediation, including drill and practice and hierarchically structured training, whi...

Conceptually, motivation can be separated into two types, intrinsic and extrinsic. Intrinsic motivation involves goal-directed behaviors that meet internal psychological needs, while extrinsic motivation involves behaviors executed to obtain external reward or avoid punishment. Both these types of motivation are diminished in psychosis and are link...

Background: The construct, convergent, discriminant, and predictive validity of Learning Potential (LP) was evaluated in a trial of cognitive remediation for adults with schizophrenia-spectrum disorders. LP utilizes a dynamic assessment approach to prospectively estimate an individual's learning capacity if provided the opportunity for specific re...

Background: Emerging research highlights the potential cognitive benefits of physical fitness programs for schizophrenia. Physical exercise (PE) is a safe, nonstigmatizing, and side effect-free intervention that has the potential to mitigate neurocognitive dysfunction in psychosis. To date, only two recent studies have explored the possibility of c...

Cognitive rehabilitation for mild cognitive impairment (MCI) and early Alzheimer's disease is readily available to the geriatric population. Initial evidence suggests that techniques incorporating motivational strategies to enhance treatment engagement may provide more benefit than computerised training alone. Seventy four adults with subclinical c...

Adherence to treatment in psychiatric populations is notoriously low. In this randomized, controlled, proof-of-concept study, we sought to examine whether motivational interviewing (MI) could be used to enhance motivation for, adherence to, and benefit obtained from cognitive rehabilitation. Dual diagnosis MI, developed specifically for individuals...

Background: Supported employment is an effective intervention for people with serious mental illnesses (SMI) but is underutilized. Clients' desire to work might be heightened by programs that provide counseling about managing one's funds, since money management helps people become more aware of the advantages of having money. Aim: To analyze the...

Introduction: Both self-report and performance-based measures are often used in assessment of everyday functioning for individuals with schizophrenia. However, there is little evidence of overlap between them, and there are no established standards for which measures might be most appropriate. In order to better understand differences among these...

Background: Adults with serious mental illness (SMI) may struggle with expectations of failure in vocational rehabilitation. These expectations can be global and trait-like or performance-specific and related to ability. Aims: To date, it has not been examined whether global or performance-specific defeatist beliefs are related to functional out...

Studies that have specifically examined the effects of motivation on work have been limited to evaluations of baseline motivation and have not accounted for cognition. These have also not examined whether motivation changes over time. In the current analyses, we examined how baseline motivation and longitudinal changes in motivation, along with the...

The Social Attribution Task-Multiple Choice (SAT-MC) uses a 64-second video of geometric shapes set in motion to portray themes of social relatedness and intentions. Considered a test of “Theory of Mind,” the SAT-MC assesses implicit social attribution formation while reducing verbal and basic cognitive demands required of other common measures. We...

This title provides a firm grounding in the theory and research of normal social cognition, builds on this base to describe how social cognition appears to be dysfunctional in schizophrenia, and explains how this dysfunction might be ameliorated. Composed of contributed chapters written by the top experts in the field, the volume is divided into th...

While research on social cognitive impairments in schizophrenia is quickly growing, relatively little is still known about the severity and correlates of these impairments. The few studies that have examined this issue suggest that social cognitive impairments may be positively related to psychiatric symptoms and negatively related to functioning....

Social cognitive treatments for schizophrenia are a rapidly expanding area of research. In this comprehensive review of the treatment literature, we provide information on nearly 50 studies evaluating a range of social cognitive interventions, including broad-based, targeted, and comprehensive approaches. Research to date has established that some...

Social cognitive impairment in schizophrenia is common and associated with poor functional outcome. While correlations in the moderate range suggest that social cognition and neurocognition are separate but overlapping domains, less is known about whether intact neurocognition represents a "necessary but not sufficient" condition for intact social...

Social cognitive impairments and negative symptoms are core features of schizophrenia closely associated with impaired community functioning. However, little is known about whether these are independent dimensions of illness and if so, whether individuals with schizophrenia can be meaningfully classified based on these dimensions (SANS) and potenti...

Intrinsic motivation is a construct commonly used in explaining goal-directed behavior. In people with schizophrenia, intrinsic motivation is usually subsumed as a feature of negative symptoms or underlying neurocognitive dysfunction. A growing literature reflects an interest in defining and measuring motivational impairment in schizophrenia and in...

This is the first report on the use of the Social Attribution Task - Multiple Choice (SAT-MC) to assess social cognitive impairments in schizophrenia. The SAT-MC was originally developed for autism research, and consists of a 64-second animation showing geometric figures enacting a social drama, with 19 multiple choice questions about the interacti...

Expectancy-value theory, a widely accepted model of motivation, posits that expectations of success on a learning task and the individual value placed on the task are central determinants of motivation to learn. This is supported by research in healthy controls suggesting that beliefs of self-and-content mastery can be so influential they can predi...

Learning potential (LP) refers to the ability to improve cognitive performance as a result of training. It is typically assessed by test-train-test administrations of a task, wherein changes in pre-post performance are an index of LP. In schizophrenia research, LP has been suggested as a mediator of the relationship between static neurocognition an...

Affect recognition (AR) is a core component of social information processing; thus, it may be critical to understanding social behavior and functioning in broader aspects of daily living. Deficits in AR are well documented in schizophrenia, but there is also evidence that many individuals with schizophrenia perform AR tasks at near-normal levels. I...

The majority of affect recognition research has used visual stimuli, with only a minority of studies examining auditory affect recognition, and fewer still comparing affect recognition across presentation modalities. In the current study, we evaluated affect recognition between 45 outpatients with schizophrenia or schizoaffective disorder and 56 he...

Most research establishing the relationship between cognition and functioning in schizophrenia has been conducted cross-sectionally, leaving unanswered the question of whether there is a predictive relationship between temporal change in cognition and temporal change in functioning. In the present study, we used longitudinal mixed models to examine...

Cognitive retraining is a promising non-pharmacological approach to the treatment of neurocognitive deficits in schizophrenia. The current study aimed to learn whether people with schizophrenia improve on attention tasks, whether individual performance varies by task, and what task improvement measures relate to pre-post-change in neuropsychologica...

A year-long program of Neurocognitive Enhancement Therapy (NET) was used to remediate cognitive deficits in people with schizophrenia who were participating in a vocational program. Seventy-two stable outpatients with schizophrenia or schizoaffective disorder, recruited from an urban community mental health center were randomly assigned to a twelve...

This investigation aimed to determine whether impaired insight influences the validity of self-report test scores in schizophrenia and schizoaffective disorder. 274 outpatients enrolled in work rehabilitation completed the Beck Depression Inventory (BDI), Eysenck Personality Questionnaire (EPQ), Bell Object Relations and Reality Testing Inventory (...

We compared basic and social cognition in individuals with schizophrenia and schizoaffective disorder. 199 individuals with schizophrenia and 73 with schizoaffective disorder were compared on measures of executive function, verbal and nonverbal memory, and processing speed, as well as two measures of social cognition, the Hinting Task and the Bell...

Cognitive deficits are a major determinant of social and occupational dysfunction in schizophrenia, and new treatments are needed that address these impairments. The current study determined whether neurocognitive enhancement therapy (NET) in combination with work therapy (WT) would show improvement in performance on neuropsychological tests that e...

Cognitive remediation is a promising rehabilitation procedure for people with schizophrenia, but very little is known about who can benefit. In the current analyses, we examined the role of pre-morbid and morbid intellectual function in predicting response to cognitive remediation in a sample of 152 patients diagnosed with schizophrenia or schizoaf...

It has been suggested that learning potential (LP), a patient's ability to benefit from training and practice, may mediate the relationship between cognition and functional outcome. Aims of this study were to (1) assess whether performance on a verbal memory-based measure of LP is associated with readiness for psychosocial rehabilitation; and (2) a...

Neurocognitive enhancement therapy (NET), which involves computerized cognitive training and other methods, has been shown to improve working memory and executive function in schizophrenia. In the present study, 145 outpatients with diagnoses of schizophrenia or schizoaffective disorder recruited from a Department of Veterans Affairs mental hygiene...

Cognitive remediation has led to improvements for some but not all individuals with schizophrenia. The goal of the current investigation was to determine which variables predicted response to cognitive remediation training. In a sample of 58 patients with DSM-IV schizophrenia or schizoaffective disorder, normalization of performance on a trained me...

The objective was to investigate the impact of a verbal memory training task on psychiatric symptoms and cognition in schizophrenia. As part of a larger, 6-month cognitive remediation program, 57 patients with schizophrenia were randomly assigned to receive performance-based, hierarchical training on a verbal memory task based on a dichotic listeni...

Studies in schizophrenia suggest that verbal learning and memory may distinguish three subgroups of patients: an unimpaired memory profile group and two groups that have memory profiles similar to those seen in cortical and subcortical dementias. Using the Hopkins Verbal Learning Test, Revised edition (HVLT-R), this study attempted to differentiate...

To determine whether older people with schizophrenia or schizoaffective disorder can benefit from work therapy as has been shown with their younger counterparts, 41 older patients (50+) were compared with 104 younger patients on their clinical and vocational outcomes while participating in a 6-month work therapy program. In an intent-to-treat analy...

A preponderance of research indicates that cognitive function in schizophrenia can be improved through cognitive remediation. However, few studies have attempted to characterise the extent of improvement relative to nonpsychiatric controls. Cognitive performance on reaction time, digit recall, and word recall of 58 schizophrenia patients at baselin...

In the present paper, we describe a behavioral rehabilitation program for patients with schizophrenia. The program combines vocational rehabilitation with cognitive training, thereby addressing two of the hallmark impairments of this chronic disorder. In addition to targeting these two types of impairments, we also wished to investigate the impact...

Patients with schizophrenia have consistently been found to exhibit cognitive deficits, particularly in memory, which have been suggested to mediate functional outcomes. Several recent reviews of cognitive retraining have concluded that these deficits respond to training, although the sustainability of cognitive improvement following completion of...

Résumé Dans cet article, les auteurs décrivent un programme de réhabilitation comportementale pour patients souffrant de schizophrénie. Le programme combine la réhabilitation occupationnelle à l’entraînement cognitif, s’attaquant ainsi à deux des déficiences marquantes de ce trouble chronique. En plus de cibler ces deux types de déficiences, les au...

There is conflicting evidence regarding the presence and direction of gender differences in verbal memory capacity in schizophrenia. We examined gender differences in verbal memory performance in schizophrenia and their interactions with repeated assessments and psychiatric symptoms. California Verbal Learning Test (CVLT) data were collected from 2...

Sixty Wistar rats (Rattus norvegicus) were assigned to 4 groups of 15 rats each: ethanol stress (ES), ethanol no-stress (EN), isocaloric stress (IS) and isocaloric no-stress (IN). The effect of restraint stress on daily intake of ethanol and a 0.72% solution of glucose was examined in an ABA design (stress-no stress-stress). During the stress phase...

Using subjects with panic disorder, we investigated the effect of alcohol on expressive-emotional facial reactions to a well-known laboratory panic provocation procedure (inhalation of 35% carbon dioxide). Subjects consuming alcohol (vs. a placebo) displayed lower levels of emotional masking and fear/distress facial responses; however, differences...

This study examines the relationships between childhood and adolescent trauma and neglect and three types of altered states of consciousness (dissociative episodes, absorption, and mysticism) in an outpatient sample of women. Thirty-eight female outpatients receiving counseling at a community clinic completed three scales measuring the tendency to...

This study tested whether alcohol consumption reduces anxiety and panic associated with a panic-challenge procedure. Subjects with panic disorder were randomly assigned to consume either a moderate dose of alcohol or a nonalcoholic placebo. All subjects were told that they were drinking alcohol to control beverage expectancies. Following the bevera...