A Pilot Study Comparing Two Cognitive Training Approaches in Psychosis-Spectrum Disorders: Effects on Cognition, Symptoms, and Functioning

Cognitive impairment is a core feature of schizophrenia. Deficits in cognition are independent of clinical symptoms, resistant to antipsychotic medication, and are one of the most reliable predictors of functional outcome. Cognitive Remediation (CR) is an avenue of behavioral treatment designed to enhance cognition and, in turn, daily living skills and psychosocial functioning. Two CR models have been identified as effective in schizophrenia: the drill-and-practice approach and the strategy-based approach. The present study is the first to compare the two models directly in a randomized controlled trial. 21 clinically stable community-dwelling adults with psychotic disorders were enrolled, and 14 completed a three-month trial of either a computerized drill-and-practice program (PSSCogRehab), a strategy-based compensatory cognitive training group (CCT), or treatment as usual. All research was done at a public mental health center in Middletown, CT. It was hypothesized that both models of CR would have positive effects on cognitive performance, while CCT would produce greater improvements on functioning. Consistent with past research (Cella et al., 2016; Twamley et al., 2012), both CR groups improved in clinical symptom severity. Within group analyses revealed that PSSCogRehab produced improvement in negative symptoms (p=0.017), and CCT produced improvement in both general psychopathology symptoms (p=0.016) and self-efficacy (p=0.048). To date, significant changes have not been observed in cognition or psychosocial function. While a larger sample size is needed before meaningful conclusions can be drawn about the efficacy of either treatment protocol, initial results regarding symptoms and self-efficacy are promising. Moreover, high attendance rates indicate the feasibility and success of CR implementation in the public sector.