Computer-assisted cognitive remediation combined with strategic instruction achieves greater improvement in cognition than an active control in schizophrenia.

Abstract

Background and aims: Cognitive impairment is a core feature of schizophrenia and predicts psychosocial disability. Cognitive remediation (CR) has shown promise for addressing cognitive dysfunction in this illness. A limitation of past research, however, is that CR often occurs alongside other psychosocial interventions, preventing assessment of unique efficacy. Active control conditions and follow-up assessments are also inconsistently utilized. This study explored whether computer-assisted ‘drill-and-strategy’ cognitive remediation would produce greater improvements in cognition, living skills and self-efficacy than a computer gaming (CG) control. Method: Fifty-six outpatients with schizophrenia were randomized into CR or CG, and offered 20 one-hour computer sessions over 10 weeks. Cognition, psychiatric symptoms, independent living skills, self-efficacy and quality of life were assessed at baseline, end-group and 3 months follow-up. Results: Primary analysis was conducted for participants who completed the end-group assessment (CR=22; Control=21). Linear mixed-effect analysis found a significant interaction effect for cognition (p=.028). Bonferroni-adjusted pairwise comparisons revealed that cognition was better at end-group and 3 month follow-up than baseline for CR participants (both p<.01), with no differences between timepoints for control participants. A significant time effect was evident for self-efficacy (p=.028), with both conditions showing higher self-efficacy at end-group than baseline. No other significant effects were observed. Conclusions: CR combined with internal cognitive strategies may achieve unique improvements in cognition in people with schizophrenia, whereas broader participation in facilitated social groups may achieve improvements in everyday self-efficacy. An explicit focus on the translation of learning experiences may, however, be needed to achieve significant functional improvements.