Cognitive Remediation for Schizophrenia: A Review of Recent Findings

Abstract

Schizophrenia and related psychotic disorders are characterized by deficits in neurocognition. Deficits in domains such as attention, memory, executive functions, and speed of processing, as well as early perceptual processes, typically appear early in the course of the disorder and remain stable over time. Cognitive deficits can cause serious impairments in community functioning (i.e., work, independent living, and social relationships). For this reason, cognitive remediation (CR) is increasingly utilized to improve neurocognition. The empirical support for CR for adults with chronic schizophrenia is encouraging and growing. CR approaches are suitable for widespread dissemination and have been the focus of the majority of recent empirical research in psychoses. There are two broad categories of computerized CR approaches: those that target higher-level cognitive processes, and those that target neuroplasticity using basic auditory and visual processing. Research currently supports the efficacy of both higher-level and neuroplasticity-based CR for improving targeted cognitive domains; however, there is more consistent support for higher-level approaches in terms of generalization to untrained cognitive domains and functional outcomes. To achieve functional outcomes, CR combined with skills training or other psychosocial rehabilitation approaches is likely the most effective approach. The majority of CR interventions allow difficulty to be individually adjusted, which is an important therapeutic feature, and some provide an array of modules to allow personalized interventions. Several CR interventions appear to have durable treatment benefits, but more research is needed to clarify whether booster sessions, pharmacological augmentation, or other treatments should routinely be incorporated into treatment plans.