Cognitive remediation in Schizophrenia: Improving our theoretical understandings and translation into practice

Abstract

Cognitive Remediation is a well-known learning-based, cognitive skills training intervention that has been found to be effective in improving cognitive, psychosocial and occupational functioning in psychiatric populations. Over the years, Cognitive Remediation has emerged as a measurable, affordable, and dynamic approach to treatment in schizophrenia, with a large literature base to support its effectiveness. While there is a robust research literature that has been conducted internationally, this field is still developing in many countries. Thus, the broad aim of this thesis was to explore the efficacy of Cognitive Remediation in augmenting psychosocial, occupational and cognition outcomes, and evaluate its application to real world functioning, in an Australian psychiatric population. In addition to examining whether improvements could be made to an existing Cognitive Remediation package by developing visual training modules. Two main investigations were conducted. The primary aim of the first proposed research was to determine whether Cognitive Remediation is beneficial for jobseekers with severe mental illness participating in a vocational assisted program. Outcomes of this pilot revealed improved occupational, psychosocial and cognitive factors, yet work participation was less promising than expected. This information was consistent with the thematic content provided by individuals enrolled in the research. A second study was designed to examine whether we could improve the efficacy of an existing Cognitive Remediation package. We aimed to do this by completing a randomized controlled pilot study, using a set of novel visual processing training modules in addition to standard Cognitive Remediation compared with just standard Cognitive Remediation. Neurocognitive and psychological assessments were used to assess the effectiveness of this domain-specific visual-processing Cognitive Remediation program, which we called Visual Processing Training (VPT). No overall neurocognitive differences were observed between participants who experienced the VPT and those who did not. Both groups showed cognitive and psychosocial improvements, which concurred with qualitative data. This thesis is noteworthy as it contains a comprehensive set of subjective data on Cognitive Remediation in Australia. The findings highlight that Cognitive Remediation training is positively experienced by participants, as well as improving cognitive and intrinsic functioning. This data can be used to develop guidelines to improve Cognitive Remediation practice. Implications of our findings are discussed in terms of clinical, theoretical and translational elements.