Abstract
Cognitive remediation performed in a cognitive laboratory was compared with a sham control using portable brain games to study effects on vocational, neurocognitive, and functional outcomes for participants with psychotic disorders in vocational rehabilitation (VR). Seventy-seven participants (61% schizophrenia, 39% other psychosis) in transitional (45.5%) or supported employment (54.5%) were randomly assigned to 6 months of portable cognitive-games (CG) or cognitive remediation (CR) plus a weekly goal-setting group, and evaluated during training, post-training and at 12 months. Overall rates of employment did not differ significantly at 12-month follow-up; however, VR + CG attained employment more rapidly during training. A significant time by condition interaction favored VR + CR on Quality of Life Total Score and Instrumental Functioning over 12 months. Neurocognitive outcomes favored VR + CR, particularly on attention. Training hours related significantly to neurocognitive improvement regardless of condition. No differences were found in training adherence despite portability for VR + CG. Results indicate that VR + CR had significantly greater effect than VR + CG on neurocognition and community functioning, but not on employment outcome. Job attainment rates during the training period revealed a potential advantage for portable training raising new questions concerning how cognitive remediation can be most effectively integrated with VR.
Highlights
Recent reviews of cognitive remediation (CR) for people with schizophrenia have found moderate effect sizes on neurocognitive outcomes, and there has been growing evidence for generalized benefits to social role functioning when paired with rehabilitation interventions
An upshift in employment in vocational rehabilitation (VR) + CR following completion of cognitive training, reaching levels equivalent to VR + CG by 12 months, supports the interpretation that participants in this condition only fully engaged in job searching after completing the 6-month curriculum of cognitive training
Since hours spent training did not differ by condition and appeared unrelated to attaining employment by 12 months, it remains possible that coming into the “cognitive training laboratory (Cog Lab)” rather than using a portable training system may have had an opportunity cost in terms of employment
Summary
Recent reviews of cognitive remediation (CR) for people with schizophrenia have found moderate effect sizes on neurocognitive outcomes, and there has been growing evidence for generalized benefits to social role functioning when paired with rehabilitation interventions. Data collection was begun in 2009 and completed in 2015 To our knowledge, it is the first study conducted on individuals with schizophrenia-spectrum illness designed to compare CR in the context of a range of vocational rehabilitation services with an active sham control comprised of portable “brain-games.”. We couldn’t do that comparison, it was still an important question to test whether portability would lead to more training adherence For these reasons, we hypothesized that (1) scientifically supported CR training would be more effective in improving neurocognitive function than a face valid, sham control, and that these neurocognitive benefits would generalize to superior vocational outcomes and community functioning; and (2) portability of computer training would lead to more overall training activity
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