Compensatory Cognitive Training for Psychosis

Abstract

Treatments for the cognitive impairments of schizophrenia are urgently needed. We developed and tested a 12-week, group-based, manualized, compensatory cognitive training intervention targeting prospective memory, attention, learning/memory, and executive functioning. The intervention focused on compensatory strategies, such as calendar use, self-talk, note taking, and a 6-step problem-solving method, and did not require computers. In a randomized controlled trial, 69 outpatients with DSM-IV primary psychotic disorders were assigned to receive standard pharmacotherapy alone or compensatory cognitive training + standard pharmacotherapy for 12 weeks. Assessments of neuropsychological performance and functional capacity (primary outcomes) and psychiatric symptom severity, quality of life, social skills performance, cognitive insight, and self-reported everyday functioning (secondary outcomes) were administered at baseline, posttreatment, and 3-month follow-up. Data were collected between September 2003 and August 2009. Hierarchical linear modeling analyses demonstrated significant compensatory cognitive training-associated effects on attention at follow-up (P = .049), verbal memory at posttreatment and follow-up (P values ≤ .039), and functional capacity (University of California, San Diego Performance-based Skills Assessment) at follow-up (P = .004). The compensatory cognitive training group also differentially improved in negative symptom severity at posttreatment and follow-up (P values ≤ .025) and subjective quality of life at follow-up (P = .002). Compensatory cognitive training, a low-tech, brief intervention, has the potential to improve not only cognitive performance but also functional skills, negative symptoms, and self-rated quality of life in people with psychosis. ClinicalTrials.gov identifier: NCT01521026.