Abstract
The majority of patients with schizophrenia display neurocognitive deficits (e.g., memory impairment) as well as inflated cognitive biases (e.g., jumping to conclusions). Both cognitive domains are implicated in the pathogenesis of the disorder and are known to compromise functional outcome. At present, there is a dearth of effective treatment options. A total of 90 patients with schizophrenia were recruited online (a diagnosis of schizophrenia had been confirmed in a large subgroup during a previous hospital admission). Subsequent to a baseline assessment encompassing psychopathology, self-reported cognition as well as objective memory and reasoning tests, patients were randomized to one of three conditions: standard cognitive remediation (mybraintraining), metacognition-augmented cognition remediation (CR) condition (variant of mybraintraining which encouraged patients to reduce speed of decision-making and attenuate response confidence when participants made high-confidence judgements and hasty incorrect decisions) and a waitlist control group. Patients were retested after 6 weeks and again 3 months after the second assessment. Groups did not differ on psychopathology and neurocognitive parameters at any timepoint. However, at follow-up the metacognitive-augmented CR group displayed a significant reduction on jumping to conclusions and overconfidence. Treatment adherence correlated with a reduction of depression; gains in the training exercises from the standard mybraintraining condition were correlated with improved objective memory performance. The study suggests that metacognition-augmented CR may ameliorate cognitive biases but not neurocognition. The study ties in well with prior research showing that neurocognitive dysfunctions are rather resistant to change; the failure to detect significant improvement of CR or metacognition-augmented CR on psychopathology and neurocognition over time may partly be attributed to a number of methodological limitations of our study (low psychopathology and chronicity of participants, low “dosage,” narrow range of tests, self-report psychopathology scales).
Highlights
Schizophrenia is frequently accompanied by neuropsychological deficits which are spread across a wide range of cognitive functions (Heinrichs and Zakzanis, 1998; Keefe and Harvey, 2012)
Upon the approval of webmasters study invitations were posted in several guided self-help internet networks pertaining to schizophrenia and psychosis
Medication status did not change between groups (p > 0.3)
Summary
Schizophrenia is frequently accompanied by neuropsychological deficits which are spread across a wide range of cognitive functions (Heinrichs and Zakzanis, 1998; Keefe and Harvey, 2012). Memory and attention problems in concert with social cognitive impairments (Fett et al, 2011) are a major predictor for disability and low functional outcome in the disorder (Green, 1996; Green et al, 2004; Lepage et al, 2014). Compromised attention, reasoning, and memory capacity may limit the comprehension and internalization of knowledge and skills acquired during cognitive therapy and impede transfer to everyday life. Apart from early (neurodevelopmental) deficits that already manifest prior to the onset of the disorder (Bang et al, 2014; Corigliano et al, 2014), avolition/lack of effort and a restricted non-challenging environment/hospitalization may compromise cognition.
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