SU35. Treatment Outcome in Compensatory Cognitive Training for Schizophrenia: Therapeutic Alliance vs Learning Potential

Abstract

Abstract Background: Engaging an individual with schizophrenia in treatment can be challenging; however, research has shown that therapeutic alliance (TA) contributes to therapeutic outcomes as well as treatment continuation. Similarly, learning potential (LP) has also been found to predict treatment outcomes in therapies that require the ability to benefit from repeated practice and learning. Although prior research has focused on TA and LP separately when examining the effectiveness for treatment, studying both TA and LP together may give us a better understanding of how individuals with schizophrenia respond to a cognitive treatment. We sought to determine whether TA or LP would best predict treatment outcome in adults with schizophrenia receiving group-based compensatory cognitive training (CCT). Our hypothesis was that baseline LP would predict potential improvements in cognition given that the treatment was a cognitive-based intervention. In exploratory fashion, we also examined whether pre-post changes in TA or LP would be associated with potential pre-post changes in symptoms. Methods: Sixty-seven outpatients with schizophrenia were enrolled in a 3-month program called Compensatory Cognitive Training (CCT; Twamley et al, 2012) focused on prospective memory, attention skills, and executive functioning. Assessments of TA, LP, cognition, and symptoms were conducted at baseline and post. LP Index was calculated as the post minus the pretraining difference score following repeat administration and training on the Hopkins Verbal Learning Test-Revised (HVLT). TA was measured using the Working Alliance Inventory-Short Revised (WAI-SR), overall cognition was assessed with the Penn Computerized Neurocognitive Battery (CNB), while symptoms were measured with the Positive and Negative Syndrome Scale (PANSS). Results: While moderate pre-post improvements were seen in cognition (d = 0.52) and negative symptoms (d = 0.59), only baseline TA, and not LP, predicted pre-post cognitive improvement, accounting for 33% of the variance. Improvement in TA from baseline to post was also related to a greater reduction in overall psychotic symptoms, and in particularly, greater improvement in memory performance. Conclusion: Therapeutic alliance rather than learning potential was found to predict cognitive improvement and symptom reduction in a group-based therapy intended to improve cognitive skills. The therapeutic relationship continues to garner more empirical support as an important predictor of treatment outcome in cognitive treatments for schizophrenia. Understanding the importance and benefits of TA may help clinicians implement a more effective and enduring form of treatment for this population.