Cognitive Enhancement Therapy Research Articles

Effects of Cognitive Enhancement Therapy on White Matter Microstructure and Extracellular Free-Water

Cognitive enhancement therapy (CET) is known to be an effective non-pharmacological intervention which addresses cognitive and functional impairments in individuals with schizophrenia; however, there is a limited understanding of the underlying neurobiological mechanisms of CET. This study aims to investigate the effects of CET on white matter alterations in early course schizophrenia utilizing free-water imaging.

The effectiveness of cognitive enhancement therapy in a community-based program

The following paper is the result of a semester-long program evaluation course at Spalding University, located in Louisville, Kentucky. During the course, the students were connected to Bridgehaven, a community based psychiatric rehabilitation and recovery program, also located in Louisville, Kentucky. The researchers of this project studied the long-term effectiveness of its Cognitive Enhancement Therapy (CET) program. Based on the data, the results did not yield significant results. However, this is potentially due to the low sample size and incomplete data set. In lieu of this, the researchers offered some recommendations to improve the collection of client information and possible future research.

Experiences of empowerment in a community cognitive enhancement therapy program: an exploratory qualitative study

ABSTRACTObjective: Empowerment is an important component of many recovery-oriented treatments for people diagnosed with psychosis. Cognitive Enhancement Therapy (CET) is an efficacious rehabilitation program targeting social and neuro- cognition, but secondary recovery benefits are unknown. The purpose of this exploratory study was to examine experiences of empowerment among CET participants.Method: Semi-structured interviews were conducted with 16 participants diagnosed with psychotic disorders. Interview transcripts were analyzed by three independent coders using thematic analysis.Results: Four themes consistent with empowerment theory emerged: (1) Peer support; (2) Optimism and control over the future; (3) Power; and (4) Self-esteem.Conclusions: Findings from this exploratory study suggest that experiences of empowerment are a measurable component of CET. Findings highlight opportunities to measure and target empowerment within cognitive rehabilitation and other recovery-oriented interventions.

Cognitive Function in Hospitalized Patients with Multiple Sclerosis: A Case-Control Study

Background: Multiple sclerosis (MS) is a chronic inflammatory disease characterized by central nervous system lesions that can lead to severe cognitive and physical disability, as well as neurological deficits such as attention and memory decline. The complications may bring about many difficulties for patients in educational and occupational functioning and low quality of life. Objectives: Considering the remarkable prevalence of cognitive deficits and its important effects on the occupational and social functioning of MSpatients, this study was conducted to investigate cognitive deficits in these patients compared to a control group. Methods: This case-control study was carried out on 34 MS patients selected from among patients admitted to Imam Reza Hospital and Razi Psychiatric Hospital in Tabriz, Iran. Moreover, a control group of 34 age and gender-matched patients admitted to internal wards was formed. The Persian version of the paper and pencil cognitive assessment package (PCAP) was used to assess cognitive functions. Data analysis was performed using SPSS version 22 software through descriptive statistics (mean and standard deviation) and inferential statistics (Student t-test and Pearson’s correlation test). A P value of < 0.05 was considered statistically significant. Results: The results of t-test showed that MS patients had lower PCAP mean scores than the control group in cognitive functions (executive function, attention, focus and work memory) (P < 0.05). Conclusions: The findings of this preliminary study confirmed that MS patients suffered from cognitive impairments. The assessment of cognitive functions must be done in MS patients. Cognitive enhancement therapy would be helpful for afflicted patients.

Treatment of Unhealthy Alcohol Use

Unhealthy alcohol use represents the fifth leading cause of morbidity and mortality globally, and the first leading cause among persons 18 to 45 years of age. Despite the global impact of unhealthy alcohol use, the adoption of evidence-based treatments has been sluggish. Behavioral strategies for lower level drinking include the brief motivational interview, designed to be within the scope of any healthcare provider, and more specialist-driven approaches for those with alcohol use disorder (AUD) such as cognitive behavioral therapy and motivational enhancement therapy. Benzodiazepines remain the mainstay treatment for inpatient alcohol withdrawal treatment, whereas other medications have similar efficacy in managing patients in the outpatient setting with milder forms of withdrawal. For maintenance treatment of AUD, four FDA-approved medications exist, with efficacy in treating AUD, as well as several non–FDA-approved medications that have been found to be effective in promoting abstinence and reducing drinking. The use of medication to treat many patients with AUD falls within the scope of primary care providers. This review contains 6 tables and 54 references. Key Words: addiction, alcohol, counseling, drinking, pharmacotherapy, primary care, psychotherapy, relapse, treatment

Treatment of Unhealthy Alcohol Use

Unhealthy alcohol use represents the fifth leading cause of morbidity and mortality globally, and the first leading cause among persons 18 to 45 years of age. Despite the global impact of unhealthy alcohol use, the adoption of evidence-based treatments has been sluggish. Behavioral strategies for lower level drinking include the brief motivational interview, designed to be within the scope of any healthcare provider, and more specialist-driven approaches for those with alcohol use disorder (AUD) such as cognitive behavioral therapy and motivational enhancement therapy. Benzodiazepines remain the mainstay treatment for inpatient alcohol withdrawal treatment, whereas other medications have similar efficacy in managing patients in the outpatient setting with milder forms of withdrawal. For maintenance treatment of AUD, four FDA-approved medications exist, with efficacy in treating AUD, as well as several non–FDA-approved medications that have been found to be effective in promoting abstinence and reducing drinking. The use of medication to treat many patients with AUD falls within the scope of primary care providers. This review contains 6 tables and 54 references. Key Words: addiction, alcohol, counseling, drinking, pharmacotherapy, primary care, psychotherapy, relapse, treatment

Treatment of Unhealthy Alcohol Use

Unhealthy alcohol use represents the fifth leading cause of morbidity and mortality globally, and the first leading cause among persons 18 to 45 years of age. Despite the global impact of unhealthy alcohol use, the adoption of evidence-based treatments has been sluggish. Behavioral strategies for lower level drinking include the brief motivational interview, designed to be within the scope of any healthcare provider, and more specialist-driven approaches for those with alcohol use disorder (AUD) such as cognitive behavioral therapy and motivational enhancement therapy. Benzodiazepines remain the mainstay treatment for inpatient alcohol withdrawal treatment, whereas other medications have similar efficacy in managing patients in the outpatient setting with milder forms of withdrawal. For maintenance treatment of AUD, four FDA-approved medications exist, with efficacy in treating AUD, as well as several non–FDA-approved medications that have been found to be effective in promoting abstinence and reducing drinking. The use of medication to treat many patients with AUD falls within the scope of primary care providers. This review contains 6 tables and 54 references. Key Words: addiction, alcohol, counseling, drinking, pharmacotherapy, primary care, psychotherapy, relapse, treatment

Cognitive Enhancement Therapy Improves Social Relationships Quality of Life among Individuals with Schizophrenia Misusing Substances

Cognitive Enhancement Therapy Improves Social Relationships Quality of Life among Individuals with Schizophrenia Misusing Substances

Cognitive Remediation Interventions in Schizoaffective Disorder: A Systematic Review.

Background: Patients with schizoaffective disorder (SAD) suffer from cognitive impairment, which negatively influences their functionality. Cognitive remediation (CR) interventions have been shown to be effective in patients with schizophrenia (SZ) and bipolar disorder (BD), but evidence in SAD is limited so far. The aim of this study is to systematically review the published data on CR interventions, either in neurocognition or social cognition, in patients with SAD.Methods: We conducted a comprehensive, computerized literature search using terms related to CR interventions in psychotic and affective disorders, and particularly in SAD. Pubmed, Embase, and Web of Knowledge databases were used up to February 28th, 2018 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search returned 2672 articles of which four were finally selected meeting the inclusion criteria.Results: Cognitive Enhancement Therapy, computerized Cognitive Remediation Therapy and Cognitive Training showed positive results in subsamples of patients with SAD regarding neurocognition and functioning in comparable terms to patients with schizophrenia as well as in a greater extent in quality of life. Benefits in social cognition were also described when Social Cognition Interaction Training was considered in patients with SAD.Conclusions: CR interventions seem to improve neurocognition and social cognition in patients with SAD as well as functioning and quality of life. However, further randomized controlled trials on CR interventions with an optimized design focusing on selected sample of patients with SAD are imperative.

Employment as a Social Determinant of Health: Exploring the Relationship Between Neurocognitive Function and Employment Status

Purpose:To explore employment as a social determinant of health through examining the relationship between neurocognitive function and employment status.Method:The authors explored the causal relationship between employment status and neurocognitive function by conducting a systematic review of 15 longitudinal studies. The identified studies were conducted in Australia, Denmark, Norway, and the United States.Results:Five neurocognitive function domains were identified (i.e., complex attention, executive function, learning and memory, language, perceptual-motor function) across diagnosis (i.e., bipolar disorder, first-episode psychosis, human immunodeficiency virus, major depression, schizophrenia-spectrum disorders, traumatic brain injury). Unemployment was correlated with poorer attention, executive function, learning and memory, perceptual-motor function, and language. Employment was correlated with better attention, executive function, learning and memory, perceptual-motor function.Conclusion:The acknowledgment of the relationship between neurocognitive function and employment status can assist service providers in assessing and developing strategies to enhance and maintain employment outcomes. The assessment of neurocognitive function could be further explored by identifying standard measures and assessment timelines to assess the six domains across diagnosis. Vocational rehabilitation services could integrate cognitive interventions (cognitive rehabilitation, cognitive enhancement therapy, cognitive remediation) to explore the effect on neurocognitive function and employment outcomes. Further longitudinal research studies are needed, for both persons with disabilities and persons without disabilities, to elucidate the relationship between employment status and neurocognitive function.

New Trends in the Treatment of Schizophrenia.

This article are to describe current trends in the treatment of schizophrenia and the most interesting new approaches to optimizing outcome and fostering the development of new schizophrenia treatments. Increasing utilization of diverse types of atypical antipsychotic drugs (AAPDs), e.g. clozapine- type serotonin (5-HT)2A and weak dopamine (DA) D2 antagonist, amisulpride, a D2/D3/5-HT7 antagonist, and cariprazine, a D3 partial agonist with additional neurotransmitter targets, is occurring as their advantages in efficacy, especially for cognitive impairment and mood symptoms, and side effects are becoming appreciated. Typical APDs, e.g. haloperidol, are diminishing in favor because of their EPS, especially, tardive dyskinesia (T D) and appreciation that reducing D2 receptor stimulation is not the only means to treat psychosis. Some of the mechanisms inherent in various AAPDs, e.g. 5-HT2A inverse agonism, and D3 receptor partial agonism, are now recognized as effective treatments for psychosis. A new focus on treating the cognitive impairment associated with schizophrenia (CIAS) has emerged via mechanisms such as stimulation of acetyldraline receptor with muscarinic and nicotinic receptor agonists, but demonstrating their efficacy in trials is proving elusive. Pharmacogenetic strategies which may lead to personalized treatment of schizophrenia are emerging but have not yet succeeded in being widely reimbursable. Transcranial stimulation and cognitive enhancement therapy are more common but more evidence for their efficacy is needed. The heterogeneity of the pathophysiology of the various domains of schizophrenia requires a diversity of treatments that are best met by the expert use of AAPDs at the current time. Pharmacogenetic efforts are consistent with new evidence that multiple genes are involved in the risk for schizophrenia and the effectiveness of AAPDs.

Cognitive enhancement therapy for adult autism spectrum disorder: Results of an 18-month randomized clinical trial.

Cognitive enhancement therapy (CET), an 18-month cognitive remediation intervention designed to improve thinking and social understanding, was found to be more effective than supportive therapy at improving mental quickness, attention, and employment in adults living with autism. Social understanding was equally improved in CET and supportive therapy. Cognitive remediation interventions are feasible and may confer significant functional benefits to adults with autism.

Effects of peer social interaction on performance during computerized cognitive remediation therapy in patients with early course schizophrenia: A pilot study

BackgroundRecent studies show that computer-based training enhances cognition in schizophrenia; furthermore, socialization has also been found to improve cognitive functions. It is generally believed that non-social cognitive remediation using computer exercises would be a pre-requisite for therapeutic benefits from social cognitive training. However, it is also possible that social interaction by itself enhances non-social cognitive functions; this possibility has scarcely been explored in schizophrenia patients. This pilot study examined the effects of computer-based neurocognitive training, along with social interaction either with a peer (PSI) or without one (N-PSI). We hypothesized that PSI will enhance cognitive performance during computerized exercises in schizophrenia, as compared with N-PSI. MethodsSixteen adult participants diagnosed with schizophrenia or schizoaffective disorder participating in an ongoing trial of Cognitive Enhancement Therapy completed several computerized neurocognitive remediation training sessions (the Orientation Remedial Module©, or ORM), either with a peer or without a peer. ResultsWe observed a significant interaction between the effect of PSI and performance on the different cognitive exercises (p<0.05). More precisely, when patients performed the session with PSI, they demonstrated better cognitive performances than with N-PSI in the ORM exercise that provides training in processing speed, alertness, and reaction time (the standard Attention Reaction Conditioner, or ARC) (p<0.01, corrected). PSI did not significantly affect other cognitive domains such as target detection and spatial attention. ConclusionOur findings suggest that PSI could improve cognitive performance, such as processing speed, during computerized cognitive training in schizophrenia. Additional studies investigating the effect of PSI during cognitive remediation are needed to further evaluate this hypothesis.

SA122. Participant Satisfaction and Subjective Experiences in a Community-Based Cognitive Enhancement Therapy Program

Background: Cognitive Enhancement Therapy (CET) is an effective treatment to improve social cognition and neurocognition for individuals with schizophrenia (Hogarty & Flesher, 1999). CET is associated with improvement in employment (Eack et al., 2009), functional outcomes (Eack et al., 2011), and reducing negative symptoms (Eack et al, 2013). While CET is linked to these outcomes, research has not investigated client satisfaction and subjective experiences. Our proposed study hopes to address this gap in the literature and evaluate experiences and satisfaction in a diverse community medical center. Methods: The current study utilizes participants (N = 17) engaging in CET. Participants completed a satisfaction survey and semistructured interview to capture satisfaction and subjective experiences. Surveys consist of 13 questions stressing CET components such as satisfaction, coaching, and homework. Survey questions are on a Likert-type scale with 1 being “completely disagree” and 5 being “completely agree”. Semistructured interviews consist of 8 open-ended questions exploring likes/dislikes, accomplishments, and areas of learning. Descriptive statistics of surveys were analyzed and thematic analysis was used to code transcribed interviews. Results: Participants’ mean age was 42.24 (SD = 12.23). All participants were diagnosed with a schizophrenia spectrum disorder (N=17). Participants’ racial/ethnic backgrounds included Caucasian/white (n = 5), African American/black (n = 5), multiracial (n = 4), and Asian/Pacific Islander (n = 3). Results from surveys indicated that CET is worth their time (n = 17, 100%), satisfaction with CET classes is high (M = 4.06), and all CET participants feel comfortable talking with their CET coach (n = 17, 100%). Several themes from interviews emerged. Themes indicated that CET compared to other groups (1) is more difficult, (2) feels more educational, and (3) has more client participation and coach questioning. Interviews also suggested that participants find CET beneficial due to (1) treatment being interactive, (2) promotion of learning communication and social skills, (3) improved attention, and (4) individual coaching and feedback. More details about participant surveys and interviews will be reported. Conclusion: The current study shows preliminary evidence that CET is a unique and satisfactory treatment. Previous research shows that client preferences affect satisfaction, completion, and clinical outcomes (Lindhiem et al., 2014). Thus, more research is needed to measure program satisfaction and experiences to improve outcomes.

107. Ten-Year Durability Effects of Cognitive Enhancement Therapy in Early Course Schizophrenia

Abstract Background: The purpose of this investigation was to examine the long-term trajectories of cognitive, functional, and clinical outcomes following Cognitive Enhancement Therapy (CET) in early course schizophrenia. Methods: Schizophrenia outpatients from a 2-year randomized clinical trial of CET applied in the early course of the illness (Eack et al., 2009) are completing a 10-year post-treatment follow-up study. Currently, a total of 25 participants (CET: n = 14; EST: n = 11) from the original trial have completed a comprehensive battery of cognitive, functional, and clinical assessments identical to those in the original trial. Composite indexes were calculated for processing speed, neurocognition, social cognition, functioning, and symptomatology. Linear growth curve models were used to examine longitudinal durability differences in these five domains 10-years following treatment with either CET or an Enriched Supportive Therapy (EST) comparison treatment. Results: Social-cognitive ability favoring CET was stable across the 10-year follow-up period, with continued evidence of group separation (F = 2.76, P = .049) and no evidence of erosion of efficacy (t = 1.53, P = .130). Some reduction in functioning was observed in both groups after completing treatment (all P < .001), but after 10 years patients in CET retained a higher level of functioning over the follow-up period (F = 3.32, P = .025). To our surprise, both groups displayed a steady improvement in neurocognition over the 10-year period (all P < .001). As reported in the original trial, no impact on processing speed was observed among these previously early course patients who exhibited high levels of baseline speed of processing (F = .52, P = .673). Finally, group separation favoring CET in symptomatology continued to persist relative to EST over the course of 10-year follow-up (F = 4.25, P = .009). Conclusion: Although these data are considered preliminary, the results suggest that CET is an effective treatment that contributes to long-term and stable improvements in cognition and functional outcome in people with schizophrenia treated in the early course of the illness.Eack, S. M., Greenwald, D. P., Hogarty, S. S., Cooley, S. J., DiBarry, A. L., Montrose, D. M., & Keshavan, M. S. (2009). Cognitive enhancement therapy for early-course schizophrenia: effects of a two-year randomized controlled trial. Psychiatric Services, 60(11), 1468–1476.

The Relationship of Meta-Emotion Dimensions and Positive and Negative Symptoms in the Patients of Chronic Schizophrenia

The aim of the present research was to determine the relationship of meta-emotion dimensions and positive and negative symptoms in the patients with chronic schizophrenia. This research is a correlation study. The statistical sample of the current research includes 100 patients with chronic schizophrenia. To collect the data, Meta-Emotion Questionnaire, Positive, and Negative Symptoms Schizophrenia Scale were used. The results of Pearson correlation coefficient showed meta-emotion with positive and negative symptoms. These results suggest that the meta-emotion of chronic schizophrenia patients may well be of important prognostic value in the intensity of symptom logy, prevention and planning of cognitive enhancement therapy.

Longitudinal functional brain imaging study in early course schizophrenia before and after cognitive enhancement therapy

ObjectiveSchizophrenia is characterized by impaired -social and non social cognition both of which lead to functional deficits. These deficits may benefit from cognitive remediation, but the neural underpinnings of such improvements have not been clearly delineated. MethodsWe conducted a functional magnetic resonance (fMRI) study in early course schizophrenia patients randomly assigned to cognitive enhancement therapy (CET) or enriched supportive therapy (EST) and treated for two years. Imaging data over three time points including fMRI blood oxygen level dependent (BOLD) data were acquired during performance of a cognitive control paradigm, the Preparing to Overcome Prepotency (POP) task, and functional connectivity data, were analyzed. ResultsDuring the two years of treatment, CET patients showed a continual increase in BOLD activity in the right dorsolateral prefrontal cortex (DLPFC), whereas EST patients tended to show no change in prefrontal brain function throughout treatment. Increases in right DLPFC activity were modestly associated with improved neurocognition (β = .14, p = .041), but not social cognition. Functional connectivity analyses showed reduced connectivity between the DLPFC and the anterior cingulate cortex (ACC) in CET compared to EST over the two years of treatment, which was associated with neurocognitive improvement. Conclusions. These findings suggest that CET leads to enhanced neural activity in brain regions mediating cognitive control and increased efficiency in prefrontal circuits; such changes may be related to the observed therapeutic effects of CET on neurocognitive function.

Multimodal Cognitive Enhancement Therapy for Patients with Mild Cognitive Impairment and Mild Dementia: AMulti- Center, Randomized, Controlled, Double-Blind, Crossover Trial.

We developed and evaluated the effect of Multimodal Cognitive Enhancement Therapy (MCET) consisting of cognitive training, cognitive stimulations, reality orientation, physical therapy, reminiscence therapy, and music therapy in combination in older people with mild cognitive impairment (MCI) or mild dementia. This study was amulti-center, double-blind, randomized, placebo-controlled, two-period cross-over study (two 8-week treatment phases separated by a4-week wash-out period). Sixty-four participants with MCI or dementia whose Clinical Dementia Rating was 0.5 or 1 were randomized to the MCET group or the mock-therapy (placebo) group. Outcomes were measured at baseline, week 9, and week 21. Fifty-five patients completed the study. Mini-Mental State Examination (effect size = 0.47, p = 0.013) and Alzheimer's Disease Assessment Scale-Cognitive Subscale (effect size = 0.35, p = 0.045) scores were significantly improved in the MCET compared with mock-therapy group. Revised Memory and Behavior Problems Checklist frequency (effect size = 0.38, p = 0.046) and self-rated Quality of Life - Alzheimer's Disease (effect size = 0.39, p = 0.047) scores were significantly improved in the MCET compared with mock-therapy. MCET improved cognition, behavior, and quality of life in people with MCI or mild dementia more effectively than conventional cognitive enhancing activities did.

Adapting cognitive remediation to a group home: A brief report.

This pilot project was designed to develop procedures for and test the feasibility of implementing Cognitive Enhancement Therapy (CET) in a group home environment, with a goal of maximizing treatment efficacy by augmenting social engagement in group CET sessions with ongoing social interaction. Six participants who met criteria including chronic schizophrenia were recruited in a group home with 30 residents. After two months of CET, pre-and posttest measures, including cognitive tests, were administered and qualitative interviews were conducted periodically. Interaction was observed in the house and staff members were interviewed in a focus group. Five of the initial six participants completed the intervention-which continued for a total of 45 weeks-engaging in weekly group CET sessions and computer exercises outside of the formal sessions. All participants liked the computer exercises, and all but one participated in and reported enjoying the group exercises. Observations and staff comments indicated increased social interaction and sustained impact for some residents. Some aspects of cognitive functioning improved for some participants during the initial two months. CET now needs to be tested more formally to determine if it can be delivered successfully in other group homes with a manualized procedure. The idea should be tested that feedback effects due to the sustained social contact may enhance the effectiveness of CET in group homes and lead to larger, sustained gains in community functioning. Clinicians who provide cognitive interventions should focus attention on the social context in which treatment is delivered and consider providing treatment to patient groups whose daily, ongoing social interaction can enhance its effects.

Cognitive Enhancement Therapy Improves Resting-State Functional Connectivity in Early Course Schizophrenia.

Cognitive remediation is emerging as an effective psychosocial intervention for addressing untreated cognitive and functional impairments in persons with schizophrenia, and might achieve its benefits through neuroplastic changes in brain connectivity. This study seeks to examine the effects of cognitive enhancement therapy (CET) on fronto-temporal brain connectivity in a randomized controlled trial with individuals in the early course of schizophrenia. Stabilized, early course outpatients with schizophrenia or schizoaffective disorder (N = 41) were randomly assigned to CET (n = 25) or an active enriched supportive therapy (EST) control (n = 16) and treated for 2 years. Functional MRI data were collected annually, and pseudo resting-state functional connectivity analysis was used to examine differential changes in fronto-temporal connectivity between those treated with CET compared with EST. Individuals receiving CET evidenced significantly less functional connectivity loss between the resting-state network and the left dorsolateral prefrontal cortex as well as significantly increased connectivity with the right insular cortex compared to EST (all corrected p < .01). These neural networks are involved in emotion processing and problem-solving. Increased connectivity with the right insula significantly mediated CET effects on improved emotion perception (z' = -1.96, p = .021), and increased connectivity with the left dorsolateral prefrontal cortex mediated CET-related improvements in emotion regulation (z' = -1.71, p = .052). These findings provide preliminary evidence that CET, a psychosocial cognitive remediation intervention, may enhance connectivity between frontal and temporal brain regions implicated in problem-solving and emotion processing in service of cognitive enhancement in schizophrenia.