Cognitive remediation aims to help people with psychosis improve their cognitive abilities (such as problem-solving) and daily function, so that they can maintain a job and relationships, for example.
National Institute for Health and Care Excellence (NICE) guidelines recommend cognitive remediation for psychosis which is severe and resistant to other approaches (complex psychosis), but not yet for people with early psychosis.
Among people with early psychosis, researchers compared group delivery of cognitive remediation with 1-to-1 sessions. They found that both approaches were more effective in the short-term than treatment as usual and offered good value for money. The findings suggest that cognitive remediation, delivered either via groups or 1-to-1 sessions, is effective and cost-effective as an early intervention in psychosis.
The researchers invited people with first episode psychosis (aged 16 to 45) from 11 Early Intervention for Psychosis services in England. Most participants (73%) were men, and their average age was 26 years.
All participants received standard care, which involves education and employment support, along with medication. Some received cognitive remediation, in addition. Cognitive remediation was delivered digitally using CIRCuiTS, which was co-developed with service users and therapists and is based on cognitive practice, strategy use and metacognition engagement. A trained therapist provided different levels of support.
The study compared groups who received standard care plus:
- cognitive remediation in 1-to-1 sessions with a therapist twice weekly for 10 and a half weeks (112 people)
- cognitive remediation in group sessions 3 times weekly for 12 weeks, in groups of up to 4 (134 people)
- cognitive remediation independently with access to a therapist for up to half an hour per week for 12 weeks (65 people)
- no extra intervention (66 people).
The therapy window was constrained to 12 weeks and missing sessions were not replaced. Therapists were trained graduate-level psychologists (25–30 h training for up to 12 weeks). Full attendance was low. Most participants received 1 therapy session (93%). Those who failed to attend 6 sessions (38% for groups; 23% for 1-to-1 sessions) were considered to have dropped out.
Til Wykes, Professor of Clinical Psychology and Rehabilitation at King’s College London and study author said:
“We now know that cognitive remediation is beneficial for individual recovery and works best if a therapist is involved. We measured changes towards people’s specific goals to see how treatment affects them personally.”
Paul French, National Specialty Lead Mental Health, NIHR Research Delivery Network commented that
“Cognitive remediation has some evidence behind it, but it is not routinely offered by Early Intervention for Psychosis services. The main interventions offered by these services coincide with NICE and National Clinical Audit of Psychosis (NCAP) guidelines. Until NICE updates its guidelines for psychosis, and NCAP incorporates them, it is unlikely that services will prioritise cognitive remediation. Cognitive remediation is used more in rehabilitation but I support further work on cognitive remediation in early intervention.”
NIHR Evidence: How best to deliver cognitive remediation for psychosis?
Schizophrenia Bulletin: Cognitive Remediation Works But How Should We Provide It? An Adaptive Randomized Controlled Trial of Delivery Methods Using a Patient Nominated Recovery Outcome in First-Episode Participants
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