We know that there are large differences in outcome between people with schizophrenia, and there is evidence that these differences may be related to differences in cognitive skills such as the ability to pay attention, concentrate, remember things and solve problems. Furthermore, individuals with impaired cognitive skills linked to the illness often show less of an ability to benefit from psychosocial interventions designed for them. Thus, we have been running a study to investigate whether improving cognitive skill with a new behavioral intervention, called cognitive remediation, translates into better benefit from well-established psychosocial interventions and ultimately better outcomes for people with the illness.
Over the past four years, with the support of a NARSAD Young Investigator Grant, Bruce Wexler at Yale University, Kim Mueser at Boston University and I have been investigating the use of cognitive remediation, a novel intervention for cognitive impairment in schizophrenia and for increasing benefit from social skills training, a well-established psychosocial treatment for improving social function in people with schizophrenia. Cognitive remediation, which is a class of interventions designed to improve cognitive skills typically through the use of strategy training or repeated task practice, has shown strong efficacy in over 40 randomized, controlled trials. Social skills training has a longer history of research, also has a strong evidence base and produces real changes in social functioning both measured in role-plays and, much more importantly, in measures of community integration. In fact it is recommended regularly by panels of schizophrenia treatment experts in the U.S. and in other countries as a key treatment for schizophrenia (e.g. PORT guidelines, 2010).
To date we have enrolled 68 people with diagnoses of schizophrenia and/or schizoaffective disorder in the study. The results to date are very promising with ratings of social function showing greater improvement when social skills training is paired with cognitive remediation as compared to when social skills training is offered to individuals without cognitive remediation. These results are preliminary, and could change as the sample gets larger, but the results are exciting to us. They suggest the potential value of meshing different psychosocial treatments aimed at different aspects of illness-related disability for more optimal outcomes in the disease. This is a study which would likely never have occurred without the support of the Brain & Behavior Research Foundation.
by Matthew M. Kurtz, PhD
NARSAD Young Investigator Grantee