A Multisite, Randomized Controlled Clinical Trial of Computerized Cognitive Remediation Therapy for Schizophrenia

Abstract

The effectiveness of cognitive remediation therapy (CRT) for the neuropsychological deficits seen in schizophrenia is supported by meta-analysis. However, a recent methodologically rigorous trial had negative findings. In this study, 130 chronic schizophrenic patients were randomly assigned to computerized CRT, an active computerized control condition (CC) or treatment as usual (TAU). Primary outcome measures were 2 ecologically valid batteries of executive function and memory, rated under blind conditions; other executive and memory tests and a measure of overall cognitive function were also employed. Carer ratings of executive and memory failures in daily life were obtained before and after treatment. Computerized CRT was found to produce improvement on the training tasks, but this did not transfer to gains on the primary outcome measures and most other neuropsychological tests in comparison to either CC or TAU conditions. Nor did the intervention result in benefits on carer ratings of daily life cognitive failures. According to this study, computerized CRT is not effective in schizophrenia. The use of both active and passive CCs suggests that nature of the control group is not an important factor influencing results.

Keywords: cognition; cognitive remediation; neuropsychology; schizophrenia.

Fig. 1.

CONSORT flow diagram of the clinical trial.

Fig. 2.

Changes in performance over time in the cognitive remediation therapy group on the different components of the FesKits program. Means for each time point (month) represent level of difficulty reached on the exercises of every component of the program.

Fig. 3.

Overall scores on the executive function battery (Behavioral Assessment of the Dysexecutive Syndrome) and memory the battery (Rivermead Behavioral Memory Test) in the 3 groups at the beginning and end of the trial.

Fig. 4.

Carer ratings of executive functioning (Dysexecutive Questionnaire) and memory (Memory Checklist) in the 3 groups at the beginning and end of the trial.