Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Jul 8;47(4):997-1006.
doi: 10.1093/schbul/sbab022.

A Meta-analysis of Cognitive Remediation for Schizophrenia: Efficacy and the Role of Participant and Treatment Factors

Julia A Lejeune  1   2 , Andrew Northrop  1 , Matthew M Kurtz  1
Affiliations
Meta-Analysis

A Meta-analysis of Cognitive Remediation for Schizophrenia: Efficacy and the Role of Participant and Treatment Factors

Julia A Lejeune et al. Schizophr Bull. .

Abstract

The number of randomized, controlled studies of cognitive remediation (CR) for schizophrenia, a therapeutic approach designed to improve cognitive skills and function, has grown substantially over the past 20 years. Active elements of CR treatment, however, remain unknown. The current meta-analysis investigated treatment, study, and participant factors in the size of observed treatment effects. Electronic databases were searched up to May 2020 using variants of the key words "cognitive remediation," "clinical trials," and "schizophrenia." This search produced 73 unique, randomized, controlled trials. Data were independently extracted by 3 reviewers with excellent reliability. Random-effects models were used to assess primary cognitive and secondary symptom and functional outcomes. Moderator analyses investigated the role of a variety of treatment, study, and participant factors. The meta-analysis (4594 participants) revealed that CR produced significant small-to-moderate size improvements in all domains of cognition studied (Hedge's gs = .19-.33). and a significant small improvement in function (Hedge's g = .21). CR programs that included a discussion ("bridging") group to help apply acquired cognitive skills to everyday life produced larger effects on global cognition and verbal memory. CR programs with strategy-coaching produced larger effects on episodic memory. Sample age, gender, positive, negative, and overall symptoms, and medication dose did not serve as barriers to treatment gains. CR produces small-to-moderate improvements in cognition and function in schizophrenia. Programs of CR that utilize bridging groups and strategy-coaching are more cognitively potent. Future research should focus on ways to modify CR to bolster generalization of cognitive improvements to function.

Keywords: cognitive rehabilitation; cognitive training; psychosis; severe mental illness.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
PRISMA flow diagram. *Multiple published articles representing results from a single RCT were grouped together.
Fig. 2.
Fig. 2.
The effects of bridging groups on global cognition and verbal memory. Error bars show standard error of mean Hedge’s g. *P < .05.
Fig. 3.
Fig. 3.
The effects of strategy coaching on verbal and visual memory. Error bars show standard error of mean Hedge’s g. *P < .05.
See this image and copyright information in PMC

References

    1. Fett A-KJ, Velthorst E, Reichenberg A, et al. . Long-term changes in cognitive functioning in individuals with psychotic disorders: findings from the Suffolk County Mental Health Project. JAMA Psychiatry. 2020;77(4):387. doi:10.1001/jamapsychiatry.2019.3993 - DOI - PMC - PubMed
    1. Schaefer J, Giangrande E, Weinberger DR, Dickinson D. The global cognitive impairment in schizophrenia: consistent over decades and around the world. Schizophr Res. 2013;150(1):42–50. doi:10.1016/j.schres.2013.07.009 - DOI - PMC - PubMed
    1. Green MF, Llerena K, Kern RS. The “Right Stuff” revisited: what have we learned about the determinants of daily functioning in schizophrenia? Schizophr Bull. 2015;41(4):781–785. doi:10.1093/schbul/sbv018 - DOI - PMC - PubMed
    1. Green MF, Kern RS, Heaton RK. Longitudinal studies of cognition and functional outcome in schizophrenia: implications for MATRICS. Schizophr Res. 2004;72(1):41–51. doi:10.1016/j.schres.2004.09.009 - DOI - PubMed
    1. Fett A-KJ, Viechtbauer W, Dominguez M-G, Penn DL, van Os J, Krabbendam L. The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: a meta-analysis. Neurosci Biobehav Rev. 2011;35(3):573–588. doi:10.1016/j.neubiorev.2010.07.001 - DOI - PubMed

Publication types