Towards personalizing cognitive remediation therapy: Examining moderators of response for euthymic people with bipolar disorder

Abstract

Background: Recent evidence suggests that cognitive remediation (CR) may reduce cognitive and functional difficulties in people with bipolar disorder (BD). However, there is a limited understanding of whether, and which, pre-treatment factors influence who will benefit from CR and this information could help to develop optimal therapy delivery. We aim to identify and examine baseline factors moderating post-treatment improvement.

Methods: This is a secondary analysis of data from a randomized controlled trial comparing CR (n = 40) to treatment-as-usual (TAU; n = 40) in euthymic people with BD. Elastic net regression was used to identify patient characteristics and baseline measures associated with post-treatment improvement in cognition, psychosocial functioning, and goal attainment. We then tested the moderating effect of retained variables on each outcome using multivariable linear regression.

Results: Despite lower baseline cognitive performance being associated with greater post-treatment changes in cognition and psychosocial functioning, there was no evidence of treatment response moderation. CR effect on goal attainment was larger for participants with better baseline cognitive performance, but this moderating effect did not reach significance (p = 0.09). Those with more severe baseline subjective cognitive complaints (p = 0.03) and more previously completed psychological therapies (p = 0.02) had also larger gains in goal attainment.

Conclusions: Treatment benefits in cognition and psychosocial functioning might not be affected by pre-treatment factors and patient characteristics. However, baseline cognition and perceived deficits may influence the effect of CR on achieving recovery goals. Therapy adaptations may be required to exert greater benefits for less responsive patients.

Keywords: Bipolar disorder; Cognition; Cognitive remediation; Functioning; Moderator; Personalized treatment.