Compensatory Cognitive Training Helps Patients with Psychosis

Compensatory Cognitive Training Helps Patients With Psychosis

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By Will Boggs, MD

NEW YORK (Reuters Health) Aug 14 – Compensatory cognitive training (CCT) improves cognitive performance and functional outcomes in patients with psychosis, according to a new trial.

“CCT and other psychosocial treatments are showing real promise for treating the cognitive deficits, negative symptoms, and functional impairments of schizophrenia,” Dr. Elizabeth W. Twamley from University of California, San Diego, told Reuters Health by email.

“My hope is that in the next 50 years, psychosocial treatments will become a mainstay of treatment for schizophrenia, along with the antipsychotic medications that have been the mainstay of treatment for the last 50 years,” she added.

Dr. Twamley and colleagues created and pilot-tested a cognitive training intervention based on compensatory strategies, such as calendar use, self-talk, note taking, and a 6-step problem-solving method. They randomly assigned 69 outpatients with primary psychotic disorders to either cognitive training and standard pharmacotherapy or drugs alone.

The findings were published online August 7 in the Journal of Clinical Psychiatry.

Compared with controls, participants in the CCT program demonstrated significant improvements in attention and verbal memory at the 3-month follow-up, as well as a trend toward improved prospective memory.

CCT also boosted functional capacity such as household and shopping skills measured in role-play scenarios at the 3-month follow-up.

What’s more, Dr. Twamley and her colleagues found significant improvements in negative symptoms at post-treatment and 3-month follow-up, as well as significantly improved subjective quality of life at the 3-month follow-up.

CCT participants reported fewer cognitive problems and used more cognitive strategies than did standard pharmacotherapy participants.

“We consistently and overtly linked the CCT strategies to each participant’s real-world goals,” Dr. Twamley said. “From the man who used his calendar to track his glucose levels, to the woman who used flashcards to learn the names of her new friends in AA, the ability of our participants to creatively apply the CCT strategies to their own circumstances was really impressive.”

“The CCT manual was designed to be easy to deliver without extensive training,” Dr. Twamley explained. “To make it even easier for clinicians, we’ve created a therapist version of the manual that has tips on the back sides of the pages. The front sides of the pages are identical to the client version of the manual, so therapists and clients are literally on the same page during sessions.”

She added, “In our current NIMH-funded studies, we’re conducting randomized controlled trials comparing CCT to robust control conditions that match CCT for therapist time, so we’ll be able to demonstrate that the effects of CCT aren’t due to non-specific therapeutic factors. We’re also studying CCT in the context of supported employment and in other populations, such as people with first-episode psychosis and veterans with traumatic brain injury.”


J Clin Psychiatry 2012.

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