Skip to main content
×
Home
    • Aa
    • Aa

Effectiveness of a low support, remotely accessible, cognitive remediation training programme for chronic psychosis: cognitive, functional and cortical outcomes from a single blind randomised controlled trial

  • G. Donohoe (a1), R. Dillon (a2), A. Hargreaves (a2), O. Mothersill (a1), M. Castorina (a3), E. Furey (a1), A. J. Fagan (a4), J. F. Meaney (a4), B. Fitzmaurice (a2), B. Hallahan (a5), C. McDonald (a5), T. Wykes (a6), A. Corvin (a2) and I. H. Robertson (a3)...
Abstract
Background

Cognitive remediation (CR) training has emerged as a promising approach to improving cognitive deficits in schizophrenia and related psychosis. The limited availability of psychological services for psychosis is a major barrier to accessing this intervention however. This study investigated the effectiveness of a low support, remotely accessible, computerised working memory (WM) training programme in patients with psychosis.

Methods

Ninety patients were enrolled into a single blind randomised controlled trial of CR. Effectiveness of the intervention was assessed in terms of neuropsychological performance, social and occupational function, and functional MRI 2 weeks post-intervention, with neuropsychological and social function again assessed 3–6 months post-treatment.

Results

Patients who completed the intervention showed significant gains in both neuropsychological function (measured using both untrained WM and episodic task performance, and a measure of performance IQ), and social function at both 2-week follow-up and 3–6-month follow-up timepoints. Furthermore, patients who completed MRI scanning showed improved resting state functional connectivity relative to patients in the placebo condition.

Conclusions

CR training has already been shown to improve cognitive and social function in patient with psychosis. This study demonstrates that, at least for some chronic but stable outpatients, a low support treatment was associated with gains that were comparable with those reported for CR delivered entirely on a 1:1 basis. We conclude that CR has potential to be delivered even in services in which psychological supports for patients with psychosis are limited.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Effectiveness of a low support, remotely accessible, cognitive remediation training programme for chronic psychosis: cognitive, functional and cortical outcomes from a single blind randomised controlled trial
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Effectiveness of a low support, remotely accessible, cognitive remediation training programme for chronic psychosis: cognitive, functional and cortical outcomes from a single blind randomised controlled trial
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Effectiveness of a low support, remotely accessible, cognitive remediation training programme for chronic psychosis: cognitive, functional and cortical outcomes from a single blind randomised controlled trial
      Available formats
      ×
Copyright
Corresponding author
*Address for correspondence: Prof. G. Donohoe, School of Psychology and Center for Neuroimaging and Cognitive Genetics, National University of Ireland, Galway, Ireland. (Email: donoghug@tcd.ie)
Footnotes
Hide All

These authors contributed equally to this work.

Footnotes
References
Hide All
AndreasenNC (1984). Scale for the Assessment of Positive Symptoms (SAPS). University of Iowa: Iowa City.
AndreasenNC (1989). Scale for the Assessment of Negative Symptoms (SANS). University of Iowa: Iowa City.
AnthesE (2016). Mental health: There's an app for that. Nature 532, 2023.
BaddeleyA (2000). The episodic buffer: a new component of working memory? Trends in Cognitive Sciences 4, 417423.
Baron-CohenS, JolliffeT, MortimoreC, RobertsonM (1997). Another advanced test of theory of mind: Evidence from very high functioning adults with autism or Asperger syndrome. Journal of Child Psychology and Psychiatry 38, 813822.
ConstantinidisC, KlingbergT (2016). The neuroscience of working memory capacity and training. Nature Reviews Neuroscience 17, 438449.
FettAKJ, ViechtbauerW, PennDL, van OsJ, KrabbendamL (2011). The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: a meta-analysis. Neuroscience and Biobehavioral Reviews 35, 573588.
FisherM, HollandC, MerzenichMM, VinogradovS (2009). Using neuroplasticity-based auditory training to improve verbal memory in schizophrenia. American Journal of Psychiatry 166, 805811.
FisherM, HollandC, SubramaniamK, VinogradovS (2010). Neuroplasticity-based cognitive training in schizophrenia: an interim report on the effects 6 months later. Schizophrenia Bulletin 36, 869879.
FiszdonJM, BrysonGJ, WexlerBE, BellMD (2004). Durability of cognitive remediation training in schizophrenia: performance on two memory tasks at 6-month and 12-month follow-up. Psychiatry Research 125, 17.
GläscherJ, GitelmanD (2008). Contrast weights in flexible factorial design with multiple groups of subjects. JISCMAIL. AC. UK.(https://www.jiscmail.ac.uk/cgibin/webadmin?A2=ind0803&L=SPM&P=R16629)
GreenMF (1996). What are the functional consequences of neurocognitive deficits in schizophrenia? American Journal of Psychiatry 153, 321.
GreenMF (2016). Impact of cognitive and social cognitive impairment on functional outcomes in patients with schizophrenia. Journal of Clinical Psychiatry 77 (Suppl. 2), 811.
GreenMF, KernRS, BraffDL, MintzJ (2000). Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the ‘right stuff’? Schizophrenia Bulletin 26, 119.
HargreavesA, DillonR, Anderson-SchmidtH, CorvinA, FitzmauriceB, CastorinaM, RobertsonIH, DonohoeG (2015). Computerised working-memory focused cognitive remediation therapy for psychosis – a preliminary study. Schizophrenia Research 169, 135140.
HautKM, LimKO, MacDonaldA (2010). Prefrontal cortical changes following cognitive training in patients with chronic schizophrenia: effects of practice, generalization, and specificity. Neuropsychopharmacology 35, 18501859.
HeatonRK, StaffPAR (2003). Wisconsin Card Sorting Test: Computer Version 4-Research Edition (WCST: CV4). Psychological Assessment Resources: Lutz, FL.
HubacherM, WeilandM, CalabreseP, StoppeG, StöcklinM, Fischer-BarnicolD, OpwisK, PennerIK (2013). Working memory training in patients with chronic schizophrenia: a pilot study. Psychiatry Journal, Article ID 154867, 8. doi: 10.1155/2013/154867.
IsaacC, JanuelD (2016). Neural correlates of cognitive improvements following cognitive remediation in schizophrenia: a systematic review of randomized trials. Socioaffective Neuroscience & Psychology 6, 30054.
JaeggiSM, BuschkuehlM, JonidesJ, PerrigWJ (2008). Improving fluid intelligence with training on working memory. Proceedings of the National Academy of Sciences of the United States of America 105, 68296833.
JaeggiSM, BuschkuehlM, PerrigWJ, MeierB (2010). The concurrent validity of the N-back task as a working memory measure. Memory 18, 394412.
JollesDD, van BuchemMA, CroneEA, RomboutsSA (2013). Functional brain connectivity at rest changes after working memory training. Human Brain Mapping 34, 396406.
KlingbergT (2010). Training and plasticity of working memory. Trends in Cognitive Sciences 14, 317324.
KunduB, SuttererDW, EmrichSM, PostleBR (2013). Strengthened effective connectivity underlies transfer of working memory training to tests of short-term memory and attention. Journal of Neuroscience 33, 87058715.
LettTA, VoineskosAN, KennedyJL, LevineB, DaskalakisZJ (2014). Treating working memory deficits in schizophrenia: a review of the neurobiology. Biological Psychiatry 75, 361370.
LiX, XiaoYH, ZhaoQ, LeungAW, CheungEF, ChanRC (2015). The neuroplastic effect of working memory training in healthy volunteers and patients with schizophrenia: implications for cognitive rehabilitation. Neuropsychologia 75, 149162.
LilienthalL, TamezE, SheltonJT, MyersonJ, HaleS (2013). Dual n-back training increases the capacity of the focus of attention. Psychonomic Bulletin and Review 20, 135141.
MausbachBT, TiznadoD, CardenasV, JesteDV, PattersonTL (2016). Validation of the UCSD Performance-based Skills Assessment (UPSA) in Hispanics with and without schizophrenia. Psychiatry Research 244, 388393.
McAvinueLP, GolemmeM, CastorinaM, TattiE, PigniFM, SalomoneS, BrennanS, RobertsonIH (2013). An evaluation of a working memory training scheme in older adults. Frontiers in Aging Neuroscience 5, 20.
McCarthyH, SkokauskasN, MulliganA, DonohoeG, MullinsD, KellyJ, JohnsonK, FaganA, GillM, MeaneyJ, FrodlT (2013). Attention network hypoconnectivity with default and affective network hyperconnectivity in adults diagnosed with attention-deficit/hyperactivity disorder in childhood. JAMA Psychiatry 70, 13291337.
MothersillO, TangneyN, MorrisDW, McCarthyH, FrodlT, GillM, CorvinA, DonohoeG (2016). Further evidence of alerted default network connectivity and association with theory of mind ability in schizophrenia. Schizophrenia Research 184, 5258.
PatelA, KnappM, RomeoR, ReederC, MatthiassonP, EverittB, WykesT (2010). Cognitive remediation therapy in schizophrenia: cost-effectiveness analysis. Schizophrenia Research 120, 217224.
PenadésR, PujolN, CatalánR, MassanaG, RamettiG, García-RizoC, BargallóN, GastóC, BernardoM, JunquéC (2013). Brain effects of cognitive remediation therapy in schizophrenia: a structural and functional neuroimaging study. Biological Psychiatry 73, 10151023.
RamsayIS, MacDonaldAW (2015). Brain correlates of cognitive remediation in schizophrenia: activation likelihood analysis shows preliminary evidence of neural target engagement. Schizophrenia Bulletin 41, 12761284.
ReitanRM, WolfsonD (1985). The Halstead-Reitan Neuropsychological Test Battery: Theory and Clinical Interpretation, vol. 4. Reitan Neuropsychology: Tucson, Arizona.
RispaudSG, RoseJ, KurtzMM (2016). The relationship between change in cognition and change in functional ability in schizophrenia during cognitive and psychosocial rehabilitation. Psychiatry Research 244, 145150.
RobbinsTW, JamesM, OwenAM, SahakianBJ, McInnesL, RabbittP (1994). Cambridge neuropsychological test automated battery (CANTAB): a factor analytic study of a large sample of normal elderly volunteers. Dementia and Geriatric Cognitive Disorders 5, 266281.
RosenbergM (1965). Rosenberg self-esteem scale (RSE). Acceptance and commitment therapy. Measures package, 61.
RudebeckSR, BorD, OrmondA, O'ReillyJX, LeeAC (2012). A potential spatial working memory training task to improve both episodic memory and fluid intelligence. PLoS ONE 7, e50431.
RybarczykB (2011). Social and occupational functioning assessment scale (SOFAS). In Encyclopedia of Clinical Neuropsychology (ed. Kreutzer J., DeLuca J., and Caplan B.), pp. 23132313. Springer: New York.
SalminenT, StrobachT, SchubertT (2012). On the impacts of working memory training on executive functioning. Training-Induced Cognitive and Neural Plasticity 6, 166.
SavulichG, PiercyT, FoxC, SucklingJ, RoweJB, O’BrienJT, SahakianB (2016). Cognitive Training Using a Novel Memory Game on an iPad in Patients with Amnestic Mild Cognitive Impairment (aMCI).
StevensAA, TapponSC, GargA, FairDA (2012). Functional brain network modularity captures inter-and intra-individual variation in working memory capacity. PLoS ONE 7, e30468.
StroopJR (1935). Studies of interference in serial verbal reactions. Journal of Experimental Psychology 18, 643662.
StroopJR (1992). Studies of interference in serial verbal reactions. Journal of Experimental Psychology: General 121, 15.
SubramaniamK, LuksTL, GarrettC, ChungC, FisherM, NagarajanS, VinogradovS (2014). Intensive cognitive training in schizophrenia enhances working memory and associated prefrontal cortical efficiency in a manner that drives long-term functional gains. Neuroimage 99, 281292.
TakeuchiH, TakiY, NouchiR, HashizumeH, SekiguchiA, KotozakiY, NakagawaS, MiyauchiCM, SassaY, KawashimaR (2013). Effects of working memory training on functional connectivity and cerebral blood flow during rest. Cortex 49, 21062125.
ThompsonTW, WaskomML, GabrieliJDE (2016). Intensive working memory training produces functional changes in large-scale frontoparietal networks. Journal of Cognitive Neuroscience 28, 575588.
WechslerD (1998). Wechsler Memory Scale, 3rd edn (WMS-III). The Psychological Corporation: New York.
WechslerD (1999). Wechsler Abbreviated Scale of Intelligence. The Psychological Corporation: Harcourt Brace & Company: New York, NY.
WexlerBE, AndersonM, FulbrightRK, GoreJC (2000). Preliminary evidence of improved verbal working memory performance and normalization of task-related frontal lobe activation in schizophrenia following cognitive exercises. American Journal of Psychiatry 157, 16941697.
World Health Organization (1996). WHOQOL-BREF: introduction, administration, scoring and generic version of the assessment: field trial version, December 1996.
WykesT, HuddyV, CellardC, McGurkSR, CzoborP (2011). A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. American Journal of Psychiatry 168, 472485.
WykesT, ReederC (2005). Cognitive Remediation Therapy for Schizophrenia. Brunner Routledge: London.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Type Description Title
WORD
Supplementary Materials

Donohoe et al. supplementary material
Donohoe et al. supplementary material 1

 Word (22 KB)
22 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 14
Total number of PDF views: 66 *
Loading metrics...

Abstract views

Total abstract views: 353 *
Loading metrics...

* Views captured on Cambridge Core between 21st September 2017 - 20th October 2017. This data will be updated every 24 hours.