Objective-This study evaluated the effects of cognitive remediation for improving cognitive performance, symptoms, and psychosocial functioning in schizophrenia.Method-A meta-analysis was conducted of 26 randomized, controlled trials of cognitive remediation in schizophrenia including 1,151 patients.Results-Cognitive remediation was associated with significant improvements across all three outcomes, with a medium effect size for cognitive performance (0.41), a slightly lower effect size for psychosocial functioning (0.36), and a small effect size for symptoms (0.28). The effects of cognitive remediation on psychosocial functioning were significantly stronger in studies that provided adjunctive psychiatric rehabilitation than in those that provided cognitive remediation alone.Conclusions-Cognitive remediation produces moderate improvements in cognitive performance and, when combined with psychiatric rehabilitation, also improves functional outcomes.Cognitive impairment is a core feature of schizophrenia, with converging evidence showing that it is strongly related to functioning in areas such as work, social relationships, and independent living (1, 2). Furthermore, cognitive functioning is a robust predictor of response to psychiatric rehabilitation (i.e., systematic efforts to improve the psychosocial functioning of persons with severe mental illness) (3), including outcomes such as work, social skills, and self-care (1,4,5). Because of the importance of cognitive impairment in schizophrenia, it has been identified as an appropriate target for interventions (6).Currently available pharmacological treatments have limited effects on cognition in schizophrenia (7,8) and even less impact on community functioning (9). To address the problem of cognitive impairment in schizophrenia, a range of cognitive remediation programs has been developed and evaluated over the past 40 years. These programs employ a variety of methods, such as drill and practice exercises, teaching strategies to improve cognitive functioning, compensatory strategies to reduce the effects of persistent cognitive impairments, and group discussions. Several reviews of research on cognitive rehabilitation in schizophrenia have been published (10-13). The general conclusions from these reviews have been that cognitive remediation NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript leads to modest improvements in performance on neuropsychological tests but has no impact on functional outcomes. However, these reviews were limited by the relatively small number of studies that actually measured psychosocial functioning, precluding any definitive conclusions about the effects of cognitive remediation on psychosocial adjustment or the identification of program characteristics that may contribute to such effects. The rationale for cognitive remediation is chiefly predicated on its presumed effects on psychosocial functioning and improved response to rehabilitation. Therefore, a critical examination of the effects of cognitive ...

Patients with severe mental disorders such as schizophrenia and co-occurring substance use disorders traditionally received treatments for their two disorders from two different sets of clinicians in parallel treatment systems. Dissatisfaction with this clinical tradition led to the development of integrated treatment models in which the same clinicians or teams of clinicians provide substance abuse treatment and mental health treatment in a coordinated fashion. We reviewed 36 research studies on the effectiveness of integrated treatment for dually diagnosed patients. Studies of adding dual-disorders groups to traditional services, studies of intensive integrated treatments in controlled settings, and studies of demonstration projects have thus far yielded disappointing results. On the other hand, 10 recent studies of comprehensive, integrated outpatient treatment programs provide encouraging evidence of the programs' potential to engage dually diagnosed patients in services and to help them reduce substance abuse and attain remission. Outcomes related to hospital use, psychiatric symptoms, and other domains are less consistent. Several program features appear to be associated with effectiveness: assertive outreach, case management, and a longitudinal, stage-wise, motivational approach to substance abuse treatment. Given the magnitude and severity of the problem of dual disorders, more controlled research on integrated treatment is needed.

The authors conducted a randomized clinical trial of individual psychotherapy for women with posttraumatic stress disorder (PTSD) related to childhood sexual abuse (n = 74), comparing cognitive-behavioral therapy (CBT) with a problem-solving therapy (present-centered therapy; PCT) and to a wait-list (WL). The authors hypothesized that CBT would be more effective than PCT and WL in decreasing PTSD and related symptoms. CBT participants were significantly more likely than PCT participants to no longer meet criteria for a PTSD diagnosis at follow-up assessments. CBT and PCT were superior to WL in decreasing PTSD symptoms and secondary measures. CBT had a significantly greater dropout rate than PCT and WL. Both CBT and PCT were associated with sustained symptom reduction in this sample.

This study compared supported employment services in 2 contrasting programs: (a) Group Skills Training, a professional rehabilitation agency outside of the mental health center that provided pre-employment skills training and support in obtaining and maintaining jobs, or (b) the Individual Placement and Support (IPS) model, which integrated clinical and vocational services within the mental health center. People with severe mental disorders who expressed interest in competitive employment (N = 143) were randomly assigned to 1 of these 2 programs. Results showed that clients in the IPS program were more likely to be competitively employed throughout most of the 18-month follow-up. Among those who obtained jobs, there were few group differences, although workers in the IPS program did work more total hours and earn more total wages during the 18-month follow-up. There were no group differences on nonvocational outcomes.

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