Adherence to a Low-Support Cognitive Remediation Training Program for Psychosis

Abstract

Cognitive remediation (CR) has emerged as the treatment of choice for impaired cognition in psychosis. However, little is known about adherence rates and factors predicting adherence to CR, particularly in clinical settings where high-level therapist support is unavailable. This study aimed to establish adherence rates and examine variables predicting adherence to a computerized CR program for psychosis (with minimal support). Patients with psychosis (n = 61) participated in an 8-week CR program. Results showed 46% completed a meaningful amount of CR training. The fully adherent (>80% of the prescribed amount) and nonadherent groups differed where adherent participants had poorer working-memory and higher negative symptom scores. These findings suggest that approximately half of the sample were adherent to treatment despite minimal therapist support. Furthermore, higher cognitive deficits and negative symptoms did not impede adherence, and may have contributed to patients' motivation to complete the program.

Free Thyroxine Concentrations Moderate the Response to a Cognitive Remediation Therapy in People With Early Psychosis: A Pilot Randomized Clinical Trial

“…Of the participants in our study, a half of the sample did not engage with at least one third of the sessions of CRT. Nevertheless, these rates are similar to those in previously published studies from other groups ( 58 ). This fact may be influenced by the study design because we included a randomized phase and half of the patients received TAU.…”

Effects of Cognitive Remediation on Cognition, Metacognition, and Social Cognition in Patients With Schizophrenia

“…First, results showed a satisfactory adherence rate, with almost 70% of the participants completing the entire course of the protocol and adhering to over 80% of the prescribed sessions and outcome measures, suggesting that subjects did not seem to find the time commitment, the assessments, or the training burdensome. These completion rates are comparable with some studies (15,(28)(29)(30) and in contrast with other ones conducted so far (31), showing a higher attrition rate. Nevertheless, the present study adopted several measures to sustain adherence, mostly by strengthening the relationship with the therapist that has been shown to have a fundamental role in ensuring participants' completion of the training modules (32) and providing social cues to improve patients' self-esteem and motivation, supporting the use of strategies, motivation, or reinforcement and helping to develop metacognition, which is thought to be a key component for improving transfer from cognitive change to functional development (33,34).…”

Can cognitive remediation therapy be delivered remotely? A review examining feasibility and acceptability of remote interventions

“…Remote treatment delivery can be easily accessed from clients' homes and may encourage treatment adherence for individuals who have motivational impairments ( Jimenez et al, 2019 ). Conversely, while specific motivational impairments are associated with treatment disengagement, past research has also demonstrated that those with higher negative symptom profiles may have greater adherence to CR programs ( Dillon et al, 2016 ), supporting the notion that there may be a specific symptom profile of individuals who may benefit most from CR. Furthermore, cognitive impairments themselves may also impede therapeutic engagement and attendance while participating in CR (e.g.…”