Developmental Theory for a Cognitive Enhancement Therapy of Schizophrenia

Abstract

Recent findings on psychosocial and neurodevelopmental anomalies in schizophrenia patients indicate that deficits related to social cognition-the ability to act wisely in social interactions-may be important constraints on complete social and vocational recovery. Social cognition is acquired over many decades and appears to be partially independent of formal IQ and neuropsychological problems. It invites a more developmental approach to the rehabilitation of schizophrenia, one that we call Cognitive Enhancement Therapy (CET). CET draws on an emerging literature that implicates both pre- and postonset neurodevelopmental difficulties, as well as a complementary literature on diffuse neuropsychological impairments that supports the notion of a neurodevelopmental insult. We analyzed evidence for an associated developmental basis to social cognitive impairment in the context of a model that addressed both the acquisition of interpersonal wisdom and the adaptive process that might follow developmental failures. A contemporary model of human cognition is then used to identify the metacognitive functions that characterize the developmental acquisition of normal cognition and, by inference, the associated difficulties of many patients with schizophrenia. A rehabilitation strategy for schizophrenia, designed to facilitate the metacognitive transition from prepubertal to young adult social cognition, would thus emphasize developmental learning experiences during the remediation of social cognitive deficits. A "gistful" appraisal of interpersonal behavior and novel social contexts best reflects the theoretical intent of this new intervention.

Cognitive Enhancement Therapy for Early-Course Schizophrenia: Effects of a Two-Year Randomized Controlled Trial

“…In order to avoid excessive univariate inference testing that could inflate experiment-wise error rates, internally consistent multivariate composite indexes of these domains were computed. Individual measures were selected for these composites based on previous literature identifying the important domains of cognitive impairment in schizophrenia (23), field standards for adjustment and symptom assessment (24, 25), as well as previous CET studies (19, 20). Measures showing poor reliability (interitem r ≤ .10) were excluded.…”

What Is It like to Be a Person with Schizophrenia in the Social World? A First-Person Perspective Study on Schizophrenic Dissociality – Part 1: State of the Art

“…Social cognition includes various and still debated psychological constructs [64][65][66][67] , including emotion perception (EP) -the capacity to decipher emotions as they emerge from facial expressions, vocal prosody and bodily gestures -and Theory of Mind (ToM). ToM implies seeing others as possessing intentional states such as beliefs and desires and using these to explain and predict the others' behaviours.…”

Neurocognitive Training in Patients with Bipolar Disorders: Current Status and Perspectives

“…Increasing the level of difficulty of the program exercises would be a relatively easy way to foster adherence to the programs. With these considerations in mind, the next step would be to adapt and focus on the specific impairments of BD and use programs with a higher degree of difficulty such as integrated neurocognitive therapy [38], neuropsychological and educational approach to remediation [39] or cognitive enhancement therapy [40,41]. In fact the application of the neuropsychological and educational approach to remediation has yielded good results in heterogeneous samples including some patients with BD [20].…”