The extant literature on Cognitive Remediation (CR) for schizophrenia, an empirically based intervention, indicates that across treatment methods, CR has moderate effects on neurocognition and functional outcomes. However, substantial individual differences in response to CR interventions indicate a need to refine intervention strategies to better meet the specific neurocognitive and functional needs of treatment participants. Evidence that neurocognitive and psychological factors predict a strong response to CR has the potential to enable a personalization of the treatment process and to thereby match patients to appropriate treatment. Using the R34 mechanism we will lay the groundwork for a study that tests the efficacy and feasibility of delivering scalable and personalized CR in a community outpatient clinic setting. There are three phases of the proposed study. (1) During Development and Adaptation, we will assemble two personalized packages of restorative computer-based cognitive exercises which, based on prior research about predictors of a positive response to CR, will address the learning needs of people with different modal cognitive profiles. (2) During Open Trial and Refinement, we will pilot test the two cognitive interventions in a sample of 10 adults with schizophrenia and schizoaffective disorder attending a community psychosocial rehabilitation clinic. A 10-session open trial will allow for the collection of qualitative feedback from the subjects and quantitative cognitive assessment data to further refine assessment and treatment parameters. The goal of this phase is to the increase acceptability and feasibility of the CR interventions. (3) During the Pilot Feasibility Trial, we wll conduct a randomized controlled trial to see if baseline cognitive profile predicts response to the different treatment approaches. We will focus on the feasibility of recruiting, enrolling, randomizing, stratifying, retaining, and assessing outcomes in the participants. Consistent with the purpose of the R34 mechanism, this pilot study will lead to a R01, which will provide a more rigorous test of the impact of personalized intervention methodologies on cognitive and functional outcomes in schizophrenia.
The purpose of this study is to develop and pilot test personalized and scalable approaches to Cognitive Remediation (CR) for schizophrenia and schizoaffective disorder. The intent is to more clearly define the therapeutic targets important to the facilitation of cognitive and functional improvement so that clinicians know how to customize cognitive interventions and deliver treatment in a more effective, efficient and personally relevant manner. This project has implications for the wider dissemination of CR in the clinical community and for enhancing treatment effectiveness in order to help people with schizophrenia and schizoaffective disorder acquire the skills needed to achieve their goals for recovery.