Cognitive deficits are a prominent and disabling feature of schizophrenia that persist despite optimal pharmacotherapy. Repeated studies show links between these deficits and functional outcomes. Thus, there is a great need for new treatments for cognitive deficits. Our preliminary VA studies have demonstrated that patients improved on computer-based cognitive training tasks (CCT), that improvements generalized to neuropsychological test improvements and that CCT led to changes in brain activation. Additionally, CCT plus cognitively-oriented rehabilitation methods yielded superior outcomes in our VA work therapy program including more hours worked and more dollars earned at follow-up. Results of our current NIMH funded study of CCT plus cognitively oriented rehabilitation methods show better vocational outcomes in community-based supported employment (SE) including better work performance, more hours worked and higher employment rates at 2-yr FU. In this submission for a competitive renewal we propose to isolate the contribution of CCT by comparing CCT + Enhanced SE to Enhanced SE alone to determine whether CCT is necessary for producing favorable outcomes. We will enroll 100 people with schizophrenia or schizoaffective disorder at 2 Connecticut CMHCs and randomly assign them to condition. CCT will involve intensive computer-based hierarchical training on attention, memory, and executive function tasks for up to10 hrs/wk for up to 1 yr. SE will be based on the Individual Place and Support model (IPS). Enhancements include the use of transitional funds for rapid placement, a weekly work performance feedback group, and a social information processing group. Assessment at baseline, 1 yr. FU, and 2 yr. FU will focus on cognitive and vocational outcomes, but will also include clinical status, quality of life and community function measures. Predictors of response to training will also be examined.
