Schizophrenia has resisted generic rehabilitation services designed to achieve a more complete social and vocational life. Cognitive remediation has been heralded as a more promising intervention. However, efforts to date have had variable results, with problems traced to: the cognitive deficits targeted and remediation methods used; failures to truly integrate elementary deficit and social cognitive training; an exclusive emphasis on more cognitively compromised inpatients; a relative de-emphasis of individual programming; and the inclusion of briefly treated, small samples that have lacked the requisite statistical power needed to detect treatment effects. In an individually tailored and personally meaningful approach that integrates elementary deficit and social cognitive training, Cognitive Enhancement Therapy attempts to develop a more abstracting social cognition related to perspective taking and the appraisal of informal rules that govern changing social contexts, (the apparent sources of schizophrenic disability), among recovering outpatients. It does so by adapting the methods and procedures of successful programs for the traumatic brain injured to the impairments, disabilities and handicaps of the Disorganized, Impoverished and Rigid cognitive styles common in schizophrenia. In a 2 year, randomized contrast to an Enriched Supportive Therapy, CET is predicted to differentially improve social cognition, with associated gains in the areas of interpersonal and vocational effectiveness, self-esteem, neuropsychological competence and residual symptoms. Support is requested to complete the ongoing study for 100 of the 150 patients who will be in protocol between 1/97 and 6/01.
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