Cognitive Remediation, Vocational Rehab Create 'Total Dose Effect' for Schizophrenia

Cognitive remediation therapy (CRT) for schizophrenia is being combined with vocational rehabilitation and other psychosocial interventions to create multimodal interventions aimed at improving “real-world” functioning. That’s what Philip Harvey, Ph.D., the Leonard M. Miller Professor of Psychiatry and Behavioral Sciences at the University of Miami Miller School of Medicine, said at the International Congress of Schizophrenia Research in Orlando, Fla., this week. The title of his talk was “Cognitive Remediation and Cognitive Enhancement: State of the Art.”

Harvey (pictured above at the congress) provided an overview of a field that has garnered increasing interest among schizophrenia researchers: the effort to address cognitive impairments, which have been shown to be more crucial to long-term functional outcome—and more stubbornly resistant to treatment—than positive symptoms of psychosis. Harvey described a trend toward using cognitive remediation in combination with other psychosocial interventions—especially vocational rehabilitation—that can produce robust effects even in a relatively short period, suggesting the importance of a multimodal strategy with a “total dose effect” that may be as important as the duration of treatment. Several researchers at the congress described cognitive remediation efforts that are embedded within vocational rehabilitation programs.

“When I look at these data, what I see is that there seems to be this total dose treatment effect,” Harvey said. “If you give people 100 sessions of CRT and nothing else, or 20 sessions of CRT plus vocational rehabilitation, you get the same outcome…. It’s very encouraging to me to review data on cognitive enhancement therapies that not only make your cognition better, but make it look like you are doing better in the world in a short time period.”

For more about Harvey's research on cognitive remediation, see the American Journal of Psychiatry.

(image: Mark Moran/ Psychiatric News)