Action-based Cognitive Remediation for First Episode Psychosis
Condition: Cognitive Impairment; Psychosis
MeSH terms: Psychotic Disorders; Mental Disorders
Study type: Interventional

Summary: 
      Cognitive impairments are a core and enduring feature of first-episode psychosis and
      schizophrenia, and are associated with significant functional impairment. Cognitive
      remediation (CR) is a behavioural intervention that has been found to have a small to
      moderate effect on cognition in individuals with schizophrenia, and recent studies suggests
      that it leads to improved cognition in persons with first-episode psychosis. Results from a
      CR feasibility project that was conducted through the Winnipeg Regional Health Authority's
      Early Psychosis Prevention and Intervention Service (EPPIS) showed promising findings.
      Specifically, large effect sizes were found in the areas of verbal learning and self-esteem.
      Moreover, the intervention was found to be acceptable to the participants. However, the
      findings are limited by the sample size and lack of control group.

      In this proposed study, the investigators seek to expand the scientific support for treating
      neurocognitive impairments in order to increase functional productivity associated with
      first-episode psychosis. A novel group CR program, action-based cognitive remediation (ABCR),
      has been developed by Dr. C. Bowie (co-investigator) to promote the generalization of
      cognitive skills to real-world activities. ABCR has been found to improve both cognition and
      functional competence in persons with schizophrenia. The primary outcome measure will examine
      whether ABCR results in improved executive functioning in persons with first-episode
      psychosis compared to psychiatric rehabilitation alone. Secondary outcome measures (e.g.,
      memory, processing speed, self-esteem, emotional functioning, adaptive functioning) will also
      be analyzed.
    

Detailed description: 
      The proposed study will be a two-group randomized control cross-over trial. Participants will
      be recruited from EPPIS and will be randomly assigned to receive ABCR or treatment-as-usual
      (TAU) for a period of 8 weeks. After this time, the TAU group will receive ABCR. TAU will be
      the psychiatric rehabilitation programming offered to all patients enrolled with EPPIS. ABCR
      will consist of two, 2-hour groups/week, for a period of 8 weeks. Each group session will
      consist of: (1) computerized cognitive training using Scientific Brain Training Pro (an
      online program used in previous CR and ABCR research), (2) strategic monitoring (i.e.,
      increasing awareness of cognitive strategies used and learning to switch strategies as
      needed), (3) role-plays and simulations of real world tasks to facilitate the transfer of
      skills to functioning, and (4) goal setting and cognitive approach planning. ABCR builds on
      procedural learning skills with explicit work-related role-plays to facilitate the immediate
      and salient abstraction of drill and practice remediation techniques. The activities are work
      skills that were developed by Dr. Bowie (co-investigator) in collaboration with community
      vocational rehabilitation partners. The props match those used in work settings and were
      designed on a miniature scale and include a cash register, filing system, conveyer belt,
      cleaning closet, garden nursery, and secretarial station. The activities in ABCR capitalize
      on procedural learning skills through role-plays and props that simulate a work environment.
      In ABCR, the important aspects of drill and practice, strategic monitoring to enhance
      flexible problem solving approaches, and bridging are maintained. The role-plays immediately
      follow the computerized drill and practice exercise and therapists facilitate group
      discussions of how the cognitive skills and flexibility in thinking from drill and practice
      can be effective while directly engaged in an everyday work environment. Thus, the bridging
      used in ABCR is a tangible, procedural, and realistic. This approach to bridging
      differentiates the treatment from standard CR, where the discussion-based approach is limited
      by the auditory learning, memory, and abstraction deficits typically observed in psychosis.
      ABCR group sessions will be facilitated by the Primary Investigator and trained bachelor's or
      master's level research assistants/psychology residents who will be trained and supervised by
      the Primary Investigator. Participants will also be encouraged to complete computerized
      cognitive training using the online program, Scientific Brain Training Pro as supplemental
      homework exercises outside of the scheduled treatment group (20 minutes/day). Due to the
      online nature of this program, participants can access this program either at their personal
      homes or at EPPIS.

      Evaluations of each participant's cognitive functioning, self-esteem, psychotic symptoms, and
      functional skills will be completed at baseline and post-treatment (approximately 8 weeks
      later). The TAU group will then participate in ABCR and all participants will be re-evaluated
      following completion of the second intervention (at approximately 16 weeks post-baseline).
      Testing will be administered by trained bachelor's or master's level research assistants who
      are blind to study hypothesis or group assignment. These assistants will be trained and
      supervised by the Primary Investigator. Test batteries will be presented in counterbalanced
      order and, when possible, alternate forms will be used to reduce the likelihood of practice
      effects.Using a repeated measures analysis of covariance (ANCOVA), the treatment and control
      group's post-intervention data will be compared while controlling for pre-treatment scores.
      For all analyses, p < .05 will be used as the statistical threshold for significance.
    

Intervention name(s): Action-based cognitive remediation; Waitlist Control Group
Intervention type(s): Behavioral; Other
Intervention description(s): Action-Based Cognitive Remediation (ABCR) is a new program that was developed to address the challenges of transferring cognitive gains to improved quality of life and reduced disability. ABCR combines traditional cognitive training with an added behavioural component (e.g., role-plays, simulations of real world tasks) to foster learning through rehearsal and procedural memory which increases the likelihood of participants bridging cognitive strategies into real-world activities. ABCR also includes goal setting and behavioural activation procedures to stimulate transfer of in-session gains to everyday life changes.; Receive treatment-as-usual through regular early psychosis programming.
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: The proposed study will be a two-group randomized control cross-over trial. Participants will be randomly assigned to receive ABCR or treatment-as-usual (TAU) for a period of 8 weeks. After this time, the TAU group will receive ABCR. Evaluations of the participant's cognitive functioning, self-esteem, psychotic symptoms, and functional skills will be completed at baseline, post-treatment (approximately 8 weeks), and 16 weeks later.
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment