Remote Cognitive Remediation
Condition: Schizophrenia; Bipolar Disorder With Psychosis
MeSH terms: Schizophrenia; Bipolar Disorder; Psychotic Disorders; Mental Disorders
Study type: Interventional

Summary: 
      With medication, many individuals with psychosis experience a remission from hallucinations
      and delusions, the most salient aspects of the disorders. However, alleviation of these
      symptoms is not associated with recovery of everyday functioning in important areas like
      working, socializing, maintaining the household, and recreational pursuits. The reason these
      difficulties with functioning persist is that psychotic disorders are associated with
      considerable difficulties with cognitive functions such as attention, memory, and planning.
      Cognitive impairments persist even when the delusions and hallucinations are treated, and in
      fact account for most of the persistent impairments in functioning.

      Recently, psychological treatments called Cognitive Remediation have been developed and
      tested in research settings, where techniques that train the brain to process information
      more efficiently result in very large improvements in cognition. However, there are two major
      hurdles remaining as investigators attempt to determine how this treatment can graduate from
      research laboratories to become a widespread clinical treatment. First, cognitive remediation
      in research settings is very intensive: it requires frequent visits with specialized
      therapists who deliver the treatment to groups of patients. This makes it quite difficult for
      people with psychosis, who might not have the financial means or motivation to travel and who
      might be experiencing symptoms that make it unlikely that they will attend groups, to
      participate fully if the traditional research techniques were directly transported to a
      clinical setting. The second hurdle is that even though cognitive remediation improves
      cognition, it does not always transfer to everyday behavior changes. Investigators recently
      found that this transfer to functioning is more meaningful and durable when using additional
      techniques that teach people skills such as being aware of your own thinking and to use
      multiple, flexible problem solving strategies.

      The goal of this project is to address these limitations by testing a new development in the
      treatment: delivering cognitive remediation to participants in their homes, with cognitive
      exercises and therapist support provided online. The techniques are the same as successful
      in-session cognitive remediation, but those with psychosis can engage in the intervention at
      home and therapists will be able to service more individuals with online discussion forums
      and video demonstrations. The more people engage in cognitive remediation, the better the
      outcomes. This is particularly true for receiving a consistent dose of exercise, rather than
      in longer, once per week sessions typical of traditional psychotherapies. The online
      component of this program provides patients with the ability to engage in a higher and more
      consistent rate of exercises and skill development, and we will explore whether the amount
      and continuity of engagement is associated with larger and broader improvements.
    


Intervention name(s): Cognitive Remediation; Sham Cognitive Remediation
Intervention type(s): Behavioral; Behavioral
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment