Optimizing Cognitive Remediation Outcomes in Schizophrenia
Condition: Schizophrenia; Psychosis
MeSH terms: Schizophrenia
Study type: Interventional

Summary: 
      The purpose of this study is to drive an optimal response to neuroplasticity-based cognitive
      remediation in schizophrenia in order to maximize treatment response. The investigators will
      investigate factors that have generally been ignored in prior computer-based cognitive
      remediation programs-those related to social cognition-- and will delineate their
      relationship to motivation, functional outcome, and the neural substrates of reward
      anticipation and emotion processing. Current research indicates that, unless the
      investigators fully understand and harness these factors, the investigators will not achieve
      meaningful treatment gains for individuals with schizophrenia.
    

Detailed description: 
      The purpose of this study is to explicitly and aggressively drive an optimal response to
      neuroplasticity- based cognitive remediation in schizophrenia in order to maximize treatment
      response. We will investigate factors that have generally been ignored in computer-based
      cognitive remediation programs-those related to social cognition-- and will delineate their
      relationship to motivation, functional outcome, and the neural substrates of reward
      anticipation and emotion processing. Current research indicates that, unless we fully
      understand and harness these factors, we will not achieve meaningful treatment gains for
      individuals with schizophrenia.

      Our specific aims are:

        1. To perform an RCT in which 100 schizophrenia subjects are assigned to either 60 hours of
           neuroplasticity- based computerized targeted cognitive training (TCT) that focuses
           exclusively on "cold cognition" (a program which trains early sensory processing,
           attention, working memory and cognitive control in auditory and visual domains), or to
           60 hours of training that combines the TCT program with 20 minutes per day of adaptive
           computerized social cognition training (SCT) exercises.

        2. To compare the outcomes of these two groups of subjects on measures of neurocognition,
           social cognition, motivation, and functional outcome.

        3. To assess subjects six months after the intervention to determine the durability of
           training effects.

        4. To identify changes in brain activation patterns in key neural regions as a result of
           TCT alone vs. TCT+SCT: during reward anticipation, and during emotion recognition.

      The timeliness of this approach is supported by recent evidence demonstrating only weak
      associations between traditional cognitive remediation approaches and functional outcome in
      schizophrenia, but a strong, direct relationship between social cognition and functional
      outcome. Thus we must now examine the clinical, functional, and neural effects of a
      well-designed state-of-the-art cognitive training program that combines neurocognition with
      social cognition training.
    

Intervention name(s): Targeted Cognitive Training; Social Cognitive Training
Intervention type(s): Other; Other
Intervention description(s): At present, the TCT exercises consist of three modules: an Auditory Processing Module (40-50 hours of training); a Visual Processing Module (30 hours); a Cognitive Control Module prototype (20 hours). [Based on the results of our current RCT, Posit Science has revised aspects of the training modules in order to further optimize its effectiveness for treatment of schizophrenia. In this study, we will use updated versions of the training software: an Auditory Module (30 hours), and a Visual Module (30 hours). Features from the Cognitive Control module prototype have been expanded and incorporated into these new modules.; We developed a systematic approach to basic training in facial emotion identification and discrimination and simple social perception and theory of mind tasks using components drawn from three commercially available software packages: the MicroExpressions Training Tool and The Subtle Expressions Training Tool (METT and SETT), plus the MindReading program. Training begins with simple emotion identification tasks, and slowly progressed to more difficult tasks that required subjects to discriminate between two subtle emotion expressions, and to correctly interpret the emotional significance of brief social scenes. A total of 10 hours of training occurred over 8 weeks.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment