Can Cognitive Training Decrease Reactive Aggression?
Condition: Schizophrenia; Cognitive Deficits; Impulsive Aggression; Emotion; Impulsivity
MeSH terms: Schizophrenia; Aggression; Cognition Disorders; Cognitive Dysfunction; Impulsive Behavior
Study type: Interventional

Summary: 
      The purpose of the study is to examine the effects of cognitive training on emotion
      regulation, impulse control, and aggression in people with schizophrenia. The study compares
      a combination of computerized cognitive remediation and social cognition training (CRT+SCT)
      to cognitive remediation alone (CRT). Study outcomes include multiple measures of aggression,
      emotion regulation, impulse control, cognition, and symptoms.
    

Detailed description: 
      Neurocognitive and social cognitive impairments are contributors to negative emotionality and
      impulsive aggression in people with schizophrenia. Impulsive aggression poses several
      challenges to the care of people with schizophrenia. These include a greater risk of
      rehospitalization and longer hospital stays, involvement with the criminal justice system,
      and increased risk of recidivism. The investigators recently found that schizophrenia
      patients with aggression history experienced improvements in neurocognition as well as
      decreased hostility/agitation and incidents of verbal and physical aggression after
      participating in cognitive remediation training (CRT). Based on these findings, it is
      hypothesized that improving neurocognition through CRT may have enhanced the capacity of
      schizophrenia patients to inhibit aggression through improved emotion regulation capacity and
      impulse control. It is also postulated that the addition of Social Cognition Training (SCT)
      to CRT would provide greater benefits on emotion regulation and impulse control over CRT
      alone. To test the hypotheses, the investigators will conduct a clinical trial that compares
      two configurations of cognitive training--CRT plus SCT versus CRT plus control computer
      games. The goal of the study is to examine the comparative benefits of the two configurations
      of cognitive training on outcomes that include neurocognition, social cognition, emotion
      regulation, impulse control, and reactive aggression. Participants assigned to the CRT plus
      SCT group will complete 24 hours of CRT and 12 hours of SCT. Participants assigned to the CRT
      only group will complete 24 hours of CRT and 12 hours of control computer activities. Emotion
      regulation, impulse control, and reactive aggression will be indexed using laboratory-based
      challenges. The investigators will recruit and characterize 90 study participants on
      demographic and clinical variables including age, gender, education, aggression history, and
      medications. Study outcome measures will be administered at baseline and posttreatment to
      participants randomized to the study groups. In a subsample of 32 patients, the study
      investigators will further examine changes in the neural network of emotion regulation and
      impulsivity before and after cognitive training.
    

Intervention name(s): Cognitive Remediation (CRT); CRT+ Social Cognition Training
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Study compares two configurations of cognitive training--computerized cognitive remediation versus a combination of computerized cognitive remediation and social cognition training. The cognitive remediation therapy group will complete computerized training activities in attention, memory, processing speed, problem solving, and executive functions.; Study compares two configurations of cognitive training--computerized cognitive remediation versus a combination of computerized cognitive remediation and social cognition training. The combined cognitive remediation and social cognition training group will complete computerized training that target neurocognitive functions, facial affect emotion recognition and mentalizing tasks.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Cognitive Remediation; Social Cognition Training; Emotion Regulation; Urgency