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A Decade of Cognitive Remediation Therapy (CRT) in Aotearoa New Zealand

Wieteke Idzerda, Occupational Therapist and CRT Therapist


Man protectively holding his hands to his head


This year marks ten years since my Cognitive Remediation Therapy (CRT) journey began in Aotearoa New Zealand in 2015. It started with a single question posed by Dr Katrina Wallis (Occupational Therapist) at one of our bimonthly Occupational Therapy meetings at Waitematā District Health Board.


“Has anyone heard of Cognitive Remediation Therapy?”


None of us had. After a brief description of CRT—and its potential to support tāngata whai i te ora (service users, or more specifically, “people who seek wellness”), it didn’t take long for a small working group of Occupational Therapists to form that very day. This working group was developed to help identify different CRT models around the world, review research, and have a specific group to ultimately drive this intervention forward within Specialist Mental Health and Addiction Services (SMH&AS). We were excited about the opportunity to provide evidence-based intervention for a group of tāngata whai i te ora with psychosis who typically have limited treatment options. The principles of CRT are also closely aligned with occupational therapy values. 


We soon developed our first CRT pilot programme. In 2016, eight service users completed a 16-week programme, with our post-pilot review finding excellent functional outcomes. This included pen and paper tasks, a digital programme with cognitive exercises (BrainHQ), and a bridging social cognition group.  This success helped us secure funding to travel to King’s College London for training. Dr. Matteo Cella and Dr. Clare Reeder introduced us to CIRCuiTSTM—Computerised Interactive Remediation of Cognition and Thinking Skills. This innovative and evidence-based digital therapy supports people experiencing serious mental illness and cognitive difficulties to enhance their functioning and overall quality of life.


By 2017, we had developed foundational CRT training and established the New Zealand CRT Steering Group with clinicians, researchers, lived-experience experts, and policymakers—a vital structure for national oversight, decision-making, and quality assurance for CRT across Aotearoa New Zealand. In 2018, we officially named CRT in New Zealand ‘Te Rau Whakaaro’ – Thinking Skills for Life – reflecting our commitment to delivering tailored treatment to our diverse population. We expanded to new regions and services, and CRT became a key part of our stepped-care model for cognition.


Despite the challenges of COVID-19, CRT in Aotearoa New Zealand continued to grow, innovate, and deepen its evidence base through recent and emerging studies. Recommendations included that cognitive assessment should be routinely conducted within Mental Health Services to identify cognitive strengths and deficits early (Morton et al. 2025). It has also been recommended that specific guidance is developed for leaders, clinicians, and policy makers on how to support the delivery of occupation-based CRT programmes in Aotearoa New Zealand (Wallis, 2024). Interest has increased nationwide, with Aotearoa New Zealand-based studies being completed.


Lessons learnt from the last 10 years


  • Just do it! Setting up and introducing any new service provision can feel like a big undertaking, but once you start, it quickly becomes a smooth and rewarding process.

  • Collaborate, be innovative, and utilise the resources around you to get CRT up and running.

  • Keep offering training and support to clinicians to maintain momentum once they start.

  • If you’re a small service running CRT, have a succession plan to ensure sustainability.

  • Share resources generously. The more we learn from each other, the greater the impact on our tāngata whai I te ora.

  • Celebrate the wins—with your tāngata whai I te ora, colleagues, and wider teams.

  • Keep reflecting and checking in. Utilise supervision and steering groups to ensure the principles of CRT are being upheld.


What began with just three districts has grown into a truly national movement. Today, CRT is delivered by professionals across Waitematā, Te Toka Tumai Auckland, Counties Manukau, Waikato, and Southern, with Capital, Coast and Hutt Valley soon to start offering it, and even more districts and specialist groups expressing interest in doing so. CRT is now offered across Adult Mental Health Services, Forensic Services, Work Rehabilitation, and Māori Specialist Services. While various models have been trialled, CIRCuiTSTM remains our main CRT programme.


The growth and enthusiasm across the motu (country) reflect CRT’s increasing recognition as an effective, meaningful, and hopeful approach that supports tāngata whai i te ora to achieve their goals, improve their day-to-day functioning, and enhance their quality of life. 



Australasian CRT clinicians and researchers, please join us for the next annual Cognitive Remediation Conference in Auckland, New Zealand:



If you or your team are interested in joining the growing global community of Cognitive Remediation therapists and completing our online course, visit our Training page to find out more or Get in touch to book your place today.

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