Being satisfied with cognitive remediation – is it important?
by Professor Dame Til Wykes, Professor of Clinical Psychology & Rehabilitation and Head of the School of Mental Health & Psychological Systems at King's College London
Cognitive remediation is a therapy to improve cognitive difficulties and use skills like problem solving strategies to help improve recovery. We know that it works and what ingredients are needed for the most benefits. But is it acceptable to the individuals who are eligible to receive this treatment? Is acceptability even important? We carried out a study – well two studies really – to investigate what service users thought about one therapy, CIRCuiTS and whether their views affected the outcome of treatment.
One of the difficulties of measuring acceptability is not having a good measure or even a measure at all. One meta-analysis used dropout and showed that having key therapy ingredients (cognitive task practice, a therapist, teaching strategies and transfer to real life) reduced it, but dropout is not the same as measuring acceptability. People dropout for a multitude of reasons. Maybe they have too much going on in their lives to fit the therapy in, or the treatment may have worked so well that they don’t need all the sessions as they achieved their treatment goal. We discovered that there were few measures of satisfaction, and none seemed to be about computerised cognitive remediation. Our focus groups discussed an older measure we developed for a paper-and-pencil cognitive remediation. Our service user researchers found four themes - therapy hours, therapist, treatment effects, computer use. We changed the wording and added new items to the scale ensure we captured all the issues that service users thought were important.
We ended up with a long list of questions and to make sure that these would be useful we asked people to complete the satisfaction measure twice at the end of a clinical trial. We wanted to know if people answered the questions the same way after a week because those items would be “reliable”. We also contrasted the scores with another measure of satisfaction with a therapist to ensure that the final measure was “valid” – it was measuring similar but not the same things. We ended up with an 18 multiple choice questions and a few open ones where the person could say a bit more about what they thought of therapy. Some questions were about using a computer rather than the therapy were missed out of the final score, but we left them in as they might be important as more software is produced.
In a second study we used the score on the Cognitive Remediation Satisfaction scale to investigate how satisfaction was related to the benefits of cognitive remediation… but that is for another blog.
References
Vita, A., Barlati, S., Ceraso, A., Deste, G., Nibbio, G., Wykes, T. Acceptability of cognitive remediation for schizophrenia: a systematic review and meta-analysis of randomized controlled trials. Psychol Med. 2023 Jun;53(8):3661-3671. doi: 10.1017/S0033291722000319
Evans, J., Tinch-Taylor, R., Csipke, E. et al. Satisfaction with cognitive remediation therapy: its effects on implementation and outcomes using the cognitive remediation satisfaction scale. Schizophr 9, 67 (2023). https://doi.org/10.1038/s41537-023-00390-9
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