Cognitive Remediation in the World: The Experience in Togo and Benin
by Giacomo Deste , Department of Clinical & Experimental Sciences, University of Brescia and Department of Mental Health & Addiction Services, ASST Valcamonica, Italy
People living in low-income countries often have inadequate access to treatments for mental health due to insufficient resources. In Sub-Saharan Africa, access to appropriate and effective care is further limited by cultural barriers, such as prejudice and superstition. Consequently, non-governmental institutions can struggle to provide care and promote rehabilitation and recovery to those living with mental illness.
Dr Mawuko Kakli, a Catholic Priest who was active in the “Saint Camille” psychiatric centre in Zooti, Togo, was eager to support people to overcome access barriers to care, so he moved to Italy and completed the Technician of Psychiatric Rehabilitation course at the University of Brescia.
During his studies, he had the opportunity to train in cognitive rehabilitation and successfully adapted Cognitive Remediation Therapy (CRT; Delahunty et al., 2002) for implementation in the rehabilitation centre in Togo. When he returned to Africa, he visited psychiatric centres in Togo and Benin, training local psychologists to deliver CRT for a study that later became his thesis.
His study assessed the clinical symptoms, psychosocial functioning, and cognitive abilities of 36 patients experiencing schizophrenia, followed by individual pen-and-paper CRT (N=18) or treatment as usual (N18) for three months. At the end of this study, the results were encouraging, with more cognitive benefits emerging in the cognitive remediation group compared to the treatment as usual. These were noticeable in processing speed, working memory, verbal memory, cognitive flexibility, and executive functions.
Cognitive remediation was received with enthusiasm and high participant and psychologist satisfaction. In particular, patients reported subjective benefits and recognised the contribution of CRT in fostering their ability to communicate effectively, with positive improvements in self-confidence, impulse management, motivation and functioning. Cognitive remediation has now been embedded as part of routine clinical care in the psychiatric centres in Togo and Benin. It is now recognised as an essential treatment approach for people living with schizophrenia.
Delahunty A, Reeder C, Wykes T, et al (2002) Revised cognitive remediation therapy manual. Institute of Psychiatry, London, United Kingdom
Deste G, Kakli M, Barlati S, Nibbio G, Dossou P, Degila SL, Ceraso A, Lisoni J, Calzavara-Pinton I, Villa S, Vita A. Application of cognitive remediation in the world: new experiences from two schizophrenia rehabilitation centers in Togo and Benin. Soc Psychiatry Psychiatr Epidemiol. 2024 Oct;59(10):1775-1783.
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