Cognitive remediation therapy – addressing the challenges in implementation research

by Dr Julaine Allan, Professor of Mental Health and Addiction, Rural Health Research Institute, Charles Sturt University

Many people with psychosis experience difficulties with their cognition, which can include difficulty concentrating on tasks and remembering things, as well as planning and organising. Cognitive remediation therapy (CRT) helps by teaching strategies for problem solving, remembering and planning and then practising them in structured activities outside of the therapy room. CIRCuiTS^TM is a software that develops these learning mechanisms into an engaging program to build skills and strategies gradually.

Cognitive remediation therapy (CRT) is included in the Australian and New Zealand Psychiatry Guidelines but is not widely available. Our research is designed to aid implementation of CIRCuiTS^TM at four public mental health service sites by addressing two key challenges – a widespread lack of knowledge of the cognitive problems people with psychosis experience and then (no surprise!) a lack of knowledge of how CRT can help.

Our CLEAR Collaborative Research Group created two resources to help people with psychosis and mental health teams learn more about cognition and CRT.

For people with psychosis

Our information booklet for people with psychosis is called “Thinking Skills for Recovery”. The booklet is in an Easy Read format, using plain language, short sentences, and pictures. It explains what thinking skills are (as in the example below), how they can be affected in schizophrenia, and what an individual can do to address thinking skills difficulties, including participating in CRT.

For clinicians

Many Australian mental health clinicians do not understand the importance of cognition in psychosis. To address this, we are running short sessions with clinicians at four mental health service sites within an Australian implementation trial of CIRCuiTS^TM.  These sessions outline the relationship between psychosis and cognition and the impact cognitive problems can have on people’s daily functioning. We also share ways for clinicians to talk to people about cognition. For these sessions, we created a second resource – a version of the “Thinking Skills for Recovery” booklet for clinicians to use when discussing cognition with their service users.

As the excerpt above shows, while this booklet gives more information than the booklet for people with psychosis, it still uses simple language, making it suitable for patients, families and carers as well as clinicians. It includes some suggestions for things people can do to improve their cognitive functions, such as showing examples of board games that are helpful for developing specific cognitive functions. It also includes a cognition skills quiz that looks at learning styles, memory and concentration and that can lead into discussions of how CIRCuiTS^TM can help.

With these two resources, we are raising awareness of CRT and making it available to more people. Making CIRCuiTS™ more available in our research sites requires much more than training clinicians in the therapy and having them deliver it. Implementation requires organisational support and resources along with a broad understanding of cognition and related problems to facilitate program delivery.

Please don't hesitate to get in touch with me at juallan@csu.edu.au if you are interested in receiving copies of these resources.

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