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How do we know that cognitive remediation is effective?

by Professor Antonio Vita, Chair of Psychiatry at University of Brescia, Italy

Puzzle pieces slotted together with one empty space showing

Cognitive Remediation effectiveness for improving the cognitive performance and the daily lives of people living with schizophrenia has been demonstrated in many, many trials. However, an individual trial conducted with impeccable methods and with large samples of participants are intrinsically limited in their scientific value, as they represent a single, isolated observation.


This is where meta-analyses come into play.


Meta-analyses combine the results of different trials that are similar in their methods and their included participants and synthesizes their results. This is very useful as it provides summarized information that can help the decision processes of clinicians and policy makers.


Think of it as a blender, where the input is scientific studies, and the output is condensed scientific results juice!


The first comprehensive meta-analysis on the effectiveness of Cognitive Remediation for people with schizophrenia was published in 2011 (Wykes T et al, Am J Psychiatry 2011, 168(5):472-485). It included 40 different studies and 2,104 individual participants and it showed that Cognitive Remediation is indeed effective in improving cognitive performance and daily functioning. It also showed that these improvements are quite durable.


Since 2011 other studies have been published, so in 2021, 10 years later, a new meta-analysis was conducted (Vita A et al, Jama Psychiatry 2021, 78(8):848-858). It included 130 studies with a total of 8851 participants, and with such large numbers it was possible to investigate not only if Cognitive Remediation works, but also what makes it work!


The benefits for cognitive performance and daily functioning were confirmed beyond doubt. Even patients with a more severe clinical condition responded well and may indeed represent ideal treatment candidates. Cognitive Remediation programs work best if they are provided by an active and trained therapist, if they promote the development of novel cognitive strategies and if they are integrated into structured rehabilitation programs.


Considering this wealth of information, the Authors of the meta-analysis concluded that Cognitive Remediation should be implemented more widely into clinical guidance and offered more consistently by mental health services to their users, as it may represent a true game changer for the lives of people diagnosed with schizophrenia.


The full version of this meta-analysis is available to read and download for free at https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2778914

 

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