What does ChatGPT really know? A Conversation with an AI Chatbot about Cognitive Remediation

Lois Ann Parri, ex-Research Assistant at King's College London and current PhD student at the University of Cambridge

With more of us engaging with Artificial intelligence (AI) tools, the CIRCuiTS™ team thought we should discover how much a widely used AI chatbot, ChatGPT, knew about Cognitive Remediation (CR). We hoped to find out how much information there is online about CR, whether or not the chatbot will generate incorrect answers, and what it knows about CIRCuiTS™ in particular. Without further ado, let’s see what ChatGPT has to say for itself.

1.      What is Cognitive Remediation?

Cognitive Remediation (CR) is a therapy aimed at improving cognitive processes such as memory, attention, executive functioning, and problem-solving through targeted exercises. It is often used for individuals with cognitive deficits due to mental health conditions like schizophrenia, brain injuries, or neurodevelopmental disorders. The therapy focuses on strengthening neural pathways through repeated practice and compensatory strategy development. CR is typically goal-oriented and integrates cognitive improvements with real-world functional gains, such as better social and occupational outcomes.

Not too bad! This answer demonstrates quite a good understanding of CR, but we would have preferred more of an emphasis on CR being a formulation-driven, evidenced-based psychological intervention. However, translation to functional gains is key.

2.      How does Cognitive Remediation help individuals with mental health conditions (e.g., schizophrenia)?

CR helps by targeting the cognitive deficits common in schizophrenia, such as poor memory, reduced attention, and impaired executive functioning. By addressing these deficits, it improves the individual’s ability to navigate daily tasks, maintain employment, and engage in social interactions. The therapy enhances quality of life by enabling patients to better manage real-world challenges. Improved cognitive functioning also helps individuals benefit more from other treatments, including psychotherapy or medication.

This highlights how CR helps people live independent lives by successfully doing day-to-day tasks after improving their cognition. Our question did note Schizophrenia as an example. It’s important to remember that CR can help a wide variety of people with cognitive difficulties and isn’t limited to severe mental health conditions. We also know there are no medications that reliably improve cognition in those with a diagnosis of schizophrenia. Similarly, CR can improve medication management and also the outcomes of other evidence-based psychological therapies such as CBT.

3.      Who is a good candidate for Cognitive Remediation therapy, and who might it not be suitable for?

Good candidates for CR include individuals with cognitive impairments stemming from conditions like schizophrenia, bipolar disorder, or brain injuries, particularly if they have functional goals related to work, education, or social skills. It is less suitable for individuals with severe intellectual disabilities, untreated psychosis, or those unable to engage in structured tasks. Motivation and readiness to engage are key factors in determining success with CR, so it may not be appropriate for those with significant motivational barriers.

We know that many people can benefit from CR. It needs to be tailored to their current experiences and areas of need. The therapy should also consider each client’s specific strengths and difficulties. ChatGPT’s idea of who might not be suitable leaves some room for error. Stating ‘untreated psychosis’ might be misleading. The focus should be on whether someone is actively experiencing psychotic symptoms that interferes with their ability to engage with CR. We know that those in the acute phase of psychosis can engage and benefit from CR. As ChatGPT says, CR works well as a stand-alone treatment or with other treatments, so individuals aren’t restricted by what else they may or may not be doing. Similarly, “or those unable to engage in structured tasks” is another vague criterion. Ultimately, whether the chatbot is referring to scheduling therapy sessions, completing the therapy tasks, or real-life difficulties. All these issues can be accommodated by the CR therapist, who can support each person’s needs.

4.      What are the biggest challenges in implementing Cognitive Remediation in clinical or community settings?

Challenges include the need for trained professionals, access to appropriate technology, and time or resource constraints in clinical settings. Additionally, maintaining participant motivation and engagement over the course of the program can be difficult, especially if clients do not see immediate results. In community settings, logistical issues such as lack of funding, cultural adaptation of materials, and limited integration with other mental health services also pose barriers.

We are back on track with a great response, identifying the many barriers faced when implementing CR. Like other therapies, it isn’t good enough to work; to be successful, CR has to work well by keeping to healthcare services rules and complementing individual therapist and client treatment preferences.

5.      How is technology being used to enhance Cognitive Remediation therapies?

Technology plays a central role in CR, with many programs using computer-based tasks to deliver engaging, adaptive exercises tailored to the user’s performance. Virtual reality (VR) environments are also being explored to simulate real-world challenges, such as navigating a workplace or social situation. Mobile apps and online platforms allow clients to practice cognitive exercises at home, increasing accessibility. AI-driven tools are starting to personalise exercises further, adapting difficulty levels to the individual’s progress in real-time.

This response highlights the transformative impact of technology on CR, showcasing its potential to make therapy more effective and widely available. However, ChatGPT may have fallen victim to a common misconception that CR is the same as brain training. Brain training doesn’t use the same evidence-based techniques as CR. The response also implies that digital CR platforms are abundant, which isn’t the case and although they can use AI, this is in its infancy.

6.      What do you know about CIRCuiTS?

CIRCuiTS™ (Computerised Interactive Remediation of Cognition - Training for Schizophrenia) is a cognitive remediation program specifically designed for individuals with schizophrenia. It was developed to improve cognitive functioning through a combination of structured, interactive tasks and real-world relevance. CIRCuiTS™ uses a computer-based platform to deliver cognitive training in areas like memory, attention, and problem-solving.

Key Features of CIRCuiTS:

• Personalisation: The program is tailored to each individual’s cognitive strengths, weaknesses, and functional goals. Tasks adapt in difficulty to match the participant's ability.

• Real-World Relevance: CIRCuiTS emphasises applying cognitive skills to everyday activities, such as planning a trip or managing a budget, making the training directly applicable to improving life skills.

• Interactive Design: It includes engaging, user-friendly exercises that aim to increase motivation and participation, particularly for individuals with low engagement in traditional therapies.

• Focus on Metacognition: The program encourages participants to reflect on their thinking strategies and problem-solving approaches, helping them generalise these skills to real-life situations.

And there we are, the first clear AI mistake, our title. The CIRCuiTS™ acronym stands for Computerised Interactive Remediation of Cognition and Thinking Skills. It also isn’t exclusive to Schizophrenia and is used to help people with cognitive difficulties who have a range of mental conditions. Other than that, ChatGPT provides an excellent account of how CIRCuiTS™ works.

There is room for improvement, and ChatGPT needs to do a bit of fact-checking here and there, but overall, this chatbot has a good sense of CR.

Disclaimer: This blog explores responses from an AI system. The content generated reflects the knowledge and training of the model as of the conversation date and should not be taken as factual.

Acknowledgement: Responses from ChatGPT, seen in italics, were generated using OpenAI's GPT-4 model.

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