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Til Wykes - One of the best experts on this subject based on the ideXlab platform.
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Effects of Cognitive Remediation Therapy versus other interventions on Cognitive functioning in schizophrenia inpatients
Neuropsychological Rehabilitation, 2017Co-Authors: Magdalena Linke, Konrad S. Jankowski, Adam Wichniak, Marek Jarema, Til WykesAbstract:ABSTRACTComputerised Cognitive Remediation Therapy (CCRT) has been shown to improve Cognitive function in individuals with schizophrenia beyond effects of other forms of Therapy. However, results vary between studies, and most are aimed at individuals who are living in the community. Very few studies have investigated its efficacy in psychiatric wards in order to assess whether or not this is a suitable site to start the Therapy. This study evaluated CCRT efficacy among schizophrenia inpatients who received a broad range of therapeutic interventions in a psychiatric ward. A randomised controlled trial of CCRT versus an active control in 66 young inpatients with a diagnosis of schizophrenia was conducted. The intervention lasted for 6 weeks and its efficacy was assessed with the composite score of the MATRICS Consensus Cognitive Battery. Both groups improved similarly in Cognitive function and psychopathological symptoms. However, the CCRT group improved more than the controls in negative symptoms. This re...
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Group Cognitive Remediation Therapy for chronic schizophrenia: A randomized controlled trial.
Neuroscience Letters, 2015Co-Authors: Shu-ping Tan, Til Wykes, Clare Reeder, Yizhuang Zou, Fu-de Yang, Fengmei Fan, Yunlong Tan, Xiaolin Zhu, Yanli Zhao, Dongfeng ZhouAbstract:Individual-level Cognitive Remediation Therapy (CRT) has been shown to be effective for Cognitive improvement and social function amelioration. Here, we aimed to test the efficacy of group-based CRT in Chinese subjects with schizophrenia. One-hundred and four inpatients were randomly assigned to either 40 sessions of small-group CRT Therapy or therapeutic contact-matched Musical and Dancing Therapy (MDT). Cognitive and social functioning, as well as clinical symptoms, were evaluated over the course of treatment. Specifically, Cognitive function was evaluated using a battery of Cognitive measurements, clinical symptoms were evaluated using the Positive and Negative Syndrome Scale, and social function was evaluated using the Nurse's Observation Scale for Inpatient Evaluation-30. All patients were evaluated pre- and post-treatment. Forty-four individuals in the CRT group and 46 in the MDT group completed all of the planned treatments and analyses. Cognitive functions, especially Cognitive flexibility and memory, showed significant improvement in the CRT group over the course of the study. The MDT group also showed improvement in several Cognitive flexibility assessments, but the degree of improvement was significantly greater in the CRT group. Several social-function factors exhibited a significant improvement in the CRT group, but not in the MDT group. Cognitive function improvement correlated positively with social function without predicting social function change. We conclude that group-based CRT is an effective and promising Therapy.
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Cognitive Remediation Therapy for schizophrenia
Minerva psichiatrica, 2012Co-Authors: Matteo Cella, Clare Reeder, Vyvyan Huddy, Til WykesAbstract:Research has consistently documented Cognitive deficits across different domains in people with a diagnosis of schizophrenia. Cognitive Remediation Therapy (CRT) programs based on a number of psychological and learning principles were developed with the aim of improving Cognitive and social Cognitive deficits. Evidence across at least 40 studies shows that CRT can produce small to medium effects on cognition with this estimate unaffected by studies' methodological rigour. Domains where positive outcomes should be expected after CRT include memory, planning, reasoning, problem solving, attention and social cognition but also general functioning. Therapeutic mechanisms have rarely been examined but increasing evidence points at the role of brain plasticity and learning dependent reorganization as potential biological mechanisms responsible for change. Recent evidence has also begun to reveal mediators and moderators of successful treatment and these include age, symptoms at intake, premorbid executive skills but also relationship with the therapist. Given that there is now a large amount of evidence of success (and relatively few studies showing failure) increasing research efforts are considering pragmatic issues that may affect CRT service delivery such as cost effectiveness, Therapy delivery format and patient acceptability. Despite evidence of efficacy there is still more research required to determine the best methods of delivery. We consider that the future research priorities should be: clarifying the translational pathway of CRT from basic science to service implementation, understand the contribution of non-specific factors such as the role of therapist to outcomes, identify which factors contribute to maximize the response to Therapy and how Therapy can be adapted to different clients presentations.
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The effect of working alliance on adherence and outcome in Cognitive Remediation Therapy.
Journal of Nervous and Mental Disease, 2012Co-Authors: Vyv Huddy, Til Wykes, Clare Reeder, Dimitris Kontis, Daniel StahlAbstract:Cognitive Remediation Therapy (CRT) for schizophrenia has been effective in improving Cognitive and global functioning outcomes. It is now important to determine what factors maximize benefit. The quality of relationship--or working alliance--between clients and therapists may be one such factor that improves outcome. To investigate this, 49 individuals with schizophrenia were recruited into a naturalistic study of the impact of CRT on work and structured activity outcomes. Participant's Cognitive skills, severity of symptoms, and social skills were assessed at baseline. Both client and therapist working alliance ratings were gathered early in Therapy. After controlling for depression, clients who rated the alliance more favorably stayed in Therapy longer and were more likely to improve on their main target complaint but notably not on working memory performance or self-esteem. Therapist's ratings of the alliance were not associated with memory outcome. These findings indicate that working alliance is important for client satisfaction with Therapy.
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Effects of Age and Cognitive Reserve on Cognitive Remediation Therapy Outcome in Patients With Schizophrenia
American Journal of Geriatric Psychiatry, 2012Co-Authors: Dimitris Kontis, Sabine Landau, Clare Reeder, Vyvyan Huddy, Til WykesAbstract:Objective Older people with a diagnosis of schizophrenia seem to show fewer benefits following Cognitive Remediation Therapy (CRT). It is not clear whether Cognitive reserve modifies the relationship with age. Methods A total of 134 individuals with schizophrenia were pooled from one randomized control trial and one observational trial. Eighty-five participants received more than 20 sessions of CRT and 49 participants received fewer than 20 sessions of CRT or treatment as usual. Participants were divided into two groups according to their age (younger than 40 years: younger, N = 77; and 40 years or older: older, N = 57). Cognition (working memory, Cognitive flexibility, and planning) was assessed at baseline and posttreatment. Premorbid IQ and vocabulary at baseline were used as Cognitive reserve proxies. Results There was a significant effect of CRT on working memory in younger but not older participants. Better premorbid IQ was associated with better working memory performance in younger participants irrespective of treatment. No significant effects of treatment or Cognitive reserve were revealed in older participants. Cognitive reserve proxies did not modify CRT treatment effect. Conclusion In conclusion, the effects of CRT were limited in older people with schizophrenia. Cognitive reserve could not be shown to influence the relationship of age with CRT efficacy. Better premorbid IQ was associated with increased practice effects on working memory in younger but not older individuals.
Camilla Lindvall Dahlgren - One of the best experts on this subject based on the ideXlab platform.
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Cognitive Remediation Therapy for Adolescents with Anorexia Nervosa-Treatment Satisfaction and the Perception of Change.
Systems Research and Behavioral Science, 2017Co-Authors: Camilla Lindvall Dahlgren, Kristin StedalAbstract:Cognitive Remediation Therapy (CRT) has recently been developed for children and adolescents with anorexia nervosa (AN). It focuses on decreasing rigid cognitions and behaviors, as well as increasing central coherence. Overall, CRT has been proven feasible for young individuals with AN, but little is known regarding the specifics of its feasibility, and the perception of change associated with the intervention. Consequently, the aim of the current study was to explore service users’ perspective on CRT with a specific focus on treatment delivery, treatment content, and perceived change. Twenty adolescents (age 13–18) with AN participated in a 10-session course of CRT. A 20-item treatment evaluation questionnaire was administered at the end of treatment, focusing on four aspects of the intervention: (1) general attitudes towards treatment, (2) treatment specifics, (3) the perception of change and (4) the patient-therapist relation. The main findings suggest high levels of treatment satisfaction, but somewhat limited perceptions of change. The current study is one of the most detailed accounts of adolescents’ perspective on CRT published on eating disorders, and highlights several important aspects of the treatment viewed through the eye of the receiver.
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Cognitive Remediation Therapy for Adolescents with Anorexia Nervosa—Treatment Satisfaction and the Perception of Change
Behavioral Sciences, 2017Co-Authors: Camilla Lindvall Dahlgren, Kristin StedalAbstract:Cognitive Remediation Therapy (CRT) has recently been developed for children and adolescents with anorexia nervosa (AN). It focuses on decreasing rigid cognitions and behaviors, as well as increasing central coherence. Overall, CRT has been proven feasible for young individuals with AN, but little is known regarding the specifics of its feasibility, and the perception of change associated with the intervention. Consequently, the aim of the current study was to explore service users’ perspective on CRT with a specific focus on treatment delivery, treatment content, and perceived change. Twenty adolescents (age 13–18) with AN participated in a 10-session course of CRT. A 20-item treatment evaluation questionnaire was administered at the end of treatment, focusing on four aspects of the intervention: (1) general attitudes towards treatment, (2) treatment specifics, (3) the perception of change and (4) the patient-therapist relation. The main findings suggest high levels of treatment satisfaction, but somewhat limited perceptions of change. The current study is one of the most detailed accounts of adolescents’ perspective on CRT published on eating disorders, and highlights several important aspects of the treatment viewed through the eye of the receiver
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A systematic review of Cognitive Remediation Therapy for anorexia nervosa – development, current state and implications for future research and clinical practice
The Journal of Eating Disorders, 2014Co-Authors: Camilla Lindvall DahlgrenAbstract:Objective To systematically review studies of Cognitive Remediation Therapy (CRT) for anorexia nervosa (AN), and to discuss findings with references to clinical practice and future research.
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a systematic review of Cognitive Remediation Therapy for anorexia nervosa development current state and implications for future research and clinical practice
The Journal of Eating Disorders, 2014Co-Authors: Camilla Lindvall DahlgrenAbstract:Objective To systematically review studies of Cognitive Remediation Therapy (CRT) for anorexia nervosa (AN), and to discuss findings with references to clinical practice and future research.
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Neuropsychological functioning in adolescents with anorexia nervosa before and after Cognitive Remediation Therapy: a feasibility trial.
International Journal of Eating Disorders, 2013Co-Authors: Camilla Lindvall Dahlgren, Bryan Lask, Nils Inge LandrøAbstract:Objective: To investigate neuropsychological functioning in adolescents with anorexia nervosa (AN) before and after receiving Cognitive Remediation Therapy (CRT). Method: Twenty young females with AN participated in an individually-delivered CRT treatment program. Neuropsychological and psychiatric assessments were administered before and after treatment. Weight, depression, anxiety, duration of illness, and level of eating disorder psychopathology were considered as covariates in statistical analyses. Results: Significant changes in weight, depression, visio-spatial memory, perceptual disembedding abilities, and verbal fluency were observed. Changes in weight had a significant effect on improvements in visuo-spatial memory and verbal fluency. Results also revealed a significant effect of depressive symptoms on perceptual disembedding abilities. Discussion: The results suggest improvements on a number of neuropsychological functions during the course of CRT. Future studies should explore the use of additional assessment instruments, and include control groups to assess the effectiveness of the intervention. V C 2013 Wiley Periodicals, Inc.
Kate Tchanturia - One of the best experts on this subject based on the ideXlab platform.
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Impact of Cognitive Remediation Therapy on neuroCognitive processing in anorexia nervosa
Frontiers in Psychiatry, 2018Co-Authors: Jenni Leppanen, James Adamson, Kate TchanturiaAbstract:Background: Anorexia nervosa (AN) is characterised by severe malnutrition as well as inefficiencies in neuroCognitive functioning, which are believed to contribute to the maintenance of disordered eating. The aim of this study was to examine the impact of individual Cognitive Remediation Therapy (CRT) on neurocognition in AN. Methods: 145 adult women from an eating disorders inpatient programme took part in the present study. All participants were given individual CRT in addition to treatment as usual. NeuroCognitive processes were assessed at baseline and at the end of treatment using task-based and self-report measures. The task-based measures included the Rey-Osterrieth Complex Figure test and the Brixton test, which were used to assess central coherence and set-shifting. The Detail and Flexibility Questionnaire was used to examine patients self-reported detail focus and Cognitive flexibility. Results: Participants showed significant improvement in task-based measures of neurocognition following CRT. There were no significant changes in self-report measures. Conclusions: These findings suggest that CRT may be an effective intervention targeting inefficiencies in neurocognition in AN. Future studies may benefit from assessing neural changes associated with these improvements and conducting randomised controlled trials to replicate these findings.
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Impact of Cognitive Remediation Therapy on NeuroCognitive Processing in Anorexia Nervosa
Frontiers Media S.A., 2018Co-Authors: Jenni Leppanen, James Adamson, Kate TchanturiaAbstract:BackgroundAnorexia nervosa (AN) is characterized by severe malnutrition as well as inefficiencies in neuroCognitive functioning, which are believed to contribute to the maintenance of disordered eating. The aim of this study was to examine the impact of individual Cognitive Remediation Therapy (CRT) on neurocognition in AN.MethodsA total of 145 adult women from an eating disorders inpatient program took part in the present study. All participants were given individual CRT in addition to treatment as usual. NeuroCognitive processes were assessed at baseline and at the end of treatment using task-based and self-report measures. The task-based measures included the Rey-Osterrieth Complex Figure test and the Brixton test, which were used to assess central coherence and set-shifting. The Detail and Flexibility Questionnaire was used to examine patients self-reported detail focus and Cognitive flexibility.ResultsParticipants showed significant improvement in task-based measures of neurocognition following CRT. There were no significant changes in self-report measures.ConclusionThese findings suggest that CRT may be an effective intervention targeting inefficiencies in neurocognition in AN. Future studies may benefit from assessing neural changes associated with these improvements and conducting randomized controlled trials to replicate these findings
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A randomised controlled trial of manualized Cognitive Remediation Therapy in adult obesity.
Appetite, 2017Co-Authors: Jayanthi Raman, Phillipa Hay, Kate Tchanturia, Evelyn SmithAbstract:Abstract Objective Research has indicated that individuals with obesity have neuroCognitive deficits, especially in Cognitive flexibility that may in turn impact on their weight loss and maintenance. Consequently, we examined the efficacy of a manualised face-to-face Cognitive Remediation Therapy for obesity (CRT-O) within a randomised controlled trial, in terms of improving Cognitive flexibility, reducing binge eating behaviour, improving quality of life and helping with weight loss. Methods 80 adults with obesity (body mass index >30 kg/m 2 ), 70% binge eaters, received three weekly sessions of group Behavioural Weight Loss (BWL) and then were randomised to 8 sessions of individual CRT-O or to a no-treatment control group. Results Mixed-effects model analyses revealed that the CRT-O group had a significant improvement in their Cognitive flexibility at post-treatment and 3-month follow-up compared to the control group (Cohen's d = 0.96 to 2.1). 68% of those in the CRT-O group achieved a weight loss of 5% or more at follow-up compared to only 15% of the controls (Cohen's d = 1.3). Changes in set-shifting predicted changes in weight (p Discussion This is the first study showing the efficacy of CRT-O for obesity. Future CRT-O studies with longer follow-ups and pairing it with longer BWL programs are needed. Trials registry (ANZCTR) 12613000537752. Date of ANZCTR registration 14 May 2013.
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Evidence for Cognitive Remediation Therapy in Young People with Anorexia Nervosa: Systematic Review and Meta-analysis of the Literature.
European Eating Disorders Review, 2017Co-Authors: Kate Tchanturia, Lucia Giombini, Jenni Leppanen, Emma KinnairdAbstract:Cognitive Remediation Therapy (CRT) for eating disorders has demonstrated promising findings in adult age groups, with randomised treatment trials and systematic reviews demonstrating medium to large effect sizes in improved Cognitive performance. In recent years, several case series have been conducted for young people with anorexia nervosa, but these findings have not been synthesised in the form of a systematic review. This systematic review aimed to evaluate the evidence for the efficacy of CRT in child and adolescent age groups. Nine studies were identified, with a subsequent meta-analysis suggesting improvements in Cognitive performance with small effect sizes. Patient feedback was positive, with low dropout rates. These findings suggest that CRT has potential as a supplementary treatment for young people with anorexia nervosa, warranting further investigation using randomised treatment trials. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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How anorexia nervosa patients with high and low autistic traits respond to group Cognitive Remediation Therapy
BMC Psychiatry, 2016Co-Authors: Kate Tchanturia, Emma Larsson, James AdamsonAbstract:The current study aimed to evaluate group Cognitive Remediation Therapy (CRT) inpatients with Anorexia Nervosa (AN). We aimed to examine the treatment response of group CRT in AN patients with high or low levels of autistic traits. Thirty-five in patients with an AN diagnosis received group CRT intervention for 6 sessions in a national eating disorder unit. All participants completed self-report questionnaires on thinking styles and motivation before and after the intervention. Patients with low autistic traits had statistically significant medium size effect improvements in self-reported thinking style scales as well as confidence (ability) to change. Patients with high autistic traits showed no statistically significant improvements in any outcome measure. The brief group format CRT intervention improves self-reported Cognitive and motivational aspects in people with AN without autistic traits. For patients with higher autistic traits brief group CRT does not improve self-reported Cognitive style or motivation. This finding suggests that brief group format CRT might not be the best suited format for individuals with elevated autistic traits and individual or more tailored CRT should be explored.
Kate Tchanturia - One of the best experts on this subject based on the ideXlab platform.
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Individual Cognitive Remediation Therapy benefits for patients with anorexia nervosa and high autistic features
European Eating Disorders Review, 2019Co-Authors: Yasemin Dandil, Katherine Smith, James Adamson, Kate TchanturiaAbstract:Cognitive Remediation Therapy (CRT) is an increasingly implemented intervention in psychiatric conditions. The majority of randomized treatment trials in psychiatry reports Cognitive improvements resulting in better functional outcomes in CRT groups. This brief report from the national inpatient treatment programme for eating disorders demonstrates Cognitive performance task-based improvements in patients with high and low autistic characteristics. This preliminary study shows feasibility and benefits of individual CRT in patients who have autism spectrum disorder features.
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Young people's experience of individual Cognitive Remediation Therapy (CRT) in an inpatient eating disorder service: a qualitative study.
Eating and Weight Disorders-studies on Anorexia Bulimia and Obesity, 2017Co-Authors: Lucia Giombini, Sophie Nesbitt, Lauren Waples, Emilia Finazzi, Abigail Easter, Kate TchanturiaAbstract:Introduction and Purpose Current literature shows promising results regarding the efficacy of Cognitive Remediation Therapy for Anorexia Nervosa (AN); however, there is a paucity of studies considering the use of CRT in Young People (YP). The aim of this study was to examine YP’s experiences of individual CRT in an inpatient eating disorder unit.
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Benefits of group Cognitive Remediation Therapy in anorexia nervosa: case series
Neuropsychiatrie, 2016Co-Authors: Kate Tchanturia, Emma Larsson, Amy BrownAbstract:Background Cognitive Remediation Therapy (CRT) is a treatment targeting Cognitive difficulties in psychiatric disorders. CRT has been used with patients with severe anorexia nervosa (AN) in individual and group formats. Research of group CRT in AN is limited.
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Cognitive Remediation Therapy for Eating Disorders
Encyclopedia of Feeding and Eating Disorders, 2015Co-Authors: Kate Tchanturia, Heather WestwoodAbstract:Cognitive Remediation Therapy (CRT) is an umbrella term for psychological interventions that use a wide range of Cognitive training exercises targeting Cognitive process and helping individuals with different Cognitive inefficiencies. Unlike psychological therapies which focus on content of thinking and symptom reduction from the early stage of treatment, CRT can facilitate reflection on Cognitive style, awareness of existing Cognitive strategies, and development of alternative ways to approach tasks and problems. CRT can be delivered in individual or group formats, and computerized versions are also available for use in some clinical groups.
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Cognitive Remediation Therapy (CRT) for eating and weight disorders
2014Co-Authors: Kate TchanturiaAbstract:Introduction: Why CRT for Eating and Weight Disorders, Kate Tchanturia. Cognitive Profiles in Adults and Children With Anorexia Nervosa and How it Helped us to Develop CRT for Anorexia, Kate Tchanturia, Katie Lang. Individual Format of CRT Complex Cases. A Case Study of CRT With an Inpatient with Anorexia Nervosa, Caroline Fleming and Kate Tchanturia. Adapting CRT to Increase Awareness of Thinking Styles in People with Severe Anorexia and Comorbid Disorders, Amy Harrison, Kate Tchanturia. Cognitive Remediation Therapy (CRT) for Anorexia in Group Format: An Evaluation From an Adult Population, Kate Tchanturia, Emma Smith, Clinicians' Experiences of Cognitive Remediation Therapy - a Qualitative Study, Naima Lounes, Kate Tchanturia. Randomised Controlled Trials. Cognitive Remediation Therapy for Patients with a Severe and Enduring Eating Disorder, Alexandra Dingemans, Unna Danner, Eric Van Furth. Comprehending and Fostering Cognitive-Behavioural Flexibility in Anorexia Nervosa, Hans-Christoph Friederich, Timo Brockmeyer. Adaptations of CRT in Young People with AN. Cognitive Remediation Therapy with Children and Adolescents, Kathleen Kara Fitzpatrick, James D. Lock. Evaluation of a Cognitive Remediation Therapy Group for Adolescents with Anorexia Nervosa in a Day Patient Setting, Natalie Pretorius, Jonathan Espie, Mima Simic. New Developments Ideas Worth Researching: CRT in the Context of Family Therapy. Family Cognitive Remediation Therapy for Child and Adolescent Anorexia Nervosa, Suzanne Hutchison, Alice Roberts, Bryan Lask, Future Developments of Remedial Therapies fMRI Studies Leon Fonville, Nick Lao-Kaim, Kate Tchanturia. Cognitive Remediation Therapy Adaptation for Obesity, Evelyn Smith, Phillipa Hay, Jayanthi Raman. Cognitive Remediation Therapy for Anorexia Nervosa: How do we Know it Works? Kate Tchanturia, Heather Westwood, Helen Davies, Developing Cognitive Remediation Therapy - Lessons from the Field of Schizophrenia, Clare Reeder, Til Wykes. Appendix. Useful Clinical Tools Weblinks and Outcome Measures.
Clare Reeder - One of the best experts on this subject based on the ideXlab platform.
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Group Cognitive Remediation Therapy for chronic schizophrenia: A randomized controlled trial.
Neuroscience Letters, 2015Co-Authors: Shu-ping Tan, Til Wykes, Clare Reeder, Yizhuang Zou, Fu-de Yang, Fengmei Fan, Yunlong Tan, Xiaolin Zhu, Yanli Zhao, Dongfeng ZhouAbstract:Individual-level Cognitive Remediation Therapy (CRT) has been shown to be effective for Cognitive improvement and social function amelioration. Here, we aimed to test the efficacy of group-based CRT in Chinese subjects with schizophrenia. One-hundred and four inpatients were randomly assigned to either 40 sessions of small-group CRT Therapy or therapeutic contact-matched Musical and Dancing Therapy (MDT). Cognitive and social functioning, as well as clinical symptoms, were evaluated over the course of treatment. Specifically, Cognitive function was evaluated using a battery of Cognitive measurements, clinical symptoms were evaluated using the Positive and Negative Syndrome Scale, and social function was evaluated using the Nurse's Observation Scale for Inpatient Evaluation-30. All patients were evaluated pre- and post-treatment. Forty-four individuals in the CRT group and 46 in the MDT group completed all of the planned treatments and analyses. Cognitive functions, especially Cognitive flexibility and memory, showed significant improvement in the CRT group over the course of the study. The MDT group also showed improvement in several Cognitive flexibility assessments, but the degree of improvement was significantly greater in the CRT group. Several social-function factors exhibited a significant improvement in the CRT group, but not in the MDT group. Cognitive function improvement correlated positively with social function without predicting social function change. We conclude that group-based CRT is an effective and promising Therapy.
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Cognitive Remediation Therapy for schizophrenia
Minerva psichiatrica, 2012Co-Authors: Matteo Cella, Clare Reeder, Vyvyan Huddy, Til WykesAbstract:Research has consistently documented Cognitive deficits across different domains in people with a diagnosis of schizophrenia. Cognitive Remediation Therapy (CRT) programs based on a number of psychological and learning principles were developed with the aim of improving Cognitive and social Cognitive deficits. Evidence across at least 40 studies shows that CRT can produce small to medium effects on cognition with this estimate unaffected by studies' methodological rigour. Domains where positive outcomes should be expected after CRT include memory, planning, reasoning, problem solving, attention and social cognition but also general functioning. Therapeutic mechanisms have rarely been examined but increasing evidence points at the role of brain plasticity and learning dependent reorganization as potential biological mechanisms responsible for change. Recent evidence has also begun to reveal mediators and moderators of successful treatment and these include age, symptoms at intake, premorbid executive skills but also relationship with the therapist. Given that there is now a large amount of evidence of success (and relatively few studies showing failure) increasing research efforts are considering pragmatic issues that may affect CRT service delivery such as cost effectiveness, Therapy delivery format and patient acceptability. Despite evidence of efficacy there is still more research required to determine the best methods of delivery. We consider that the future research priorities should be: clarifying the translational pathway of CRT from basic science to service implementation, understand the contribution of non-specific factors such as the role of therapist to outcomes, identify which factors contribute to maximize the response to Therapy and how Therapy can be adapted to different clients presentations.
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The effect of working alliance on adherence and outcome in Cognitive Remediation Therapy.
Journal of Nervous and Mental Disease, 2012Co-Authors: Vyv Huddy, Til Wykes, Clare Reeder, Dimitris Kontis, Daniel StahlAbstract:Cognitive Remediation Therapy (CRT) for schizophrenia has been effective in improving Cognitive and global functioning outcomes. It is now important to determine what factors maximize benefit. The quality of relationship--or working alliance--between clients and therapists may be one such factor that improves outcome. To investigate this, 49 individuals with schizophrenia were recruited into a naturalistic study of the impact of CRT on work and structured activity outcomes. Participant's Cognitive skills, severity of symptoms, and social skills were assessed at baseline. Both client and therapist working alliance ratings were gathered early in Therapy. After controlling for depression, clients who rated the alliance more favorably stayed in Therapy longer and were more likely to improve on their main target complaint but notably not on working memory performance or self-esteem. Therapist's ratings of the alliance were not associated with memory outcome. These findings indicate that working alliance is important for client satisfaction with Therapy.
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Effects of Age and Cognitive Reserve on Cognitive Remediation Therapy Outcome in Patients With Schizophrenia
American Journal of Geriatric Psychiatry, 2012Co-Authors: Dimitris Kontis, Sabine Landau, Clare Reeder, Vyvyan Huddy, Til WykesAbstract:Objective Older people with a diagnosis of schizophrenia seem to show fewer benefits following Cognitive Remediation Therapy (CRT). It is not clear whether Cognitive reserve modifies the relationship with age. Methods A total of 134 individuals with schizophrenia were pooled from one randomized control trial and one observational trial. Eighty-five participants received more than 20 sessions of CRT and 49 participants received fewer than 20 sessions of CRT or treatment as usual. Participants were divided into two groups according to their age (younger than 40 years: younger, N = 77; and 40 years or older: older, N = 57). Cognition (working memory, Cognitive flexibility, and planning) was assessed at baseline and posttreatment. Premorbid IQ and vocabulary at baseline were used as Cognitive reserve proxies. Results There was a significant effect of CRT on working memory in younger but not older participants. Better premorbid IQ was associated with better working memory performance in younger participants irrespective of treatment. No significant effects of treatment or Cognitive reserve were revealed in older participants. Cognitive reserve proxies did not modify CRT treatment effect. Conclusion In conclusion, the effects of CRT were limited in older people with schizophrenia. Cognitive reserve could not be shown to influence the relationship of age with CRT efficacy. Better premorbid IQ was associated with increased practice effects on working memory in younger but not older individuals.
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Cognitive Remediation Therapy in schizophrenia: cost-effectiveness analysis.
Schizophrenia Research, 2010Co-Authors: Anita Patel, Clare Reeder, Brian S. Everitt, Martin Knapp, Renee Romeo, Pall Matthiasson, Til WykesAbstract:Abstract Purpose There is a lack of evidence on the cost-effectiveness of Cognitive Remediation Therapy (CRT). Methods Randomised controlled trial comparing usual care plus CRT with usual care alone. Participants had a diagnosis of schizophrenia and Cognitive and social functioning difficulties. Health/social care and societal costs were estimated at 14 weeks (time 2) and 40 weeks (time 3) after randomisation. The outcome, proportion of participants improving their working memory since baseline, was combined with costs to explore cost-effectiveness. Results 85 participants were recruited. There were no differences in total health/social care or societal costs between the two groups at either time 2 or time 3. An additional 21% of participants in the CRT group improved their working memory at both follow-ups. When placing these cost and outcomes in hypothetical scenarios concerning how much policy-makers would pay for another 1% of participants improving their working memory, there was more than an 80% chance that CRT would be cost-effective compared to usual care; at time 3, the likelihood of cost-effectiveness peaked at 30% even for investments up to £5000. Conclusions CRT can improve memory among people with schizophrenia and Cognitive deficits at no additional cost. Although cost-effective in the short term, CRT may have limited potential to save costs in the medium term because it could increase take up of services. This could confer important longer term benefits for the patient group examined here, in terms of improved social functioning and less reliance on services. This can only be ascertained through longer follow-up.