A Copyright Harvard Health Publications
Used early on, this hybrid therapy may improve mental and social functioning. Difficulties in thinking and socializing, known as “negative” symptoms, often develop in patients with schizophrenia and typically persist even after hallucinations, delusions, and other “positive” symptoms of the disorder are under control. Now, fortunately, cognitive remediation therapies exist to improve mental and social functioning.
Practicing essential life skills
Cognitive enhancement therapy is based on the premise that schizophrenia is a brain disorder that affects attention and verbal memory, and that these deficits contribute to disorganized thoughts and loss of social competence. A series of interactive drills and exercises helps patients improve aspects of cognitive function, such as appraisal of social context. In recent years, computer-based cognitive exercise programs have contributed to efforts to boost patients’ “real world” functioning. Researchers have shown that such exercises result in better employment outcomes.
This research is encouraging because it contradicts the idea that schizophrenia is an irreversible brain illness. In fact, the studies show that important skills can be practiced and learned.
Some of the techniques used during cognitive enhancement therapy were adapted from the treatment of traumatic brain injuries. The techniques take advantage of the brain’s remarkable plasticity, its ability to form new neural connections that can help people compensate for loss of brain function.
Studies have shown that cognitive enhancement therapy helps patients in several ways. Thinking can become more organized, and less rigid. Emotional processing improves as does the ability to think and plan ahead. In general, patients see improved social adjustment and a greater ability to function in social or work settings.
Initial and follow-up results
Improvements appear to last. Patients who participate in cognitive enhancement therapy maintain their overall social adjustment, are more likely to get and keep friends and more able to enjoy social activities. They do better on these dimensions than patients who, while getting supportive therapy, do not receive the cognitive enhancement piece.
Furthermore, changes can be seen on brain scans that estimate the amount of grey matter in specific areas of the brain. (Grey matter is largely made up of
interconnected nerve cell bodies.) Patients participating in cognitive enhancement therapy have been more likely than those getting usual treatment to retain grey matter in brain regions associated with social and cognitive functioning.
Real-world improvement is the goal
Ultimately, the goal of these treatments is to help people with a potentially devastating illness to enjoy the usual benefits of participation in day-to-day life. Research has shown that people with schizophrenia can be helped to manage and to some extent overcome the challenges they face. The development and refinement of computer-based exercises has led to even more success. Such tools are relatively easy to standardize and could be made available to an ever-widening group of patients.
There is increasing evidence that cognitive enhancement therapy has value as an adjunct to medication in the treatment of schizophrenia. Most important, it is becoming an established way to help patients participate and contribute meaningfully in their communities.