Joanna Fiszdon - US grants

DESCRIPTION (provided by applicant): Cognitive remediation training is a promising behavioral technique for improving cognitive function in individuals with schizophrenia. Researchers consistently conclude that cognitive remediation is effective in improving performance on specific attention, memory, and executive function tasks. However, the clinical meaningfulness of this intervention remains a largely unexamined question. Clinically significant effects of cognitive remediation would include evidence that: 1) there has been a return to normal levels of cognitive function; 2) normal levels of cognitive function are sustained after the conclusion of training; 3) the effects of the intervention generalize to other measures of targeted neurocognitive functions not specifically trained; 4) the intervention is beneficial to a significant portion of individuals with schizoprhenia. In order to take the best advantage of this intervention, it would also be important to identify who is most likely to respond to the intervention with clinically meaningful change. The proposed study addresses the above-mentioned issue of clinical meaningfulness of cognitive remediation in schizophrenia by: 1) obtaining normative (healthy control) performance data on a commonly used cognitive remediation battery; 2) using the obtained normative data to determine the proportion of schizophrenia patients who meaningfully benefit from cognitive remediation training (i.e. attain normal levels of performance); 3) evaluating whether normal-level performance is sustained up to 6 months following the end of the intervention; 4) evaluating whether remediation of cognitive task battery performance generalizes to untrained neuropsychological tests; 5) examining pre-treatment variables which predict the efficacy of cognitive remediation training.

DESCRIPTION (provided by applicant): Schizophrenia is a disabling illness, characterized by severe impairments in social, occupational, and community function. Moreover, social impairments are identified as key unmet treatment needs by the very individuals who suffer from this disorder. Existing psychosocial treatments for schizophrenia fall short of significantly improving social and community function. There is ample evidence of neurocognitive impairments in schizophrenia, and these impairments have in turn been identified as key determinants of social and other functional outcomes, and as rate-limiters for skill acquisition in psychosocial rehabilitation. More recent research indicates that social cognition, or how an individual processes, interprets, and responds to social information, may mediate the relationship between neurocognition and functioning and may be a more proximal treatment target for interventions aimed at improving functional outcomes in schizophrenia. Potential targets for social cognitive training include affect recognition, social knowledge /social perception, and attributional style (AS)/Theory of Mind (ToM). While a number of researchers have reported success in remediating affect recognition deficits, there has been little treatment development focusing on AS/ToM impairments. The few studies that have targeted these domains specifically have had limited success, suggesting that further development of such interventions may be of benefit. The primary aim of this application is to develop, refine, manualize and assess the feasibility and preliminary efficacy of a brief, narrowly-focused social cognitive intervention targeting attributional bias/Theory of Mind in schizophrenia. This individually administered treatment will focus on remediating established elements of atttributional style/Theory of Mind, but unlike previous efforts will utilize training methods that have been successfully used in bottom-up neurocognitive remediation approaches that reduce the cognitive load necessary to learn the relevant skill areas, including massed drill and practice, graded increases in task difficulty, scaffolding and errorless learning. Study methods include preliminary treatment and manual development based on series of uncontrolled cases, manual refinement, and a small feasibility/efficacy trial of the newly developed intervention. PUBLIC HEALTH RELEVANCE: Schizophrenia is a disabling illness characterized by severe impairments in social functioning. Social cognition has been identified as a proximal treatment target for interventions aimed at improving functional outcomes. Primary aim of this application is to develop, manualize, and assess the preliminary efficacy of a new social cognitive intervention which uses methods from bottom-up approaches to neurocognitive remediation to train social cognitive content.