At issue: The future of cognitive rehabilitation of schizophrenia

Cognitive rehabilitation is becoming an increasingly popular intervention in treatment programs for people with schizophrenia. Despite this increased acceptance, however, the evidence base on its effectiveness is not impressive. Moreover, given the evidence of cognitive recovery in treated patients who do not receive cognitive rehabilitation--from newer medications and from other evidence-based psychosocial interventions--it is not clear whether cognitive rehabilitation is worth its expense in time and resources. We believe that the slow progress in the field of cognitive rehabilitation of schizophrenia is related to failure to address several critical issues: (1) the importance of manipulating stimulus and context structure in rehabilitative interventions; (2) the need to base a cognitive rehabilitation of schizophrenia on cognitive neuroscience as opposed to neuropsychology; (3) the importance of systematically addressing motivation, self-esteem, and affective factors when designing cognition-enhancing interventions; (4) the need to move beyond one-size-fits-all interventions and develop individualized treatments; and (5) the need to address abnormalities in the experience of the self when designing interventions to optimize cognitive and behavioral performance. Suggestions for addressing these issues are discussed.