Cognitive adaptation training combined with assertive community treatment: a randomised longitudinal trial

Cognitive adaptation training (CAT) targets the adaptive behaviour of patients with schizophrenia and has shown promising results regarding the social aspects of psychosocial treatment. As yet, no reports have appeared on the use of CAT in combination with assertive community treatment (ACT). Our purpose was to evaluate the effect of CAT in comparison with ACT, focusing on social functions (primary outcome), symptoms, relapse, re-hospitalisation, and quality of life of outpatients with schizophrenia.

The trial was a parallel, randomised, multicentre trial conducted in three centres treating patients with a first episode of schizophrenia disorder. A total of 62 outpatients diagnosed as having schizophrenia were randomly assigned to CAT+ACT or ACT alone. The CAT was conducted in the patient's home and included instruction in prompting for specific actions. The treatment lasted for 6months, and the patients were assessed at baseline and at 6- and 9-month follow-ups.

The results of mixed-effects regression models indicated no significant differences between intervention group and control group at 6 and 9months in any outcome [Global Assessment of Functioning at 6months (p=0.32) and the Health of the Nation Outcome Scales social subscale at 6months (p=0.30)].

The results from this trial differ from previous CAT trials because use of CAT showed no significant effects. However, the low number of participants may have been responsible for these results. Thus, additional studies are needed to determine whether the use of some elements of CAT can help to make ACT more economically effective.