Developing models of how cognitive improvements change functioning: mediation, moderation and moderated mediation.

Area of Science:

• Neuroscience and Rehabilitation
• Psychiatry and Behavioral Science

Background:

• Cognitive remediation therapy (CRT) is known to impact functional outcomes.
• The specific cognitive improvements and their extent required for functional gains remain unclear.

Purpose of the Study:

• To develop and test models explaining how cognitive improvements translate to work behavior.
• Utilizing data from a current service to investigate the transfer of cognitive gains to work outcomes.

Main Methods:

• A Phase 2, single-group design study with 49 participants receiving CRT.
• Assessments included baseline, post-therapy, and follow-up measures of working memory, cognitive flexibility, planning, and work outcomes.
• Three statistical models (mediation, moderation, moderated mediation) were tested.

Main Results:

• Evidence of mediation was found, with planning improvements significantly associated with better work quality.
• Working memory and cognitive flexibility did not show evidence of mediating work functioning.
• Moderated mediation was observed for planning, particularly in individuals with poorer memory or fewer errors on the Wisconsin Card Sorting Test (WCST).

Conclusions:

• Improvements in planning skills positively impacted work quality, but explained only a minor portion of the overall CRT effect.
• Non-specific effects of CRT and the work program likely contribute significantly to observed functional improvements.
• This study pioneers the testing of complex mediation models for CRT, advocating for further validation in Phase 3 trials.