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Confirmatory Efficacy of Cognitive Enhancement Therapy for Early Schizophrenia: Results From a Multisite Randomized
Jessica A Wojtalik1, Raquelle I Mesholam-Gately1, Susan S Hogarty1
1Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland (Wojtalik); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Mesholam-Gately, Sandoval, Shashidhar, Keshavan); Department of Psychiatry, Harvard Medical School, Boston (Mesholam-Gately, Sandoval, Guimond, Keshavan); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Hogarty, Greenwald, Litschge, Eack); Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, Quebec, Canada (Guimond); School of Social Work, University of Pittsburgh, Pittsburgh (Eack).
Objective:
Cognitive enhancement therapy (CET) is an 18-month comprehensive cognitive remediation intervention designed to improve cognition and functioning among patients with schizophrenia. The current study sought to confirm previously observed benefits of CET on cognitive and behavioral outcomes in the early course of the condition in a large multisite trial.
Methods:
Overall, 102 outpatients with early-course schizophrenia were randomly assigned to 18 months of CET (N=58) or enriched supportive therapy (EST; N=44). Participants completed cognitive, social adjustment, and symptom assessments at baseline and at 9 and 18 months. Composite indices were calculated for these outcomes. Mixed-effects models investigated differential changes in outcomes between CET and EST. Because of a high attrition rate, sensitivity analyses of data from treatment completers (N=49) were conducted.
Results:
The effects of CET on improved overall cognition were confirmed and tentatively confirmed for social cognition in both intent-to-treat and completer analyses, and beneficial effects on attention/vigilance were also observed. An effect of CET on social adjustment was not confirmed in the analyses, because both CET and EST groups had considerably improved social adjustment. Although not statistically significant, the between-group effect size for CET's effect on social adjustment doubled from the intent-to-treat (Cohen's d=0.23) to completer analyses (Cohen's d=0.51) (p=0.057). Both groups displayed similar symptom improvements.
Conclusions:
CET effectively improved cognition among patients with early-course schizophrenia. The functional benefits of CET appeared to increase with treatment retention. Further research is needed to understand predictors of attrition and mechanisms of change during CET for this population.
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