Computerized or manual? Long term effects of cognitive remediation on schizophrenia

Cognitive remediation therapy (CRT) and Computerized CRT (CCRT) improve cognition and functioning, but there is no direct evidence of whether there is an advantage of using a computer. This study fills this gap and extends research evidence to the long-term effect of these two treatments in a large sample of Chinese inpatients with a diagnosis of schizophrenia.

We conducted a randomized single-blind, follow-up study with participants randomized to receive CCRT (n = 144), CRT (n = 72) or Active control (n = 54) for 12 weeks with 4-5 sessions per week. The main outcome was cognition (MATRICS Consensus Cognitive Battery total score, MCCB), and secondary outcomes were cognitive domains, symptoms and functioning assessed at baseline (0 month), post-treatment (3 months) and follow-up (6, 12 and 18 months).

The primary outcome (MCCB total score) improved in both treatment groups which was maintained at 18 months but did not differ between treatment groups. Post hoc analysis demonstrated that the CRT group had an advantage over CCRT for the Trail Making and Symbol Coding Tests (all p < 0.05), which lasted for almost 18 months.

Both CCRT and CRT contribute to general cognitive improvements in schizophrenia and the overall efficacy was similar. The effects were maintained for 18th months. Exploratory analyses revealed few differences except that CRT had a processing speed advantage.