Cognitive Remediation Works But How Should We Provide It? An Adaptive Randomized Controlled Trial of Delivery Methods...

Area of Science:

• Psychiatry
• Clinical Psychology
• Health Economics

Background:

• Cognitive remediation (CR) is known to benefit cognition and functioning in individuals with psychosis.
• The optimal level of therapist contact for CR remains unclear.
• This study evaluated different modes of therapist-supported CR to determine their effectiveness.

Purpose of the Study:

• To compare the effectiveness of different therapist-supported cognitive remediation (CR) modes in early psychosis.
• To assess the functional recovery and cost-effectiveness of various CR delivery methods.
• To identify the optimal CR approach for improving outcomes in psychosis.

Main Methods:

• A multi-center, adaptive trial randomized 377 participants with early psychosis to Independent CR, Group CR, One-to-One CR, or Treatment-as-usual (TAU).
• The primary outcome was functional recovery, measured by the Goal Attainment Scale (GAS) at 15 weeks.
• Health economic analyses evaluated cost per Quality Adjusted Life Year (QALY).

Main Results:

• Combined Group and One-to-One CR significantly improved GAS scores and cognitive function compared to TAU (P<0.01).
• Individual CR modes (Group vs. One-to-One, Independent vs. TAU) did not show significant differences in functional recovery.
• Cost per QALY was £4306 for Group CR and £3170 for One-to-One CR versus TAU.

Conclusions:

• Therapist-supported cognitive remediation, particularly combined group and one-to-one approaches, is a cost-effective treatment for functional recovery in early psychosis.
• Active therapist involvement in CR is beneficial and should be integrated into early intervention services.
• Further research is needed to understand individual differences in response to CR.