Impact of Early Auditory Processing on Negative Symptom Response to Cognitive Remediation for Schizophrenia

Early auditory processing (EAP) has increasingly become a focus of efforts to identify markers of treatment response in people with schizophrenia spectrum disorders. Assessment of baseline need provides an opportunity for cognitive remediation (CR) programs that include EAP training to personalize treatment and optimize its impact. CR has been shown to help reduce negative symptoms, but less is known about how EAP tailoring may influence this relationship. This study hypothesized a differential benefit of EAP training on negative symptom reduction for those with and without baseline EAP deficits as defined by performance on the Tone Matching Test.

150 outpatient adults diagnosed with schizophrenia or schizoaffective disorder were classified as having intact (44.7%) or impaired (55.3%) EAP and were randomly assigned to CR that either included EAP training (N = 77) or did not (N = 73). Negative symptom improvement was measured via the Positive and Negative Syndrome Scale posttreatment and 3 months later.

CR resulted in significant negative symptom improvement in the sample overall. Only EAP impaired participants demonstrated significant negative symptom benefit from EAP training. EAP impaired participants who did not receive embedded auditory training had near-zero reductions in negative symptom severity.

These findings extend prior research on cognitive remediation as treatment for negative symptoms in people with schizophrenia spectrum disorders. Accumulating evidence suggests that routine assessment of EAP is critical for personalizing and optimizing a response to CR that is clinically significant for both cognitive and negative symptoms.