Neurocognitive impairment and functional outcome in cognitive-behavioral social skills training for schizophrenia

Neurocognitive impairment is associated with low functional outcome in schizophrenia. Mixed findings exist regarding the impact of neurocognitive impairment on functional improvement following psychosocial treatments. Cognitive-Behavioral Social Skills Training (CBSST) is an intervention aimed at improving functioning. The current study examined whether baseline neurocognitive impairment moderated functional outcome in CBSST relative to a goal-focused supportive contact condition (GFSC).

This is a secondary analysis of two single-blind, randomized controlled trials conducted in individuals with schizophrenia or schizoaffective disorder (Trial 1: N = 64 (older adults M age = 55.0); Trial 2: N = 149 (M age = 41.4)). Participants received 36 weekly 2-h group sessions of either CBSST or GFSC. CBSST combined cognitive behavioral therapy with social skills training and problem solving to improve functioning. GFSC focused on setting and achieving functioning goals, with minimal therapist guidance. Regression models examined whether multiple domains of baseline neuropsychological impairment moderated functional outcome at 9- or 12- month follow-up in CBSST relative to GFSC.

Executive function impairment, but not any other neuropsychological domain, was a significant moderator of treatment outcome. Lower executive functioning was associated with better functioning at follow-up in CBSST than in GFSC, whereas higher executive functioning was associated with similar functional outcome in CBSST and GFSC.

Individuals with cognitive impairment can benefit from CBSST and may even benefit more than individuals with intact cognition. The thought challenging, cognitive flexibility and problem-solving skills trained in CBSST may be compensatory for individuals with schizophrenia with executive function deficits.