Predictors of Treatment Engagement and Homework Completion in Cognitive Remediation Therapy for Schizophrenia and Depression

Cognitive remediation (CR) improves neurocognition and functioning in severe mental illnesses. However, there is inconsistent information regarding predictors of who might engage with CR.

We investigated two measures of CR engagement: session attendance and homework completion. Across two studies, we examined baseline differences between treatment and homework "engagers" and "non-engagers" (<50% of sessions or homework) among individuals with schizophrenia (N = 70) and depression (N = 74).

In schizophrenia, treatment engagers were older, had been out of hospital for longer, and were enrolled in executive training-focused CR, whereas homework engagers had higher neurocognitive functioning. Only CR type (i.e., executive training) predicted session attendance in schizophrenia. No significant differences were found between treatment or homework engagement groups for depression.

These findings highlight the difficulty in predicting who may or may not engage with CR, which has implications for how decisions are made around offering CR to patients with severe mental illness.