Cognitive Therapy for Schizophrenia

Cognitive dysfunction is a core feature of schizophrenia. Deficits are moderate to severe across several domains, including attention, working memory, verbal learning and memory, and executive functions. These deficits appear at the onset of diagnosable psychosis and are stable throughout the course of the illness in most patients. Over the past decade, the focus on these deficits has increased dramatically with the recognition that they are consistently the best predictor of functional outcomes across outcome domains and patient samples. Recent treatment studies, both pharmacological and behavioral, suggest that cognitive deficits can be remediated. (Bowie & Harvey, 2006)

The goal of cognitive remediation therapy for schizophrenia is to help patients progress to the most productive level of functioning possible.

In persons with schizophrenia, the underlying cognitive skills may either be impaired from prior superior levels or they may not have developed adequately, even though the potential may have been present. The goal of cognitive remediation is to help people develop the underlying cognitive skills that will make them better able to function in daily tasks, including those performed in school, work, social interactions, and independent living. For example, it might help a patient become more attentive so he can better focus on schoolwork, household tasks, and job responsibilities.

Impairments in attention, memory, processing speed and problem-solving abilities are the most common cognitive deficits found in patients with psychiatric conditions (Bowie et al., 2008). The degrees to which these deficits are present vary depending on many factors including, but not limited to, diagnosis, course of illness and social environment factors. In schizophrenia, a generalized cognitive decline is evident early on in the illness, with an overlay of greater problems in attention, memory, processing speed and problem-solving. Even in the face of psychiatric stability, cognitive impairment remains evident.

In schizophrenia, impaired cognition has consistently been associated with poor social problem-solving (Green, 1996; Green, Kern, Braff & Mintz, 2000). Patients with more pronounced attention deficits are least likely to acquire skills in psychosocial programs as the attention problems make it difficult for them to process the information given in groups, and they may not be able to sustain attention for the session duration. (Spaulding et al., 1999)

Cognitive deficits make it difficult to succeed at work (McGurk & Meltzer, 2001).