A comparison of compensatory and restorative cognitive interventions in early psychosis

Sean A Kidd; Yarissa Herman; Gursharan Virdee; Christopher R Bowie; Dawn Velligan; Christina Plagiannakos; Aristotle Voineskos

doi:10.1016/j.scog.2019.100157

A comparison of compensatory and restorative cognitive interventions in early psychosis

Schizophr Res Cogn. 2019 Jul 24:19:100157. doi: 10.1016/j.scog.2019.100157. eCollection 2020 Mar.

Authors

Sean A Kidd¹, Yarissa Herman², Gursharan Virdee², Christopher R Bowie³, Dawn Velligan⁴, Christina Plagiannakos⁵, Aristotle Voineskos⁶

Affiliations

¹ University of Toronto Department of Psychiatry, Canada.
² Toronto Centre for Addiction and Mental Health, CAMH, 1001 Queen St. W., Toronto, Ontario M6J1H1, Canada.
³ Queens University, Department of Psychology, 219 Craine Hall, Kingston K7L 3N6, Ontario, Canada.
⁴ University of Texas at San Antonio, Department of Psychiatry, 7526 Louis Pasteur Dr, San Antonio, TX 78229, USA.
⁵ Toronto Centre for Addiction and Mental Health, Canada.
⁶ University of Toronto Department of Psychiatry, CAMH, 250 College St., Toronto M5T1R8, Ontario, Canada.

Abstract

This randomized trial examined the relative effectiveness of primarily compensatory and primarily restorative cognitive interventions in an early psychosis population. A total of 56 patients were randomized to one of two treatments which were applied for four months with a five month follow up assessment. Comparisons were between (1) Cognitive Adaptation Training (CAT) - a treatment that uses environmental supports and weekly home visits to compensate for cognitive challenges and improve community functioning and (2) Action Based Cognitive Remediation (ABCR) - a treatment involving computerized cognitive drill and practice exercises, simulations, goal setting, and behavioral activation. Linear mixed effects models demonstrated significant effects on community functioning for both CAT and ABCR without a difference between conditions (n = 39), with an indication of greater gains at follow up in the ABCR group (n = 31). Improvements in symptomatology were less robust with mixed findings across neurocognition metrics. This study concluded that both CAT and ABCR hold promise as interventions for early intervention psychosis populations but more work is needed to identify illness severity, subtype and contextual considerations that might indicate an emphasis on more compensatory versus more restorative cognitive interventions.

Keywords: Cognitive adaptation training; Cognitive remediation; Psychosis; Randomized trial; Schizophrenia.