Skip to main content Accessibility help
×
Home

The effect of rehabilitation combined with cognitive remediation on functioning in persons with severe mental illness: systematic review and meta-analysis

  • Daniëlle van Duin (a1) (a2) (a3), Lars de Winter (a1), Matthijs Oud (a2), Hans Kroon (a2) (a3), Wim Veling (a4) (a5) and Jaap van Weeghel (a1) (a3)...

Abstract

Background

Psychiatric rehabilitation (PR) can improve functioning in people with severe mental illness (SMI), but outcomes are still suboptimal. Cognitive impairments have severe implications for functioning and might reduce the effects of PR. It has been demonstrated that performance in cognitive tests can be improved by cognitive remediation (CR). However, there is no consistent evidence that CR as a stand-alone intervention leads to improvements in real-life functioning. The present study investigated whether a combination of PR and CR enhances the effect of a stand-alone PR or CR intervention on separate domains of functioning.

Method

A meta-analysis of randomized controlled trials of PR combined with CR in people with SMI was conducted, reporting on functioning outcomes. A multivariate meta-regression analysis was carried out to evaluate moderator effects.

Results

The meta-analysis included 23 studies with 1819 patients. Enhancing PR with CR had significant beneficial effects on vocational outcomes (e.g. employment rate: SMD = 0.41), and social skills (SMD = 0.24). No significant effects were found on relationships and outcomes of community functioning. Effects on vocational outcomes were moderated by years of education, intensity of the intervention, type of CR approach and integration of treatment goals for PR and CR. Type of PR was no significant moderator.

Conclusions

Augmenting PR by adding cognitive training can improve vocational and social functioning in patients with SMI more than a stand-alone PR intervention. First indications exist that a synergetic mechanism also works the other way around, with beneficial effects of the combined intervention compared with a stand-alone CR intervention.

Copyright

Corresponding author

Author for correspondence: Daniëlle van Duin, E-mail: dduin@trimbos.nl and dduin@kcphrenos.nl

References

Hide All
Anthony, WA, Cohen, MR, Farkas, M and Gagne, C (2002) Psychiatric Rehabilitation, 2nd Edn. Boston, MA: Center for Psychiatric Rehabilitation, Boston University.
Au, DWH, Tsang, HWH, So, WWY, Bell, MD, Cheung, V, Yiu, MGC, Tam, KL and Lee, GT (2015) Effects of integrated supported employment plus cognitive remediation training for people with schizophrenia and schizoaffective disorders. Schizophrenia Research 166, 297303.
Aubin, G, Stip, E, Gelinas, I, Rainville, C and Chapparo, C (2009) Daily activities, cognition and community functioning in persons with schizophrenia. Schizophrenia Research 107, 313318.
Bell, M, Bryson, G, Greig, T, Corcoran, C and Wexler, BE (2001) Neurocognitive enhancement therapy with work therapy. effects on neuropsychological test performance. Archives of General Psychiatry 58, 763768.
Bell, MD, Bryson, GJ, Greig, TC, Fiszdon, JM and Wexler, BE (2005) Neurocognitive enhancement therapy with work therapy: productivity outcomes at 6- and 12-month follow-ups. Journal of Rehabilitation Research & Development 42, 829838.
Bell, MD, Zito, W and Wexler, BE (2008 a) Neurocognitive enhancement therapy and competitive employment in schizophrenia: effects on clients with poor community functioning. American Journal of Psychiatric Rehabilitation 11, 109122.
Bell, MD, Zito, W, Greig, T and Wexler, BE (2008 b) Neurocognitive enhancement therapy with vocational services: work outcomes at two-year follow-up. Schizophrenia Research 105, 1829.
Bell, MD, Choi, KH, Dyer, C and Wexler, BE (2014) Benefits of cognitive remediation and supported employment for schizophrenia patients with poor community functioning. Psychiatric Services 65, 469475.
Bowie, CR and Harvey, PD (2006) Cognitive deficits and functional outcome in schizophrenia. Neuropsychiatric Disease and Treatment 2, 531536.
Bowie, CR, McGurk, SR, Mausbach, B, Patterson, TL and Harvey, PD (2012) Combined cognitive remediation and functional skills training for schizophrenia: effects on cognition, functional competence, and real-world behavior. American Journal of Psychiatry 169, 710718.
Brüne, M, Dimaggio, G and Lysaker, PH (2011) Metacognition and social functioning in schizophrenia: evidence, mechanisms of influence and treatment implications. Current Psychiatry Reviews 7, 239247.
Cavallero, R, Anselmetti, S, Poletti, S, Bechi, M, Ermoli, E, Cocchi, F, Stratta, P, Vita, A, Rossi, A and Smeraldi, E (2009) Computer-aided neurocognitive remediation as an enhancing strategy for schizophrenia rehabilitation. Psychiatry Research 169, 191196.
Cella, M, Reeder, C and Wykes, T (2015) Lessons learnt? The importance of metacognition and its implications for cognitive remediation in schizophrenia. Frontiers in Psychology 6, 1259. Accessed September 2015.
Chan, JYC, Hirai, HW and Tsoi, KKF (2015) Can computer-assisted cognitive remediation improve employment and productivity outcomes of patients with severe mental illness? A meta-analysis of prospective controlled trials. Journal of Psychiatric Research 68, 293300.
Chinn, S (2000) A simple method for converting an odds ratio to effect size for use in meta-analysis. Statistics in Medicine 19, 31273131.
Corrigan, PW, Mueser, KT, Bond, GR, Drake, RE and Solomon, P (2008). Principles and Practice of Psychiatric Rehabilitation. New York/London: The Guilford Press.
Couture, SM, Penn, DL and Roberts, DL (2006). The functional significance of social cognition in schizophrenia: a review. Schizophrenia Bulletin 32(suppl. 1), S44S63.
Dickinson, D, Bellack, AS and Gold, JM (2007) Social/communication skills, cognition, and vocational functioning in schizophrenia. Schizophrenia Bulletin 33, 12131220.
Fiszdon, JM and Bell, MD (2004) Remédiation cognitive et thérapie occupationnelle dans le traitement ambulatoire du patient souffrant de schizophrénie. Santé mentale au Québec 29, 117142..
Gest, SD, Graham-Bermann, SA and Hartup, WW (2001) Peer experience: common and unique features of number of friendships, social network centrality, and sociometric status. Social Development 10 , 2340.
Gigantesco, A, Vittorielli, M, Pioli, R, Falloon, IRH, Rossi, G and Morosini, P (2006) The VADO approach in psychiatric rehabilitation: a randomized controlled trial. Psychiatric Services 57, 17781783.
Gold, JM, Goldberg, RW, McNary, SW, Dixon, LB and Lehman, AF (2002) Cognitive correlates of job tenure among patients with severe mental illness. American Journal of Psychiatry 159, 13951402.
Goldberg, TE and Green, MF (2002) Neurocognitive functioning in patients with schizophrenia: an overview. In Davis, KL, Charney, D, Coyle, JT and Nemeroff, C (eds), Neuropsychopharmacology: The Fifth Generation of Progress. Philadelphia: Lipincott, Williams & Wilkins, pp. 657669.
Green, MF (1996) What are the functional consequences of neurocognitive deficits in schizophrenia? American Journal of Psychiatry 153, 321330.
Green, MF and Horan, WP (2010) Social cognition in schizophrenia. Current Directions in Psychological Science 19, 243248.
Grynszpan, O, Perbal, S, Pelissolo, A, Fossati, P, Jouvent, R, Dubal, S and Perez-Diaz, F (2011) Efficacy and specificity of computer-assisted cognitive remediation in schizophrenia: a meta-analytical study. Psychological Medicine 41, 163173.
Guyatt, GH, Oxman, AD, Schuneman, HJ, Tugwell, P and Knottnerus, A (2011) GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology. Journal of Clinical Epidemiology 64, 380382.
Hadas-Lidor, N, Katz, N, Tyano, S and Weizman, A (2001) Effectiveness of dynamic cognitive intervention in rehabilitation of clients with schizophrenia. Clinical Rehabilitation 15, 349359.
Higgins, JPT and Green, S (2008) Cochrane Handbook for Systematic Reviews of Interventions. Chichester, Hoboken, NJ, England: Wiley Blackwell.
Hurford, IM, Kalkstein, S and Hurford, MO (2011) Cognitive Rehabilitation in Schizophrenia. Psychiatric Times. Available at http://www.psychiatrictimes.com/schizophrenia/cognitive-rehabilitation-schizophrenia.
Jablensky, A, McGrath, J, Herrman, H, Castle, D, Gureje, O, Evans, M, Carr, V, Morgan, V, Korten, A and Harvey, C (2000) Psychotic disorders in urban areas: an overview of the study on Low prevalence disorders. Australian and New Zealand Journal of Psychiatry 34, 221236.
Keefe, RSE and Harvey, PD (2012) Cognitive impairment in schizophrenia. In Geyer, MA and Gross, G (eds), Novel Antischizophrenia Treatments. Handbook of Experimental Pharmacology, vol. 213. Berlin-Heidelberg: Springer-Verlag, pp. 1137. doi: 10.1007/978-3-642-25758-2.
Kidd, SA, Kaur, J, Virdee, G, George, TP, McKenzie, K and Herman, Y (2014) Cognitive remediation for individuals with psychosis in a supported education setting: a randomized controlled trial. Schizophrenia Research 157, 9098.
Kinoshita, Y, Furukawa, TA, Kinoshita, K, Honyashiki, M, Omori, IM, Marshall, M, Bond, GR, Huxley, P, Amano, N and Kingdon, D (2013) Supported employment for adults with severe mental illness. Cochrane Database of Systematic Reviews 9: Art. No.: CD008297. doi: 10.1002/14651858.CD008297.pub2. (Accessed September 2013).
Kontis, D, Huddy, V, Reeder, C, Landau, S and Wykes, T (2012) Effects of age and cognitive reserve on cognitive remediation therapy outcome in patients with schizophrenia. American Journal of Geriatric Psychiatry 21, 218230.
Kurtz, MM, Moberg, PJ, Gur, RC and Gur, RE (2001) Approaches to cognitive remediation of neuropsychological deficits in schizophrenia: a review and meta-analysis. Neuropsychology Review 11, 197.
Kurtz, MM, Mueser, KT, Thime, WR, Corbera, S and Wexler, BE (2015) Social skills training and computer-assisted cognitive remediation in schizophrenia. Schizophrenia Research 162, 3541.
Lee, WK (2013) Effectiveness of computerized cognitive rehabilitation training on symptomatological, neuropsychological and work function in patients with schizophrenia. Asia-pacific Psychiatry 5, 90100.
Lindenmayer, JP, McGurk, SR, Mueser, KT, Khan, A, Wance, D, Hoffman, L, Wolfe, R and Xie, H (2008) A randomized controlled trial of cognitive remediation among inpatients with persistent mental illness. Psychiatric Services 59, 241247.
Lysaker, PH, Vohs, J, Minor, KS, Irarrázaval, L, Leonhardt, B, Hamm, JA, Kukla, M, Popolo, R, Luther, L, Buck, KD, Wasmuth, S and Dimaggio, G (2015) Metacognitive deficits in schizophrenia: presence and associations with psychosocial outcomes. Journal of Nervous and Mental Disease 203, 530536.
Mattsson, M, Topor, A, Cullberg, J and Forsell, Y (2008) Association between financial strain, social network, and five-year recovery from first-episode psychosis. Social Psychiatry and Psychiatric Epidemiology 43, 947952.
McGurk, SR and Meltzer, HY (2000) The role of cognition in vocational functioning in schizophrenia. Schizophrenia Research 45, 175184.
McGurk, SR and Mueser, KT (2004) Cognitive functioning, symptoms, and work in supported employment: a review and heuristic model. Schizophrenia Research 70, 147173.
McGurk, SR and Mueser, KT (2008) Response to cognitive rehabilitation in older versus younger persons with severe mental illness. American Journal of Psychiatric Rehabilitation 11, 90105.
McGurk, SR, Mueser, KT and Pascaris, A (2005) Cognitive training and supported employment for persons with severe mental illness: one-year results from a randomized controlled trial. Schizophrenia Bulletin 31, 898909.
McGurk, SR, Mueser, KT, Feldman, K, Wolfe, R and Pascaris, A (2007 a) Cognitive training for supported employment: 2–3 year outcomes of a randomized controlled trial. American Journal of Psychiatry 164, 437441.
McGurk, SR, Twamley, EW, Sitzer, DI, McHugo, GJ and Mueser, KT (2007 b) A meta-analysis of cognitive remediation in schizophrenia. American Journal of Psychiatry 164, 17911802.
McGurk, SR, Mueser, KT, DeRosa, TJ and Wolfe, R (2009) Work, recovery, and comorbidity in schizophrenia: a randomized controlled trial of cognitive remediation. Schizophrenia Bulletin 35, 319335.
McGurk, SR, Mueser, KT, Xie, H, Welsh, J, Kaiser, S, Drake, RE, Becker, DR, Bailey, E, Fraser, G, Wolfe, R and McHugo, GJ (2015) Cognitive enhancement treatment for people with mental illness Who Do Not respond to supported employment: a randomized controlled trial. American Journal of Psychiatry 172, 852861.
McGurk, SR, Mueser, KT, Xie, H, Feldman, K, Shaya, Y, Klein, L and Wolfe, R (2016) Cognitive remediation for vocational rehabilitation nonresponders. Schizophrenia Research 175, 4856.
Medalia, A and Saperstein, AM (2013) Does cognitive remediation for schizophrenia improve functional outcomes? Current Opinion in Psychiatry 26, 151157.
Modini, M, Tan, L, Brinchmann, B, Wang, MJ, Killackey, E, Glozier, N, Mykletun, A and Harvey, SB (2016) Supported employment for people with severe mental illness: systematic review and meta-analysis of the international evidence. British Journal of Psychiatry 209, 1422.
Moher, D, Liberati, A, Tetzlaff, J and Altman, DG (2009) Reprint – preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Physical Therapy 89, 873880.
National Institute for Health and Care Excellence (2014) Psychosis and Schizophrenia in adults: prevention and management. Clinical Guideline CG178. NICE.
Nordic Cochrane Centre (2012) Review Manager (RevMan) Version 5.2. Cochrane Collaboration.
Pilling, S, Bebbington, P, Kuipers, E, Garety, P, Geddes, J, Martindale, B, Orbach, G and Morgan, C (2002) Psychological treatments in schizophrenia: II. Meta-analyses of randomized controlled trials of social skills training and cognitive remediation. Psychological Medicine 32, 783791.
Radhakrishnan, R, Kiluk, BD and Tsai, J (2016) A meta-analytic review of non-specific effects in randomized controlled trials of cognitive remediation for schizophrenia. The Psychiatric Quarterly 87, 5762.
Revell, ER, Neill, JC, Harte, M, Khan, Z and Drake, RJ (2015) A systematic review and meta-analysis of cognitive remediation in early schizophrenia. Schizophrenia Research 168, 213222.
Silverstein, SM, Hatashita-Wong, M, Solak, BA, Uhlhaas, P, Landa, Y, Wilkniss, SM, Goicochea, C, Carpiniello, K, Schenkel, LS, Savitz, A and Smith, TE (2005) Effectiveness of a two-phase cognitive rehabilitation intervention for severely impaired schizophrenia patients. Psychological Medicine 35, 829837.
Silverstein, SM, Spaulding, WD, Menditto, AA, Savitz, A, Liberman, RP, Berten, S and Starobin, H (2009) Attention shaping: a reward-based learning method to enhance skills training outcomes in schizophrenia. Schizophrenia Bulletin 35, 222232.
Smith, TE, Hull, JW, Romanelli, S, Fertuck, E and Weiss, KA (1999) Symptoms and neurocognition as rate limiters in skills training for psychotic patients. American Journal of Psychiatry 156, 18171818.
Spaulding, WD, Reed, D, Sullivan, M, Richardson, C and Weiler, M (1999) Effects of cognitive treatment in psychiatric rehabilitation. Schizophrenia Bulletin 25, 657676.
Swildens, W, van Busschbach, JT, Michon, H, Kroon, H, Koeter, MW, Wiersma, D and van Os, J (2011) Effectively working on rehabilitation goals: 24-month outcome of a randomized controlled trial of the Boston psychiatric rehabilitation approach. Canadian Journal of Psychiatry 56, 751760.
Tan, BL and King, R (2013) The effects of cognitive remediation on functional outcomes among people with schizophrenia: a randomised controlled study. Australian and New Zealand Journal of Psychiatry 47, 10681080.
Tsang, HWH, Bell, MD, Cheung, V, Tam, KL and Yeung, WS (2016) Integrated supported employment plus cognitive remediation training for people with schizophrenia. Hong Kong Medical Journal 22, S15S18.
Vargas, G, Strassnig, M, Sabbag, S, Gould, F, Durand, D, Stone, L, Patterson, TL and Harvey, PD (2014) The course of vocational functioning in patients with schizophrenia: re-examining social drift. Schizophrenia Research. Cognition 1, e41e46. (Accessed March 2014).
Vauth, R, Corrigan, PW, Clauss, M, Dietl, M, Dreher-Rudolph, M, Stieglitz, RD and Vater, R (2005) Cognitive strategies versus self-management skills as adjunct to vocational rehabilitation. Schizophrenia Bulletin 31, 5566.
Vita, A, De Peri, L, Barlati, S, Cacciani, P, Deste, G, Poli, R, Agrimi, E, Cesana, BM and Sacchetti, E (2011) Effectiveness of different modalities of cognitive remediation on symptomatological, neuropsychological, and functional outcome domains in schizophrenia: a prospective study in a real-world setting. Schizophrenia Research 133, 223231.
Wykes, T and Dunn, G (1992) Cognitive deficit and the prediction of rehabilitation success in a chronic psychiatric group. Psychological Medicine 22, 389398.
Wykes, T, Huddy, V, Cellard, C, McGurk, SR and Czobor, P (2011) A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. American Journal of Psychiatry 168, 472485.
Yamaguchi, S, Sato, S, Horio, N, Yoshida, K, Shimodaira, M, Taneda, A, Ikebuchi, E, Nishio, M and Ito, J (2016) Cost-effectiveness of cognitive remediation and supported employment for people with mental illness: a randomized controlled trial. Psychological Medicine 47, 5365.

Keywords

Type Description Title
UNKNOWN
Supplementary materials

van Duin et al. supplementary material
van Duin et al. supplementary material 1

 Unknown (258 KB)
258 KB

The effect of rehabilitation combined with cognitive remediation on functioning in persons with severe mental illness: systematic review and meta-analysis

  • Daniëlle van Duin (a1) (a2) (a3), Lars de Winter (a1), Matthijs Oud (a2), Hans Kroon (a2) (a3), Wim Veling (a4) (a5) and Jaap van Weeghel (a1) (a3)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed