Skip to main content Accessibility help
×
Home

A new generation computerised metacognitive cognitive remediation programme for schizophrenia (CIRCuiTS): a randomised controlled trial

  • C. Reeder (a1), V. Huddy (a2), M. Cella (a1), R. Taylor (a1), K. Greenwood (a3) (a4), S. Landau (a1) and T. Wykes (a1)...

Abstract

Background

Cognitive remediation (CR) is a psychological therapy, which improves cognitive and social functioning in people with schizophrenia. It is now being implemented within routine clinical services and mechanisms of change are being explored. We designed a new generation computerised CR programme, CIRCuiTS (Computerised Interactive Remediation of Cognition – a Training for Schizophrenia), to enhance strategic and metacognitive processing, with an integrated focus on the transfer of cognitive skills to daily living. This large trial tested its feasibility to be delivered in therapist-led and independent sessions, and its efficacy for improved cognitive and social functioning.

Methods

A two arm single blind randomised superiority trial comparing CIRCuiTS plus treatment-as-usual (TAU) with TAU alone in 93 people with a diagnosis of schizophrenia. Cognitive, social functioning and symptom outcomes were assessed at pre- and post-therapy and 3 months later.

Results

85% adhered to CIRCuiTS, completing a median of 28 sessions. There were significant improvements in visual memory at post-treatment (p = 0.009) and follow-up (p = 0.001), and a trend for improvements in executive function at post-treatment (p = 0.056) in favour of the CIRCuiTS group. Community function was also differentially and significantly improved in the CIRCuiTS group at post-treatment (p = 0.003) but not follow-up, and was specifically predicted by improved executive functions.

Conclusions

CIRCuiTS was beneficial for improving memory and social functioning. Improved executive functioning emerges as a consistent predictor of functional gains and should be considered an important CR target to achieve functional change. A larger-scale effectiveness trial of CIRCuiTS is now indicated.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      A new generation computerised metacognitive cognitive remediation programme for schizophrenia (CIRCuiTS): a randomised controlled trial
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      A new generation computerised metacognitive cognitive remediation programme for schizophrenia (CIRCuiTS): a randomised controlled trial
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      A new generation computerised metacognitive cognitive remediation programme for schizophrenia (CIRCuiTS): a randomised controlled trial
      Available formats
      ×

Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

*Address for correspondence: Dr C. Reeder, Ph.D., Department of Psychology, PO77, IoPPN, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK. (Email: clare.reeder@kcl.ac.uk)

Footnotes

Hide All

Joint last authors.

Footnotes

References

Hide All
Baron, RM, Kenny, DA (1986). The moderator mediator variable distinction in social psychological-research – Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology 51, 11731182.
Bowie, CR, McGurk, SR, Mausbach, B, Patterson, TL, 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.
Burgess, P, Shallice, T (1997). The Hayling and Brixton Tests. Thames Valley Test Company/Pearson Assessment: Bury St. Edmunds, UK.
Cella, M, Bishara, AJ, Medin, E, Swan, S, Reeder, C, Wykes, T (2014). Identifying cognitive remediation change through computational modelling – effects on reinforcement learning in schizophrenia. Schizophrenia Bulletin 40, 14221432.
Choi, J, Kurtz, MM (2009). A comparison of remediation techniques on the Wisconsin Card Sorting Test in schizophrenia. Schizophrenia Research 107, 7682.
CREW (2012). Definition of Cognitive Remediation. Cognitive Remediation Expert Working Group: Florence, Italy.
Dickerson, F, Schroeder, J, Stallings, C, Origoni, A, Katsafanas, E, Schwienfurth, LAB, Savage, CLG, Khushalani, S, Yolken, R (2014). A longitudinal study of cognitive functioning in schizophrenia: clinical and biological predictors. Schizophrenia Research 156, 248253.
Drake, RJ, Day, CJ, Picucci, R, Warburton, J, Larkin, W, Husain, N, Reeder, C, Wykes, T, Marshall, M (2014). A naturalistic, randomized, controlled trial combining cognitive remediation with cognitive-behavioural therapy after first-episode non-affective psychosis. Psychological Medicine 44, 18891899.
Eack, SM, Greenwald, DP, Hogarty, SS, Cooley, SJ, DiBarry, AL, Montrose, DM, Keshavan, MS (2009). Cognitive enhancement therapy for early-course schizophrenia: effects of a two-year randomized controlled trial. Psychiatric Services 60, 14681476.
Flavell, JH (1979). Metacognition and cognitive monitoring: a new area of cognitive -developmental inquiry. American Psychologist 34, 906911.
Gomar, JJ, Valls, E, Radua, J, Mareca, C, Tristany, J, Del Olmo, F, Rebolleda-Gil, C, Janez-Alvarez, M, de Alvaro, FJ, Ovejero, MR, Llorente, A, Teixido, C, Donaire, AM, Garcia-Laredo, E, Lazcanoiturburu, A, Granell, L, Mozo, CP, Perez-Hernandez, M, Moreno-Alcazar, A, Pomarol-Clotet, E, McKenna, PJ, Cognitive Rehabilitation Study G (2015). A multisite, randomized controlled clinical trial of computerized cognitive remediation therapy for schizophrenia. Schizophrenia Bulletin 41, 13871396.
Green, MF, Kern, RS, Braff, DL, Mintz, J (2000). Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the ‘right stuff’? Schizophrenia Bulletin 26, 119136.
Harvey, KE, Galletly, CA, Field, C, Proeve, M (2009). The effects of verbalisation on cognitive performance in schizophrenia: a pilot study using tasks from the Delis Kaplan Executive Function System. Neuropsychological Rehabilitation 19, 733741.
Heaton, R, Chelune, G, Talley, J, Kay, G, Curtiss, G (1993). Wisconsin Card Sorting Test Manual, Revised and Expanded. P. Resources: Odessa.
Kay, SR, Fiszbein, A, Opler, LA (1987). The positive and negative syndrome scale (panss) for schizophrenia. Schizophrenia Bulletin 13, 261276.
Krabbendam, L, Aleman, A (2003). Cognitive rehabilitation in schizophrenia: a quantitative analysis of controlled studies. Psychopharmacology 169, 376382.
Landgraf, S, Amado, I, Brucks, M, Krueger, F, Krebs, M-O, Van der Meer, E (2011). Inflexible information acquisition strategies mediate visuo-spatial reasoning in stabilized schizophrenia patients. World Journal of Biological Psychiatry 12, 608619.
MacKinnon, DP, Valente, MJ (2014). Mediation from multilevel to structural equation modeling. Annals of Nutrition and Metabolism 65, 198204.
McGurk, SR, Twamley, EW, Sitzer, DI, McHugo, GJ, Mueser, KT (2007). A meta-analysis of cognitive remediation in schizophrenia. American Journal of Psychiatry 164, 17911802.
Murthy, NV, Mahncke, H, Wexler, BE, Maruff, P, Inamdar, A, Zucchetto, M, Lund, J, Shabbir, S, Shergill, S, Keshavan, M, Kapur, S, Laruelle, M, Alexander, R (2012). Computerized cognitive remediation training for schizophrenia: an open label, multi-site, multinational methodology study. Schizophrenia Research 139, 8791.
Osterreith, PA (1944). Filetest de copie d'une figure complex: contribution a l'etude de la perception et de la memoire. Archives de Psychologie 30, 286356.
Reeder, C, Harris, V, Pickles, A, Patel, A, Cella, M, Wykes, T (2014). Does change in cognitive function predict change in costs of care for people with a schizophrenia diagnosis following cognitive remediation therapy? Schizophrenia Bulletin 40, 14721481.
Reeder, C, Pile, V, Watson, A, Crawford, P, Huddy, V, Cella, M, Rose, D, Callard, F, Wykes, T (2015). The feasibility and acceptability to service users of CIRCuiTS – computerised interactive remediation of cognition – a training for schizophrenia. Behavioural and Cognitive Psychotherapy Bulletin 44, 288305.
Reeder, C, Smedley, N, Butt, K, Bogner, D, Wykes, T (2006). Cognitive predictors of social functioning improvements following cognitive remediation for schizophrenia. Schizophrenia Bulletin 32, S123S131.
Reeder, C, Wykes, T (2010). Cognitive Interaction Remediation of Cognition – a Training for Schizophrenia (CIRCuiTS). King's College London: UK.
Rey, A (1941). L'examen psychologique dans les cas d'encephalopathie traumatique (Les problems.). Archives de Psychologie 28, 215285.
Short, S (2006). Review of the UK 2000 Time Use Survey. O. f. N. Statistics: London, UK.
SIGN (2013). A national clinical guideline: Health Care Improvement.
Silverstein, A (1982). Two- and four-subtest short forms of the Wechsler adult intelligence scale-revised. Journal of Consulting and Clinical Psychology 50, 415418.
New York State, Office of Mental Health (2010). Personalized Recovery Oriented Services Regulations (Part 512). New York State, USA.
Stenmark, R (2006). Cognitive Remediation Therapy Fidelity Scale. University of Lund: Jonkoping, Sweden.
Vinogradov, S, Fisher, M, de Villers-Sidani, E (2012). Cognitive training for impaired neural systems in neuropsychiatric illness. Neuropsychopharmacology 37, 4376.
Wallwork, RS, Fortgang, R, Hashimoto, R, Weinberger, DR, Dickinson, D (2012). Searching for a consensus five-factor model of the Positive and Negative Syndrome Scale for schizophrenia. Schizophrenia Research 137, 246250.
Wechsler, D (1993). Wechsler Adult Intelligence Scale – 3rd edn., manual. Psychological Corporation: San Antonio.
Wechsler, D (2001). Wechsler Test of Adult Reading (WTAR). The Psychological Corporation: San Antonio.
Wykes, T, Huddy, V, Cellard, C, McGurk, SR, Czobor, P (2011). A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. American Journal of Psychiatry 168, 472485.
Wykes, T, Reeder, C (2005). Cognitive Remediation Therapy for Schizophrenia: Theory and Practice. Brunner Routledge: London, UK.
Wykes, T, Reeder, C, Huddy, V, Taylor, R, Wood, H, Ghirasim, N, Kontis, D, Landau, S (2012). Developing models of how cognitive improvements change functioning: mediation, moderation and moderated mediation. Schizophrenia Research 138, 8893.
Wykes, T, Reeder, C, Landau, S, Everitt, B, Knapp, M, Patel, A, Romeo, R (2007). Cognitive remediation therapy in schizophrenia – Randomised controlled trial. British Journal of Psychiatry 190, 421427.
Wykes, T, Spaulding, WD (2011). Thinking about the future cognitive remediation therapy-what works and could we do better? Schizophrenia Bulletin 37, S80S90.

Keywords

Type Description Title
WORD
Supplementary materials

Reeder et al supplementary material
Reeder et al supplementary material 1

 Word (675 KB)
675 KB

A new generation computerised metacognitive cognitive remediation programme for schizophrenia (CIRCuiTS): a randomised controlled trial

  • C. Reeder (a1), V. Huddy (a2), M. Cella (a1), R. Taylor (a1), K. Greenwood (a3) (a4), S. Landau (a1) and T. Wykes (a1)...

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