I presented this brief presentation on CRT at the PSI Early Graduate Group Annual Meeting in September 2017

1. Cognitive Remediation for Psychosis
An investigation of patient experiences
Authors
Dr. April Hargreaves
Niamh Daly Ryan
Dr. Rachael Dillon
Professor Gary Donohoe
Acknowledgements
Dr. David Mothersill,
Dr. Hyun Ju Kang

2. Definitions
Cognitive remediation training is a psychological therapy that targets
cognitive deficits in neuropsychiatric disorders.
‒ Linked with improvements in cognitive performance & functioning.
Many different types available – depending on therapist
involvement, procedure and length.
Psychosis is a distressing condition characterised by severe cognitive and
emotional dysfunction resulting in a disconnect with reality.
‒ Poor cognitive performance is associated with psychotic disorders.
Anti-psychotic medications do not treat cognitive deficits: CR
training attempts to target these.
Putting the research into context

3. Trinity College Dublin, The University of Dublin

4. Trinity College Dublin, The University of Dublin
Previous research
90 patients were recruited; 48 randomised into the intervention group
(IG), 42 randomised into the control group.
– Patients with schizophrenia & related psychosis recruited via
community mental health services & diagnosis confirmed by a
psychiatric nurse.
– At 2-week and 3-6 month follow-ups, improvements in IG in
neuropsychological functioning (working memory, episodic memory
& performance IQ), social & occupational functioning (living skills),
problem solving ability & in resting state functional connectivity.
– 24/48 adhered to full treatment. Drop out rates huge issue in CR
research, may suggest dissatisfaction with the procedure/therapist
contact/mode of delivery.
Psychosis research group, Trinity Centre for Health Sciences, St. James’s Hospital
Dublin

5. Trinity College Dublin, The University of Dublin
The aims of our study
How feasible and acceptable is
a low therapist contact,
computerised CR training to
the patient?
Patient experiences of CR training

6. Trinity College Dublin, The University of Dublin
The aims of our study
Patient experiences of CR training
What are the specific aspects
that may have positively or
negatively affected patient
experiences?

7. Trinity College Dublin, The University of Dublin
The aims of our study
Do patients express subjective
awareness of the objective
cognitive improvements
observed?
Patient experiences of CR training

8. Trinity College Dublin, The University of Dublin
Methodology
– 13 males: 7 females, mean age of 45
– Phone interview conducted 6 months
post CR training
– Cognitive Remediation Questionnaire
– 42 questions asked & divided into
topics
– Answers recorded verbatim then
transcribed into longhand
immediately post interview
– Conducted by an independent
researcher separate from the original
data collection
– Thematic analysis applied to generate
themes from the data
Patient experiences of CR training
TasksTherapist
Computer Sessions
Abilities/
general
Benefits/
costs
Topics

9. Trinity College Dublin, The University of Dublin
Results
Patient experiences of CR training
Benefits
•Skills development
•Transfer to life
•Improved cognition
•Psychological benefits
Costs
•Practical costs
•Psychological costs
Experience
•Use of computer
•Role of therapist
•Ending of therapy
Themes

10. Trinity College Dublin, The University of Dublin
Benefits
‘I do find that it has helped my
concentration when working on projects
now in work.’
Patient experiences of CR training

11. Trinity College Dublin, The University of Dublin
Costs
‘Stressful. I didn’t want to open the
laptop. I had to force myself…I worried I
couldn’t focus on those 40 minutes every
day. It was difficult.’
Patient experiences of CR training

12. Trinity College Dublin, The University of Dublin
Experience
‘I was asked questions I could relate to
and I wasn’t talked down to.’
Patient experiences of CR training

13. Trinity College Dublin, The University of Dublin
Were patients aware of their own
cognitive improvements?
– Objectively, the patients (who had taken part in CR
training and had answered the questionnaire)
showed improvements in general cognitive &
intellectual functioning, visual spatial abilities & in
short term memory.
– Subjectively, all said that it helped with
concentration, 18 said it helped with memory, &
18 said it helped with being alert and focused.

14. Trinity College Dublin, The University of Dublin
What about long-term cognitive
improvements?
– Objectively, improvements in memory, visual
spatial abilities, social & occupational functioning
& problem solving ability found at 3-6 months post
treatment follow up (in press).
– Subjectively, 45% of patients believe their
improvements in memory and concentration were
enduring & 40% believed their improvements in
alertness & ability to focus were enduring.

15. Trinity College Dublin, The University of Dublin
Discussion/future research
– Feasible & acceptable. Potential delivery in services
where psychological supports are limited.
– Improved cognition, improved positive self-regard,
development of life skills & transfer of benefits to
everyday life.
– Difficult, tiring, frustrating, performance anxiety
leading to reduced self esteem & self-worth.
Explaining drop out rates?
– Role of the therapist highly positive – must not be
taken for granted in ‘e-health’ technologies.
– Psychological benefits AS important as cognitive gains.
Pre-therapy computer training &/or the introduction
of esteem boosting variables.
Patient experiences of CR training

16. Trinity College Dublin, The University of Dublin
Strengths/weaknesses
– Useful as a practical CR model for clinical use.
– First qualitative study examining CR training
users’ experiences of a low support version.
– Limited sample size. 20/48 agreed to take
part in the interview; those who were most
happy with therapy outcome may have been
more motivated to answer questions on their
experience.
– Participants who had completed the entire
CR training were interviewed. Future
research should try and interview
participants as they drop out to try and get a
further understanding of withdrawal rates.
Patient experiences of CR training

17. Trinity College Dublin, The University of Dublin
References
Braun, V. and Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology,
3(2), 77-101.
Dillon, R., Hargreaves, A., Anderson-Schmidt, H., Castorina, M., Corvin, A., Fitzmaurice, B., Robertson, I.,
Donohoe, G. (2016). Adherence to a low-support cognitive remediation training program for psychosis.
Journal of Nervous Mental Disorders, 204(10), 741-745.
Donohoe, G., Dillon, R., Hargreaves, A., Mothersill, O., Castorina, M., Furey, E., Fagan, A.J., Meaney, J.F.,
Fitzmaurice, B., Hallahan, B., McDonald, C., Wykes, T., Corvin, A., Robertson, I.H. (2017). Effectiveness
of a low support, remotely accessible, cognitive remediation training program for chronic psychosis:
Cognitive, functional and cortical outcomes from a single blind randomised controlled trial. In press.
Hargreaves, A., Daly-Ryan N., Dillon R., Donohoe G. Independent computerised cognitive remediation for
psychosis: an investigation of patient experiences. In press.
Hargreaves, A., Dillon, R., Anderson-Schmidt, H., Corvin, A., Fitzmaurice, B., Castorina, M., Robertson, I.H.,
Donohoe, G. (2015). Computerised working-memory focused cognitive remediation therapy for
psychosis: A preliminary study. Schizophrenia Research, 169(1-3), 135-140.
Rose, D., Wykes, T., Farrier, D., Dolan, A., Sporle, T., & Bogner, D. (2008). What do clients think of cognitive
remediation therapy? A consumer-led investigation of satisfaction and side effects . American Journal
of Psychiatric Rehabilitation, 11(2), 181-204.
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(5), 472-485.
Patient experiences of CR training

18. Thank You
-‘It made me think there’s life in my brain yet!’