Cognitive training interventions aimed at improving outcomes in psychosis

Abstract

Psychosis is characterised by both cognitive and metacognitive deficits, which negatively impact functional capacities. Psychological interventions featuring the training of cognitive and metacognitive capacities may prove promising for individuals with psychosis, given that impairments can be longstanding. It is hoped that training of deficits translates into improved functional outcomes. A systematic review examined 13 studies to explore the impact of the newly theorised core ingredients (facilitation by therapist, repeated cognitive exercises, strategy development, and transfer/generalisation) that make Cognitive Remediation Therapy (CR) effective, as well as impacts on the durability of functional outcomes. Results suggested that functional improvement was maintained for up to 12-months in some studies. Further longitudinal research and evaluations of the core ingredients are needed to understand optimal delivery of CR. CR programmes incorporate metacognitive processes such as, monitoring and applying strategies to circumvent deficits. However, training that seeks to enhance metacognitive accuracy (confidence about correctness) has yet to be explored for psychosis. An empirical study evaluated the effect of 8-weeks of metacognitive training and feedback on self-reported metacognition in those with psychosis spectrum experiences (n=22) and depression (n=92). Large attrition in the psychosis sample meant data was pooled with the depression controls. Cognitive insight significantly improved following training. Psychosis participants demonstrated reliable and clinically significant change on some domains of metacognition such as decentration and mastery. This indicates it may be possible to enhance accurate self-assessment in psychosis, however, adherence to training needs to be strengthened.

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Identifiers

ORCID for Laura Jayne Lee: orcid.org/0009-0005-7575-8291

ORCID for Emma Palmer-Cooper: orcid.org/0000-0002-5416-1518

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