Therapies for cognition

What are cognitive rehabilitation interventions?

Cognitive impairment is a significant problem for many people with schizophrenia, effecting domains such as executive functioning, attention, memory and social cognition. These deficits interfere considerably with day-to-day function. Cognitive remediation or rehabilitation interventions usually take the form of repetitive exercises with or without computers and sometimes augmented by group sessions, strategy coaching and homework exercises, which serve as training for cognitive processes as well as social skills and communication. Strategy learning focuses on providing alternative strategies to compensate for the observed difficulties with cognition; in contrast, rehearsal learning is aimed at restitution of lost skills. This type of intervention is specifically targeted to particular cognitive domains which are known to be deficient in people with schizophrenia, with the intention of compensating or improving functional outcome.

What is the evidence for cognitive rehabilitation interventions?

Moderate to high quality evidence finds a medium-sized benefit of computerised or non-computerised cognitive remediation over control interventions for improving attention, memory, processing speed, problem solving, cognitive flexibility and social functioning. There was also a small benefit for improving symptoms. Moderate to low quality evidence finds similar effectiveness for short (<15 sessions) and long duration of training (>15 sessions), and that strategy learning is more effective than rehearsal learning.

For computerised cognitive drill and practice training, moderate to high quality evidence finds small to medium-sized improvements in attention and positive symptoms when compared to mixed control conditions. There was also a small improvement in functioning. Moderate quality evidence finds medium-sized improvements in working memory and depressive symptoms, and small improvements in psychomotor speed. There were also small improvements in verbal fluency, verbal and visual learning and memory., and negative and total symptoms.

For observation and imitation of social emotions interventions, moderate to high quality evidence finds a medium-sized benefit of improved theory of mind.

September 2020

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Last updated at: 5:01 pm, 24th February 2022
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