Effects of cognitive treatment in psychiatric rehabilitation

Ninety subjects with severe and disabling psychiatric conditions, predomina ntly schizophrenia, participated in a controlled-outcome trial of the cogni tive component of Integrated Psychological Therapy (IPT), a group-therapy m odality intended to reestablish basic neurocognitive functions. The cogniti ve therapy was delivered to subjects in the experimental condition during i ntensive 6-month treatment periods. Control subjects received supportive gr oup therapy Before, during, and after the intensive treatment period, all s ubjects received an enriched regimen of comprehensive psychiatric rehabilit ation, including social and living skills training, optimal pharmacotherapy , occupational therapy, and milieu-based behavioral treatment. IPT subjects showed incrementally greater gains compared with controls on the primary o utcome measure, the Assessment of Interpersonal Problem-Solving Skills, sug gesting that procedures that target cognitive impairments of schizophrenia spectrum disorders can enhance patients' response to standard psychiatric r ehabilitation, at least in the short term, in the domain of social competen ce. There was equivocal evidence for greater improvement in the experimenta l condition on the Brief Psychiatric Rating Scale disorganization factor an d strong evidence for greater improvement on a laboratory measure of attent ional processing. There was significant improvement in both conditions on m easures of attention, memory, and executive functioning, providing support for the hypothesis that therapeutic procedures that target impaired cogniti on enhance response to conventional psychiatric rehabilitation modalities o ver a 6-month timeframe.