Randomized controlled trial of the use of compensatory strategies to enhance adaptive functioning in outpatients with schizophrenia

Objective: Cognitive adaptation training is a novel psychosocial treatment approach designed to improve adaptive functioning by using compensatory str ategies in the home or work environment to bypass the cognitive deficits as sociated with schizophrenia. The authors tested the effect of cognitive ada ptation training on level of adaptive functioning in outpatients with schiz ophrenia. Method: Forty-five patients with DSM-IV schizophrenia or schizoaffective di sorder were randomly assigned for 9 months to one of three treatment condit ions: 1) standard medication follow-up, 2) standard medication follow-up pl us cognitive adaptation training, and 3) standard medication follow-up plus a condition designed to control for therapist time and provide environment al changes unrelated to cognitive deficits. Comprehensive assessments were conducted every 3 months by raters who were blind to treatment condition. Results: Significant differences were found between the three treatment gro ups in levels of psychotic symptoms, motivation, and global functioning at the end of the 9-month study period. Patients in the cognitive adaptation t raining group overall had higher levels of improvement, compared with those in the remaining treatment conditions. In addition, the three groups had s ignificantly different relapse rates over the 9-month study: 13% for the co gnitive adaptation training group, 69% for the group in which therapist tim e and environmental changes were controlled, and 33% for the group who rece ived standard follow-up only. Conclusions: Compensatory strategies may improve outcomes for patients with schizophrenia.