Evaluation of a new online cognitive remediation therapy (CIRCuiTSTM ) training for mental health professionals.

OBJECTIVE: Cognitive remediation (CR) improves cognition and aids recovery in people with psychosis. An active therapist provides increased benefit, but CR training for therapists is not routinely available, so CR has limited scalability. This study describes the development and evaluation of the first online CR therapist training programme. METHODS: An online CR training, based on expert and novice therapist consultations, was developed, and then pilot tested with novice trainees and changes made to produce the evaluation version. Feasibility, acceptability, and training benefits were assessed in a group of naïve UK NHS mental health professionals. Training engagement with a group of clinicians who accessed the programme for professional development was compared to those who paid fees. RESULTS: Most mental health professionals finished training and passed the knowledge test, indicating that training enhanced clinicians' knowledge. Fee-paying trainees had significantly faster completion times and a higher proportion finished in the recommended time. Those who were successful at passing the knowledge questionnaire had significantly fewer years in practice. The majority were satisfied with the programme, felt they had made considerable progress and that training would allow them to begin practicing CR, and would recommend the training to colleagues. CONCLUSIONS: This online CR training programme was feasible, acceptable to participants and showed benefits for clinicians. It improved knowledge even in the most junior of staff who have had less time to develop clinical know-how.

Feasibility and acceptability of brief cognitive remediation targeting metacognition in acute inpatients with psychosis: a case series.

Cognitive remediation (CR) is an intensive intervention targeting cognitive impairment with the aim of improving functioning in people with psychotic disorders. Shorter forms of CR based on metacognition and targeting awareness of cognitive problems may be more appropriate for acute inpatient settings where time is limited. The objective of the study was to evaluate the feasibility and acceptability of a new brief course of CR targeting cognitive and metacognitive difficulties within an acute inpatient psychiatric setting. Thirteen male service users with psychosis received a three-week course of CR. Participants were assessed at baseline and post-treatment on cognitive measures, subjective cognitive complaints, functional impairment, and symptom severity. Feasibility was assessed based on engagement, attendance, and attrition. Acceptability was evaluated through treatment satisfaction. Eight participants completed therapy, with 81% session attendance. Therapy was considered acceptable, with the majority of participants considering it satisfactory. Potential benefit analysis showed a significant post-treatment improvement in global cognition and memory. Subjective cognitive complaints did not change over time. It was concluded that it is feasible to deliver brief CR in an acute inpatient setting. Context of delivery and engagement are challenges for optimal therapy implementation. CR protocol adaptations made to promote metacognitive competencies may compensate for lack of intensive practice.

The CIRCuiTS study (Implementation of cognitive remediation in early intervention services): protocol for a randomised controlled trial.

BACKGROUND: Cognitive problems in people with schizophrenia predict poor functional recovery even with the best possible rehabilitation opportunities and optimal medication. A psychological treatment known as cognitive remediation therapy (CRT) aims to improve cognition in neuropsychiatric disorders, with the ultimate goal of improving functional recovery. Studies suggest that intervening early in the course of the disorder will have the most benefit, so this study will be based in early intervention services, which treat individuals in the first few years following the onset of the disorder. The overall aim is to investigate different methods of CRT. METHODS: This is a multicentre, randomised, single-blinded, controlled trial based in early intervention services in National Health Service Mental Health Trusts in six English research sites. Three different methods of providing CRT (intensive, group, and independent) will be compared with treatment as usual. We will recruit 720 service users aged between 16 and 45 over 3 years who have a research diagnosis of non-affective psychosis and will be at least 3 months from the onset of the first episode of psychosis. The primary outcome measure will be the degree to which participants have achieved their stated goals using the Goal Attainment Scale. Secondary outcome measures will include improvements in cognitive function, social function, self-esteem, and clinical symptoms. DISCUSSION: It has already been established that cognitive remediation improves cognitive function in people with schizophrenia. Successful implementation in mental health services has the potential to change the recovery trajectory of individuals with schizophrenia-spectrum disorders. However, the best mode of implementation, in terms of efficacy, service user and team preference, and cost-effectiveness is still unclear. The CIRCuiTS trial will provide guidance for a large-scale roll-out of CRT to mental health services where cognitive difficulties impact recovery and resilience. TRIAL REGISTRATION: ISRCTN, ISRCTN14678860 , Registered on 6 June 2016.

Tackling Social Cognition in Schizophrenia: A Randomized Feasibility Trial.

BACKGROUND: Social cognition difficulties in schizophrenia are seen as a barrier to recovery. Intervention tackling problems in this domain have the potential to facilitate functioning and recovery. Social Cognition and Interaction Training (SCIT) is a manual-based psychological therapy designed to improve social functioning in schizophrenia. AIMS: The aim of this study is to evaluate the feasibility and acceptability of a modified version of SCIT for inpatient forensic wards. The potential benefits of the intervention were also assessed. METHOD: This study is a randomized single blind controlled design, with participants randomized to receive SCIT (N = 21) or treatment as usual (TAU; N = 15). SCIT consisted of 8-week therapy sessions twice per week. Participants were assessed at week 0 and one week after the intervention on measures of social cognition. Feasibility was assessed through group attendance and attrition. Participant acceptability and outcome was evaluated through post-group satisfaction and achievement of social goals. RESULTS: The intervention was well received by all participants and the majority reported their confidence improved. The SCIT group showed a significant improvement in facial affect recognition compared to TAU. Almost all participants agreed they had achieved their social goal as a result of the intervention. CONCLUSIONS: It is feasible to deliver SCIT in a forensic ward setting; however, some adaptation to the protocol may need to be considered in order to accommodate for the reduced social contact within forensic wards. Practice of social cognition skills in real life may be necessary to achieve benefits to theory of mind and attributional style.

Intensive Individual and Group Cognitive Behavioural Therapy for Obsessive-Compulsive Disorder.

Whilst there is good evidence to show intensive individual therapy can be effective for obsessive-compulsive disorder (OCD), this treatment can be challenging to deliver for therapists in the National Health Service (NHS). We report on a novel means of delivering intensive cognitive behavioural therapy (CBT) by combining it with group work, which allowed therapists to offer each other mutual support and permitted patients to gain the interpersonal benefits of working with others. This case study describes the combined intensive individual and group CBT programme for a 46-year-old woman with OCD. This treatment took place within a community mental health team within outer London. Following treatment, the client showed significant improvements in symptoms. This creative method for treating OCD as part of routine clinical practice may be beneficial for therapists to feel supported, for reduction in clinicians' time in treatment, and for clients to benefit from a group experience.

A comparison of the illness perceptions of North Indian and white British women.

BACKGROUND: Treatment seeking by South Asians for depression has been shown to be lower than for white British people. AIMS: This study compared illness perceptions about depression and the help-seeking behaviour of white British (n = 70) and North Indian women (n = 70) living in the UK. Previous studies have used interviews to elicit illness perceptions but have been time-consuming. The shorter Brief Illness Perception Questionnaire (BIPQ) was used instead. METHOD: A cross-sectional survey design was used. Participants were asked to evaluate problems of a vignette character using the BIPQ. RESULTS: Compared with the British group, Indian participants believed treatment would be less beneficial; felt they had less of an understanding of the character's difficulties and that the character's difficulties had less of an effect on her emotionally. Significantly fewer of the Indian sample suggested the character should go to her general practitioner (GP). Consistent with previous findings, Indian women reported themselves to be feeling more distressed when compared with British women. No differences in perceived causes of the vignette character's difficulties were found between the groups which is slightly discrepant with previous studies. CONCLUSIONS: Ethnic differences were found in illness perceptions which could help explain the lower rate of GP consultation amongst Indian women.

Developing models of how cognitive improvements change functioning: mediation, moderation and moderated mediation.

BACKGROUND: Cognitive remediation (CRT) affects functioning but the extent and type of cognitive improvements necessary are unknown. AIM: To develop and test models of how cognitive improvement transfers to work behaviour using the data from a current service. METHOD: Participants (N49) with a support worker and a paid or voluntary job were offered CRT in a Phase 2 single group design with three assessments: baseline, post therapy and follow-up. Working memory, cognitive flexibility, planning and work outcomes were assessed. RESULTS: Three models were tested (mediation - cognitive improvements drive functioning improvement; moderation - post treatment cognitive level affects the impact of CRT on functioning; moderated mediation - cognition drives functioning improvements only after a certain level is achieved). There was evidence of mediation (planning improvement associated with improved work quality). There was no evidence that cognitive flexibility (total Wisconsin Card Sorting Test errors) and working memory (Wechsler Adult Intelligence Scale III digit span) mediated work functioning despite significant effects. There was some evidence of moderated mediation for planning improvement if participants had poorer memory and/or made fewer WCST errors. The total CRT effect on work quality was d=0.55, but the indirect (planning-mediated CRT effect) was d=0.082 CONCLUSION: Planning improvements led to better work quality but only accounted for a small proportion of the total effect on work outcome. Other specific and non-specific effects of CRT and the work programme are likely to account for some of the remaining effect. This is the first time complex models have been tested and future Phase 3 studies need to further test mediation and moderated mediation models.