What is… Cognitive Remediation

In this series, I dig a little deeper into the meaning of psychology-related terms. This week’s term is cognitive remediation.

Cognitive remediation (CR) aims to improve psychosocial functioning by addressing several areas of neurocognitive functioning, such as attention, working memory, and executive functioning.

CR is used mostly in schizophrenia and traumatic brain injury. It’s also been used in anorexia nervosa, where the focus is on improving metacognitive awareness of problematic thinking styles associated with the illness.

Strategies used

There are two types of strategies used in CR. Compensatory strategies are aimed at developing workarounds for deficits, while restorative strategies promote the building of new neural connections in the brain through neuroplasticity.

A variety of information processing skills are taught, including verbalization, breaking a task into smaller steps, chunking, self-monitoring, using mnemonics, categorization, organization, and planning.  Some of the tasks include:

• making change with the fewest number of coins possible
• spotting the picture that doesn’t fit in a group of pictures
• matching a picture to the one of a group it’s most similar to
• word puzzles
• complete a series based on the pattern shown
• mental arithmetic
• remembering information that was read 20 minutes before

How it’s delivered

There is computer software available for CR, but exercises can also be done on paper. Work is also done with the therapist on bridging the skills learned into real-life tasks that the individual would likely be faced with.

It’s usually run as a group, with 2 or more weekly sessions for 3-4 months. There’s a Cognitive Remediation Therapy for Anorexia Nervosa group manual that has more details on that particular variation of CR.

In people with serious mental illness, CR has been shown to lead to improvements in standardized neuropsychological test results. That improvement continued for 1-2 years. In addition to improving cognitive functioning, it also improves social and occupational functioning.

CR has picked up steam in the area where I live over the last couple of years. The concurrent disorders transitional program where I work runs a computer-based CR group. I’ve never actually asked any of the clients what they thought of it. I would guess that motivation would be an issue. I’m all for exercising your brain, but I don’t know that I’d be keen on doing it in this particular way for 3-4 months.

I’m guessing that this is a more targeted version of some of the brain exercise programs that are aimed at the general public (there’s a list of apps in the MH Resource Directory). I’ve never tried any of them, but my uncle swears by Lumosity.

Have you ever tried cognitive remediation or any sort of brain exercise program?

References

• Barlati, S., et al. (2013). Cognitive remediation in schizophrenia: Current status and future perspectives. Schizophrenia Research and Treatment, 2013: 156084.
• Bates, J., & Allred, S. (2016). Patients with severe mental illness can benefit from cognitive remediation training. Current Psychiatry, 15(4), 37, 40-44.
• Boston University Center for Psychiatric Rehabilitation: Cognitive Remediation and Spotlight on the Thinking Skills for Work Program
• Wikipedia: Cognitive remediation therapy

The Coping Toolkit page has a broad collection of resources to support mental health and well-being.

Ashley L. Peterson

BScPharm BSN MPN

Ashley is a former mental health nurse and pharmacist and the author of four books.