Could computers help people who have schizophrenia? Computerized and computer-assisted cognitive remediation programs may be effective at improving the cognitive functioning, interpersonal relationships, and overall psychiatric symptoms of individuals with schizophrenia, research shows.

Studies Show Promise

Some 60 individuals with schizophrenia were enrolled in the study, with 29 receiving cognitive remediation and the other 31 receiving treatment such as social skills training and group recreational and sport activities. The group that received cognitive remediation showed greater improvement in a variety of areas, such as interpersonal relationships and work skills.

This is good news for people who have schizophrenia since they typically experience a decline in their functional ability because of their symptoms, including paranoia as well as low energy and low motivation. “They also can experience a disorganization in their thoughts and actions,” Philip Watson, PhD, senior neuropsychologist at the Center for Neurological Services at Northwell Health in Glen Oaks, NY, says. “The totality of those symptoms impacts the ability to interact with others and/or function effectively in academic or vocational pursuits.”

“The present findings showed that providing cognitive remediation in addition to psychiatric rehabilitation contributed to greater improvement in both cognitive and social functioning than psychiatric rehabilitation alone,” the study authors concluded. “Cognitive remediation may enhance the efficacy of psychiatric rehabilitation, improving social functioning.”

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What is Cognitive Rehabilitation Therapy?

In computer-assisted cognitive rehabilitation therapy, the individual logs into an online program and then engages in tasks that seem like games; the person must rely on certain cognitive abilities in order to complete the tasks, Dr. Watson explains.

“The tasks focus on memory, attention processing, and the speed of processing, along with recognizing the emotions of the faces and the tones of someone’s voice,” he explains. “The tasks are designed to start off slow and become more difficult as you do well. The idea is that it helps you to make new connections that strengthen your cognitive ability.” The sessions last for around 30 minutes, and the person may engage in a session three or four times a week.

The computer-assisted programs often incorporate rewards like the ones seen in computer and video games, says Stephen Rush, MD, assistant professor of clinical psychiatry in the University of Cincinnati Department of Psychiatry and Behavioral Neuroscience. “They offer encouraging feedback and the presence of enjoyable colors and noises,” he says.

Patients engage in exercises that enhance learning and specifically target the cognitive areas that are deficient, explains Bryan Freilich, PsyD, ABPP, director of neuropsychological assessment service at Montefiore Health System and an assistant professor of psychiatry at Albert Einstein College of Medicine in New York City.

A second research study looked at whether participants who engaged in computer-assisted cognitive remediation demonstrated greater benefits in cognitive functioning and quality of life when they practiced it for three months versus six months; no significant difference was found between the two groups.

How Does CRT Help People with Schizophrenia?

Still, cognitive remediation for patients with schizophrenia can be effective, says Dr. Rush. Trouble with memory and concentrating can make even simple tasks in the workplace, like ringing up items at a register or filing away library books, more difficult for patients experiencing certain symptoms and side effects of schizophrenia.

“Studies of the effect of cognitive remediation demonstrate moderate improvement in function in the workplace with impacts on employment rates, hours worked, and wages earned,” he says. “All of these outcomes are more often seen when CRT is paired with other psychiatric rehabilitation programs such as vocational rehabilitation and social skills training.”

Medication is still the first line of treatment for schizophrenia as it helps stabilize symptoms and improves the ability to concentrate, notes Dr. Watson. “But cognitive remediation therapy, while not new, is an emerging treatment option for schizophrenia,” he says.

Someone who has acute psychosis would not be a good candidate for CRT, Dr. Watson explains, since it requires engagement and the ability to sit for 30 minutes at a time. “When people are acutely ill, they could have trouble doing this,” he explains. “But once they are stable, even if they are symptomatic, they can engage in the treatment and benefit from it.”

“A large portion of individuals with schizophrenia, estimated at around 80 percent, have some degree of cognitive impairment, often in the areas of attention, memory, and executive functioning,” Dr. Freilich says. “Cognitive remediation is a good treatment option for those with schizophrenia.”

CRT is More than Computer Games

Computer-assisted cognitive remediation is not only about sitting at a computer. At the Early Psychosis Intervention Center in Tucson, Arizona, where Matthew Moffitt, PhD, works, a clinician is part of the therapy, too. “After each exercise or task is completed, the clinician discusses with the patient how best to transfer the knowledge learned on the computer to real-world situations,” Dr. Moffitt says.

The downside of computer-assisted CRT? It may not be as effective with people who are not adept at computers, says Dr. Rush.

Meanwhile, more research is needed to assess the benefits of computer-assisted cognitive remediation programs, Dr. Rush says. “Most studies available are small, like those cited in this article,” he says. “I would like to see more and larger such studies and further meta-analyses of these studies to evaluate the effectiveness of using computers in cognitive remediation therapy.”

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Last Updated: Apr 24, 2020