Stability and Generalization of Combined Theory of Mind and Cognitive Remediation Interventions in Schizophrenia: Follow-Up Results

• Published in: Psychiatric rehabilitation journal 2020-06, Vol.43 (2), p.140-148
• Main Authors: Bechi, Margherita, Bosia, Marta, Buonocore, Mariachiara, Agostoni, Giulia, Bosinelli, Francesca, Silvestri, Maria Paola, Bianchi, Laura, Cocchi, Federica, Guglielmino, Carmelo, Spangaro, Marco, Cavallaro, Roberto
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Adult; Cognitive ability; Cognitive Generalization; Cognitive Mediation; Cognitive Remediation; Cognitive Therapy; Female; Follow-Up Studies; Human; Humans; Intervention; Male; Medical treatment; Middle Aged; Neurocognition; Outcome Assessment, Health Care; Outpatient; Psychosis; Schizophrenia; Schizophrenia - rehabilitation; Social Cognition; Theory of Mind; Treatment Outcomes
• ISSN: 1095-158X; 1559-3126
• DOI: 10.1037/prj0000379

Objective: Daily functional impairment is a main target of treatment in schizophrenia. Multiple rehabilitation treatments have been developed to improve patients' sociocognitive and neurocognitive abilities and to generalize the benefits to functioning. However, whether the effects of these treatments can be generalized and maintained remains equivocal. Our study aims to evaluate the stability and generalization of benefits, following combined Theory of Mind (ToM) and cognitive remediation (CR) trainings, compared with an active control group + CR, at a 3-year follow-up. Method: Sixty-seven outpatients with schizophrenia who had completed an earlier study of ToM and CR were recruited for a 3-year follow-up assessment. We examined changes in ToM and functioning, at baseline, after treatment, and at follow-up. Results: ANOVAs showed significant Time × Group interactions on ToM and functioning. ANOVAs showed significant differences between groups in effect sizes of ToM and functioning from before treatment to follow-up. Conclusions and Implications for Practice: Posttraining ToM improvement was maintained at follow-up, and ToM + CR participants experienced greater functional improvement than participants in the control condition. This study represents the first attempt to report the stability and generalization of treatment effects obtained by combining CR and ToM interventions after 3 years. Combined sociocognitive and neurocognitive treatments can enhance rehabilitation practice for people with schizophrenia to achieve good results on both cognitive and functional outcomes and to maintain positive outcomes. Impact and Implications Despite demonstrated efficacy of cognitive remediation and psychosocial interventions on both neurocognitive and sociocognitive abilities in schizophrenia, further studies are required to support stability and generalization of their effects. Combined cognitive and sociocognitive interventions are recommended for rehabilitation practice as they improve social well-being and functioning over time.