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Effects on the brain of a psychological treatment: cognitive remediation therapy

Functional magnetic resonance imaging in schizophrenia

Institute of Psychiatry, London

JOHN MELLERS, MRCPsych

Maudsley Hospital, South London and Maudsley Trust

PETER BRAY, BSc, CLARE REEDER, DClinPsych, CLARE WILLIAMS, BA and JULIA CORNER, BA

Institute of Psychiatry, London

Correspondence: Professor Til Wykes, Department of Psychology, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. Tel: 0171 919 3596; e-mail: t.wykes{at}iop.kcl.ac.uk

Declaration of interest This work was supported by the Wellcome Trust.

Background The results of one randomised control trial testing a psychological rehabilitation programme aimed at information processing strategies showed improvements in cognition post-treatment.

Aims To determine whether there are concomitant brain activation changes as a result of engaging in cognitive remediation therapy (CRT).

Method Three groups (patients receiving control therapy or CRT and a healthy control group) were investigated in a repeated measures design using the two-back test. Functional magnetic resonance imaging (fMRI) data and a broad assessment of executive functioning were completed at baseline and post-treatment. Brain activation changes were identified after accounting for possible task-correlated motion artefact.

Results fMRI analyses indicate that the control group showed decreased activation but the two patient groups showed an increase in activation over time. The patient group that received successful CRT had significantly increased brain activation in regions associated with working memory, particularly the frontocortical areas.

Conclusions This is the first time that brain activation changes in a seriously disabled group of patients with schizophrenia can be associated clearly with psychological rather than pharmacological therapy.

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