The British Journal of Psychiatry (2007) 190: 421-427. doi: 10.1192/bjp.bp.106.026575
© 2007 The Royal College of Psychiatrists
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Cognitive remediation therapy in schizophrenia

Randomised controlled trial

Til Wykes, MPhil, PhD and Clare Reeder, DClin Psych, PhD

Department of Psychology

Sabine Landau, PhD and Brian Everitt, BSc

Department of Biostatistics and Computing

Martin Knapp, PhD, Anita Patel, PhD and Renee Romeo, PhD

Department of Health Services Research, King's College London, Institute of Psychiatry, London, UK

Correspondence: Professor Til Wykes, Department of Psychology, PO Box 77, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. Tel: ++44 (0) 020 7848 0596; fax: +44 (0) 020 7848 5006; email: t.wykes{at}iop.kcl.ac.uk

Declaration of interest None.

Background Cognitive difficulties are prevalent in people with a diagnosis of schizophrenia and are associated with poor long-term functioning.

Aims To evaluate the effectiveness of cognitive remediation therapy on cognitive difficulties experienced by people with schizophrenia.

Method Participants with a diagnosis of schizophrenia, a social behaviour problem and a cognitive difficulty (n=85) were randomised to 40 sessions of cognitive remediation or treatment as usual in a single-blind randomised controlled trial. Working memory, cognitive flexibility and planning, were measured at weeks 0,14 and 40.

Results There were durable improvements in working memory (advantage 1.33 points, 95% CI 0.43-2.16, standardised effect size 0.34) as well as an indication of improvement in cognitive flexibility. Memory improvement predicted improvement in social functioning. Costs were lower in the cognitive remediation group following therapy but rose at follow-up. However, cost-effectiveness analyses showed that improvements in memory were achieved at little additional cost.

Conclusions Cognitive remediation therapy is associated with durable improvements in memory, which in turn are associated with social functioning improvements in people with severe mental illness.


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