Cognitive remediation therapy improves functioning for people with cognitive decline. Repeated practice sessions boost memory, attention, language and motor skills.
Mental disorders create distressing symptoms ranging from mild to severe. Many people with these disorders have problems with cognitive skills. These include skills people use every day like concentration, memory and problem-solving. Cognitive remediation therapy (CRT) is a method of behavioral training used to improve a person’s cognitive functioning.
CRT is often used along with traditional therapies to help people with mental disorders like depression, anxiety or addiction. These disorders typically cause a decline in cognitive skills, along with emotional and behavioral management skills. CRT can be used in outpatient settings or residential treatment settings. Because of the therapy’s practical nature, CRT exercises are easily combined with other therapies.
What Is Cognitive Remediation?
Cognitive remediation therapy uses repeated strategies and exercises to strengthen different cognitive skills. This form of brain training can be used with counseling to help improve cognitive processes. If these impaired skills are ignored, a person will have trouble getting through a normal day. This difficulty could cause more distress in addition to the symptoms of a mental health disorder.
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CRT exercises can be done on a computer or with a pencil and paper. Some exercises focus on working through problem-solving scenarios with different strategies. Other exercises help the person work through procedures and actions in daily life. According to an article from Frontiers in Psychiatry, these CRT exercises also focus on the person’s metacognition. Metacognition is the observation of one’s thinking. This is a vital skill for improving self-awareness, social skills and learning about one’s environment.
Goals of CRT
The primary goal of cognitive remedial training is to improve impaired cognitive skills. This improvement promotes better social interactions, daily functioning and overall quality of life.
Who Benefits from Cognitive Remediation Therapy?
Cognitive remediation therapy is helpful when combined with typical treatment for several mental health disorders. When people can think and learn more clearly, they can improve more easily and better understand their own recovery process. Better cognitive functioning is an important part of successful treatment.
Cognitive remediation therapy can be beneficial to people with a wide range of mental health conditions, including:
- Schizophrenia: Widespread cognitive decline is one of the core features of schizophrenia. Cognitive remediation significantly improves the skills needed for daily living.
- Attention-Deficit Hyperactivity Disorder: Cognitive remediation therapy has shown to be useful for improving working memory, but research results have been mixed with the effect on symptoms or other skills.
- Anorexia Nervosa: Cognitive decline is not a prominent part of eating disorders. However, cognitive remediation therapy has shown promise as a way of helping cognitive flexibility.
- Major Depressive Disorder: Cognitive remediation improves the cognitive functioning needed to respond well to depression treatment.
- Bipolar Disorder: Cognitive decline is common with bipolar disorder. Cognitive remediation therapy for psychological disorders is critical for restoring normal functioning.
- Obsessive-Compulsive Disorder (OCD): Cognitive remediation therapy restores cognitive functioning to prevent OCD symptoms from getting worse.
- Autism Spectrum Disorder: More research is needed to know whether cognitive enhancement therapy for autism spectrum disorder would be helpful.
How Does CRT Work?
The main goal of cognitive remediation therapy is to improve cognitive decline, which can develop when a major mental health disorder interferes with a person’s core cognitive skills. As a result, a person can struggle with recovery even when their symptoms appear to improve.
Cognitive remediation therapy is delivered as a series of practice sessions to strengthen a particular cognitive skill, like working memory or attention. Practice can take place in the therapy setting and between sessions. Some common methods include using cognitive remediation worksheets, journals and exercises done on a computer. This treatment requires some level of sustained concentration to be effective.
Cognitive Domains
Substance misuse can also cause cognitive decline. The risk of cognitive decline is higher if substance misuse is ignored for a long period of time. The cognitive domains affected by substance use disorders are the same ones helped by cognitive remediation therapy, and include:
Memory
Substance use can distort and interrupt short and long-term memory
Attention
Attention span is often shortened and interrupted by substance abuse when the substance causes either too much stimulation or drowsiness
Visual Information Processing
Substance use distorts the way people see things, sometimes even triggering visual hallucinations
Language
Speech can become slurred or incoherent when under the influence of substances
Motor Function
Substance intoxication can cause tremors or poor body coordination, which make walking or standing more difficult
Cognitive Remediation Effectiveness
Research on the effectiveness of cognitive remediation programs is still in its early stages. The practice is still new, and more research is being conducted each year. A closer look at some studies shows that cognitive remediation therapy programs help people improve their skills in therapy. However, the ultimate goal of cognitive remediation therapy is to improve functioning at home, work and social situations.
According to an article in ISRN Rehabilitation, cognitive remediation techniques work best when paired with other support services. Just undergoing cognitive remediation therapy on its own was somewhat helpful, but improvements were not seen at long-term follow-up. The future of cognitive remediation may lie in the development of treatments that work in conjunction with vocational rehabilitation programs.
This same article reports promising outcomes with social cognition skills. This area of cognition includes the ability to function within and interpret social situations. Training in one area of social cognition can be helpful to other areas of social cognition. Benefits were even felt in cognitive domains that were not the focus of therapy. More research needs to be done to see how consistent this is across all cognitive domains.
Examples of Cognitive Remediation in Substance Abuse Treatment
Cognitive remediation activities can be done in a variety of ways. Many activities are set up as games or puzzles. These methods can easily be done within a substance treatment therapy session. For example, executive functioning includes reasoning and strategy skills. Training for these areas can be done using sorting, stacking and arranging activities.
Virtual reality is a newer technique being used to simulate social settings in cognitive remediation therapy sessions. Typical computer activities don’t provide the opportunity to interact in a realistic social way, which means that virtual reality can play a unique and crucial role in therapy. Simulation techniques immerse the person in the experience and create a real-time learning opportunity.
Many training activities are visual, but verbal skills are important as well. Verbal exercises could include memorizing a few seconds of music. Other exercises may involve teaching a person to distinguish between different recorded sounds or repeat verbal information.
Benefits of Cognitive Remediation in Addiction Treatment
Cognitive impairment affects a significant amount of people with substance use disorders. According to one study, nearly 44% of people in therapy experienced some amount of cognitive decline.
Because cognitive decline is so common in people with mental health and substance use disorders, cognitive remediation therapy offers a number of benefits in treatment, including:
- Reduced Treatment Drop-Out Rates: Several studies have shown a much higher completion rate of substance disorder treatment when care includes cognitive remediation therapy.
- Reduced Symptoms of Depression: One study showed that CRT could reduce depression symptoms over multiple weeks of practice sessions.
- Improved Memory: While research shows that it may be more difficult to improve memory than other cognitive functions, cognitive remediation therapy is still one of the most ways effective ways to restore memory skills.
How Long Is Cognitive Remediation Therapy?
Typically, most cognitive remediation therapy programs involve between three and six months of therapy. An analysis of 40 studies about cognitive remediation therapy revealed that the average length of treatment was 16 weeks. In that period, 32 hours of treatment were provided.
The number of sessions of cognitive remediation therapy a person undergoes depend on their individual needs. A person must be able to pay attention to a task for up to 20 minutes per session. People with severe or multiple mental health disorders, like schizophrenia, chronic depression and bipolar disorder, often need more time in mental health therapy.
