Adding functional skills training to CRT improves schizophrenia functioning

By Ingrid Grasmo

Adding functional skills training to cognitive remediation therapy (CRT) significantly improves functional competence and real-world behavior in patients with schizophrenia, show study findings.

CRT is a cognitive rehabilitation therapy designed to improved neurocognitive abilities such as attention, working memory, executive functioning, and cognitive flexibility and planning, which leads to improvements in social functioning.

This treatment has been shown effective for schizophrenia, but "no studies to date have directly compared the benefits of CRT with and without supplemental skills training," say Christopher Bowie (Queens University, Kingston, Ontario, Canada) and colleagues.

In total, 107 outpatients with schizophrenia were randomly assigned to receive 12 weeks of CRT followed by 12 weeks of treatment as usual (TAU), 12 weeks of functional adaptation skills training followed by 12 weeks of TAU, or 12 weeks of CRT followed by 12 weeks of functional skills training.

Clinical symptoms, neurocognition, social competence, functional competence, and case manager-rated real-world behavior were assessed at baseline, the end of treatment, and 12 weeks after the interventions.

Significant improvements were seen in neurocognition following CRT alone and in combination with functional skills training, with positive effects maintained at the 12-week assessment. No improvement was seen with functional skills training alone.

Social competence improved significantly with functional skills training alone and combined treatment, but not with CRT alone. Patients showed significantly greater improvements in functional competence that were more durable with combined treatment compared with the other two treatments.

No significant improvements from baseline for real-world behavior were observed with CRT alone, but when combined with functional skills training, significant improvements from baseline to the end of treatment and follow-up were observed for community or household activities and work skills.

Analyses of the number needed to treat showed that as few as three cases are required for a meaningful 30% improvement in functional skills, reaching 60% for 18.0.

Similar findings were observed for clinician-rated real-world work skills, with the number needed to treat being 3.3 for a response of 20% and 42.0 for a response of 50%. For clinician-rated real-world community activities, the number needed to treat was 18.0 for a response of 10% and 36.0 for a response of 30%.

"The extra cost of combining these interventions must be considered in the context of the impressive number-needed-to-treat statistics - as few as three patients for the combined treatment to improve functioning by 20-30%," say the authors in the American Journal of Psychiatry.

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