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Cognitive Enhancement Therapy in Early Schizophrenia: A Qualitative and Quantitative Case Series of Patients’ Experiences

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Abstract

Evidence shows that cognitive remediation therapy improves cognition in individuals with schizophrenia. However, its broader impact on patients’ lives remains unclear. Furthermore, little is known about the motivational factors influencing treatment engagement. This quantitative and qualitative case series study identified factors that influence patients’ experiences while receiving cognitive enhancement therapy (CET). Nine individuals with schizophrenia who received CET completed two questionnaires and participated in semi-structured focus groups or in an individual interview about their experience with CET. Four deductive themes were assessed when analyzing responses: (1) perceived impact, (2) motivational facilitators, (3) motivational barriers, and (4) suggestions to improve CET. All participants reported that CET was helpful, and the majority enjoyed participating in CET. Most participants reported high satisfaction with their work and school, but lower satisfaction with their social life. Results also indicated perceived improvements in negative symptoms, neurocognition, and confidence following CET. Participants identified extrinsic, intrinsic, and program-specific facilitators and barriers motivating their participation in the program. Suggestions to improve CET included changes to treatment design and content. Altogether, these results indicate that the perspective of CET end users can provide useful information on the factors influencing treatment engagement, satisfaction, and perceived impact.

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The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank all participants who took part in the study, as well as Hassan Khan for his help with the preliminary analysis and Dr. Kristelle Alunni-Minichini for her guidance with the qualitative analyses.

Funding

This work was funded by an operating Grant from NIMH MH 92440; MSK, PI, Clinicatrials.gov #NCT01561859). SG was supported by a postdoctoral training fellowship from the Fonds de recherche du Québec – Santé and by an Emerging Research Innovators in Mental Health award.

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Authors and Affiliations

  1. Department of Psychiatry, The Royal’s Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada

    Chelsea Noël, Feng Gu, Alexandra Tucci, Patrizia Pezzoli & Synthia Guimond

  2. Department of Psychiatry, Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center Division of Public Psychiatry, Boston, MA, USA

    Leighanne Ormston, Samantha Tingue, Shezal Padani, Luis Sandoval, Matcheri S. Keshavan & Synthia Guimond

  3. Department of Psychology, Carleton University, Ottawa, ON, Canada

    Alexandra Tucci & Synthia Guimond

  4. Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA

    Jessica A. Wojtalik

  5. School of Social Work and Department of Psychiatry, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA, USA

    Shaun M. Eack

  6. Department of Psychiatry, Harvard Medical School, Boston, MA, USA

    Matcheri S. Keshavan & Synthia Guimond

  7. Department of Psychoeducation and Psychology, University of Quebec in Outaouais, Gatineau, QC, Canada

    Synthia Guimond

  8. BIDMC-Mass. Mental Health Center, 75 Fenwood Road, Boston, MA, 02115, USA

    Matcheri S. Keshavan

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  1. Chelsea Noël
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Contributions

SG and MSK designed the study, and SG oversaw every step of the study. LS helped with the development of the focus group and the interview guide. SG, SP, and LO collected the data. LO and ST transcribed all verbatim. CN, FG and SG performed the analyses. CN wrote the first draft of the manuscript, helped by AT and PP. LS, JW, and MSK also provided valuable expertise on cognitive enhancement therapy throughout the study. All authors contributed to the writing and approval of the final manuscript.

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Correspondence to Matcheri S. Keshavan.

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Noël, C., Gu, F., Ormston, L. et al. Cognitive Enhancement Therapy in Early Schizophrenia: A Qualitative and Quantitative Case Series of Patients’ Experiences. J. Psychosoc. Rehabil. Ment. Health 8, 109–123 (2021). https://doi.org/10.1007/s40737-020-00204-6

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