Cognitive Remediation and Psychopathology: Training the Brain

                A new form of treatment in neuroscience is emerging, and it’s called cognitive remediation.  Cognitive remediation can, in its simplest terms, be thought of as “training” the brain.  Current evidence supports its validity in improving cognitive deficiencies associated with psychopathological disorders and schizophrenia.  However, in order to employ this method, it is important to identify the mental weaknesses or deficiencies that accompany different psychological conditions.  With this information, different regimens of cognitive remediation can be tailored to address each disorder specifically.

                One study, conducted by Baskin-Sommers and colleagues has investigated the use of cognitive remediation in correcting impairments associated with psychopathy and individuals exhibiting externalizing traits.  These two types of individuals have similar, but distinct cognitive deficiencies that the researchers addressed with cognitive remediation.  Since psychopathic individuals have cognitive impairments different from those exhibited by individuals with externalizing traits, each group had a remediation (or training) regimen specifically geared toward them.  With two programs (one for psychopathy and one for externalizing traits), the researchers divided up the subjects into 4 groups:  psychopathic individuals receiving the psychopathic-specific program, psychopathic individuals receiving the externalizing traits-specific program, individuals with externalizing traits receiving the externalizing traits-specific program, and individuals with externalizing traits receiving the psychopathic-specific program.  The subjects were tested before the administration of any training to obtain a baseline of their cognitive abilities, and tested again after a few weeks of receiving their designated remediation program.  Generally, the findings of the study showed that individuals receiving cognitive remediation designed to address their particular set of cognitive deficiencies (psychopathic individuals receiving the psychopathic-specific program, and individuals with externalizing traits with the externalizing traits-specific program) showed significant improvement in cognitive abilities than individuals who were given training specifically geared toward the other subgroup.  Not only did this study provide evidence that cognitive remediation is effective, but also that it is not a one-size-fits-all treatment.  To be truly effective, it must be constructed to address the sets of cognitive impairments and abilities of each patient given their pathology.

                A similar study examined the effects of cognitive remediation in conjunction with other tasks on schizophrenic adults.  Specifically, subjects in the study either received cognitive remediation alone or cognitive remediation with a computer program that was developed to increase emotion perception abilities.  The results indicate that cognitive remediation supplemented with the additional emotion perception task yielded significantly greater improvements than cognitive remediation alone.  Unfortunately, this study is limited in that there are no negative controls (i.e., subjects who received no treatment).  This is likely due to the fact that previous research has already shown that cognitive remediation alone results in significant cognitive improvement among schizophrenic patients.  Generally, this study shows that cognitive remediation, an already effective way to improve different aspects of cognition, can be strengthened when combined with additional relevant training tasks.

                Overall, studies like these extend beyond the identification of efficient and effective ways to improve cognition.  For instance, they also make a crucial point about cognitive remediation:  that cognitive remediation and any additional treatment tasks must be geared toward specific disorders or even individuals.  This intuitively makes sense.  To better illustrate this, think about cognitive remediation as an exercise regimen.  In order to establish the proper routine, you need to first identify your weaknesses.  For instance, if you feel you want to run faster, then lifting heavy weights probably won’t help as much as riding a bike or running on a treadmill.  Granted, lifting weights might strengthen your muscles and help you increase your speed, but a routine specifically designed to help you run faster would likely make a more dramatic and reliable difference.  On the other hand, lifting heavy weights might simply make you heavier (as you gain muscle mass) so you actually become slower because you’re carrying extra weight.  Similarly, regimens of cognitive remediation made up of irrelevant tasks might help or hurt the individual’s cognitive ability in some way, but cognitive remediation designed for a particular disorder will likely be the most effective way to help individuals improve.   Therefore, this research not only calls for further investigation of cognitive remediation, but also for a better understanding of the cognitive impairments associated with certain psychological conditions.

Baskin-Sommers, A.R., Curtin, J.J., Newman, J.P. (2014). Altering the cognitive-affective dysfunctions of psychopathic and externalizing offender subtypes with cognitive remediation. Clinical Psychological Science.

Lindenmayer, J. P., McGurk, S. R., Khan, A., Kaushik, S., Thanju, A., Hoffman, L., ... & Herrmann, E. (2013). Improving social cognition in schizophrenia: a pilot intervention combining computerized social cognition training with cognitive remediation. Schizophrenia bulletin, 39(3), 507-517.