TY - JOUR
T1 - Is cognitive adaptation training (CAT) compensatory, restorative, or both?
AU - Fredrick, Megan M
AU - Mintz, Jim
AU - Roberts, David L.
AU - Maples, Natalie J.
AU - Sarkar, Sonali
AU - Li, Xueying
AU - Velligan, Dawn I.
PY - 2015/3/3
Y1 - 2015/3/3
N2 - Cognitive adaptation training (CAT) is a psychosocial treatment incorporating environmental supports including signs, checklists to bypass the cognitive deficits of schizophrenia. Our objective was to examine the association between CAT, functional outcomes, and cognitive test performance (cognition). The two research questions were as follows: 1) Does cognition mediate the effect of CAT intervention on functional outcome? 2) Does CAT impact cognitive test performance? A total of 120 participants with schizophrenia were randomized to one of three treatments: 1) CAT (weekly for 9. months; monthly thereafter), 2) generic environmental supports (given to participants on clinic visits to promote adaptive behavior), or 3) treatment as usual (TAU). Assessments of cognition and functional outcome were conducted at baseline, 9 and 24. months. Mediation analyses and mixed effects regression were conducted. Mediation analyses revealed that during the initial 9. months, the direct path from treatment group to functional outcome on the primary measure was positive and highly significant. CAT significantly improved functional outcome compared to the other treatments. However, paths involving cognition were negligible. There was no evidence that cognition mediated improvement in functional outcomes. At 24. months, cognition improved more in CAT compared to other treatment groups. The test for cognition mediating improvement in functional outcomes was not significant at this time point. However, improvement in functional outcome led to better performance on cognitive testing. We concluded that improvement in cognition is not a necessary condition for improvement in functional outcome and that greater engagement in functional behavior has a positive impact on cognition.
AB - Cognitive adaptation training (CAT) is a psychosocial treatment incorporating environmental supports including signs, checklists to bypass the cognitive deficits of schizophrenia. Our objective was to examine the association between CAT, functional outcomes, and cognitive test performance (cognition). The two research questions were as follows: 1) Does cognition mediate the effect of CAT intervention on functional outcome? 2) Does CAT impact cognitive test performance? A total of 120 participants with schizophrenia were randomized to one of three treatments: 1) CAT (weekly for 9. months; monthly thereafter), 2) generic environmental supports (given to participants on clinic visits to promote adaptive behavior), or 3) treatment as usual (TAU). Assessments of cognition and functional outcome were conducted at baseline, 9 and 24. months. Mediation analyses and mixed effects regression were conducted. Mediation analyses revealed that during the initial 9. months, the direct path from treatment group to functional outcome on the primary measure was positive and highly significant. CAT significantly improved functional outcome compared to the other treatments. However, paths involving cognition were negligible. There was no evidence that cognition mediated improvement in functional outcomes. At 24. months, cognition improved more in CAT compared to other treatment groups. The test for cognition mediating improvement in functional outcomes was not significant at this time point. However, improvement in functional outcome led to better performance on cognitive testing. We concluded that improvement in cognition is not a necessary condition for improvement in functional outcome and that greater engagement in functional behavior has a positive impact on cognition.
KW - Cognitive
KW - Cognitive adaptation training
KW - Environmental supports
KW - Functional outcomes
KW - Functioning
KW - Schizophrenia
KW - Treatment
UR - http://www.scopus.com/inward/record.url?scp=84933059681&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84933059681&partnerID=8YFLogxK
U2 - 10.1016/j.schres.2015.06.003
DO - 10.1016/j.schres.2015.06.003
M3 - Article
C2 - 26126419
AN - SCOPUS:84955216719
SN - 0920-9964
JO - Schizophrenia Research
JF - Schizophrenia Research
ER -