JMIR Publications

ABSTRACT

Background:

Cognitive impairment is common with schizophrenia spectrum disorders. Cognitive remediation is effective in improving global cognition, but not all individuals benefit from this type of intervention. A better understanding of the potential mechanism of effect of cognitive remediation is needed. One proposed mechanism is reward learning, the cognitive processes responsible to adapt behaviour following positive or negative feedback. It is proposed that the structure of cognitive remediation enhances reward learning and motivation to engage in increasingly challenging tasks and this is a potential mechanism by which cognitive remediation improves cognitive functioning in schizophrenia.

Objective:

This project is an exploratory study, which will investigate reward processing in individuals with schizophrenia spectrum disorders before and after completing cognitive remediation.

Methods:

This is a clinical non-randomised pilot study comparing the impact of cognitive remediation on reward learning and neurocognitive outcomes. The study will use a combination of objective and subjective measures to assess neurocognitive, psychiatric symptoms, and neurophysiological domains. The impact of cognitive remediation on social reward learning versus non-social reward learning will also be examined. Forty individuals with schizophrenia spectrum disorders (aged 18 - 35 years) will receive cognitive remediation therapy (n = 20) or treatment as usual (n = 20). Reward processing will be evaluated using a reinforcement learning task with two conditions (social reward vs. non-social reward) at baseline and 12-week follow-up. Functional magnetic resonance imaging responses will be measured during this task. To validate the reinforcement learning task, reward learning will also be assessed in 20 healthy controls, matched for age, sex, and premorbid functioning. Mixed factorial ANOVAs will be conducted to evaluate treatment group differences.

Results:

As of September 2023, we enrolled 15 participants into the cognitive remediation group, one participant into the treatment as usual group, and 11 healthy controls. We expect to complete recruitment by September 2024.

Conclusions:

This study will inform a larger randomised controlled trial and have implications for the development of CR programmes. Clinical Trial: This trial is registered with the Australian and New Zealand Clinical Trials Registry ACTRN:12621001081808.