Can behavior therapies treat a disease thought to be treatable only by psychotropic drugs? A new Yale study says they can.
In a recent issue of Schizophrenia Research, a team of researchers showed that schizophrenic patients on medication can further improve their condition by using computer cognitive remediation — a technique in which patients perform tasks designed to target certain cognitive functions. The research is part of a growing body of evidence suggesting behavioral therapies could augment drug regimens for previously unresponsive patients.
“We know that the psychotropic medications are quite helpful for reducing many of the most prominent psychiatric symptoms, like delusions or hallucinations,” said Matthew Kurtz, professor of psychiatry at the Yale School of Medicine and the paper’s lead author. “[The medications] moderate them, but what you’re left with are these other areas of deficit that drugs have no effect on, and one of the very important areas of deficit, are areas of cognition, memory, problem solving.”
The team, which has conducted extensive research on the use of cognitive remediation therapy, previously showed the potential benefits of a combined pharmacological and behavioral intervention. But in this paper, they showed particular effects on patients’ attention, working memory and empathy — cognitive functions typically hampered by schizophrenia and untreated by psychotropics.
Cognitive remediation is made to treat people with cognitive deficits, although it is unknown if it works by repairing weak parts of the brain or by strengthening other parts to compensate, said Bruce Wexler, professor of psychiatry at the Yale School of Medicine and senior author of the paper. It is also unknown how long and to what extent the treatment needs to be continued after the study’s intervention is complete in order to maintain progress.
“The degree to which that improvement is durable over time is still an open question,” Kurtz said, adding that the effects of the treatment were still evident four to six months after it had ended.
According to Cornell professor of psychology in psychiatry Sarah Morimoto, who was unaffiliated with the study, the future of research in the field lies in identifying exactly what is effective about cognitive remediation.
In addition to being used to treat schizophrenia, cognitive remediation has been shown to be effective in treating depression in geriatric patients, hoarding and children with ADHD, Wexler said, adding that he had treated the latter successfully in some schools. The researchers have developed software for those school programs for which the University is now seeking a patent.
Still, Kurtz said he is concerned that cognitive remediation might not reach the patients who need it most.
“There are very limited public resources for the folks,” Kurtz said. “These studies are very exciting. The problem is there’s a big gap between these new interventions in the research literature and then getting out to the front line clinicians at community mental health centers, where a lot of people with schizophrenia and other psychiatric disorders are being treated.”
But Morimoto said she thinks the portability of cognitive remediation methods is an advantage to the technique, noting that the treatment requires minimal intervention by a professional and many of the exercises can be done by a patient him or herself.
According to the Schizophrenia and Related Disorders Alliance of America, approximately 3.5 million people in the United States have been diagnosed with schizophrenia.