OPAL 1 Project 1

Improving Accessibility and Personalization of Cognitive Remediation for Schizophrenia

Consistent with the aims of the OPAL center, this project explored adaptations of treatments for schizophrenia, with the goal of optimizing their effectiveness in real-world clinical settings and readiness for broad deployment. Schizophrenia is associated with cognitive deficits that negatively impact essential areas of daily functioning. NY State Office of Mental Health (OMH) is the first and largest state system of care to implement a statewide program of cognitive remediation (CR), an evidence-based practice for improving cognition and aiding functional recovery. Through Cognitive Remediation to Promote Recovery (CR2PR), CR is offered in OMH outpatient programs to improve treatment outcomes. This project worked directly with OMH clinics and clinicians, and drew on the resources of the Center’s trans-disciplinary expertise to build upon and improve current CR delivery methods.

This project studied the impact of two adaptations. One adaptation focused on increasing the accessibility of the program, which participants reported was limited by the requirement of twice weekly attendance. This project therefore compared the feasibility and acceptability of delivering CR in either two clinic-based sessions (Clinic) or one clinic and one remote session (Hybrid) per week. Semi-structured qualitative interviews were conducted with stakeholders to explore the impact of the adaptation. The second adaptation was intended to improve personalization of CR by systematically accounting for individual differences in neurocognitive needs. Drawing upon convergent evidence for tailoring CR based on need for early auditory processing (EAP) training, this project examined whether integrating a measure of EAP into the current baseline assessment was feasible and facilitated personalization of the menu of restorative computer-based exercises used in CR. Practitioners reported how they used EAP assessment to personalize the CR treatment plan, and exercise activity indicated actual implementation of the personalized treatment plan. This project supported the mission of the Center, to rapidly translate laboratory evidence to clinical practice in a manner congruent with the realities of publically funded clinics. By improving CR utilization and treatment outcomes in large systems of care, this project aimed to impact the lives of many people with schizophrenia. 

Investigators:

What we found:

Clients reported satisfaction with CR regardless of the condition they were in. Positive aspects of doing homework were the participants’ experiences of independence and pride in overcoming challenge. As much as the clinicians’ support and guidance were valued, so was the opportunity for independence. Clinicians appreciated this in their comments about the need to personalize delivery of CR, suggesting that those who require more assistance attend all sessions in person, while those with access to technology and capacity for more independent functioning be given homework.

Interestingly, there was no consensus about the social benefits of group-based CR. Clients differed in the degree to which they valued working alone or engaging with peers. This is congruent with the findings of prior qualitative CR research which indicates that for some, the presence of peers can feel distracting or anxiety provoking, while for many there is a perceived benefit of peer support, for reducing isolation, engaging in shared problem-solving, and promoting a positive learning environment. These findings further support the importance of personalization, to provide an optimal learning environment according to individuals’ needs.

Publications:

  1. Medalia A, Saperstein, AM, Stefanic A, Meyler S, Styke S, Qian M., Liu J, Cabassa LJ. Feasibility and Acceptability of Remotely Accessed Cognitive Remediation for Schizophrenia in Public Health Settings, Psychiatry Research 2021 doi: https://doi.org/10.1016/j.psychres.2021.113956 (Link)
  2. Christina Arlia, C., Saperstein, AM, Meyler, S., Styke, S., Medalia, A. Disparities in Technology Literacy and Access Negatively Impact Cognitive Remediation Scalability, Schizophrenia Research, 2022, ISSN 0920-9964 https://doi.org/10.1016/j.schres.2022.04.006 (Link)
  3. Medalia, A., Saperstein, A.M., Javitt, D.C., Qian, M., Meyler, S., Styke,S., Feasibility and clinical utility of using the tone matching test for assessment of early auditory processing in schizophrenia. Psychiatry Research, 2023, 323,115152, ISSN 0165-1781, https://doi.org/10.1016/j.psychres.2023.115152. (Link) 

Presentations:

  1. Shanique Meyler, The Disparity in Access to Technology for the Administration of Remote Cognitive Remediation for Schizophrenia in Public Health Settings, Cognitive Remediation in Psychiatry June 4, 2021, NYC

Grants:

5R01MH123561

Efficacy of Personalizing Cognitive Remediation for Schizophrenia by Targeting Impairments in Early Auditory Processing

Alice Medalia, PhD, Principal Investigator