Adding Brain Stimulation to Cognitive Remediation
by Anika Poppe, GRIP research group @ University of Groningen and Lentis Psychiatric Institute, The Netherlands
In the evolving landscape of cognitive rehabilitation, the integration of innovative techniques holds promise for enhancing therapeutic outcomes. One such combination gaining attention is the use of cognitive remediation alongside transcranial direct current stimulation (tDCS). This novel approach aims to synergise the cognitive benefits of cognitive remediation with the neuromodulatory effects of tDCS, potentially offering a more effective treatment for various cognitive impairments.
The rationale behind combining cognitive remediation and tDCS lies in their complementary mechanisms. Cognitive remediation targets cognitive processes directly through structured exercises, while tDCS modulates brain activity to create an optimal environment for cognitive improvements. Theoretically, tDCS could enhance the plasticity and responsiveness of neural networks, making cognitive remediation more effective. But how feasible and acceptable is this combined approach? To answer this question we compared cognitive remediation (CIRCuiTS™) and active tDCS with cognitive remediation and sham tDCS (the placebo group)
Acceptability and Feasibility of the Treatment Combination
We were encouraged to find that nearly two thirds of our participants completed at least 20 sessions of CIRCuiTS™ and it was heartening to hear that 71% enjoyed the training and 76% didn’t find it burdensome. Even more encouraging, 58% said they would recommend it to others.
When it came to the side effects of tDCS, most participants (68%) reported experiencing no or only mild discomfort. More severe effects like burning or itching were mentioned in just a few sessions and in both the active and sham tDCS so this effect was not about the treatment itself. Brain stimulation was distracting during the first few sessions, but this quickly subsided.
Our findings suggest that combining cognitive remediation with tDCS is not only possible but also well-tolerated by participants. The minimal side effects of tDCS didn't interfere with the cognitive remediation sessions, which is a promising sign for this treatment approach. Now, we are taking the next steps to evaluate its effectiveness. We’re currently running a larger trial with 126 individuals living in sheltered housing to determine if tDCS can boost the effects of cognitive remediation on everyday functioning and goal attainment.
This integrated approach has the potential to revolutionise cognitive rehabilitation for individuals with severe mental illness. It offers a promising, more effective treatment option that could address both cognitive deficits and improve daily functioning, enhancing the quality of life for many.
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