What do people with psychosis think of Remote Cognitive Remediation Therapy?

by Lois Parri BSc MSc, Research Assistant at King's College London

In the ever-evolving landscape of mental health care, understanding the efficacy and acceptability of innovative approaches is crucial for improving outcomes. For individuals with psychosis, a recent study by King’s College London funded by NIHR South London and Maudsley (1) sheds light on the potential benefits and challenges associated with delivering cognitive remediation (CR) remotely.

Psychosis is a complex mental health condition that can manifest with significant cognitive difficulties, affecting memory, attention, and executive functions (2) that act as a barrier to achieving personal goals. Cognitive Remediation provided by CIRCuiTS™ is a therapeutic approach to overcome these cognitive challenges that is effective in improving the lives of individuals with psychosis (3, 4). However, this therapy is still not available in most mental health services. Providing the therapy remotely may be able to fill this gap although it may be difficult to implement in a population with a known lack of digital skills and device ownership (6, 7).

We used service-user-centred methods, underscoring the importance of involving those with lived experiences in research. Twenty-six people with experience of psychosis completed 12 weeks of therapist-supported remote CR using CIRCuiTS™ and were interviewed about their experiences by a service user researcher. The transcripts were analysed using reflexive thematic analysis and findings were checked by a Lived Experience Advisory Panel and the interviewees to ensure it captured all their thoughts.

Figure 1

The themes that emerged were:

1. "perceived treatment benefits", that emphasised the positive impact of remote CR on cognitive functioning and overall well-being. Many people reported improvements in their cognitive abilities and other benefits that were not the main target of CR, including having fun and gaining digital skills.

2. "remote versus in-person therapy", highlighted people’s preference for the flexibility and convenience that remote therapy offers. But some also reported missing the in-person human contact or seeking a combination of in-person and remote (Figure 1).

3. "the therapist's role", underlined the crucial role of therapists in remote CR. Their support and guidance were valued throughout therapy, highlighting the importance of a strong therapeutic relationship, even in a remote setting. Many said that the intervention would not be as effective if it was entirely stand alone.

4. "how it could be better", shed light on areas for improvement. Some people faced challenges with their digital skills that needed to be addressed to ensure a seamless therapy experience. Other suggestions included offering a taster session to become familiar with the technology and tailoring the tasks and what’s done in each session more. Some also suggested continuing with CIRCuiTS™ would be an advantage for maintaining and boosting skills.

These findings highlight the potential of remote CR to expand treatment options and improve access for users of psychosis services once technological challenges are effectively addressed. Integrating technology training and ensuring people have access to adequate equipment should facilitate a more inclusive and accessible remote therapy experience. By doing so, mental health professionals can harness the benefits of remote CR, maximising its potential to transform the lives of individuals grappling with psychosis and cognition.

The full version of this paper is available to read and download for free at Parri LA, Barret K, Hill R, et al. Evaluating the acceptability of remote cognitive remediation from the perspective of psychosis service users. Behavioural and Cognitive Psychotherapy.

References

1) Parri, L.A., Barret, K., Hill, R., Hoque, A., Isok, I., Kenny, A., Markham, S., Oyeleye, N., Quinn, R., Sweeney, A. and Wykes, T. (2024). Evaluating the acceptability of remote cognitive remediation from the perspective of psychosis service users. Behavioural and Cognitive Psychotherapy. pp.1-13.

2) Wright, A. L., Phillips, L. J., Bryce, S., Morey-Nase, C., & Allott, K. (2019). Subjective experiences of cognitive functioning in early psychosis: A qualitative study. Psychosis: Psychological, Social and Integrative Approaches. 11, 63–74. doi: 10.1080/17522439.2019.1571623

3) Vita, A., Barlati, S., Ceraso, A., Deste, G., Nibbio, G., & Wykes, T. (2022). Acceptability of cognitive remediation for schizophrenia: A systematic review and meta-analysis of randomized controlled trials. Psychological Medicine. 1–11. doi: 10.1017/S0033291722000319

4) Reeder, C., Pile, V., Crawford, P., Cella, M., Rose, D., Wykes, T., Watson, A., Huddy, V., & Callard, F. (2016). The Feasibility and Acceptability to Service Users of CIRCuiTS, a Computerised Cognitive Remediation Therapy Programme for Schizophrenia. Behavioural and Cognitive Psychotherapy, 44(3), 288–305. doi: 10.1017/S1352465815000168

5) Kocsis, B. J., & Yellowlees, P. (2018). Telepsychotherapy and the Therapeutic Relationship: Principles, Advantages, and Case Examples. Telemedicine Journal and E-Health: The Official Journal of the American Telemedicine Association, 24(5), 329–334. doi: 10.1089/tmj.2017.0088 

6) Robotham, D., Satkunanathan, S., Doughty, L., & Wykes, T. (2016). Do we still have a digital divide in mental health? A five-year survey follow-up. Journal of medical Internet research, 18(11), e309. doi: 10.2196/jmir.6511 

7) Spanakis, P., Wadman, R., Walker, L., Heron, P., Mathers, A., Baker, J., ... & Peckham, E. (2022). Measuring the digital divide among people with severe mental ill health using the essential digital skills framework. Perspectives in public health, doi:  10.1177/1757913922110639 

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