Vom kognitiven Training zur Kognitiven Remediationstherapie: Nutzen und Grenzen

Abstract

Most schizophrenia patients suffer from cognitive deficits. The latter seem to be important for the course and the social (re-) integration of patients. Several neuro-cognitive and social-cognitive domains of functioning relevant for schizophrenia disorders have been identified. Today, quite a lot of cognitive remediation therapy (CRT) approaches are available for the treatment of these functions. They can be categorized as follows: some are simple PC-based trainings following a drill and practice approach (restitution) to increase neuro-cognitive functions. CRT for improving social cognition is rather oriented towards a compensation approach. Additionally, there are some integrated group approaches of CRT that use restitution and compensation. Integrated approaches combine neurocognition with other intervention topics, e.g., functions or symptoms. Empirical data support the evidence for the effectiveness of CRT in improving different cognitive functions (proximal outcome). However, only integrated therapy approaches successfully demonstrated generalization effects on other functions (distal outcome) and follow-up effects. Therefore, integrated approaches can be stronger recommended for clinical practice. The efficacy of CRT contradicts the S3-guidelines of the Deutsche Gesellschaft för Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde', which do not strongly recommend CRT for common clinical practice. This review on CRT also considers this contradiction.