215. Action-Based Cognitive Remediation: Pairing Cognitive Training With Skill Development and CBT Principles

Background: Most people with mental disorders experience a reduction of symptoms with treatment, but recovery of everyday functions is often delayed and incomplete. Cognitive Remediation is widely recognized as an efficacious treatment that improves attention, memory, and executive functions, but its ability to effectively promote behavior change is more limited and retention in treatment is often low. In response, we developed Action-Based Cognitive Remediation (ABCR) to build on intact procedural learning skills, pair neurocognitive training with skill-based training, and promote engagement in everyday behaviors considered cognitively challenging. We sought to determine if ABCR was more efficacious (improved neurocognition) and more effective (improved functional skills and vocational outcomes) than traditional cognitive remediation. Methods: In this study, we compared ABCR to a traditional form of cognitive remediation in 50 participants with severe mental disorders. Treatment was 10 weeks, twice per week, in a group format. Both treatments provided computerized cognitive training, discussions of how to monitor and flexibly adapt strategies when solving problems, and discussions of how cognitive skills and strategies can be used in everyday life. Compared to traditional cognitive remediation, ABCR also included role-plays in simulated work tasks and goal setting with an emphasis on seeking cognitive challenge in everyday life. Results: Cognitive response was moderate to large and statistically significant for both groups. and the ABCR group demonstrated larger improvements in a role-play measure of functional skills (P < .001). A statistical trend was observed for more participants in the ABCR group working at 6 months postintervention (P = .09) and, among those working, ABCR participants reported less job stress (P = .03). ABCR was more tolerable, with 83% retention rates compared to 57% for traditional cognitive remediation (P = .03). Conclusion: These results support the placing of cognitive training within a broader skill training and psychotherapeutic milieu that encourages approaching cognitively challenging activities and reducing withdrawal from social and instrumental tasks. Compared to the more passive experience of traditional cognitive remediation, ABCR challenges participants to engage with their environment and produces larger and more lasting changes in behavior.