For patients with schizophrenia, having the ability to self-reflect and adjust beliefs may help mitigate many of the cognitive challenges associated with the disease and improve daily functioning, according to a new study published in the journal Clinical Psychological Science.
“Often times, individuals think there is something fundamentally wrong with them that can’t be changed. This paper provides hope that the problem isn’t as entrenched or as stable as it might seem, or that it’s a devastating and unremittable disorder,” said senior author Paul M. Grant, Ph.D., a research assistant professor of psychology in the department of psychiatry in the Perelman School of Medicine at the University of Pennsylvania.
For the study, researchers asked 228 participants diagnosed with schizophrenia or schizoaffective disorder to rate statements, such as “I have jumped to conclusions too fast,” on a scale from (0) “do not agree at all” to (4) “completely agree.” Neurocognitive performance was assessed with a series of behavioral tasks.
The findings question the long-held notion that a schizophrenic patient’s neurocognitive performance (behavioral measures of attention and memory) is predictive of his or her cognitive insight (a measure of self-reflection and confidence in one’s own interpretations). Instead, the new findings show that it’s the other way around — that cognitive insight is a significant predictor of neurocognition.
For example, reduced self-reflection and greater overconfidence in judgments (low cognitive insight) are more likely to result in poorer neurocognition in the future. Similarly, improvements in self-reflection and overconfidence predict better neurocognitive performance in the future.
The findings suggest that improving cognitive insight may directly improve performances on laboratory and real-world tasks, the authors suggest.
“The relationship between the two is important because it presents a promising opportunity to improve outcomes for individuals diagnosed with schizophrenia, many of whom experience long periods of disability, not to mention the 1.5 million new people who are diagnosed with schizophrenia worldwide every year,” said Grant.
“There’s a lot of effort in the schizophrenia field to help people through what’s called cognitive remediation, which is basically a bottom-up process of learning, memory, and attention,” Grant said.
“But we think that having interventions that target positive and negative beliefs, along with goals, would be key in terms of helping the individuals have better lives, the lives that they want.”
One intervention is called recovery-oriented cognitive therapy (CT-R), a hands-on, active approach that focuses on life aspirations, successful goal achievement, and development of resiliency in the face of stressful symptoms and life events. Overall, this method helps promote positive beliefs and neutralize negative attitudes.
CT-R was created by Grant, along with Aaron T. Beck, M.D., an emeritus professor in the department of Psychiatry at Penn, and co-author on the study.
A June 2017 study in the journal Psychiatric Services, authored by this same team, found that CT-R is quite effective in poor-functioning schizophrenia patients. The study was a follow up to a randomized clinical trial and showed that participants who received CT-R for 18 months, as compared to those who received standard treatment (e.g., anti-psychotic medications, case management), showed major improvements in daily functioning, motivation, and psychotic symptoms that persisted after the therapy had ended. Importantly, patients with the longest course of illness showed improvement by the end of the study.
“Some of what produces the disability is related to how individuals think about the disability. And that thinking is quite changeable,” Grant said. “CT-R does indeed adjust beliefs, so that would be one of the main therapies we would suggest practitioners to implement.”
The researchers called for further studies to confirm these findings and to examine the clinical ratings of metacognition — higher order thinking involved in learning — and behavioral engagements when investigating the link between insight and cognition.