VA Desert Pacific Mental Illness Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, United States; Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.
Department of Psychology, Colorado State University, Fort Collins, CO, United States; Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.
Schizophr Res. 2019 Aug;210:215-220. doi: 10.1016/j.schres.2018.12.034. Epub 2019 Jan 16.
Cognitive training is effective for improving cognitive performance among people with schizophrenia. An individual's perception of their own cognition is dissociable from performance on objective cognitive tests. Since subjective cognitive benefit may impact engagement, motivation, and satisfaction with time-intensive cognitive interventions, this study aimed to determine whether subjective cognitive difficulties improve in conjunction with cognitive gains following 30 h of cognitive training.
Patients with schizophrenia or schizoaffective disorder (N = 46) were randomized to treatment as usual (TAU) or TAU augmented with auditory-targeted cognitive training (TCT). All participants completed assessment batteries at baseline and follow-up. As previously reported, the TCT group showed significant improvements in verbal learning and memory and reductions in auditory hallucinations relative to the TAU group.
Subjective cognitive difficulties did not significantly improve following TCT, even among TCT participants who showed improvements in cognitive performance (all ps > 0.05). Subjective cognitive difficulties were significantly associated with severity of depressive symptoms and hallucinations (r = 0.48 and r = 0.28, p < 0.001), but not global or specific domains of cognition (all rs < 0.1) at baseline. There were no significant relationships between change in subjective cognitive difficulties and change in cognitive or clinical variables (all ps > 0.05).
Patients with schizophrenia do not detect change in their cognition following cognitive training, even among those who showed robust gains in cognitive performance. Failure to detect improvement may undermine treatment engagement, motivation, and satisfaction. Translating score improvements on the cognitive exercises into tangible metrics, and providing ongoing, clinician-delivered feedback on performance may facilitate patient ability to detect improvements and improve motivation to engage with cognitive training interventions.
认知训练可有效改善精神分裂症患者的认知表现。个体对自身认知的感知与客观认知测试的表现不同。由于主观认知获益可能会影响参与度、动机和对时间密集型认知干预的满意度，因此本研究旨在确定在接受 30 小时认知训练后，认知收益是否会同时改善个体的主观认知困难。
将精神分裂症或分裂情感障碍患者（N=46）随机分为常规治疗（TAU）组或常规治疗加听觉靶向认知训练（TCT）组。所有参与者在基线和随访时都完成了评估测试。正如之前报道的，TCT 组在言语学习和记忆方面有显著提高，听觉幻觉减少，而 TAU 组则没有。
即使在 TCT 组中认知表现有改善的参与者中，TCT 也没有显著改善主观认知困难（所有 p 值>0.05）。主观认知困难与抑郁症状和幻觉的严重程度显著相关（r=0.48 和 r=0.28，p<0.001），但与基线时的整体或特定认知领域无关（所有 rs<0.1）。主观认知困难的变化与认知或临床变量的变化之间没有显著关系（所有 p 值>0.05）。
精神分裂症患者在认知训练后无法察觉自身认知的变化，即使是那些在认知表现上有明显提高的患者也是如此。无法察觉改善可能会破坏治疗的参与度、动机和满意度。将认知练习中的分数提高转化为有形的指标，并提供持续的、由临床医生提供的绩效反馈，可能有助于患者提高察觉改善的能力，并提高参与认知训练干预的动机。
