Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK.
South London and Maudsley NHS Foundation Trust, London, UK.
Schizophr Bull. 2024 Aug 27;50(5):993-1005. doi: 10.1093/schbul/sbae075.
In our previous paper on the Future of Cognitive Remediation published more than 10 years ago, we envisaged an imminent and wide implementation of cognitive remediation therapies into mental health services. This optimism was misplaced. Despite evidence of the benefits, costs, and savings of this intervention, access is still sparse. The therapy has made its way into some treatment guidance, but these documents weight the same evidence very differently, causing confusion, and do not consider barriers to implementation. This paper revisits our previous agenda and describes how some challenges were overcome but some remain. The scientific community, with its commitment to Open Science, has produced promising sets of empirical data to explore the mechanisms of treatment action. This same community needs to understand the specific and nonspecific effects of cognitive remediation if we are to provide a formulation-based approach that can be widely implemented. In the last 10 years we have learned that cognitive remediation is not "brain training" but is a holistic therapy that involves an active therapist providing motivation support, and who helps to mitigate the impact of cognitive difficulties through metacognition to develop awareness of cognitive approaches to problems. We conclude that, of course, more research is needed but, in addition and perhaps more importantly at this stage, we need more public and health professionals' understanding of the benefits of this therapy to inform and include this approach as part of treatment regimens.
在我们 10 多年前发表的关于认知矫正未来的那篇论文中，我们设想认知矫正疗法即将广泛应用于精神卫生服务。这种乐观是错误的。尽管这种干预措施的好处、成本和节省有据可查，但仍然很难获得。这种疗法已经进入了一些治疗指南，但这些文件对相同的证据有不同的权重，造成了混乱，并且没有考虑到实施的障碍。本文重新审视了我们之前的议程，并描述了一些挑战是如何被克服的，但仍有一些挑战存在。科学界致力于开放科学，已经产生了有希望的一系列经验数据来探索治疗作用的机制。如果我们要提供一种可以广泛实施的基于配方的方法，那么这个同样的社区就需要了解认知矫正的具体和非特定效应。在过去的 10 年里，我们了解到认知矫正不是“大脑训练”，而是一种整体疗法，它涉及到一个积极的治疗师提供动机支持，并通过元认知帮助减轻认知困难的影响，以发展对解决问题的认知方法的意识。我们的结论是，当然需要更多的研究，但除此之外，也许更重要的是，我们需要更多的公众和卫生专业人员了解这种疗法的好处，以便将这种方法纳入治疗方案。
