Computerized Cognitive Training for Psychosis

(STEP (P4) Trial)

Overseen By Angus MacDonald III, Ph.D.

Age: < 65

Sex: Any

Trial Phase: Academic

Sponsor: University of Minnesota

Disqualifiers: Pregnancy, Illiteracy, Neurological disorder, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 3

200 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests computerized cognitive training to help individuals with psychotic illnesses better understand and process their surroundings. Researchers compare two types of training to assess their effects on brain activity and task performance. The study seeks participants who speak English well and have an IQ of 70 or higher, particularly those with stable schizophrenia or similar conditions. As an unphased trial, it offers participants the chance to contribute to innovative research that could enhance cognitive therapies for psychotic illnesses.

Do I have to stop taking my current medications to join the trial?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the study team to understand any specific requirements.

What prior data suggests that this computerized cognitive training is safe for individuals with psychosis?

Research shows that computerized cognitive training is generally safe for people. Studies have found it is well-tolerated by individuals with conditions like depression and schizophrenia. This training has been used in various clinical settings without major safety issues.

For Perceptual Discrimination Training, evidence indicates that cognitive training, which aims to improve mental skills, has been safely used in people with schizophrenia. These programs have reported no major side effects.

Similarly, Visual Cognitive Control Training uses computerized methods and is also considered safe. Reviews of its use in people with psychosis-related disorders have found no serious safety concerns.

Both types of training adjust to each person's progress, ensuring the exercises remain challenging but manageable. Overall, past experiences suggest these training exercises are safe to participate in. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these treatments for psychosis because they focus on enhancing cognitive abilities through computerized exercises, a novel approach compared to standard medications like antipsychotics. Perceptual Discrimination Training sharpens visual processing and attention by challenging participants to identify subtle differences in visual stimuli, which adapts to their skill level. Meanwhile, Visual Cognitive Control Training boosts working memory and cognitive flexibility by requiring participants to remember and apply rules while interacting with visual stimuli. This adaptive, game-like method is distinct from traditional treatments and could offer a non-pharmaceutical way to improve cognitive functions in individuals with psychosis.

What evidence suggests that this trial's cognitive training treatments could be effective for psychosis?

This trial will compare two types of Computerized Cognitive Training for individuals with psychosis. Studies have shown that Perceptual Discrimination Training, one of the methods in this trial, can significantly improve how people with schizophrenia perceive and understand moving objects. This training helps them distinguish between important information and distractions, a challenge for those with psychotic conditions. Research has found that this training can quickly enhance their ability to manage complex visual tasks.

Visual Cognitive Control Training, another method tested in this trial, has research supporting its effectiveness in boosting thinking skills in people with schizophrenia. This training helps individuals remember information and choose appropriate actions, improving decision-making and mental flexibility. Evidence suggests that these exercises enhance overall mental health and cognitive abilities, making them promising tools for those with psychotic disorders. ^{6 7 8 9 10}

Who Is on the Research Team?

Sophia Vinogradov, M.D.

Principal Investigator

University of Minnesota

Angus MacDonald III, Ph.D.

Principal Investigator

University of Minnesota

Are You a Good Fit for This Trial?

This trial is for individuals aged 15-40 with a recent diagnosis of psychosis or related conditions, who speak English and have an IQ above 70. They must be clinically stable, not pregnant, non-dependent on substances, and without major medical or neurological issues.

Inclusion Criteria

I was diagnosed with a psychosis-related disorder and am between 36-45 years old with symptoms starting in the last 5 years.

Estimated IQ at or above 70, as estimated by the cognitive assessments

I have been stable and out of the hospital for at least one month.

Exclusion Criteria

Unable or unwilling to provide informed consent

I do not have, nor does my immediate family have, a history of psychotic, bipolar, or autism spectrum disorders.

I have a significant neurological condition.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Cognitive Training

Participants complete 10 hours of computerized cognitive training over a 3-6 week period

3-6 weeks

Multiple sessions (in-person or virtual)

Post-Intervention Follow-up

Participants undergo post-intervention assessments including interviews, questionnaires, neurocognitive assessments, and imaging appointments

Immediately after intervention

2 visits (in-person)

Long-term Follow-up

Participants are monitored for changes in cognitive performance and symptoms 5 months after intervention

5 months

1 visit (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Computerized Cognitive Training

Trial Overview The study is testing two types of computerized cognitive training designed to improve information processing in young adults with psychotic illnesses compared to those without psychiatric diagnoses.

How Is the Trial Designed?

Group I: Visual Cognitive Control Training Experimental Treatment 1 Intervention

Training will involve maintaining accurate representations of cognitive context (the "rule") in working memory during response selection. On each training trial, participants must observe stimuli, and hold the correct response context "on-line" in order to select the correct response from among the stimuli. Training is adaptive using a staircase function, such that two consecutive correct responses increases either the speed of stimuli presentation or the working memory load via an increased number of stimuli that are presented; one incorrect response reduces the cognitive load. Each session will consist of 45 exercises requiring \~45 minutes.

Group II: Perceptual Discrimination Training Experimental Treatment 1 Intervention

Training will involve Gabor patch and other visual stimuli discrimination exercises that focus on improving signal-to-noise resolution and attentional control with minimal working memory/cognitive control effects. On each training trial, participants are required to distinguish a target stimulus among a set of distractor stimuli. The similarity between target and distractors increases in level of difficulty based on an adaptive perceptual processing staircase function. Consecutive correct responses lead to increased modulation of the distractors to be more similar to the target, while 1 incorrect response drops the user to an easier level. Difficulty is adapted to maintain an 80% correct response rate. Each session will consist of 4 exercises requiring \~45 minutes. with 40 trials for each exercise.

Who Is Running the Clinical Trial?

University of Minnesota

Lead Sponsor

Trials

1,459

Recruited

1,623,000+

National Institute of Mental Health (NIMH)

Collaborator

Trials

3,007

Recruited

2,852,000+

Published Research Related to This Trial

In a study of 131 individuals with schizophrenia undergoing 40 hours of targeted cognitive training (TCT), significant improvements in auditory processing speed (APS) were observed, particularly after the first 20 hours, indicating that TCT can enhance cognitive functions related to auditory processing.

The degree of cognitive improvement was closely linked to how quickly and effectively individuals could achieve and maintain their APS plateau, suggesting that this plateau may serve as a key measure of engagement with the treatment and its effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Engagement with the auditory processing system during targeted auditory cognitive training mediates changes in cognitive outcomes in individuals with schizophrenia. Biagianti, B., Fisher, M., Neilands, TB., et al.[2019]

In a study involving 100 clinically stable patients with schizophrenia spectrum disorders, two cognitive remediation programs (CCT and CIRCuiTs) showed no significant differences in effectiveness based on neurocognition and functional outcomes.

Both treatment groups experienced small improvements in cognitive assessments, but the study's limited sample size may have affected its ability to detect meaningful differences, suggesting that cost-effective options could be viable for cognitive interventions in schizophrenia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Randomized Control Trial of Cognitive Compensatory Training (CCT) and Computerized Interactive Remediation of Cognition-Training for Schizophrenia (CIRCuiTS). Dark, FL., Gore-Jones, V., Newman, E., et al.[2023]

In a study involving 120 individuals (60 with subjective memory complaints and 60 with early-stage Alzheimer's), computerized cognitive training (CCT) significantly improved cognitive scores in Alzheimer's patients compared to a control group, indicating its potential efficacy in this population.

While CCT showed some positive effects in cognitively healthy older adults, the improvements were much smaller, suggesting that CCT may be more beneficial for individuals with cognitive impairments like Alzheimer's disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of the online computerized cognitive training program BEYNEX on the cognitive tests of individuals with subjective cognitive impairment and Alzheimer’s disease on rivastigmine therapy Çinar, N., Şahiner, TAH.[2021]

The ongoing pilot randomized controlled trial is evaluating the efficacy of Compensatory Cognitive Training (CCT) compared to recreational therapy (RT) in Latino youth aged 12-30 at clinical high risk for psychosis, aiming to improve neurocognitive performance and functional capacity.

This study is significant as it targets an underserved population and assesses outcomes in participants' preferred language, potentially leading to a low-risk intervention that could enhance cognitive and functional outcomes in pre-illness phases of psychosis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Compensatory Cognitive Training for Latino Youth at Clinical High Risk for Psychosis: Study Protocol for a Randomized Controlled Trial. Mahmood, Z., Kelsven, S., Cadenhead, K., et al.[2020]

This study aims to systematically review and analyze the efficacy of computerized cognitive training (CCT) in improving cognitive performance in adults with depression, focusing on randomized controlled trials.

The research will explore how CCT affects not only cognitive outcomes but also mood and daily functioning, making it the first comprehensive analysis of its kind in this specific clinical population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Computerized cognitive training in people with depression: a protocol for a systematic review and meta-analysis. Lampit, A., Launder, NH., Minkov, R., et al.[2022]

Computerized cognitive training (CCT) has been shown to improve cognitive performance in both healthy older adults and individuals with schizophrenia, as indicated by various studies.

Functional improvements in schizophrenia are primarily observed in cognitive remediation (CR) studies rather than CCT, highlighting the need for clear definitions and measurements of cognitive and functional gains in treatment programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Controversies in Computerized Cognitive Training. Harvey, PD., McGurk, SR., Mahncke, H., et al.[2022]

Computerized cognitive remediation therapy (CCRT) significantly improved cognitive function in patients with schizophrenia, as evidenced by a notable increase in the MATRICS Consensus Cognitive Battery total score after 12 weeks of treatment involving 311 participants.

The effectiveness of CCRT was influenced by factors such as age and baseline cognitive levels, with younger participants showing improvements on different cognitive tests compared to older participants, suggesting the need for personalized treatment approaches.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Who will benefit from computerized cognitive remediation therapy? Evidence from a multisite randomized controlled study in schizophrenia. Tan, S., Zhu, X., Fan, H., et al.[2021]

Cognitive remediation therapy (CRT) and computerized cognitive remediation therapy (CCRT) both significantly improved cognitive function in Chinese inpatients with schizophrenia, with effects maintained for up to 18 months after treatment.

While both therapies showed similar overall efficacy, CRT demonstrated a specific advantage in processing speed on certain cognitive tests compared to CCRT.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Computerized or manual? Long term effects of cognitive remediation on schizophrenia. Zhu, X., Fan, H., Zou, Y., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7418924/

Development and Evaluation of a Visual Remediation ... Results from other studies of this auditory training module in schizophrenia ... Perceptual training strongly improves visual motion perception in schizophrenia.

2. researchgate.net researchgate.net/publication/306393993_Visual_Perceptual_Remediation_for_Individuals_With_Schizophrenia_Rationale_Method_and_Three_Case_Studies

(PDF) Visual Perceptual Remediation for Individuals With ... Other studies have shown that in patients with schizophrenia visual remediation improved visual motion discrimination (Norton et al., 2011), visual backward ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5322250/

Visual Perceptual Remediation for Individuals with ... Perceptual training strongly improves visual motion perception in schizophrenia. Brain and Cognition. 2011;77(2):248–256. doi: 10.1016/j.bandc.2011.08.003 ...

4. cognitiveresearchjournal.springeropen.com cognitiveresearchjournal.springeropen.com/articles/10.1186/s41235-023-00467-0

Evaluating the effectiveness of different perceptual training ... We found that perceptual training can rapidly improve performance on a difficult radiology task, albeit not to a comparable level as expert performance.

5. nature.com nature.com/articles/s41598-022-15649-x

Change-detection training and its effects on visual ... Our results suggest a general improvement in perceptual skills that was primarily driven by a conjunction search task and to a much lesser extent by a complex ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8870375/

Advances in Cognitive Remediation Training ... Cognitive Remediation Training (CRT) in schizophrenia has made great strides since its introduction in the 1990s.

7. withpower.com withpower.com/trial/phase-disease-6-2022-54732

Computerized Cognitive Training for Psychosis Computerized cognitive training (CCT) is considered safe and has been used in various clinical populations, including those with depression and schizophrenia, ...

8. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC3160117/

Social-Cognitive Remediation in Schizophrenia The Training of Affect Recognition (TAR) has effects on prosodic affect recognition, theory of mind (ToM) performance, social competence in a role-play task,

9. clinicaltrials.gov clinicaltrials.gov/study/NCT02404194

Targeted Cognitive Training in Clinical High Risk (CHR) for ... This project is a randomized-controlled trial to test the efficacy of computer-based targeted cognitive training (TCT) versus a placebo intervention of ...

10. nature.com nature.com/articles/npp2011251

Cognitive Training for Impaired Neural Systems in ... In this review, we briefly examine the current state of knowledge from studies of cognitive remediation in psychiatry and we highlight open ...