Cognitive Training for Schizophrenia

Overseen By Gregory P Strauss, PhD

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: University of Georgia

Must be taking: Antipsychotics

Disqualifiers: Intellectual disability, Neurological disorder, others

Compensation: Varies

Number of Visits: Unknown

Duration: 30 days

70 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores a new cognitive training program designed to help individuals with schizophrenia or schizoaffective disorder better manage their emotions. The program, called Emotional Working Memory Training, aims to enhance brain function in areas related to emotion control. Participants will receive either the actual training or a placebo (a treatment with no active effect) for comparison. It is suitable for English-speaking adults diagnosed with schizophrenia or schizoaffective disorder who have not recently changed their antipsychotic medication. As an unphased trial, this study provides participants the opportunity to contribute to innovative research that could lead to new methods for managing emotional challenges.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but it requires that you have not changed your antipsychotic medication in the last month or two, depending on the type.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research shows that emotional working memory training is generally easy for people to handle. One study found that this mental exercise benefits individuals with schizophrenia, particularly by enhancing attention and verbal learning skills, which can be challenging for them.

Another study found that this training helped reduce stress-related memory problems, suggesting it might alleviate stress while boosting memory. Importantly, these studies reported no major negative effects, indicating a good safety profile.

Overall, evidence suggests that emotional working memory training is safe and could effectively improve memory and attention in people with schizophrenia. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about emotional working memory training for schizophrenia because it offers a novel approach that focuses on cognitive rehabilitation. Unlike traditional treatments, which often rely on medications like antipsychotics to manage symptoms, this method aims to enhance cognitive functions by training the brain's emotional working memory. This innovative technique has the potential to improve patients' cognitive abilities, leading to better overall functioning and quality of life. By targeting the cognitive deficits associated with schizophrenia rather than just the symptoms, this approach could complement existing treatments and provide a more comprehensive management strategy.

What evidence suggests that this cognitive training is effective for improving emotion regulation in psychotic disorders?

This trial will compare emotional working memory training with placebo working memory training for individuals with schizophrenia. Research has shown that emotional working memory training can benefit people with schizophrenia. Studies have found that this training can improve emotional regulation and cognitive processes. Approximately 35% of studies on cognitive training reported improvements in working memory. This training might help align the brain activity of people with schizophrenia more closely with typical brain activity. Some research also suggests it can reduce negative symptoms and enhance overall cognitive skills. ^{1 6 7 8 9}

Are You a Good Fit for This Trial?

This trial is for adults aged 18-60 with a diagnosis of schizophrenia or schizoaffective disorder, who are clinically stable and have not changed their antipsychotic medication recently. Participants must speak English and have an IQ over 70. Those with recent substance abuse (except nicotine), significant brain injury, or neurological disorders cannot join.

Inclusion Criteria

premorbid intelligence quotient > 70

speaks English

clinically stable as indicated by no antipsychotic medication changes in the last month or if on depot, no change in the past 2 months.

Exclusion Criteria

endorsement of MRI exclusion factors

You have struggled with addiction to drugs or alcohol in the past 6 months (excluding nicotine).

You have a history of severe head injury with unconsciousness or ongoing behavior issues.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo emotional working memory cognitive training or placebo training via a smartphone app

30 days

Follow-up

Participants are monitored for changes in prefrontal activation and emotion regulation ability

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Emotional working memory training
• Placebo working memory training

Trial Overview

The study tests whether cognitive training can help people with psychotic disorders manage their emotions better. It involves two types of training: one that targets emotional working memory and another placebo version without this focus. The goal is to see if the targeted training improves brain function related to emotion regulation.

How Is the Trial Designed?

Group I: Cognitive training Experimental Treatment 1 Intervention

Emotional working memory training

Group II: Placebo training Placebo Group 1 Intervention

Placebo working memory training

Who Is Running the Clinical Trial?

University of Georgia

Lead Sponsor

Trials

109

Recruited

43,500+

Published Research Related to This Trial

A study involving 29 inpatients with chronic schizophrenia showed that a computerized working memory training program (BrainStim) significantly improved both visual and verbal working memory, as well as visual short-term memory, after four weeks of training.

In contrast, the control group that did not receive the training experienced a decline in verbal working memory, highlighting the potential efficacy of BrainStim as a cognitive remediation tool for patients with schizophrenia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Working memory training in patients with chronic schizophrenia: a pilot study. Hubacher, M., Weiland, M., Calabrese, P., et al.[2021]

A meta-analysis of over a decade of cognitive remediation research has identified key factors for effective cognitive training in schizophrenia, such as computerized practice, high dosing schedules, and individualized learning trials.

A preliminary randomized controlled trial showed that cognitive training based on these principles led to significant improvements in working memory and global cognition in patients with schizophrenia, along with evidence of cortical plasticity in the brain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive training in schizophrenia: a neuroscience-based approach. Genevsky, A., Garrett, CT., Alexander, PP., et al.[2021]

In a study involving 22 patients with chronic schizophrenia and 22 healthy controls, patients exhibited significantly more intrusion errors and poorer long-term memory performance when recalling affective and neutral words.

The findings suggest that individuals with chronic schizophrenia may have a general attentional control deficit, particularly when it comes to managing affective information, which could contribute to their memory challenges.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Is there an affective working memory deficit in patients with chronic schizophrenia? Mammarella, N., Fairfield, B., De Leonardis, V., et al.[2019]

Individuals with schizophrenia struggle with high cognitive load during working memory tasks, particularly in the early stages like encoding, but can still activate relevant brain areas similarly to healthy individuals under certain conditions.

While people with schizophrenia have trouble identifying and expressing emotions, they show heightened automatic processing of facial emotions, indicating a complex relationship between cognition and emotion that varies depending on the context.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognition-emotion interactions in schizophrenia: emerging evidence on working memory load and implicit facial-affective processing. Mano, QR., Brown, GG.[2013]

Individuals with schizophrenia (SCZ) demonstrated poorer working memory performance compared to healthy controls, particularly when faced with emotional distractions, indicating a significant impact of emotional interference on cognitive tasks.

Neurophysiological analysis revealed that while healthy controls showed enhanced brain activity related to working memory maintenance after negative distractions, this response was absent in individuals with SCZ, suggesting deficits in inhibitory control mechanisms that may contribute to their cognitive difficulties.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using ERPs to explore the impact of affective distraction on working memory stages in schizophrenia. Okruszek, Ł., Jarkiewicz, M., Gola, M., et al.[2019]

The study involved 39 male patients with schizophrenia who underwent an eight-week computerized working memory training, resulting in significant improvements in working memory and cognitive assessments compared to a control group.

Participants in the experimental group also showed enhanced emotional perception, particularly an increased pleasure response to negative images, indicating that working memory training can positively affect both cognitive and affective functions in schizophrenia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of computerized working memory training on working memory and emotion perception for patients with chronic schizophrenia and normal cognition. Chiang, SK., Liu, WY., Hu, TM.[2022]

A 10-week cognitive remediation training program for 22 participants with schizophrenia improved neural activity in the postcentral gyrus during emotion recognition tasks, suggesting a positive impact on the brain regions involved in social cognition.

While the training did not lead to significant improvements in general cognition or functional outcomes, increased neural activity in the postcentral gyrus was associated with better performance in emotion processing, indicating a potential mechanism for the observed behavioral improvements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neural activity during emotion recognition after combined cognitive plus social cognitive training in schizophrenia. Hooker, CI., Bruce, L., Fisher, M., et al.[2021]

Cognitive remediation strategies for schizophrenia have shown improvements in working memory, emotion perception, and executive function, indicating that targeted cognitive exercises can effectively engage underfunctioning brain systems.

Cognitive adaptation interventions have been linked to better symptoms, psychosocial status, and reduced relapse rates, suggesting that modifying the environment can help patients manage their cognitive deficits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neurocognitive rehabilitation for schizophrenia. Kurtz, MM.[2019]

Patients with schizophrenia (SCZ) demonstrated a general inability to filter distractions during a visual working memory task, showing increased distraction from both emotional and nonemotional stimuli compared to control subjects.

Functional MRI results indicated that while SCZ patients had similar brain activation patterns to controls in response to negative distractions, they exhibited reduced activity in prefrontal regions crucial for filtering distractions, suggesting a broader deficit in managing interference.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Negative and nonemotional interference with visual working memory in schizophrenia. Anticevic, A., Repovs, G., Corlett, PR., et al.[2019]

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