The BEST Trials: Examining Brief Executive Skills Training for Schizophrenia-Spectrum Disorders

Abstract

Cognitive remediation is an efficacious treatment for schizophrenia that focuses on enhancing neurocognitive abilities and improving community functioning. However, there is currently no gold-standard cognitive remediation therapy and different approaches have produced varying results on cognitive and functional outcomes. One of the major barriers preventing cognitive remediation from being recommended in treatment guidelines has been limited generalization of cognitive improvement to functional improvement. Although results have been inconsistent, executive functioning may be more closely related to community functioning than other domains of neurocognition. The objective of the current dissertation was to examine the efficacy of cognitive training that specifically targets executive functioning for individuals with schizophrenia-spectrum disorders. In Chapter 2 data are presented from a randomized, double blind trial examining a brief two-week executive functioning intervention compared to a sham training condition. Compared to sham training, executive training significantly improved EEG alpha and theta band synchronization during working memory tasks, and neuropsychological measures of working memory and executive functioning. In Chapter 3 data are presented from a randomized, double-blind trial examining brief executive function training compared to training of perceptual abilities on measures of neurophysiology, neurocognition, and functioning. Perceptual training improved the EEG mismatch negativity more than executive training immediately post-treatment however, the effect did not persist 12-weeks post-treatment. At 12-week follow-up, executive training significantly improved EEG theta power, neurocognition, functional competence, and case manager rated community functioning to a greater extent than perceptual training. Executive training may be a more efficient cognitive enhancing treatment than other cognitive remediation techniques, and treatment effects generalize to community functioning better than alternative cognitive training approaches.