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Seven Common Questions about Cognitive Remediation

 

Alice Medalia, PhD

 

Cognitive Remediation (CR) is one of the skills training interventions that can be provided within a psychiatric rehabilitation program. CR

focuses on neuro-cognitive (for example, attention, memory) and social-cognitive (for example, emotion perception, theory of mind) skills

to improve the success and satisfaction people experience in their chosen living, learning, working, and social environments. Like any

psychiatric rehabilitation intervention, CR is a collaborative process that is person-centered and recovery-oriented. The ultimate goal is to

help clients develop the cognitive skills and/or supports needed to achieve their goals.

It is not difficult to set up a CR program, and the rewards will become quickly evident in client satisfaction, and progress toward recovery

goals. There are a number of published and web-based resources about CR program development, as well as CR experts who can

serve as guides throughout the process. Below are answers to some questions that are commonly asked by people who want to start a

CR program.

 

1. What does a CR session look like? When conducted in a psychiatric rehabilitation setting, CR is provided in groups of six to eight

clients that meet at least twice weekly, with sessions ranging from 45-90 minutes long. In each CR session, the bulk of the time involves

individualized computer-based cognitive activities. There is also a 10-15 minute verbal discussion about the use of cognitive skills and

strategies in real world situations. Because the treatment is personalized, each person works at their own pace on computer tasks

chosen to address their particular needs. The clinician provides individual guidance and support, and facilitates the group discussion.

 

2. How does one start a CR group? Establishing a CR program can take several months. A typical time frame is: 2 months to purchase

computers and supplies, designate a clinician, and set up a space; 2 months to train the staff; and 3 months to build up to a caseload of

12 clients. Because CR clients work at their own rate, there is a rolling admission to the groups. Should one client then leave, another

one is recruited to fill the spot. This way groups are comprised of clients in different stages of treatment, which can enrich the potential for productive interactions and peer mentorship among group members.

 

3. What does it cost to start and run a CR program? Costs relate to the physical space, staff, and computer related equipment and

supplies. There needs to be at least one designated CR clinician; a commitment of 8 hours per week allows for 3 hours of group time and

2 hours assessment and administration for a case load of 12, assuming 6 clients are seen at a time. The physical space needs to

accommodate at least 6 computers and allow space for group discussion. There needs to be internet enabled computers or tablets, one set of headphones per client, and one printer networked to all the computers. Cognitive training exercises need to be purchased, usually with contracts with web delivered programs.

 

4. What is involved in the Referral and Assessment process? Referrals are a collaborative process between the care coordinator,

client and CR clinicians. Scheduling a 45-minute in-service on cognition in the psychiatric disorders is an excellent way to train staff (and

clients) to recognize who might benefit from CR. The CR clinician facilitates the process of referral, assessment, and enrollment, and

maintains the recovery orientation of CR by linking CR to each client’s goals. A clinician will need to be trained to administer, score, and interpret the results of a brief 20-30 minute cognitive assessment and then create a  CR treatment plan that is linked to other psychosocial interventions and the overall recovery goal(s).

 

5. How does one choose the Cognitive Training Exercises? Training methods used in CR may include computer-based drill and practice exercises, paper and pencil tasks, strategy coaching, and/or teaching of compensatory skills. There is a wide array of computer-based exercises to choose from, and most provide 30-day free trials. Manuals (many at no charge) are available for some CR approaches.

 

6. Who should be the Cognitive Remediation Therapist?  No schools formally teach people how to do

cognitive remediation with psychiatric patients, and there is no one group of clinicians who is trained in this

specialty. CR is a skill that is now taught in workshops, or by a supervisor, and is ultimately developed within the practicum context. In

general, clinicians who will be expected to run the program should have at least a Master’s degree in a mental health field. Web based training for people interested in providing cognitive health treatments can be found at www.teachrecovery.com

 

7. Where can I get more information about setting up a CR program:

 

Dr. Medalia is Professor of Medical Psychology, and Director of Psychiatric Rehabilitation Services, at the Department of Psychiatry,

Columbia University Vagelos College of Physicians & Surgeons. She can be reached at am2938@columbia.edu.

 

Cognitive Remediation Resource Library:

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