Outcomes From Remediation and Behavioural Intervention Techniques

Dominant treatment approaches for schizophrenia-spectrum disorders improve psychiatric symptoms but do little to improve community functioning, leading to persistent disability and substantial economic burden. The proposed trial aims to examine the efficacy of a multi-mechanism approach to combining CBT and CR with the goal of predicting treatment response to either monotherapy or combination therapy. To date, there have been no randomized controlled trials examining the combination of CBT and CR. Given the differential mechanisms of CBT and CR, the combined multi-mechanism approach is expected to more effectively improve functional recovery than either monotherapy. Additionally, it is currently unknown what factors predict response to CBT or CR, thus the current trial will examine predictors of response to determine who requires the combined intervention and who might respond sufficiently to either monotherapy. The proposed trial will be one of the largest trials of psychosocial interventions for schizophrenia-spectrum disorders ever conducted and will simultaneously evaluate the combined intervention and moderators of differential treatment response. Narrower fields of inquiry examining mono-mechanism interventions have demonstrated little utility in improving functional recovery in schizophrenia, thus, the proposed approach represents a critical advancement by examining the utility of a multi-mechanism cognitive intervention and determining characteristics of those requiring this level of treatment.

The goals of the current study are three-fold:

1. Examine the efficacy of combining CBT and CR on the primary outcome of community functioning, and secondary outcomes of quality of life, personal recovery, psychiatric symptoms, and neurocognition compared to either intervention alone. 2. Examine demographic, cognitive, and psychological factors that predict differential response to CBT, CR, or combined CBT and CR. 3. Examine the specificity of cognitive content and cognitive functions as therapeutic mechanisms in CBT and CR respectively.

• World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) [Срок оценки: Change between baseline assessment and 18-month assessment]
• Questionnaire About the Process of Recovery (QPR) [Срок оценки: Change between baseline assessment and 18-month assessment]
• Positive and Negative Syndrome Scale (PANSS) [Срок оценки: Change between baseline assessment and 18-month assessment]
• Psychotic Symptom Rating Scale (PSYRATS) [Срок оценки: Change between baseline assessment and 18-month assessment]
• Neurocognitive Assessment [Срок оценки: Change between baseline assessment and 18-month assessment]
• Beliefs About Paranoia Scale (BAPS) [Срок оценки: Change between baseline assessment and 18-month assessment]
• Interpretations of Voices Inventory (IVI) [Срок оценки: Change between baseline assessment and 18-month assessment]
• Brief Core Schema Scale (BCSS) [Срок оценки: Change between baseline assessment and 18-month assessment]
• Defeatist Beliefs Scale (from Dysfunctional Attitudes Scale, DAS) [Срок оценки: Change between baseline assessment and 18-month assessment]
• Treatment Inventory of Costs in Patients in Psychiatric Disorders (TiC-P) [Срок оценки: Change between baseline assessment and 18-month assessment]
• Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) [Срок оценки: Change between baseline assessment and 18-month assessment]
• Davos Assessment of Cognitive Biases in Schizophrenia (DACOBS) [Срок оценки: Change between baseline assessment and 18 month assessment]