CLINICAL HANDBOOK OF SCHIZOPHRENIA

25. Cognitive Rehabilitation 2597. Use scaffolding. “Scaffolding” is a metaphor for the way in which the educatorprovides the necessary supports, then takes them away over time.8. Errorless learning. People with diagnoses of schizophrenia learn more quickly ifthey make few errors, because it is difficult to differentiate in memory between behaviorsthat produce a correct response and those that produced errors.9. Developing successful strategies. Use verbalization, chunk material, and reducethe task to a series of subtasks.10. Generalize to everyday activity. During sessions, link the cognitive strategies toreal-life actions and encourage the generation of such situation descriptions by the participant.Then, use all possible supports in the person’s environment to help him or her usecognitive skills in the real world.KEY POINTS• Cognitive difficulties are prevalent and are related to functional outcome in schizophrenia.• Therapies have been developed to improve thinking styles and particularly CRT.• CRT, an umbrella term, covers a number of different therapies that have varying levels oftherapist input and varying levels of success.• Cognition improved following CRT targeted therapy, has been durable, and can lead to improvementsin functional outcome.• To improve gains in functioning, therapies need to be based on theories of the relationshipbetween cognition and action.• The theory proposed includes a new form of cognition–metacognition that is necessary forgains in cognition that transfer into actions in the community.• Future therapies need to concentrate on the transfer phase, in which the participant usesthe skills learned in therapy in the real world.REFERENCES AND RECOMMENDED READINGSBell, M., Bryson, G., Greig, T., Corcoran, C., & Wexler, B. E. (2001). Neurocognitive enhancementtherapy with work therapy: Effects on neuropsychological test performance. Archives of GeneralPsychiatry, 58, 763–768.Bellack, A. S., Gold, J. M., & Buchanan, R. W. (1999). Cognitive rehabilitation for schizophrenia:Problems, prospects, and strategies. Schizophrenia Bulletin, 25, 257–274.Goldberg, T. E., Weinberger, D. R., Berman, K. F., Pliskin, M. H., & Podd, M. H. (1987). Further evidencefor dementia of the prefrontal type in schizophrenia—a controlled study of teaching theWisconsin Card Sorting Test. Archives of General Psychiatry, 44, 1008–1014Green, M. F., Kern, R. S., Braff, D. L., & Mintz, J. (2000). Neurocognitive deficits and functional outcomein schizophrenia: Are we measuring the “right stuff”? Schizophrenia Bulletin, 26, 119–136.Hogarty, G., Flesher, S., Ulrich, R., Carter, M., Greenwald, D., Pogue-Geile, M., et al. (2004). Cognitiveenhancement therapy for schizophrenia: Effects of a 2-year randomized trial on cognitionand behavior. Archives of General Psychiatry, 61, 866–876.Krabbendam, L., & Aleman, A. (2003). Cognitive rehabilitation in schizophrenia: A quantitativeanalysis of controlled studies. Psychopharmacology, 169, 376–382.Kurtz, M. M., Moberg, P. J., Gur, R. C., & Gur, R. E. (2004). Approaches to cognitive remediation ofneuropsychological deficits in schizophrenia: A review and meta-analysis. Neuropsychology Review,11, 197–210.McGhie, A., & Chapman, J. (1961). Disorders of attention and perception in early schizophrenia.British Journal of Medical Psychology, 34, 103–113.McGurk, S., & Mueser, K. (2004). Cognitive functioning, symptoms, and work in supported employment:A review and heuristic model. Schizophrenia Research, 70 147–173.