Efficacy of integrated social cognitive remediation vs neurocognitive remediation in schizophrenia: Results from the multicenter randomized controlled ISST (Integrated Social Cognition And Social Skills Therapy) study.

Introduction: Persistent poor psychosocial functioning, which is associated with impairments in cognition, is one of the main barriers to recovery in schizophrenia. Although cognitive remediation therapy (CRT) has shown general efficacy in improving cognition and functioning, simultaneously focusing on social cognition and social behavioural processes may increase its efficacy.

Methods: In a multicenter, rater-blinded, randomized controlled trial, schizophrenia patients (N = 177) were assigned to six months of either Integrated Social Cognitive and Behavioral Skills Therapy (ISST) or, as an active control intervention, Neurocognitive Remediation Therapy (NCRT). The primary endpoint was all-cause discontinuation (ACD) over the 12-month study period. Secondary endpoints were cognition, psychosocial functioning and quality of life, and clinical symptoms.

Results: ACD was not significantly different between the ISST and NCRT groups (43.3 % vs 34.5 %, respectively). More improvement was seen in social cognition (Pictures of Facial Affect; d = 0.83) in the ISST group and in neurocognition (subscores of the Auditory Verbal Learning Test; d = 0.29-0.40) in the NCRT group. Level of functioning, quality of life, and clinical symptoms significantly improved in both groups, with no significant between-group differences.

Discussion: Both therapies differentially improved measures of the cognitive domains they were designed for. Moreover, they both improved social functioning with high effect sizes (d = 0.8-1.0), underlining the important role of CRT in recovery-oriented schizophrenia treatment. However, the absence of a third group without an active intervention limits the interpretability of the results.