Effects of a Multifaceted Cognitive Remediation Program on Cognitive Abilities in Patients with Schizophrenia: A Mixed Methods Study

Abstract

Introduction Cognitive remediation is an effective treatment for deficits in schizophrenia. A multifaceted cognitive remediation programme (MCRP) including relaxation, orientation, attention, memory, executive function, and social participation may promote cognitive function. This study aimed to investigate the effects of MCRP on cognition and the experiences of patients with schizophrenia. Methods Using mixed methods, a randomized controlled trial was implemented. The experimental group (n = 10) underwent MCRP for 12 sessions (3 days/week for 4 weeks) and conventional occupational therapy (OT), while the control group (n = 10) only received conventional OT. The dynamic Lowenstein occupational therapy cognitive assessment (DLOTCA) was used to evaluate the outcomes. A Mann–Whitney U test was used to calculate group differences. MCRP group demonstrated better outcomes in the orientation (p = 0.005) and verbal mathematic questions (p = 0.003) compared to the control group. A Wilcoxon signed-rank test was used to compare the before and after outcomes within the same groups. Results The MCRP group showed significant differences in orientation, visual perception, visuomotor construction, and thinking (p ≤ 0.05), while the control group only exhibited significant differences in visual perception (p ≤ 0.05). In the phenomenological study, nine participants in the MCRP group were interviewed through semistructured interviews and analyzed using thematic analysis. Five themes emerged: (1) understanding insight into activities and rehabilitation; (2) interest in and satisfaction with performing activities; (3) level of performance when performing activities; (4) management skills suitable for one's context; and (5) engagement in activities with others. Conclusion This study could provide information on implementing combined intervention-incorporated occupational therapy to improve cognitive function in patients with schizophrenia. Trial registration ClinicalTrials.gov, TCTR20190123002, Registered January 23, 2019