RATIONALE FOR THE GROUP 

Cognitive deficits are common among persons experiencing a psychotic disorder. Such cognitive deficits have important implications for the community functioning of those with psychotic disorders independently of clinical symptoms. Recognition of the importance of cognitive deficits has resulted in increased focus on reduction of such deficits as an important clinical outcome.

Attention to cognitive concerns in the early phases of psychosis may prevent the discouragingly low rates of employment and self-sufficiency seen in later stages. The mandate of the Prevention and Early Intervention Program for Psychoses (PEPP) has been to examine the effect of early treatment in persons experiencing a first episode of psychosis. Given the age of the patient population in this program (late adolescence/early adulthood), many of the functional issues arising at the time of initial treatment relate to reintegration into and completion of high school or college/university studies. The cognitive difficulties commonly seen among our patients mirror those that have been reported in the literature and have clear implications for their future functioning at school or work. This population is clearly academically and vocationally vulnerable, thus the development of effective treatments to address these specific cognitive concerns is important.

Many of our patients have not had the opportunity to develop the necessary learning and study skills to manage the demands of a high school or post secondary. Their ability to maximize their cognitive potential has often been further compromised during a prolonged prodromal period. Thus significant declines in academic performance prior to program admission are commonly seen. All of these findings have led to interest in the potential remediation of such deficits and the timely provision of cognitive skills teaching.  

BACKGROUND INFORMATION 

Cognitive difficulties have been recognized as a component of psychotic disorders since the early twentieth century. In fact, the early name given to this disorder (dementia praecox) reflected these observations. Deficits in the areas of verbal learning and memory, attention/concentration, speed of thinking and executive functions (e.g. concept formation and abstraction) have been frequently identified.

Review of the cognitive rehabilitation literature reveals that four approaches have typically been utilized to remediate deficits: relearning and practice of the deficit skill; substitution of an intact skill to replace a weak one; use of prosthetic devices (e.g. calendars, notebooks); and adaptation of the physical and social environment. Research supports the efficacy of teaching compensatory cognitive and behavioral strategies rather than trying to rehabilitate targeted deficits. These findings have held true for patient with head injury as well as psychosis.

The direct and secondary benefits of a group model of cognitive skills instruction have also been reported and include: enhancement of attention and concentration through verbal and visual pencil and paper exercises, facilitation of communication and social skills building through interactions with others, stimulation of the unique skills of each member by the group process, and the opportunity to receive feedback and experience success in a structured and concrete format.

Unfortunately, there is little research examining cognitive skills development among first episode patients who are in school or planning a return to their academic studies following stabilization of their symptoms. Much of the research to date has focussed on older and more chronic patients and either remediation of a specific aspect of cognitive functioning (e.g. attention) or performance on a specific test (e.g. Wisconsin Card Sorting). Research regarding the cognitive functioning of older and more chronic patients has demonstrated a trend towards deterioration over time, or the continuation of significant cognitive difficulties which act as a barrier to successful academic or vocational functioning. The use of this intervention in a program such as PEPP, which is designed to treat psychosis at an early stage, may be particularly appropriate. 
 

OBJECTIVES OF THE GROUP 

The cognitive skills group is designed to address deficits in functioning which relate to academic performance. It aims to teach cognitive and behavioral compensatory strategies specifically on the domains most commonly impacted among patients with psychosis. The direct focus of the group is for participants to: