Showcasing: Cognitive remediation therapy for young people with psychosis
Nepean Blue Mountains
Headspace Penrith and Nepean Blue Mountains Local Health District
Living Well Domain
Right type of care
Cognitive remediation therapy supports people to improve their cognitive functioning including attention, learning and memory through a series of games and mental activities. Psychosis is a broad term that describes psychological symptoms that affect an individual’s perception or understanding of reality.
Young people are drawn from Headspace Early Psychosis and Nepean Blue Mountains Local Health District Early Psychosis Intervention (EPI) Program to participate in the jointly run cognitive remediation group. The project was implemented within existing funding of the two services and is part of a wider multi-site research study.
Planning commenced in late 2018, with the project delivered from March 2019. The first group of six participants are mid-way through the trial project.
Medical and psychological treatment can help some symptoms of psychosis, however neither the headspace Early Psychosis or EPI support programs specifically address cognitive functioning. The challenge was to address that gap.
A first occurrence of psychosis typically happens during late adolescence or early adulthood, at a time when young people are forming their identity and sometimes experiencing significant life changes. This can have a negative impact on physical health, mental health, wellbeing and cognitive functioning.
Psychosis in young people impacts their ability to learn as it affects memory, attention, concentration, processing speed, reasoning, and problem solving – all part of a person’s cognitive function which is important for succeeding in work, study and other goals.
The project was designed to use cognitive remediation therapy to assist young adults between the ages of 12-25 in the community who have lived experience of psychosis. The project supports young people to work towards their goals for work, study, social and independent living, so they can live well in the community.
The teams were trained to deliver both cognitive remediation therapy and social cognition and interaction training to improve social cognition, such as emotion recognition, by people who have experienced psychosis.
The Advantage Trial, led by Dr Anthony Harris, Western Sydney Local Health District, is a multi-site randomised controlled trial investigating impact for young people of adding social cognition and interaction training to cognitive remediation therapy. This trial enabled the two Nepean Blue Mountains organisations to receive training and support for implementation of a local project. Team leaders and managers of both organisations decided to pool resources and jointly deliver the trial project together.
To determine eligibility and individualise the program, young people referred by each organisation underwent a series of tests to determine their cognitive strengths and difficulties.
The program delivers cognitive remediation therapy twice weekly for one hour over 10 weeks, with each group requiring two facilitators and a maximum of six participants. The small number of participants allows facilitators to tailor their interventions to individuals.
iPads and games are used to support young people to develop their cognitive skills, such as attention, concentration, multi-tasking, memory, and processing speed, with all results recorded.
Although formal evaluation will be undertaken once the trial has ended, participant feedback has been positive.
Participants say they are now able to identify situations in which they may need to use strategies to compensate for their cognitive difficulties, such as using alarms on mobile phones as reminders if they experience memory difficulties.
They also report being able to apply strategies they learned to assist them in carrying out everyday tasks and say their confidence has improved as a result.
An average of four clients have attended each group session.
Program leads say given this early success they anticipate continuing to run the group after the research trial has ended.