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Cognitive Remediation Theory

Cognitive Remediation Theory is rehabilitation technique for lost cognitive functions that traditionally was used for treating patients with brain injury or trauma. The technique mainly focuses on restoration as compared to a similar therapeutic technique called Cognitive Enhancement Therapy which focuses on enhancement of weak cognitive functions. The cognitive remediation process intents at focusing the attention on the problem by repeated exercise similar to what a sports person does, learning and improving performance of a skill by repeated practice.

Cognitive Function

Cognitive function or cognition is an umbrella term for the activities that take place in the brain and result in gathering information of any kind, like attention, memory encoding and recalling, reasoning and comprehending. Cognitive function for different activities is different. It usually requires a combination of multiple cognitive functions to carry out even a simple task. As the number of functions required to accomplish the task increases so does the difficulty of the task. For example, while Chinese language has only thirteen words to describe mathematical notions, English language has 29 words for the same notions. Also, the number syntax for Chinese language is simpler as compared to the English number syntax. Hence, it is simpler for the Chinese children to acquire mathematical skills.

Cognitive Dysfunction

Cognitive dysfunction is also referred to as brain fog, is the term used for loss of cognitive functions. Usually the cause of this loss is considered to pathogenic and supposed to advance for the duration of immunopathology. The cognitive dysfunction so caused by pathogens is also expected to get better with antibiotics and as the body recovers but some dysfunctions can worsen without any recovery. Although different diseases and disorders affect different cognitive functions, the most common cognitive functions to be affected are attention and memory. Executive functioning is affected by cognitive dysfunction in what is considered to be the worst form of the disease.

Cognitive Remediation

Cognitive remediation refers to non-pharmacological, rehabilitative treatment of brain fog or cognitive dysfunction which is not meant to replace medical or therapeutic treatment but to further facilitate the treatment of the disorder or the disease. The expected result of cognitive remediation is indirect positive effect on the cognitive dysfunctions influencing day to day life. But the use of this technique is limited to the consciously stable patients only as the process requires conscious participation and concentration by the patient.

The process of therapy

The fundamental aim of the CRT should be:

• to enhance the capacity and capability of the cognitive functions
• to develop vast, interchangeable cognitive schema to guide cognitive functions
• to enhance meta-cognition
• to enhance motivation.

CRT can be delivered through computer based programs and in-person, according to the comfort and requirement of the patient, as different researches show benefits of both delivery methods.

The therapeutic process to achieve the above stated aim should be based upon:

• a clear understanding of the strengths and weaknesses of the cognitive functions and dysfunctions associated with the disorder
• a clear understanding of the relationship between the targeted cognitive functions and the day to day life of the patient
• training methods should theoretically and empirically driven and designed
• an understanding of the effect of individual differences and environmental factors of the patient on the desired change or growth.

Ending the CRT

It is highly advised that the patient should be specifically informed in the starting of the therapeutic treatment about the length of the treatment, i.e. that an end date should be agreed upon. The therapist must also remind the the patient as the deadline approaches, but if the patient portrays specific negative emotions to the finishing the therapy, such emotions should not be ignored and should be addressed and normalized. Also if the therapy is to be continued by any other disciplinary expert, then the current therapist should gradually discontinue the sessions and make the transition smooth for the patient.

Therapeutic Uses

Traditionally, CRT was only used to treat patients with brain injury but now, empirical studies show that CRT can be successfully used to treat the other disorders as well.

Schizophrenia

Empirical researches and studies conducted with schizophrenic patients using cognitive remediation, has shown great improvement, specially in chronic and severe patients. These studies show the positive effect of cognitive remediation in multiple areas like cognition, social cognition, independent living skills and social adjustment. It seems to work best when incorporated with comprehensive skills training program that constitutes of psycho-social groups or work rehabilitation programs. Helping recover cognitive dysfunctions also help delaying the onset of schizophrenia among the patients who fall under greater risk population . Studies also show the occurrence of brain repair mechanism which can provide the biological validity to determine neurobiological changes resulting from CRT.

Eating Disorders

Studies conducted with patients of Anorexia Nervosa, CRT showed relevant cognitive improvements. The participants reported positively about the treatment plan and the researchers saw lesser drop-out rate and higher acceptability rate with CRT as compared to other therapeutic methods. CRT for anorexic patients focuses on developing cognitive flexibility and holistic thinking without directly focusing on topics of diet and weight management which patients reported are uncomfortable to focus on. This method helps the develop their meta-cognitive thinking with the help of specific and non threatening tasks which are easy to accomplish.

Mood Disorders

Studies show that CRT is an emerging mode of non-pharmacological treatment for patients with Major Depressive Disorder and Bipolar Disorder as it helps enhance "psycho-social functioning" and reduce disability. But further research is required with CRT and mood disorders to avoid the "pseudo-specificity" effecting the results. Pseudo-specificity here refers to the false results that may have been influenced by the effective mood state of the patient at the time of data collection instead of actual cognitive change that should have been reported.

Attention Deficit Hyperactivity Disorder in Adults

Research conducted with adult ADHD patients using CRT showed that patients were better able to mange their anger, their symptoms became "less problematic" and their self esteem enhanced. The researchers assume that the results were so obtained mainly because primarily, CRT enable the patient to compensate the cognitive dysfunction cause by ADHD using a structured skill/training program, secondarily, CRT may demand attention and memory systems of the patient to level of reducing the problematic symptoms and thirdly, because better anger management and increased self esteem helps cater the problematic symptoms of adult ADHD.