The Need for an Individualized, Everyday Life and Integrative Approach to Cognitive Remediation in Schizophrenia

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The main goal of any rehabilitation program is to improve everyday functioning, and cognitive remediation for schizophrenia is no exception. Recent meta-analyses show that cognitive remediation provides beneficial effects for persons with schizophrenia on both a cognitive and functional level. However, these effects are limited, particularly in their ability to improve functional outcome. Reasons for this are threefold. The vast heterogeneity in schizophrenia has not been taken into account, and, consequently, an individualized approach is called for. Second, specific difficulties in everyday life should be the focus of rehabilitation programs, but these difficulties have not been given the importance they deserve when designing and proposing cognitive (and otherwise) rehabilitation programs. Finally, cognitive functioning is not the only factor involved in predicting functional outcome in schizophrenia, and thus an integrative approach is needed that comprises the various other factors that also play a significant role in functional outcome. It is argued that taking these three issues into account will result in more effective intervention programs in their ability to provide improvements in functional outcome. To conclude, an individualized, everyday life and integrative approach is described. Furthermore, preliminary examples of such an approach are given, in addition to various methods that can be used in order to test the efficacy of this approach in future studies.

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