Cognitive Enhancement Therapy Improves Resting-State Functional Connectivity in Early Course Schizophrenia
Open accessAbstract
Objective: Cognitive remediation is emerging as an effective psychosocial intervention for addressing untreated cognitive and functional impairments in persons with schizophrenia, and might achieve its benefits through neuroplastic changes in brain connectivity. This study seeks to examine the effects of cognitive enhancement therapy (CET) on fronto-temporal brain connectivity in a randomized controlled trial with individuals in the early course of schizophrenia. Method: Stabilized, early course outpatients with schizophrenia or schizoaffective disorder (N = 41) were randomly assigned to CET (n = 25) or an active enriched supportive therapy (EST) control (n = 16) and treated for 2 years. Functional MRI data were collected annually, and pseudo resting-state functional connectivity analysis was used to examine differential changes in fronto-temporal connectivity between those treated with CET compared with EST. Results: Individuals receiving CET evidenced significantly less functional connectivity loss between the resting-state network and the left dorsolateral prefrontal cortex as well as significantly increased connectivity with the right insular cortex compared to EST (all corrected p< .01). These neural networks are involved in emotion processing and problem-solving. Increased connectivity with the right insula significantly mediated CET effects on improved emotion perception (z′ = −1.96, p = .021), and increased connectivity with the left dorsolateral prefrontal cortex mediated CET-related improvements in emotion regulation (z′ = −1.71, p = .052). Conclusions: These findings provide preliminary evidence that CET, a psychosocial cognitive remediation intervention, may enhance connectivity between frontal and temporal brain regions implicated in problem-solving and emotion processing in service of cognitive enhancement in schizophrenia.
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Processes of change such as emotional acceptance are themselves mediated by the connectivity strength between brain areas known to relate to difficult emotional responses.
“It is also known that processes of change such as emotional acceptance are themselves mediated by the connectivity strength between brain areas known to relate to difficult emotional responses 109 .”
From “Third-wave” cognitive and behavioral therapies and the emergence of a process-based approach to intervention in psychiatry (2021) · cites this paper as [109]
The Results section (page unavailable) reports that changes in connectivity mediated CET-related improvements in emotion perception and emotion regulation in people with early-course schizophrenia. The paper does not examine emotional acceptance or establish the broader claim about difficult emotional responses; its mediation finding concerns specific treatment outcomes. (LLM, conf=0.86)
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References 56 · Cited by 37
Research works printed but not linked: 2
- Ben-Yishay Y Piasetsky EB Rattok J Meir MJ Benton AL Diller L A systematic method for ameliorating disorders in basic attention Neuropsychological rehabilitation 1985 165 181 Guilford Press New York, NY
- First MB Spitzer RL Gibbon M Williams JBW Structured clinical interview for DSM-IV-TR Axis I disorders, research version, patient edition 2002 Biometrics Research, New York State Psychiatric Institute New York, NY
- Authors
- Eack, S. M., Newhill, C. E., & Keshavan, M. S.
- Affiliations
- University of Pittsburgh (US)
- Harvard University (US)
- Venue
- Journal of the Society for Social Work and Research
- Publisher
- University of Chicago Press
- Published
- 2016-06-01
- Volume
- 7
- Issue
- 2
- Pages
- 211-230
- ISSN
- 1948-822X (ISSN-L)
- 2334-2315
- PMC
- PMC5047289
- OpenAlex
- W2346366035
- Cited by
- 37
- References
- 56
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 4 · 2023: 1 · 2022: 4 · 2021: 3 · 2020: 5 · 2019: 6 · 2018: 4 · 2017: 5 · 2016: 1
- FWCI
- 4.74
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the Society for Social Work and Research (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Institute of Mental Health (K23MH095783, R01MH060902)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Life Sciences › Neuroscience › Cognitive Neuroscience › Functional Brain Connectivity Studies
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- cognitive enhancement therapy, cognitive remediation, schizophrenia, schizoaffective disorder, resting-state functional connectivity, fronto-temporal connectivity, dorsolateral prefrontal cortex, insula, emotion perception, emotion regulation, neuroplasticity
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