Feasibility and acceptability of brief cognitive remediation targeting metacognition in acute inpatients with psychosis: a case series

ABSTRACT

Cognitive remediation (CR) is an intensive intervention targeting cognitive impairment with the aim of improving functioning in people with psychotic disorders. Shorter forms of CR based on metacognition and targeting awareness of cognitive problems may be more appropriate for acute inpatient settings where time is limited. The objective of the study was to evaluate the feasibility and acceptability of a new brief course of CR targeting cognitive and metacognitive difficulties within an acute inpatient psychiatric setting. Thirteen male service users with psychosis received a three-week course of CR. Participants were assessed at baseline and post-treatment on cognitive measures, subjective cognitive complaints, functional impairment, and symptom severity. Feasibility was assessed based on engagement, attendance, and attrition. Acceptability was evaluated through treatment satisfaction. Eight participants completed therapy, with 81% session attendance. Therapy was considered acceptable, with the majority of participants considering it satisfactory. Potential benefit analysis showed a significant post-treatment improvement in global cognition and memory. Subjective cognitive complaints did not change over time. It was concluded that it is feasible to deliver brief CR in an acute inpatient setting. Context of delivery and engagement are challenges for optimal therapy implementation. CR protocol adaptations made to promote metacognitive competencies may compensate for lack of intensive practice.

KEYWORDS:

• Cognitive remediation
• metacognition
• psychosis
• inpatient
• acute

Acknowledgements

The authors wish to thank Lisa Walshe and Tina Regent for their help in data collection, as well as all the clinical staff at Gresham 2 ward, Bethlem Royal Hospital, for their support throughout the project. Lastly, but most importantly, we wish to thank all the service users who took part in this project.

Disclosure statement

No potential conflict of interest was reported by the authors.