Grant: Operating Grant

The moderate effect sizes associated with pharmaceutical intervention in psychosis have opened the door for development of a range of novel non-pharmaceutical treatment methods that can supplement the impact of medication. The objective of this study is to demonstrate that although neurocognition-focused (cognitive remediation therapy; CRT) and thought-focused (metacognitive training; MCT) group therapy methods both improve social/everyday functioning in psychosis, they produce distinct patterns of efficacy, differentially affecting symptoms, and producing distinct changes in cognitive and functional neuroimaging measures. All participants will be inpatients with a primary diagnosis of schizophrenia or schizoaffective disorder from the BC Psychosis program. Participants will be randomly assigned CRT or MCT, with the treatment as usual (TAU) comparison captured within subjects as a baseline condition. All measures will be collected at three timepoints, baseline, pre-intervention, and post intervention (TAU followed by CRT/MCT). Groups will consist of approximately 10 participants. We hypothesize that (1) CRT and MCT will produce greater change in social/everyday functioning than TAU, (2) MCT will have more impact on positive symptoms than CRT, (3) CRT (but not MCT) will improve basic attention and memory measures and their biological underpinnings, whereas MCT (but not CRT) will reduce targeted cognitive biases on reasoning tasks and their biological underpinnings. Evidence that different psychosocial treatments lead to different brain responses in people with psychosis is an important development in the field because neural responses to psychosocial interventions are relatively unknown. This knowledge could pave the way for more precise biological targets for both pharmaceutical and non-pharmaceutical interventions, and adds to the literature on the effectiveness of non-pharmaceutical interventions in psychosis.