Cognitive Remediation for Schizophrenia

[MUSIC PLAYING]

SOPHIA VINOGRADOV: When we see someone who has a really serious form of schizophrenia, we get really frightened. We forget that perhaps with the right intervention they might have had an entirely different life history. For people with schizophrenia, the biggest fear is that things are just going to get worse and worse.

TOM: I was starting to hear voices, like 1,000 whispering voices. The medication—it helps, but it by no means leaves me clear of symptoms. I have a hard time keeping track of where I'm going, what I'm going to be doing, the nuts and bolts of daily life can be really difficult. I'm willing to try anything that might help.

SOPHIA VINOGRADOV: The brain works by having direct wiring. We call them brain networks. And in order to speak, to listen, to understand, that wiring diagram has to be correct. In schizophrenia, we know that the wiring diagram is not quite right. Despite a lot of advances in neuroscience research, we still really only have two forms of treatment—medications, which helps reduce symptoms. The second form of treatment is what we call psychosocial treatment, like psychotherapy.

Neither of these two forms of treatment address the underlying brain dysfunction of serious psychiatric illnesses. We asked ourselves the question, would it be possible to use what is called brain plasticity—which is the ability of the brain to change—by having the brain do exercises to strengthen its weak areas and help some of the cognitive symptoms in schizophrenia.

WOMAN: OK, so we can head back to this way today.

SOPHIA VINOGRADOV: We now know that the brain is kind of like a muscle, in that if you use it, and if use it in certain ways, it'll grow stronger, if you don't use it, certain areas will grow weaker or even dysfunctional. CAST stands for Cognitive and Social Cognitive Training. So for example, a person may do an exercise in which they have to distinguish between two tones.

The other set of exercises focuses on social information, how the brain processes when there are emotions in faces, and what we train the brain to do is to get faster and better and more efficient at making those distinctions. These basic malfunctions in processing really simple information is contributing to all of the symptoms of schizophrenia.

[WHISPERED VOICES]

Our idea is that if we can intervene, especially early, people's thinking abilities can get better, they can get back to work, they can get back to school, they can start to interact again with life in the way they want. And that will halt this continuous progressive decline that we often see in people.

GWYN: He mentioned, kind of casually that, the night before two nights before, he had begun to feel an episode coming on. And so he got on the computer, did CAST, and it didn't happen.

TOM: I noticed the impact on my daily life every day. It just makes everything easier. I plan to continue the training indefinitely.

GWYN: He's always managed his illness, but we'd love to be able to do something more than just manage it. I have all kinds of hope.

SOPHIA VINOGRADOV: The data we have so far really indicates people with schizophrenia can make gains in their brain functions. I think we're almost at the point where getting the diagnosis of schizophrenia doesn't condemn you to this really serious debilitating illness. We're going to have treatments which are going to get them right back on track, and you'll be able to have a really rich and satisfying life.