T39. CAN INDIVIDUALS WITH NEUROCOGNITIVE IMPAIRMENT BENEFIT FROM COGNITIVE-BEHAVIORAL SOCIAL SKILLS TRAINING?

Research has consistently demonstrated that neurocognitive impairment is related to poor functional outcomes among individuals diagnosed with schizophrenia. Further, neurocognitive impairment has been shown to predict poor outcomes in psychosocial treatments that target functioning such as social skills training. Cognitive-Behavioral Social Skills Training (CBSST) is a group intervention aimed at improving day-to-day functioning that includes aids to compensate for cognitive impairment in schizophrenia. The current study examined whether neurocognitive impairment at baseline moderated functional outcome in CBSST relative to a goal-focused supportive contact condition (SC).

Two single-blind, randomized controlled trials were conducted; one with middle-age and older (age > 45; N = 64) and one with younger (age > 18; N = 149) participants with schizophrenia or schizoaffective disorder. Both CBSST and SC involved 36 weekly 2-hour group sessions, and data was collapsed across studies. Participants completed the self-report Independent Living Skills Survey (ILSS) and a comprehensive neuropsychological battery at baseline, end of treatment, and either 9- or 12-months post-treatment. Linear regression models were used to examine whether baseline neurocognitive impairment moderated functional outcome (i.e., ILSS composite score at follow-up). Group (coded as CBSST = 0.5; SC = -0.5), baseline functioning, baseline neurocognitive domain t-score, and the interaction between group and baseline neurocognitive domain t-score were included in these moderation models.

Analyses revealed a significant cross-level interaction between executive function (EF) and group assignment (Beta = .78, p <. 05), indicating that individuals randomized to CBSST with poor EF at baseline had better functioning (xxxx = .720) at follow-up than individuals assigned to SC with poor EF (xxxx = .643). Moreover, their level of functioning at follow-up was similar to that of participants in the CBSST condition with intact EF (xxxx = .717; t(46) = 0.28, p = .78) as well as those in the SC condition with intact EF (xxxx = .726; t(50) = .04, p = .97). Post-hoc analyses indicated a significant decline in functioning from baseline to follow-up for participants with low EF in the SC condition (t(22) = 2.07, p = .05); there was no significant improvement in functioning over time for participants with intact EF in either group or those in the CBSST condition with low EF. No other neurocognitive domain (i.e., global neurocognition, working memory, processing speed, verbal/visual learning and memory) moderated the relation between group assignment and follow-up functioning.

Engagement in CBSST prevents functional decline in individuals with low EF. It is likely that problem-solving training and teaching skills for how to gather evidence and test hypotheses about thoughts/ mistakes in thinking help to compensate for EF deficits in schizophrenia.