What Are the 3 Pillars of Cognitive Remediation Therapy?

Cognitive remediation therapy (CRT) is a therapeutic intervention technique that combines computerized cognitive training with real-world activities that challenge clients to apply practiced cognitive skills. Commonly used for remediating cognitive impairment for people diagnosed with schizophrenia or major depressive disorder (MDD), cognitive remediation therapy can be used to help a multitude of clinical populations including stroke, traumatic brain injury, learning disability, and for both healthy and abnormal aging populations. Cognitive remediation therapy is composed of three main components: computerized cognitive training, strategy monitoring, and bridging. In this blog post, we discuss these three pillars of cognitive remediation therapy.

1. Computerized Cognitive Training

Computerized cognitive training is cognitive training done by using digital cognitive therapy tools. The purpose of these digital cognitive therapy tools is to provide a space where clients can practice important cognitive skills, such as working memory. As training progresses, the exercises become more difficult, and the client must learn new strategies to overcome new obstacles. 

 

To help facilitate this learning, clinicians must provide proper stepping stones and required practice time in between visits. Clinicians who provide their clients with computerized cognitive training may assign their clients homework where they practice important cognitive skills without the clinician being present. This is an excellent feature of some digital cognitive therapy tools,  as this allows clients to get an effective amount of cognitive remediation therapy over time.  

2. Strategy Monitoring

As clients complete computerized cognitive training, it is important that both the clinician and the client are aware of the client’s own problem-solving skills. In this component of cognitive remediation therapy, the clinician should work with the client on 4 key components of effective strategy development and implementation:

 

  1. Help the client identify what the strategy is that they are currently applying to solve a real-world problem.
  2. Identify which strategies they may want to try for the problem at hand. This can be done by brainstorming and writing each one down. 
  3. Have the client reflect upon which strategies they have tried to find the strategy/strategies that have been successful and eliminate the ones that haven’t been helpful. 
  4. Pick the effective strategy/strategies and implement it/them. 

 

This part of cognitive remediation therapy aims to help the client be cognitively flexible in learning and applying effective strategies while removing the use of ineffective ones. The clinician should help the client become self-aware of their own problem solving skills, how they apply strategies for different problems, and the outcomes of strategy application for different situations. 

3. Bridging

Bridging is one of the most important parts of cognitive remediation therapy. This part of cognitive remediation therapy serves to help the client apply their computerized cognitive training and newly developed strategies to situations in the real-world.

 

How does one “bridge”?. Bridging is typically done by:

 

  1. Having a discussion with the client (or clients, as this is typically done in group format) about how the skill can be practiced.

 

  1.  Identifying what strategies can be used to solve problems using this cognitive skill.

 

  1. Listing what real-world applications there are for the cognitive skill and strategies that the client has practiced during their cognitive remediation therapy. 

 

After a discussion, the clinician provides a bridging activity that requires the client to apply the practiced cognitive skill and learned strategies to a task that they would encounter in the real world. After the exercise is completed, the client would discuss with the clinician on what obstacles they faced, what areas they felt they succeeded in, and help the client refocus on their therapy goals and the steps they are taking to achieve them. Without bridging, the computerized cognitive training and strategy monitoring work will not be effective as the client needs the guidance as to how to apply their compensatory strategies and cognitive training to the real-world. 

Conclusion

Cognitive remediation therapy is a therapeutic intervention that combines computerized cognitive training with real-world activities that challenge clients to apply practiced cognitive skills. This method of therapy is commonly used for people with psychological disorders, but can be used for other patient populations. Cognitive remediation therapy is provided by a licensed clinician using a combination of print and digital cognitive therapy tools, strategy monitoring, and application activities and discussion known as bridging. Without bridging, the cognitive training and strategy monitoring components will not be effective, as the client will need help learning how to transfer their learned strategies and cognitive training to the real-world. 

 

Cognitive remediation therapy is highly effective in improving cognitive skills in people with psychological disorders. To learn more about cognitive remediation therapy and bridging, check out this blog post

Sources
Douglas, K. M., Milanovic, M., Porter, R. J., & Bowie, C. R. (2020). Clinical and methodological considerations for psychological treatment of cognitive impairment in major depressive disorder. BJPsych open, 6(4).
Dustin Luchmee
Dustin Luchmee

Dustin is HappyNeuron Pro's Product Specialist. With research experience in stroke, Dustin learned how a stroke can change someone's life. He also learned how different kinds of therapists can work together to help a person get better. He is passionate about neuro-rehabilitation and finding the active ingredients for effective therapy.

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