ABSTRACT
There is now clearly more optimism for the development of therapies to improve cognition in schizophrenia. Both laboratory and clinical studies have shown improvements on individual cognitive tests and in some studies these have led to functional changes. Our model concentrated on this issue: What is the key change in cognition that will improve functioning? Our conclusion was that the bottom-up models that assume change will be based solely on practice of task-specific, low-level cognitive skills is unlikely to have dramatic effects. Therapy should concentrate on training cognitive skills that will lead to a flexible transfer of strategies and cognitive schemas. Therefore executive functioning and particularly metacognitive knowledge and metacognitive processing should be targets for CRT and the instructional techniques should be designed to develop these skills. Therapy is still at an early stage and we consider that further investigations of the effectiveness of types of task and instruction are essential. The usefulness of some instructional techniques from adult education for training people with some existing cognitive difficulties needs also to be tested.
