A network approach exploring the effects of cognitive remediation on cognition, symptoms, and functioning in early psychosis

Andrew J. Watson; Dominic Stringer; Andrew Pickles; Paul McCrone; Clare Reeder; Max Birchwood; David Fowler; Kathryn Greenwood; Sonia Johnson; Jesus Perez; Andrew Thompson; Rachel Upthegrove; Jon Wilson; Alex Kenny; Iris Isok; Balaji Suseendrabose; Eileen M. Joyce; Til Wykes; Matteo Cella

doi:10.1017/S0033291725000212

A network approach exploring the effects of cognitive remediation on cognition, symptoms, and functioning in early psychosis

Andrew J. Watson, Dominic Stringer, Andrew Pickles, Paul McCrone, Clare Reeder, Max Birchwood, David Fowler, Kathryn Greenwood, Sonia Johnson, Jesus Perez, Andrew Thompson, Rachel Upthegrove, Jon Wilson, Alex Kenny, Iris Isok, Balaji Suseendrabose, Eileen M. Joyce, Til Wykes, Matteo Cella^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Background Although cognitive remediation (CR) improves cognition and functioning, the key features that promote or inhibit its effectiveness, especially between cognitive domains, remain unknown. Discovering these key features will help to develop CR for more impact. Aim To identify interrelations between cognition, symptoms, and functioning, using a novel network analysis approach and how CR affects these recovery outcomes. Methods A secondary analysis of randomized controlled trial data (N = 165) of CR in early psychosis. Regularized partial correlation networks were estimated, including symptoms, cognition, and functioning, for pre-, post-treatment, and change over time. Pre- and post-CR networks were compared on global strength, structure, edge invariance, and centrality invariance. Results Cognition, negative, and positive symptoms were separable constructs, with symptoms showing independent relationships with cognition. Negative symptoms were central to the CR networks and most strongly associated with change in functioning. Verbal and visual learning improvement showed independent relationships to improved social functioning and negative symptoms. Only visual learning improvement was positively associated with personal goal achievement. Pre- and post-CR networks did not differ in structure (M = 0.20, p = 0.45) but differed in global strength, reflecting greater overall connectivity in the post-CR network (S = 0.91, p = 0.03). Conclusions Negative symptoms influenced network changes following therapy, and their reduction was linked to improvement in verbal and visual learning following CR. Independent relationships between visual and verbal learning and functioning suggest that they may be key intervention targets to enhance social and occupational functioning.

Original language	English
Article number	e66
Journal	Psychological Medicine
Volume	55
DOIs	https://doi.org/10.1017/S0033291725000212
Publication status	Published - 3 Mar 2025

Keywords

Cognitive Training
Early Intervention
Network Analysis
Psychosis
Recovery

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10.1017/S0033291725000212

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Watson, A. J., Stringer, D., Pickles, A., McCrone, P., Reeder, C., Birchwood, M., Fowler, D., Greenwood, K., Johnson, S., Perez, J., Thompson, A., Upthegrove, R., Wilson, J., Kenny, A., Isok, I., Suseendrabose, B., Joyce, E. M., Wykes, T., & Cella, M. (2025). A network approach exploring the effects of cognitive remediation on cognition, symptoms, and functioning in early psychosis. Psychological Medicine, 55, Article e66. https://doi.org/10.1017/S0033291725000212

@article{7ee271462aea4af5b5760b8003feb1d4,

title = "A network approach exploring the effects of cognitive remediation on cognition, symptoms, and functioning in early psychosis",

abstract = "Background Although cognitive remediation (CR) improves cognition and functioning, the key features that promote or inhibit its effectiveness, especially between cognitive domains, remain unknown. Discovering these key features will help to develop CR for more impact. Aim To identify interrelations between cognition, symptoms, and functioning, using a novel network analysis approach and how CR affects these recovery outcomes. Methods A secondary analysis of randomized controlled trial data (N = 165) of CR in early psychosis. Regularized partial correlation networks were estimated, including symptoms, cognition, and functioning, for pre-, post-treatment, and change over time. Pre- and post-CR networks were compared on global strength, structure, edge invariance, and centrality invariance. Results Cognition, negative, and positive symptoms were separable constructs, with symptoms showing independent relationships with cognition. Negative symptoms were central to the CR networks and most strongly associated with change in functioning. Verbal and visual learning improvement showed independent relationships to improved social functioning and negative symptoms. Only visual learning improvement was positively associated with personal goal achievement. Pre- and post-CR networks did not differ in structure (M = 0.20, p = 0.45) but differed in global strength, reflecting greater overall connectivity in the post-CR network (S = 0.91, p = 0.03). Conclusions Negative symptoms influenced network changes following therapy, and their reduction was linked to improvement in verbal and visual learning following CR. Independent relationships between visual and verbal learning and functioning suggest that they may be key intervention targets to enhance social and occupational functioning.",

keywords = "Cognitive Training, Early Intervention, Network Analysis, Psychosis, Recovery",

author = "Watson, {Andrew J.} and Dominic Stringer and Andrew Pickles and Paul McCrone and Clare Reeder and Max Birchwood and David Fowler and Kathryn Greenwood and Sonia Johnson and Jesus Perez and Andrew Thompson and Rachel Upthegrove and Jon Wilson and Alex Kenny and Iris Isok and Balaji Suseendrabose and Joyce, {Eileen M.} and Til Wykes and Matteo Cella",

note = "Publisher Copyright: {\textcopyright} The Author(s), 2025.",

year = "2025",

month = mar,

day = "3",

doi = "10.1017/S0033291725000212",

language = "English",

volume = "55",

journal = "Psychological Medicine",

issn = "0033-2917",

publisher = "Cambridge University Press",

}

Watson, AJ , Stringer, D , Pickles, A , McCrone, P , Reeder, C, Birchwood, M, Fowler, D, Greenwood, K, Johnson, S, Perez, J, Thompson, A, Upthegrove, R, Wilson, J, Kenny, A, Isok, I, Suseendrabose, B, Joyce, EM, Wykes, T & Cella, M 2025, 'A network approach exploring the effects of cognitive remediation on cognition, symptoms, and functioning in early psychosis', Psychological Medicine, vol. 55, e66. https://doi.org/10.1017/S0033291725000212

TY - JOUR

T1 - A network approach exploring the effects of cognitive remediation on cognition, symptoms, and functioning in early psychosis

AU - Watson, Andrew J.

AU - Stringer, Dominic

AU - Pickles, Andrew

AU - McCrone, Paul

AU - Reeder, Clare

AU - Birchwood, Max

AU - Fowler, David

AU - Greenwood, Kathryn

AU - Johnson, Sonia

AU - Perez, Jesus

AU - Thompson, Andrew

AU - Upthegrove, Rachel

AU - Wilson, Jon

AU - Kenny, Alex

AU - Isok, Iris

AU - Suseendrabose, Balaji

AU - Joyce, Eileen M.

AU - Wykes, Til

AU - Cella, Matteo

PY - 2025/3/3

Y1 - 2025/3/3

N2 - Background Although cognitive remediation (CR) improves cognition and functioning, the key features that promote or inhibit its effectiveness, especially between cognitive domains, remain unknown. Discovering these key features will help to develop CR for more impact. Aim To identify interrelations between cognition, symptoms, and functioning, using a novel network analysis approach and how CR affects these recovery outcomes. Methods A secondary analysis of randomized controlled trial data (N = 165) of CR in early psychosis. Regularized partial correlation networks were estimated, including symptoms, cognition, and functioning, for pre-, post-treatment, and change over time. Pre- and post-CR networks were compared on global strength, structure, edge invariance, and centrality invariance. Results Cognition, negative, and positive symptoms were separable constructs, with symptoms showing independent relationships with cognition. Negative symptoms were central to the CR networks and most strongly associated with change in functioning. Verbal and visual learning improvement showed independent relationships to improved social functioning and negative symptoms. Only visual learning improvement was positively associated with personal goal achievement. Pre- and post-CR networks did not differ in structure (M = 0.20, p = 0.45) but differed in global strength, reflecting greater overall connectivity in the post-CR network (S = 0.91, p = 0.03). Conclusions Negative symptoms influenced network changes following therapy, and their reduction was linked to improvement in verbal and visual learning following CR. Independent relationships between visual and verbal learning and functioning suggest that they may be key intervention targets to enhance social and occupational functioning.

AB - Background Although cognitive remediation (CR) improves cognition and functioning, the key features that promote or inhibit its effectiveness, especially between cognitive domains, remain unknown. Discovering these key features will help to develop CR for more impact. Aim To identify interrelations between cognition, symptoms, and functioning, using a novel network analysis approach and how CR affects these recovery outcomes. Methods A secondary analysis of randomized controlled trial data (N = 165) of CR in early psychosis. Regularized partial correlation networks were estimated, including symptoms, cognition, and functioning, for pre-, post-treatment, and change over time. Pre- and post-CR networks were compared on global strength, structure, edge invariance, and centrality invariance. Results Cognition, negative, and positive symptoms were separable constructs, with symptoms showing independent relationships with cognition. Negative symptoms were central to the CR networks and most strongly associated with change in functioning. Verbal and visual learning improvement showed independent relationships to improved social functioning and negative symptoms. Only visual learning improvement was positively associated with personal goal achievement. Pre- and post-CR networks did not differ in structure (M = 0.20, p = 0.45) but differed in global strength, reflecting greater overall connectivity in the post-CR network (S = 0.91, p = 0.03). Conclusions Negative symptoms influenced network changes following therapy, and their reduction was linked to improvement in verbal and visual learning following CR. Independent relationships between visual and verbal learning and functioning suggest that they may be key intervention targets to enhance social and occupational functioning.

KW - Cognitive Training

KW - Early Intervention

KW - Network Analysis

KW - Psychosis

KW - Recovery

UR - http://www.scopus.com/inward/record.url?scp=86000142113&partnerID=8YFLogxK

U2 - 10.1017/S0033291725000212

DO - 10.1017/S0033291725000212

M3 - Article

C2 - 40025686

AN - SCOPUS:86000142113

SN - 0033-2917

VL - 55

JO - Psychological Medicine

JF - Psychological Medicine

M1 - e66

ER -

A network approach exploring the effects of cognitive remediation on cognition, symptoms, and functioning in early psychosis

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