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Cognitive remediation for people with bipolar disorder: The contribution of session attendance and therapy components to cognitive and functional outcomes

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
Pages (from-to)144-151
Number of pages8
JournalJournal of Psychiatric Research
Early online date17 Jun 2022
Accepted/In press9 Jun 2022
E-pub ahead of print17 Jun 2022
PublishedAug 2022

Bibliographical note

Funding Information: This paper represents independent research part-funded by the National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London . The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. DT would like to acknowledge that this scientific paper was supported by the Onassis Foundation - Scholarship ID: F ZO077-1/2018–2019. AHY and TW would like to acknowledge their NIHR Senior Investigator award. Publisher Copyright: © 2022 The Authors


  • 1-s2.0-S0022395622003272-main

    1_s2.0_S0022395622003272_main.pdf, 485 KB, application/pdf

    Uploaded date:23 Jun 2022

    Version:Final published version

    Licence:CC BY

King's Authors


Cognitive remediation (CR) can reduce cognitive and functional difficulties in people with bipolar disorder (BD). To date, there is limited evidence on the contribution of session attendance and therapy components to treatment outcomes. This study explores whether attendance and core CR components contribute to treatment outcomes.
This is a secondary analysis using data from a randomized controlled trial comparing CR plus treatment-as-usual (TAU; n = 40) to TAU only (n = 40) in euthymic people with BD. Session attendance was measured by number of sessions and by achieving therapy completion, pre-defined as attending ≥20 sessions. We used instrumental variable analysis to examine the effect of attendance on treatment outcomes. We then considered the association between core therapy components (i.e., massed practice, errorless learning, strategy use, therapist contact) and post-treatment outcome changes using correlation.
The CR group improved significantly in measure of global cognition, psychosocial functioning, and goal attainment. Therapy recipients attended 27.1 sessions on average, with 32 (80%) completing the minimum number of 20 sessions. Attending more sessions and achieving therapy completion were associated with improved treatment outcomes, but this relationship was not significant within the subgroup of CR completers. Improvement in psychosocial functioning was associated with therapist contact and goal attainment with selecting useful strategies during therapy.
Our findings highlight the relevance of session attendance, specifically the importance of achieving a minimum threshold of CR sessions, for outcome improvement. Strategy use and therapist contact might facilitate improvements in psychosocial functioning and personal recovery goals.

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