Satisfaction with cognitive remediation therapy: its effects on implementation and outcomes using the cognitive remediation satisfaction scale

Joanne Evans, Rose Tinch-Taylor, Emese Csipke, Matteo Cella, Andrew Pickles, Paul McCrone, Dominic Stringer, Abigail Oliver, Clare Reeder, Max Birchwood, David Fowler, Kathryn Greenwood, Sonia Johnson, Jesus Perez, Rosa Ritunnano, Andrew Thompson, Rachel Upthegrove, Jon Wilson, Alex Kenny, Iris IsokEileen M Joyce, Til Wykes

Research output: Contribution to journalReview articlepeer-review

2 Citations (Scopus)


Cognitive Remediation (CR) improves cognition and functioning but is implemented in a variety of ways (independent, group and one-to-one). There is no information on whether service users find these implementation methods acceptable or if their satisfaction influences CR outcomes. We used mixed participatory methods, including focus groups, to co-develop a CR satisfaction scale. This was refined using three psychometric criteria (Cronbach's alpha, item discrimination, test-retest agreement) to select items. Factor analysis explored potential substructures. The refined measure was used in structural equation joint modelling to evaluate whether satisfaction with CR is affected by implementation method and treatment engagement or influences recovery outcome, using data from a randomised controlled trial. Four themes (therapy hours, therapist, treatment effects, computer use) generated a 31-item Cognitive Remediation Satisfaction scale (CRS) that reduced to 18 Likert items, 2 binary and 2 open-ended questions following psychometric assessment. CRS had good internal consistency (Alpha = 0.814), test-retest reliability (r= 0.763), and concurrent validity using the Working Alliance Inventory (r = 0.56). A 2-factor solution divided items into therapy engagement and therapy effects. Satisfaction was not related to implementation method but was significantly associated with CR engagement. Therapy hours were significantly associated with recovery, but there was no direct effect of satisfaction on outcome. Although satisfaction is important to therapy engagement, it has no direct effect on outcome. CR therapy hours directly affect outcome irrespective of which implementation model is used, so measuring satisfaction early might help to identify those who are likely to disengage. The study has mixed methods design.

Original languageEnglish
Article number67
Pages (from-to)67
Issue number1
Publication statusPublished - Dec 2023


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