BEYOND MEDICATION: COGNITIVE ENHANCEMENT THERAPY FOR SCHIZOPHRENIA

Shawn Eack

Schizophrenia is a mental illness that produces a significant amount of disability. While antipsychotic treatments and medications have proven to be extremely effective, for many people there is an important piece missing in their recovery. Shaun Eack, the James and Noel Browne Chair and professor of social work and of psychiatry, focuses his work on how we can support patients with schizophrenia beyond medication. 

“People with schizophrenia are incredibly intelligent, but the way the condition affects the brain can cause a lot of challenges,” says Eack. “If we can address some of these cognitive challenges, such as difficulty paying attention at work or school, which are unaddressed by current medications, we could help individuals go further in their recovery.”

Eack is researching cognitive enhancement therapy—a treatment developed at Pitt by late professor of psychiatry Gerard Hogarty that utilizes the brain’s neuroplasticity to learn new things. Cognitive enhancement focuses on improving social cognition and neurocognition with three main components: neurocognitive training exercises that focus on problem solving strategies, small group work to address social challenges and individual therapy sessions to best tailor the treatment to each person. 

As shown by brain scans using structural magnetic resonance imaging, cognitive enhancement therapy protects against the loss of brain tissue that often happens in the early course of schizophrenia. The therapy also helps activate the prefrontal areas of the brain and allow for more effective neural communication, enhancing overall brain function. While this treatment has been proven to be effective, the question remains, why hasn’t it been widely implemented into the standard of care? 

“These treatments are only going to be helpful if they get implemented in practice,” says Eack. “A lot of my work has turned from neuroscience to implementation science as I work with communities to make this treatment available.” 

Eack’s team is currently working on a 20-site implementation trial with sites across the country. Through this work, they found that simplifying the treatments better accommodated health care providers in community spaces. Learning more about how to make these treatments both effective and practical makes Eack hopeful about achieving his goal of easily accessible clinics that offer cognitive enhancement therapy. 

“For so long it was about proving that we could be doing more for patients with schizophrenia,” says Eack. “Now that we know cognitive enhancement treatment works, the challenge becomes how we make it a reality.”