Cognitive Rehabilitation in Schizophrenia and Depression

Schizophrenia and depression are among the most disabling disorders in all of medicine. Cognitive deficits play a key role in patients' disability, affecting their capacity to contribute actively to society by sustaining employment or academic activity. Moreover, cognitive difficulties tend to persist even after the stabilization of other clinical symptoms. Verbal memory and emotion regulation are two important cognitive domains that are impaired in schizophrenia and depression and are associated with patients' functional outcomes. However, no medication has shown clear positive effects on these impairments at this point. Therefore, there is a great need to find effective cognitive remediation treatments (CRT) that could improve these domains in both psychiatric populations. In this study, the investigators will assess the efficacy of a cognitive rehabilitation intervention on the targetted cognitive domains (i.e., verbal memory and emotion regulation), general cognition, brain functioning, community functioning, symptom severity, and perceived cognitive deficits in both psychiatric populations. The study team also aims to investigate potential predictors of positive response to the intervention.

Participants will be randomized into either a treatment group or an active control group for 6 weeks. They will also be invited to undergo clinical and cognitive assessments as well as brain imaging before and after 6 weeks of intervention in order to compare the efficacy of the intervention. Additionally, their verbal memory and emotion regulation abilities will be assessed mid-intervention to examine the specific effect of each CRT module.

Patients will be randomized to either 6 weeks of cognitive intervention (half of those will start with the verbal memory module, and the other half with the emotion regulation module) or 6 weeks of active control intervention.

Due to the nature of the intervention, treatment administrators will not be able to remain blind to group assignment; however, assessment staff, investigators, and participants will be blind to group assignment. Assessment staff and investigators will never be involved in the randomization or treatment procedures.

In each of the 6 visits, participants will be completing some computerized tasks for a period of about 40 minutes. At the end of each session, there will be 10-15 minutes of bridging discussion between the research therapist and the participants. (More details about each condition will be added after study completion to protect the blinding of our participants) .

In each of the 6 visits, participants will be completing some computerized tasks for a period of about 40 minutes. At the end of each session, there will be 10-15 minutes of bridging discussion between the research therapist and the participants. (More details about each condition will be added after study completion to protect the blinding of our participants) .

The Hopkins Verbal Learning Test - Revisited (HVLT-R) for verbal memory is a 12-item test to measure a person's ability to encode, combine, store and recover verbal information in memory.

Change in emotion regulation performance from baseline - Mayer-Salovey-Caruso Emotional Intelligence Test (MSECIT)

The Mayer-Salovey- Caruso Emotional Intelligence Test (MSCEIT) is a 141-item ability-based test designed to measure the four branches of emotional intelligence model of Mayer and Salovey (including emotion regulation).

Assessed with a battery of standardized tests examining cognitive capacity. These tests measure various cognitive domains such as attention, memory, executive function, speed of processing and emotion recognition.

Brain activity as measured using resting-state and task-based functional magnetic resonance imaging (fMRI).

Assessed with a battery of standardized tests examining social functioning. These tests measure an individual's level of social and occupational functioning as well as performance on everyday functional tasks (e.g., making phone calls, counting change, etc.).

The Positive and Negative Syndrome Scale (PANSS) is a 30-item medical scale used for measuring symptom severity of patients with schizophrenia. Total scores range from 30 to 210, with a larger score indicating greater severity of symptoms.

Change in perceived cognitive impairments from baseline - Subjective Scale to Investigate Cognition in Schizophrenia - Brief (SSTICS-B)

The Subjective Scale to Investigate Cognition in Schizophrenia - Brief (SSTICS-B) is a self-rated 14-item scale that assesses the subjective level of cognitive abilities over the past week, ranging from "never" to "very often". The total score of SSTICS ranges from 0 to 84, with a greater score indicating greater perceived cognitive impairments.

Inclusion Criteria: age 18-45 years current Intelligence Quotient (IQ) > 70 as measured by the Wechsler Abbreviated Scale of Intelligence (WASI) the ability to read and speak fluent English a diagnosis of schizophrenia, schizoaffective or major depression disorder stable medication for more than one month Exclusion Criteria: significant neurological or other medical disorders that may produce cognitive impairment a recent history of substance abuse or dependence (within the past 3 months) any magnetic resonance imaging (MRI) contraindications (e.g. metallic head implant, history of seizure, pacemaker) decisional incapacity requiring a guardian taking medications that are rated as Anticholinergic Burden (ACB) Score 3 (severe) or taking benzodiazepines on a daily basis

De-identified data collected from this study may be shared with other researchers at the Royal's Institute of Mental Health Research for analyses and re-analyses. Variables of the study and scripts used for analyses will be made available to the public. De-identified data will also be shared with the general public upon request. Data that can connect with participants' identity will NOT be used or shared for analyses.

De-identified data will become available upon completion of the study and once results have been published in an academic journal (anticipated time frame: the year of 2024).