Definition of cognitive remediation / cognitive rehabilitation

The primary aim of cognitive remediation therapyis to reduce cognitive deficits. When considering the remediation tools that are currently in practice one could compare it to brain training. However in contrast to cognitive remediation, brain training is aimed at healthy subjects wishing to prevent aging-related cognitive deficits before they occur. Brain training programs (in addition to possible medical indications) employ evidence-based techniques to prevent cognitive aging (e.g. brain training program).

Cognitive deficits can manifest as attention, memory, and executive function (ability to organize one's actions and speech) disorders. Certain mental illnesses are sometimes characterized by specific cognitive deficits, such an example being social cognition disorders (which prevent the patients from understanding other people's intentions, desires and emotions). These type of cognitive disorders highly compromise the social and professional integration of people suffering from them.

Cognitive remediation is a type of rehabilitation treatment offering exercises with an aim at improving attention, memory, language and/or executive functions. The expected result is an indirect positive impact on functional deficits affecting everyday life. Proper treatment with these therapies can help enhance the social and professional integration of patients.

Cognitive remediation is not meant to replace medical treatments or certain types of psychotherapy but rather to complement their effects. Indeed, all three types of treatment have differing effects. Psychoactive drugs impact brain receptors, where as psychotherapy impacts the patient's image of him/herself and his/her environment, and cognitive remediation impacts the processing of information. These different therapeutic approaches can be combined and work synergistically. In short, cognition is enhanced by training one's deficient functions or by developing those that have been preserved with compensational mechanisms. For instance,several clinically validated cognitive remediation programs are available in English and French for patients suffering from schizophrenia and depression. For a list of cognitive therapy exercises and features for one of these recommended tools please visit

Cognitive remediation is also available for children suffering from psychotic disorders, ADHD (Attention-deficit hyperactivity disorder), people with mild intellectual deficits, people with brain injuries, and for older subjects suffering from early stage dementia.

Terms of use and results

It is important to note cognitive remediation can only be used with clinically stable patients who can be actively involved in their own treatment. They have to be able to concentrate during therapy sessions that last twenty minutes or more. Before suggesting cognitive remediation to a patient, their cognition first has to be accurately assessed. It is necessary to define the deficient cognitive areas and the nature of these deficits. The objective of such a treatment is to help the patient achieve greater autonomy in their social and professional life. It is beneficial to set objectives focused on everyday situations before the treatment even begins.

There are two main techniques for this treatment. One technique is to train the brain functions with exercises which are regularly repeated and allow specific training in the deficient aspect(s) of a cognitive function (for example, training the coding of information by going through the data over and over again). This is referred to as restoring the deficient function. Another rehabilitation technique is to work with the preserved cognitive functions. In this case, the patient will be encouraged to develop strategies to process information. For example, the patient is told to memorize a shopping list by using a mental image composed of the various ingredients.

Cognitive remediation has been subject to many controlled studies; two meta-analyses also confirm its effectiveness in treating schizophrenia (Roder et al., 2006 ; McGurk et al., 2007). Peer reviewed research shows cognitive remediation is beneficial when it comes to social and integration skills. Remediation is therefore advisable and should now be a standard component of the care program of all patients suffering from schizophrenia with a cognitive impairment. It has also been used for other pathologies with promising results but these results still need to be medically validated.

An official position in the therapeutic arsenal

Appreciated by both patients and medical staff, cognitive remediation is an easy technique to implement. To patients with cognitive alteration, cognitive remediation should be introduced as early as possible. The success rate of this therapy increases with patient buy-in so it should be combined with psycho-educational methods for the patient to become aware of his/her cognitive deficits and of the opportunity to increase the benefit from such remediation.


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