Cognitive training in schizophrenia: golden age or wild west?

S ix years ago, at the first Cognitive Neuroscience Treatment Research to Improve Cognition in Schizophrenia (CNTRICS) meeting, a neuroscientist questioned whether attention dysfunction was malleable in schizophrenia, despite a recent report that patients were 5 times more likely to work when cognitive remediation was combined with supported employment (1). The idea that impaired neural systems could demonstrate learning-induced plasticity was not part of the biological research lexicon at that point in time. Experimental neuroscientists were rightfully skeptical of a broad array of cognitive remediation interventions that were often studied under nonblinded and variously controlled conditions. Perplexing, also, was the homogeneity of effect sizes, despite widely varying treatment approaches, outcome measures, and length of intervention.