COGNITIVE ADAPTATION TRAINING: EFFECTIVENESS IN REAL-WORLD SETTINGS AND MECHANISMS OF ACTION (CAT-EM)

Schizophrenia remains one of the most disabling conditions world-wide with an economic burden thatexceeded $155 billion dollars in fiscal year 2013 alone. Despite existing medication and community treatment,many individuals with this diagnosis continue to have poor outcomes and struggle toward recovery. CAT is apsychosocial treatment using environmental supports such as signs, alarms, pill containers, checklists,technology and the organization of belongings established in a person's home or work environment to bypassthe cognitive and motivational difficulties associated with schizophrenia, and support habits for functionalbehavior to promote recovery. In a series of efficacy studies, CAT improved social and occupationalfunctioning, symptoms, and adherence to medication, and reduced rates of readmission. We propose a clusterrandomized effectiveness trial comparing Cognitive Adaptation Training (CAT) to existing community treatment(CT) for individuals with schizophrenia in 8 community mental health centers across multiple states including400 participants. This would be the first large-scale effectiveness study of CAT for improving functionaloutcomes for those with schizophrenia seen in community mental health centers (CMHCs) where the majorityof those with schizophrenia are followed for outpatient care and to study the purported mechanisms of actionbased on an integrated theoretical model. Participants will be assessed at baseline and 6 and 12 months onmeasures of functional and community outcome, medication adherence, symptoms, habit formation andautomaticity, cognition and motivation. CAT treatment will be weekly for 6 months, biweekly for 3 months andmonthly for the remainder of the trial. Purported mechanisms of action for CAT including bypassingimpairments in cognitive function to improve functional outcome and bypassing motivational impairments tocreate automatic habits to improve functional outcome will be examined.