Compensatory strategies. Kern and colleagues28 explored the effectiveness of EL in community
settings. The results of their work show improvement in the learning of simple entry-level job tasks,
such as index card filing and toilet tank assembly. Another community-based study used EL to train
participants with schizophrenia or schizoaffective disorder in entry-level tasks at a thrift-type
clothing store and found significantly better work quality when compared with participants trained
using conventional methods.41
Randomized studies have demonstrated that CAT results in greater adaptive function, better quality
of life, and fewer positive symptoms than other forms of psychosocial treatment.42 CAT has also
been associated with a reduced incidence of re-hospitalization and with improved levels of
motivation and community functioning.43 While EL and CAT use different compensatory approaches,
both appear to be beneficial in the treatment of cognitive deficits in schizophrenia.
Cognitive remediation. CR has been demonstrated to improve overall (global) cognition as well as
specific domains, including attention, executive function, working memory, verbal learning and
memory, processing speed, and affect recognition.38-40,44-47 The effect sizes for improvements in
cognitive domains generally fall into the small to moderate range (about 0.3 to 0.6).35,45 Effect sizes
for improvements in global cognition tend to be in the moderate range as well.35,45 (Of note,
moderate effect sizes are generally considered meaningful in the social sciences, but the
improvements in cognition after CR merely attenuate the degree of deficit, which still remains large
compared with that in control subjects.) These improvements in cognition often persist after CR has
ended.35 In their study, Hogarty and colleagues48 tested participants 12 months after the completion
of CET and reported that improvements in processing speed, cognitive style, social cognition, and
social adjustment persisted.