Computer-assisted cognitive remediation (CACR) as a recovery-oriented intervention for schizophrenia: a randomized controlled trial

Recovery-oriented care focuses on empowering individuals with schizophrenia to live meaningful lives despite persistent challenges. Schizophrenia often involves cognitive impairments and reduced participation in purposeful activities, contributing to poor psychosocial outcomes. Although computer-assisted cognitive remediation (CACR) is a well-established method for improving cognitive function, its potential to enhance recovery-related outcomes remains underexplored. This study investigated the impact of CACR on personal recovery, psychological needs satisfaction, self-esteem, and occupational engagement in individuals with schizophrenia. In a double-blind randomized controlled trial, 54 outpatients with schizophrenia were allocated to either CACR (n = 27) or an active control condition (n = 27). The CACR group completed 30 sessions of computerized cognitive training using four CANTAB tasks (visual attention, memory, and planning) under therapist supervision, incorporating feedback and meta-cognitive reflection. The control group participated in matched sessions of computerized leisure activities without cognitive training or therapist guidance. Outcomes included the Recovery Assessment Scale–Domains and Stages (RAS-DS), Engagement in Meaningful Activities Survey (EMAS), Basic Psychological Needs Satisfaction in General Scale (BPNSG-S), Rosenberg Self-Esteem Scale (RSES), and General Health Questionnaire-12 (GHQ-12), assessed at baseline, post-intervention, and 3-month follow-up. CACR group experienced significant improvements in personal recovery, autonomy, competence, self-esteem, and engagement in meaningful activities (all p < 0.05). Psychological well-being also improved at follow-up. However, no significant changes were observed in relatedness. The control group demonstrated only transient or non-significant fluctuations across outcomes. These findings suggest that CACR can support key elements of recovery, offering a person-centered intervention beyond cognitive improvement. CACR may serve as a valuable adjunct to standard care in schizophrenia by promoting recovery-oriented outcomes such as autonomy, self-esteem, and meaningful activity engagement. However, the findings should be interpreted with caution given the relatively small sample size and short follow-up period. Future studies with larger and more diverse samples, and longer observation, are needed to confirm and extend these results. The study was registered with www.irct.ir: IRCT20180317039116N2, on 2023/01/28. Prospectively registered.