Bridging Disciplinary Boundaries (January 11 - 14, 2007)

This study aimed to demonstrate that better understanding of mechanisms and conditions of rehabilitative change in schizophrenia would be attained from a perspective which spanned the disciplines of social work, cognitive psychology, and psychophysiology. We examined how neurocognition and social cognition were associated with initial functional level, and with rates of functional change in community-based psychosocial rehabilitation interventions for individuals with schizophrenia. We also examined how service intensity was associated with rates of change, and whether it served as a moderator in the relationship between functional change and both neurocognition and social cognition.

Method.

The sample consisted of 125 individuals diagnosed with schizophrenia or schizoaffective. Subjects were recruited at four community-based psychosocial rehabilitation programs in Los Angeles and followed prospectively for 12 months between 1996-2000. The subjects were assessed at baseline on all study variables including neurocognition, social cognition, and psychosocial functioning and reassessed 6 and 12 months later. Hierarchical Linear Modeling was used to test four study hypotheses.

Results.

Results were as follows: 1) Data supported hypothesis one: better neurocognition (β = 0.255, t = 2.96, P < .01) and social cognition (β = 0.134, t = 3.12, P < .001) scores at baseline would be significantly associated with higher levels of initial functional status. 2) Data supported hypotheses two: better neurocognition (β = 0.107, t = 2.72, P < .01) and social cognition (β = 0.024, t = 1.63, P < .05) scores at baseline would be associated with higher rates of functional rehabilitative change over twelve months. 3) Data supported hypothesis three: more days of treatment (service intensity) would be related to higher rates of functional change (β = 0.006, t = 2.15, P < .05). 4) Hypothesis four was that service intensity would moderate the relationship between both neurocognition and social cognition and subsequent functional change, with two competing types of moderation proposed: a) compensatory moderation and b) potentiating moderation. There were two notable results. As days of treatment decreased across subjects, 1) the relationship between neurocognition and initial level of psychosocial functioning increased (β = -0.003, t = -2.34, P < .05), and 2) the influence of social cognition on the rate of rehabilitative change increased at a trend level (P = .06). This result provides some support for the compensatory moderation mechanism.

Implication for practice.

Community-based psychosocial rehabilitation programs need to begin to integrate neurocognition and social cognition into their services. Practitioners and consumers could benefit from understanding these factors for their service activities. For example, with relevant assessment these factors could be used to identify individuals for whom functional change might be easier or more challenging. This can be used to educate both consumers and practitioners so that interventions can be more individually tailored and realistic change goals can be set. Rather than being used to delimit the rates of possible functional change, these assessments can be used to maximize individual change rates by minimizing practitioner and consumer frustration due to inaccurate goal setting and inappropriately low or high expectations for change.