Abstract: Examining the Relationship between Cognition and Stages of Recovery in the Early Course of Schizophrenia (Society for Social Work and Research 27th Annual Conference - Social Work Science and Complex Problems: Battling Inequities + Building Solutions)
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Examining the Relationship between Cognition and Stages of Recovery in the Early Course of Schizophrenia

Schedule:
Thursday, January 12, 2023
Valley of the Sun A, 2nd Level (Sheraton Phoenix Downtown)
* noted as presenting author
Rochanne Vincent, MSW, Doctoral Student, Case Western Reserve University, Cleveland, OH
Jessica A. Wojtalik, PhD, Assistant Professor, Case Western Reserve University, Cleveland, OH
Anju Kotwani, MSW-Student, Case Western Reserve University, Cleveland, OH
Matcheri S. Keshavan, MD, Stanley Cobb Professor of Psychiatry, Harvard Medical School, Boston, MA
Shaun M. Eack, PhD, James and Noel Browne Professor of Social Work, University of Pittsburgh, PA
Background and Purpose: Advancements in the understanding and treatment of schizophrenia have increased the possibility for recovery, a personal process of developing self-acceptance, resilience, and management of the condition. Evidence supports that recovery from schizophrenia occurs across stages, from moratorium to awareness to growth (Andresen et al., 2006). Because of the chronic and severe nature of the cognitive impairments associated with schizophrenia, it is likely that such impairments impact the recovery process. To our knowledge, this is the first study to link cognitive performance and stages of recovery in a large sample of individuals in the early course of schizophrenia.

Methods: In this secondary analysis, baseline data were used from an 18-month confirmatory multi-site (Pittsburgh, n = 53; Boston, n = 49) clinical trial of Cognitive Enhancement Therapy (CET) for early course schizophrenia. Of the 102 randomized participants, 93 had stage of recovery data from The Stages of Recovery Instrument (STORI; Andresen et al., 2006). Cognition was assessed with a standardized battery assessing an overall composite of cognition and the domains of processing speed, attention/vigilance, working memory, verbal learning, visual learning, reasoning and problem solving, and social cognition. Linear regression models, adjusting for study location, were executed in R to examine the relationships between cognition (predictor) and the five stages of recovery (outcome).

Results: The five stages of recovery scores demonstrated good reliability (all Cronbach’s α > 0.82). Overall cognition was not a significant predictor of any of the five stages of recovery (all p’s > 0.146). Regarding the cognitive domains, social cognition was a significant negative predictor for the first (Moratorium; b = -0.02, p = 0.025) and second (Awareness; b = -0.02, p = 0.013) stages of recovery, such that poorer social cognition was associated with higher scores on these lowest stages of recovery. Social cognition was also a significant positive predictor of the fifth stage (Growth; b = .02, p = .021). Better social-cognitive performance was related to higher scores on this peak stage of recovery. Lastly, processing speed and Stage 1 (Moratorium) scores were significantly related (b = .03, p = 0.028). No other cognitive domains or stages of recovery demonstrated significant associations.

Conclusions and Implications: The findings provide initial evidence that social cognition may be a unique predictor of an individual’s stage of recovery in the early course of schizophrenia. Improving social cognition may be particularly important for facilitating recovery, especially in the early phase. Such evidence has implications for cognitive remediation interventions that specifically target social cognition, such as the social work-developed program of CET. This research warrants future investigation of the effects of CET on changes in the stages of recovery during treatment.

Andresen, R., Caputi, P., & Oades, L. (2006). Stages of recovery instrument: Development of a

measure of recovery from serious mental illness. Australian & New Zealand Journal of Psychiatry, 40(11-12), 972-980. doi:10.1080/j.1440-1614.2006.01921.x

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