The CIRCuiTS study: Implementation of Cognitive Remediation into Early Intervention Services: A randomised controlled trial

Background: Cognitive problems in people with schizophrenia predict functional recovery even with the best possible rehabilitation opportunities and optimal medication. A psychological treatment known as cognitive remediation therapy (CRT) aims to improve cognition in neuropsychiatric disorders with the ultimate goal of improving functional recovery. Studies suggest that intervening early in the course of the disorder will have the most benefit, so this study will be based in Early Intervention Services (EIS) which treat individuals in the first few years following the onset of the disorder. The overall aim is to investigate different methods of CRT. Methods: This is a multicentre, randomised, single blinded, controlled trial based in EIS in NHS Mental Health Trusts in six English research sites. Three different methods of providing CRT (intensive, group, and independent) will be compared to treatment-as-usual. We will recruit 720 service users aged between 16 and 45 over three years who have a research diagnosis of non-affective psychosis and will be at least three months from the onset of the first episode of psychosis. The primary outcome will be the degree to which participants have achieved their stated goals using the Goal Attainment Scale. Secondary outcomes will include improvements in cognitive function, social function, self-esteem and clinical symptoms. Discussion: It has already been established that cognitive remediation improves cognitive function in people with schizophrenia. Successful implementation in mental health services has the potential to change the recovery trajectory of individuals with schizophrenia-spectrum disorders. However, the best mode of implementation in terms of efficacy, service user and team preference and cost-effectiveness is still unclear. The CIRCuiTS Trial will provide guidance for large-scale roll-out of CRT to mental health services where cognitive difficulties impact recovery and resilience.