The CIRCUITS Study: Implementation of Remediation into EI Services
Research type
Research Study
Full title
Building Resilience and Recovery through Enhancing Cognition and quality\nof LIfe in the early PSychosEs (ECLIPSE) - Study 9: Implementation of Remediation into Early Intervention Services
IRAS ID
174796
Contact name
Til Wykes
Contact email
Sponsor organisation
Kings College London
ISRCTN Number
ISRCTN14678860
Clinicaltrials.gov Identifier
45, Mental Health and Neurosciences (now KHP) Clinical Trials Unit
Duration of Study in the UK
4 years, 9 months, 1 days
Research summary
Summary of Research
Cognitive problems in people with schizophrenia predict functional recovery even with the best possible rehabilitation opportunities and optimal medication. However, one new psychological treatment known as cognitive remediation (CRT) can improve cognitive and functional recovery – such as social relationships and the opportunity to go to work or take part in further education. The ideal time to provide CRT is in Early Intervention Services (EIS) as we know that it is more effective for younger people and may have larger effects on functioning if we intervene at the earliest opportunity. Our plan is to develop a training programme and investigate different methods of CRT implementation to guide the UK-wide implementation. \n\nThe present study (Study 9) aims to investigate three different methods of providing CRT across ten EIS teams and compare their outcomes with treatment as usual. Our main outcome is whether service users achieve their personal goals which fits with our recovery-focused approach. Participants in the trial will be users of early intervention services, aged between 16 and 35 with a diagnosis of non-affective psychosis (schizophrenia, schizo-affective disorder or schizophreniform disorder). Therapy will be provided in three separate regimes each with different associated hours of therapist/coach contact but all envisaging a total of 40 hours of treatment. We are aiming to recruit approximately 700 participants for the trial over the course of three years.Summary of Results
Building Resilience and Recovery through Enhancing Cognition and quality of LIfe in the early PSychosEs (ECLIPSE) - Study 9: Implementation of Remediation into Early Intervention Services Thinking difficulties in people with schizophrenia predict functional recovery even when the best possible rehabilitation opportunities and optimal medication are provided. One psychological therapy, known as cognitive remediation, can improve cognitive and functional recovery – such as social relationships and the opportunity to work or take part in education. We know that the earlier you provide therapy the better the outcomes so we chose to investigate the effects of Cognitive Remediation in Early Intervention Services.
Our study investigated three different methods of providing cognitive remediation therapy – one-to-one, in a group or independently. We investigated this in Early Intervention Services in England (North London, South London, Warwick, Birmingham, Sussex, and Cambridge; 2016-2020). We compared the benefits of therapy with usual treatment. Our five-member Patient Advisory Group were involved in planning and designing the study and they provided guidance throughout the whole programme. Cognitive remediation therapy was delivered on a computer using the CIRCuiTSTM programme and was guided by a therapist. Our study participants were randomised to receive therapy in one of the three groups or usual treatment. Each treatment method differed in the amount of time with a therapist, but all had a maximum of 40 hours of treatment. Our participants were 16 - 45 years and had a diagnosis schizophrenia, schizo-affective disorder or schizophreniform disorder. The main benefit we were interested in was whether participants achieved their personal recovery goals. We collected other measures that included symptoms, cognitive tests of thinking skills and the amount of care they received to assess the costs to the NHS before and after receiving therapy. All measures were repeated after therapy was completed, and again 6 months later. The research team did not know which group an individual was in to make sure we were not biased in our assessments.
Three hundred and seventy-seven people took part were allocated to one of the therapy delivery methods or usual treatment. The four groups were similar on all measures before they began therapy. Their average age was 26, a quarter were women, nearly half were of white ethnicity, a third were working or in education, and most (85%) were living in their own or their parent’s home. We did not find any serious adverse events that were related to participation in the study. Those in the independent arm, with the least amount of therapist contact, took part in fewer therapy sessions than those in the other two therapy groups. Cognitive remediation therapy provided either in a group or one-to-one was more beneficial at the end of treatment, but the benefits reduced at 6 months. We found that group and one-to-one cognitive remediation led to the greatest personal goal achievement compared to those who carried out therapy on their own or were in the usual treatment group. Group and one-to-one CR were also more cost effective compared to usual treatment.
Overall, CIRCuiTSTM cognitive remediation therapy was acceptable and well-liked by participants. Our data suggests that it should be more easily accessible in the NHS. As both group and one-to one cognitive remediation therapy were acceptable and benefitted our participants, we suggest that service users be given the choice between the two methods. We noticed that some individuals benefited more than others, so this needs further investigation. Contact with a therapist seemed to improve adherence, which may increase therapy benefits. Future studies should investigate whether patient characteristics can inform the choice of group or one-to-one therapy.
Full details of the study results have been published in: https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Fu2790089.ct.sendgrid.net%2Fls%2Fclick%3Fupn%3DXv3JSvJ-2B3M71ppf7N9agbSC57-2FbeI7keTO1joKk0v-2Bw4w-2FKSnybrXEtIip9Vokv5-2FrGrmNbAJ3fTKvrEo7Od6vZaip6O3GC3fw8cUO2YZj2ZKnxbDT38HE4-2F6o-2Bz5nqEOlLl1bNDzjtF5CBz51l7MZl5m7CLpE5Jg1xbKOBdsFJyHEIsodXWew5DHH-2FKi890zfkD7U4YcPMts9uvtlCUPRM9r3um6yiJbw-2BDr-2FHaG9xZ8WqjN03BMvCRtaomRCt9QjA4ytHWSSTmaccKPRj5Fw-3D-3DSEZU_E1aO2-2BZlVOSJJV-2FajQqskegTd6IRomHYTi-2Fbt8SH3YL10glLzOTwtF5-2BTbnf-2F-2BB4rwb52eqFROLQY5vJtE-2FwYjf0edvO-2F6NbaBSM9O3Kx8VlaHt-2FVOKmjC3Net1RVcHk6nxOjyluIU256xmZPs0M1SiEOVVCcgpPMBJ0YuheA-2FVcrmgpwwxk8D6blheBDuAAC9c5fcv57F36c0tQXMZ-2B3A-3D-3D&data=05%7C01%7Capprovals%40hra.nhs.uk%7Ca3238db14e4541d5880408db29636c94%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638149279217174952%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=ym98QmkJeSEtMp56EPy5p%2F3f2SVPbRG76XOBnLL6Vgw%3D&reserved=0REC name
London - Camden & Kings Cross Research Ethics Committee
REC reference
15/LO/1960
Date of REC Opinion
19 Jan 2016
REC opinion
Further Information Favourable Opinion