Cognitive remediation for people with psychosis in low-and-middle-income countries (LAMICs)

Yamini Vig, former MSc student, and Matteo Cella, Professor of Clinical Psychology, both at King’s College London, UK

Around the world, millions of people living with severe mental health conditions—such as schizophrenia, bipolar disorder, or major depression—struggle with distressing symptoms and cognitive challenges. These include memory, attention, problem‑solving, and information processing challenges that make daily life tasks harder, aggravate other distressing symptoms, limit employment opportunities, and reduce quality of life.

CRT is a structured, evidence‑based psychological intervention designed to improve cognitive skills that typically involves thinking skills exercises - sometimes computer‑based - combined with strategies to help people apply these skills in real life. In high‑income countries, CRT has been shown to improve functioning, support recovery, and enhance people’s ability to engage in work or education. We know it works, but the evidence comes mostly from high-income countries. The question arises whether we can effectively implement it in other cultures and countries like low‑ and middle‑income countries (LAMICs) where cognitive impairment is still a major determinant of long-term functional disability and access to evidence-based interventions is limited.

A paper published recently in Social Psychiatry and Psychiatric Epidemiology answers this question by establishing the efficacy, feasibility, and scalability of cognitive remediation in LAMICs. An understanding of whether CRT can be adapted and effectively delivered in these settings is important if we are to improve the outcomes of people with serious mental health problems.

The paper found that:

• CRT is feasible in LAMICs. Even in settings with limited resources, trained facilitators can deliver CRT effectively.

• Participants benefit from the therapy with improvements not only in cognitive skills but also in broader areas of functioning.

• Adaptation matters. CRT cannot simply be “imported” from high‑income countries. It needs cultural tailoring (e.g., using words and items for cognitive tests that are culturally relevant), flexible delivery formats (e.g., with a family member supporting therapy sessions), and sensitivity to local barriers, such as limited access to technology, transportation challenges, or high levels of stigma around mental health.

• Community involvement is key. Successful implementation relies on collaboration with local health workers, families, and community organisations that can promote this approach and help deliver it. This aligns with global mental health research showing that community‑based approaches often lead to better engagement and outcomes.

Mental health care in LAMICs faces significant challenges: shortages of specialists, limited funding, and high levels of unmet need. Interventions like CRT that can be delivered by trained non-specialists offer a way to expand care access and support people’s employment, education, and social participation. But scaling it up will require investment, training, and collaboration across sectors. Evidence on successful implementation in LAMICs can also be a stepping stone for implementation in high-income countries by showing us the most cost-effective method of providing the intervention.

For CRT to realise its full benefits in LAMICs, we will need five actions:

1. Researchers collaborating on large multicentre studies

2. Prioritising cultural and contextual therapy adaptation

3. Investing in low‑cost digital solutions

4. Developing scalable training pathways, and

5. Advocating for CRT to be included in national mental health strategies

You can read and download the full paper here: https://link.springer.com/article/10.1007/s00127-026-03136-x