Cognitive Remediation implementation in Canada

Christy Au-Yeung, PhD Candidate in Clinical Psychology, McGill University, Douglas Research Centre, Douglas Mental Health University Institute

When I reflect on my time working with patients within the Canadian healthcare system, one person stands out. “Colin” (name changed), a young man in his mid-twenties who sought therapy after his first episode of psychosis. The focus of our work was on managing his worries and distress about others being likely to cause him harm. But he also experienced memory and concentration problems that led to intense feelings of shame and reluctance to engage in social activities and employment. These difficulties affected his quality of life. My colleagues, though, were unaware of ways we could support Colin with his cognition. This reflects a larger reality in Canada: even when cognitive difficulties are acknowledged, clinicians trained in cognitive remediation interventions are few and far between. Colin was fortunate, as we found a computerized cognitive training program supported by a social worker in a nearby clinical team.

How to make a change

In response to these challenges, several Canadian cognitive remediation implementation trials have been run. The current one, the iCog Canada effectiveness-implementation trial, has delivered cognitive remediation to 100 people with psychosis and bipolar disorder. We co-designed a training platform to provide education on the importance and effects of poor cognition and share the technical skills for delivering cognitive remediation.

Collaborating with other hospitals across the country identified that culturally appropriate materials were needed in English and French, e.g., using maps of relevant Canadian cities. These have been co-developed alongside our patient partners. At some sites, trained peer support workers have been involved as co-therapists. This significantly helped to engage patients in the initial stages of the intervention and enriched treatment, for instance by facilitating open discussions about the role that positive symptoms have on cognitive performance. 

Encouragingly, a cognitive remediation (CR) implementation pilot project in the province of British Columbia that served over 800 individuals with psychosis in both inpatient and outpatient settings has led to ongoing permanent public funding for cognitive remediation in the province. Clinicians who co-facilitated groups championed the intervention at each site, built capacity by raising the profile of cognitive remediation, and demonstrated its benefits. Only 1.6 full-time equivalent clinicians were able to provide services to over 100 clients each year. These clinicians came from different professional backgrounds, and they were able to facilitate or support cognitive remediation with fidelity.

The journey toward effective cognitive remediation for individuals like Colin has been a challenging but rewarding one. Through initiatives like iCog Canada and the BC Provincial CR trial, we've made strides in providing cognitive remediation to individuals across the country - breaking down barriers with online training, drawing expertise from those with lived experience to adapt interventions, and taking multi-faceted approaches to deliver cognitive remediation in resource-limited settings. This much-needed intervention is now being offered and improving cognition and functioning for patients across Canada.

For more information about the iCog project, visit https://www.icogca.com/.

You can also read the full study protocol at https://www.researchprotocols.org/2025/1/e63269