Cognitive Remediation Therapy may improve communication for people with schizophrenia

by Matt Thomas, Principal Practice Lead, Marathon Health and Adjunct Associate Professor - School of Psychology, Charles Sturt University & Discipline of Psychiatry and Mental Health, University of NSW

Cognitive remediation therapy improves cognitive functioning for people with schizophrenia. This therapy’s potential effect on communication - an area central to daily functioning, therapeutic engagement and overall quality of life – has received less attention.

Communication difficulties are common in people with schizophrenia, particularly in practical day-to-day and social communication. These challenges include staying on topic, explaining complex information, initiating conversations and using communication effectively in social contexts. They are related to difficulties in executive functioning, metacognition and social cognition. CIRCuiTS™, which combines computer-based tasks with therapist-guided strategy development, is focussed on these cognitive problems and so may also affect communication.

My colleagues and I analysed changes in communication ability following a trial of CIRCuiTS™ in New South Wales, Australia with thirty people with psychosis. Before therapy, communication functioning was extremely poor, and many people needed a lot of support with activities of daily living. Most were admitted to mental health rehabilitation units at Bloomfield hospital, where they received 24-hour care. A small number of participants lived in the community, where many received regular support from family members or professional carers to complete daily tasks such as personal hygiene, cooking, shopping and aspects of personal administration.

After completing CIRCuiTS™, these people showed large improvements in communication. Gains were seen in initiating conversations, maintaining discussions for longer periods, answering complex questions, and talking about activities and future goals. These individuals also improved in functional communication tasks such as using diaries and reminders, managing written forms, writing letters or emails and handling personal finances.

The improvement in communication is likely linked to elements of the CIRCuiTS™ programme, as repeated practice of cognitive strategies, therapist modelling, errorless learning and real-world tasks all prompt discussion. This continuous interaction between the client and therapist in the sessions provides a structure that encourages greater confidence and more consistent engagement in social communication.

This wasn’t a controlled study, but it provides some meaningful preliminary evidence that cognitive remediation therapy may help with communication. For clinicians, the findings support cognitive remediation therapy as an exciting treatment option in rehabilitation. For researchers, they highlight the need for controlled studies using more comprehensive measures of communication.

This study suggests that communication is not a fixed problem. With targeted cognitive remediation, measurable and clinically relevant improvements could be achieved.

The full paper is available at:

McGuiness et al. (2025). The potential of cognitive remediation therapy for improving the communication capabilities of adults with schizophrenia and other psychotic spectrum disorders. . International Journal of Language and Communication Disorders, 60, e13141. https://doi.org/10.1111/1460-6984.13141