Implementation of cognitive remediation in Japan

by Satoru Ikezawa, Visiting Scholar, National Center of Neurology and Psychiatry, Tokyo, Japan

In Japan, although the number of psychiatric inpatient settings has gradually declined, outpatient services remain busy and over capacity. Despite access to such rehabilitation programs, many individuals with severe mental illness continue to report dissatisfaction with their functioning and face ongoing difficulties with employment and independent living. In 2006, we began disseminating a CR program, the Neuropsychological Educational Approach to Remediation (NEAR), across mental health institutions in Japan to improve patient functioning. Two certified Japanese NEAR clinicians have since conducted 21 training workshops for 679 therapists, including occupational therapists (50.7%), psychotherapists (25.8%), and psychiatrists (9.1%). Ongoing supervision, provided either in person or via video conferencing, ensures treatment fidelity and quality.

We investigated what helped and hindered CR implementation and discovered that 61% of settings where training had occurred implemented the therapy. The most common barrier was staff shortages. Across sites that implemented NEAR, 1,780 clients completed the program. Over ten years, the diagnostic composition of participants shifted, with the number of people with a diagnosis of schizophrenia decreasing and those with mood disorders increasing. This suggests that there is increased recognition of the importance of cognitive impairment in many mental health conditions. In terms of outcomes, the intervention not only improved social functioning but also led to gains in patients’ self-confidence and sense of self-competence, highlighting its broader psychological impact beyond functional measures.

CR is most effective when combined with other psychosocial interventions, so NEAR was not implemented as a standalone treatment in any setting. Instead, it was typically integrated with vocational rehabilitation, occupational therapy, and psychoeducation. Although most participating services were non-academic, nearly all adopted standardized cognitive assessment tools, despite the absence of insurance reimbursement for such evaluations.

We also asked what might facilitate implementation, and many services emphasized Ministry of Health, Labour and Welfare approval. This would enable insurance reimbursement and so would help sustain the service, as currently NEAR and other CR programs are implemented on a voluntary basis and do not raise funds for the services offering it.

CR has attracted considerable interest among therapists, patients, and their families throughout Japan and appears to be both feasible and culturally adaptable within routine clinical settings, highlighting its potential as a scalable psychosocial intervention to improve functional outcomes. Looking ahead, efforts are now focused on embedding CR into professional development and continuing education frameworks, which may further expand interest and uptake among therapists.