Listening to Lived Experience: Improving Cognitive Remediation Together
Synthia Guimond, PhD, Associate Professor of Psychology, Université du Québec en Outaouais, and Scientist, The Royal’s Institute of Mental Health Research, University of Ottawa, Canada
During the co-development of ThinkTactic VR, our virtual reality cognitive remediation program for psychosis, one member of our lived-experience expert group encouraged us to think differently about cognitive training: in everyday life, we do not use attention, memory, executive functions, and social cognition in isolation, so why should we train them as separate skills?
Looking back, I recognize it as an important insight that changed the direction of ThinkTactic VR and how I now think about designing cognitive remediation interventions.
There are good reasons to organize cognitive remediation around specific domains, and this was how I had initially conceptualized ThinkTactic VR. Doing so allows us to target particular processes, progressively increase difficulty, evaluate change, and tailor interventions to individual needs. It can also make the aims and potential benefits of cognitive remediation more concrete and easier to communicate to patients.
But everyday life is not divided into cognitive domains. Preparing a meal, finding our way to an appointment, completing a work task, or participating in a conversation requires several abilities working together. For people experiencing cognitive difficulties, distinctions between domains may matter less than being able to accomplish something meaningful.
This illustrates why incorporating lived-experience perspectives can be so valuable in intervention development. Researchers bring scientific knowledge, clinicians bring experience delivering treatment, and people with lived experience understand how cognitive difficulties affect everyday life. All three forms of expertise are necessary.
ThinkTactic VR shows how co-design can strengthen innovation. It helped us create an intervention grounded in science and clinical practice, as well as in the priorities and experiences of the people for whom it was developed.
Co-design should not be limited to new interventions
People with lived experience can also help improve established programs. In an earlier study, we spoke with people who had completed Cognitive Enhancement Therapy (CET) about what helped and what could be improved. Their feedback highlighted both the strengths of CET and opportunities for refinement. For example, participants valued the support and feedback from coaches and peers, while recommending that CET materials and computerized exercises be streamlined and modernized.
Some cognitive remediation programs have been used for years and are supported by substantial evidence. Building on this foundation, we should continue adapting these programs based on the experiences of patients and clinicians to make them as engaging and relevant as possible.
Co-design requires humility, time, and resources. The team must be willing to recognize that even carefully developed ideas may not always fully meet the needs of the people they are intended to support, listen openly, share decisions, and sometimes change direction.
Traditional metrics-based academic evaluation does not always recognize this work. Meetings, interviews, qualitative analyses, and repeated revisions require substantial time and effort, and generate fewer traditional academic outputs. Funding competitions also tend to prioritize new interventions or clinical trials, with fewer opportunities to support the collaborative improvement of existing programs. Yet this work is essential and deserves greater recognition.
Funding agencies have an important role to play. Co-design should not be optional or end after initial development and testing. People with lived experience should be given genuine opportunities to influence decisions and remain involved as interventions are implemented and modified over time. Dedicated support is essential if interventions are to keep pace with changing needs and advances in technologies, reach more people, and stay sustainable in clinical practice.
People with lived experience helped shape ThinkTactic VR from the beginning, and our team remains committed to ensuring that their perspectives continue to inform what comes next. As cognitive remediation continues to evolve, this type of collaboration should become a standard part of how interventions are developed and improved.
Read more about the related projects
Yee J, Matheson H, Bogie BJM, et al. (2025). Cognitive Remediation for Psychosis in Virtual Reality (ThinkTactic VR): Qualitative, Iterative, and User-Centered Codevelopment Study. JMIR Mental Health, 12, e69359.
Noël C, Gu F, Ormston L, et al. (2021). Cognitive Enhancement Therapy in Early Schizophrenia: A Qualitative and Quantitative Case Series of Patients’ Experiences. Journal of Psychosocial Rehabilitation and Mental Health, 8, 109–123.
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