Why awareness of cognitive difficulties matters

Tobias Landström, Licensed Psychologist, Specialist in Clinical Neuropsychology, Region Skåne, Sweden (formerly Centre for Clinical Research Västmanland, Uppsala University)

While research has shown that cognitive remediation is effective for people with a diagnosis of schizophrenia, its implementation in routine care remains variable. One reason may be recognition of cognitive problems or their importance in recovery by both clinicians and people with lived experience. If we better understand how cognitive difficulties are experienced in everyday life by those with lived experience of schizophrenia, we can perhaps take steps to increase awareness, improve engagement in treatment and overcome cognitive limitations on recovery.

We interviewed people with psychosis and cognitive impairment recruited from a specialist outpatient service in Sweden. After completing a cognitive assessment, participants told us about a typical day. Rather than asking directly about memory or attention, we used an open-ended approach to allow participants to describe their daily experiences.

We discovered not only the many ways that cognitive difficulties can show up in daily life but also individual differences in awareness of these challenges. Some people struggled to describe or explain their cognitive difficulties. For example:

“No, it’s hard to explain. I haven’t even managed to explain it fully to my family, they don’t really under­stand it.”

Others demonstrated a different understanding:

“I just did a ChatGPT search for what visuospatial means, and it said things like reading maps, for example. I’m good at that kind of thing, like spatial stuff. I have a good sense of direction and all that, but then I’m really slow in my thoughts on certain things.”

We use the term awareness to refer to participants’ ability to recognize, describe, and reflect on their cognitive difficulties in daily life. While all participants recognized that they had cognitive challenges, they differed in how clearly they could articulate or make sense of them. This form of awareness is related to, but distinct from, clinical insight, which more broadly refers to recognizing symptoms.

These findings suggest that awareness of cognitive difficulties is not only about how severe they are, but also about how accessible they are as experiences. This has implications for clinical work involving cognitive remediation. When difficulties are hard to articulate, they may be challenging to address, both for the individual and the clinician. In contrast, more clearly recognized and described difficulties may provide a better starting point for developing coping strategies and engaging in treatment.

Supporting individuals in recognizing and articulating their cognitive difficulties may be an important first step in making these interventions more accessible and meaningful. This could involve structured reflection on everyday situations, feedback from cognitive assessments, or guided psychoeducation. However, there is currently limited evidence on how best to enhance this kind of awareness, and further research is needed.

You can read more about this research in: Landström et al. (2026) Living with psychosis and cognitive impairment: a qualitative study - BMC Psychiatry