Many of us know someone who believes in something that is not true, and sometimes it is difficult to change their mind. For people living with schizophrenia, it is much more common to believe in false ideas, even in the face of contradicting evidence. This is a delusion, and is one of the biggest problems for people with schizophrenia and often contribute to the person’s hospitalization.

Dr. Todd Woodward and his team are looking at how participation in group-based treatment for delusions and cognitive impairment alters pathways in the brain. This research is helping to identify specific neural pathways in hopes that these pathways can be targeted with treatments to improve symptoms in people living with schizophrenia.

Group-Based Therapy for Delusions and Cognitive Impairment

While medications prescribed for schizophrenia targets the neurotransmitters that influence brain pathways, cognitive therapy targets the thought process. The goal is to reduce the severity of the symptoms by changing the thought process.

This project used two specific types of group-based therapy: metacognitive training (MCT) and cognitive remediation therapy (CRT). These therapies have been proven to work in previous studies. The goal of this project was to look at how brain activity changes due to these therapies. Since each of these therapies targets a different brain pathway, it was expected to change different parts of the brain.

Metacognitive Training

People with schizophrenia have brain networks that lead to biased information processing, which can then lead to delusions and hallucinations. Dr. Todd Woodward and Dr. Steffen Moritz developed MCT to help people counteract delusions and paranoia by becoming more aware of how thinking patterns can lead to these symptoms of psychosis.

MCT trains people to be aware of their thought processes and points out how everyone – not just those living with schizophrenia – can process information in a biased way, including ignoring evidence that would prove a belief wrong or jumping to conclusions.

The idea is that if a person can accept that not all beliefs are true and learn to gather more information before deciding whether something is true, then they may find it easier to overcome delusions that are impacting their lives.

Cognitive Remediation Therapy

Schizophrenia impairs cognitive function in a few ways, including interfering with memory, attention span, and the ability to plan. CRT exercises the mind to improve these cognitive functions. With practice, people with schizophrenia can reactivate dysfunctional brain pathways so that they get better at performing these tasks.

A randomized controlled study was done over five years and participants were recruited from outpatients in Vancouver and randomly assigned to one of three groups:

  • Group-based MCT
  • Group-based CRT
  • Treatment as usual (usually just medication)

After participants completed their course of treatment, the research team examined the brain changes that occurred for each group.

How Brain Imaging Helps Identify Specific Pathways for Treatment

We know that people use different areas of the brain for different functions. But how do we see exactly which pathways in the brain are activated to carry out specific tasks?

When a specific neural pathway in our brain is in use, the neurons need oxygen to fire. The way they get that oxygen is through blood flow to the area. Functional magnetic resonance imaging (fMRI) shows where in the brain oxygenated blood is flowing.

This study used fMRI to compare which areas of the brain are used when performing specific tasks.  It turns out that there was no difference between people with schizophrenia and those without. In other words both groups engaged the same neural pathways in brains to accomplish the same tasks, however people with schizophrenia needed to work harder to complete the same cognitive tasks compared to people without schizophrenia.

Gathering Evidence to Support New Treatments

Medication works while a person is taking it and only serves to help a person manage positive and negative symptoms of schizophrenia. Cognitive training, however, gives people tools they can use to improve cognitive skills and work to counter the cognitive losses associated with schizophrenia.

This therapy is proven to help people remember things, pay attention for longer periods, and better organize their lives. This study seeks to identify the specific pathways in the brain involved in these tasks so that they can be targeted to improve symptoms of people living with schizophrenia.

Funds provided by BCCSF are making it possible for the research team to compile and analyze five years of data so that they will be able to report on how MCT and CRT change the brain.

Analysis of the data collected for this project is likely to give insight into promising treatments for people living with schizophrenia. Finding new effective ways to improve the lives of people is important in the development of full and comprehensive treatment plans, which includes the use of medication and managing their side effects.