Feasibility and acceptability of combining cognitive remediation and tDCS in long-term psychiatric clinical care

Background and hypothesis: Cognitive impairments are commonly experienced by individuals with severe mental illness (SMI) and are associated with problems in everyday life. This pragmatic, randomized, controlled, pilot trial explored the acceptability, feasibility, and preliminary effects of cognitive remediation (CR) combined with transcranial direct current stimulation (tDCS) for cognitive and everyday functioning in individuals with SMI in long-term psychiatric clinical care. We hypothesized that combining CR and tDCS is feasible and acceptable to individuals with SMI.

Study design: Twenty-four individuals with SMI were randomized to either CR + active tDCS (n = 13) or CR + sham tDCS (n = 11) over 32 sessions (16 weeks). Acceptability was evaluated in semi-structured interviews. Cognitive and everyday functioning were evaluated at baseline, post-16 week waiting period, post-intervention, and 6-months post-intervention.

Study results: Overall, participants were positive about the training. Over 60 % of participants successfully finished at least 20 sessions, meeting the predefined criteria for feasibility. CR appeared to yield subjective improvements to participants, significant improvements in cognitive tests post-intervention and at follow-up and improved self-reported negative symptoms at follow-up. Observer-rated everyday functioning and cognition, and subjective cognitive complaints did not change following CR.

Conclusions: This study concludes that CR is an acceptable and feasible intervention for individuals with SMI in long-term psychiatric clinical care. The addition of tDCS requires further investigation to ascertain its potential benefits.