Schizophrenia: targeting auditory difficulties shows no demonstrated additional cognitive benefit

Putting a plausible hypothesis to the test

Early auditory processing difficulties affect some people with schizophrenia, but not all. They are linked to more complex cognitive difficulties. According to the abstract, improvements in auditory processing are also associated with cognitive gains, although this association alone does not establish a causal link.

The researchers therefore tested a specific hypothesis: patients with an auditory deficit at baseline would benefit more from cognitive remediation that included exercises targeting this deficit than from remediation without those exercises.

Comparing two forms of remediation

The randomized study involved adults receiving outpatient care for schizophrenia. After an assessment of their auditory processing at baseline, participants received cognitive remediation with or without early auditory training. Cognitive and functional outcomes were measured after treatment and again three months later.

The abstract reports 184 participants, but the detailed counts total 172 people, both across auditory categories and across treatment groups. This discrepancy is not explained in the available excerpt. The program's duration is not specified either.

Gains observed, but no advantage from targeting auditory processing

Cognitive gains described as moderate in magnitude were observed under the remediation conditions studied. At the final assessment, however, including auditory training had no significant effect on auditory, cognitive or functional outcomes, regardless of the baseline auditory profile.

Among participants with a deficit at baseline, auditory processing improved significantly but modestly, with or without targeted auditory exercises. The analysis also did not confirm that cognitive gains mediated the relationship between auditory improvements and functional capacity.

This finding does not demonstrate that the two approaches are equivalent. Nor does it establish the effectiveness of cognitive remediation compared with no remediation, since both groups received it.

What we can take away

This trial does not justify routinely favoring targeted auditory training within cognitive remediation solely because an auditory deficit is present at baseline. On its own, it does not call cognitive remediation as a whole into question.