iCogCA: An innovative protocol promoting cognitive health through online group interventions for individuals living with a schizophrenia-spectrum disorder (Preprint)

BACKGROUND Cognitive impairments are a key aspect of schizophrenia-spectrum disorders (SSD), significantly affecting clinical and functional outcomes. The COVID-19 pandemic has heightened concerns about mental health services and cognitive stimulation opportunities. Despite evidence-based interventions like action-based cognitive remediation (ABCR) and metacognitive training (MCT), a research-to-practice gap exists in their application across mental health settings. OBJECTIVE The iCogCA study aims to address this gap by implementing virtual ABCR and MCT through a national Canadian collaborative effort using online psychological interventions to enhance cognitive health in SSD. METHODS The study involves five Canadian sites, with mental healthcare practitioners trained virtually through the E-Cog platform which was developed by our research group. Over 2.5 years, participants with SSD will undergo pre- and post-intervention assessments for clinical symptoms, cognition, and functioning. Each site will run four groups annually for both ABCR and MCT, totaling ~390 participants. A non-randomized concurrent control design will assess effectiveness design in which one intervention (e.g., ABCR) acts as the active control for the other (e.g., MCT) and vice-versa, comparing cognitive and clinical outcomes between the interventions using generalized linear mixed effect modeling. Implementation strategy evaluation will consider the digital platform's efficacy for mental healthcare practitioners training, contextual factors influencing implementation, and sustainability, using descriptive statistics for quantitative data and thematic analysis for qualitative data. RESULTS A pilot pragmatic trial has been conducted previously at the Montréal site, evaluating three early implementation outcomes: acceptability, feasibility, and engagement. Patient and therapist acceptability was deemed as high and feasible (75% of recruited service users completed therapy, rated feasible by therapists). Technology did not appear to significantly impede program participation. Therapist-rated levels of engagement were also satisfactory. In the ongoing study, recruitment is underway, and intervention groups have been conducted at all sites, with therapists receiving training via the E-Cog learning platform. CONCLUSIONS At least three significant innovations will stem from this project. First, this national effort represents a catalyst for the use of digital technologies to increase the adoption of evidence-based interventions and will provide important results on the effectiveness of virtually-delivered ABCR and MCT. Second, the results of the implementation component of this study will generate the expertise needed to inform the implementation of similar initiatives. Third, the proposed study will introduce and validate our platform to train and supervise mental healthcare practitioners to deliver these interventions, which will then be made accessible to the broader mental health community.