Note: I wrote this article for an organization called NAMI (National Alliance on Mental Illness).
On yet another bitterly cold night during one of the worst winters in U.S. history, those perhaps stressed by the requisite cabin fever were treated not only to their own brain-shaped squish-ball, but also to some very exciting news in the world of mental health treatment. On Thursday, February 27, 2014, Chicago and suburban-Chicago NAMI members and supporters attending NAMI Barrington’s monthly speaker meeting welcomed Ray Gonzalez, ACSW, LISW-S, to a packed house at Oakton Community College in Des Plaines, IL. At this meeting, Gonzalez shared extensive information about a compelling advancement in the treatment of schizophrenia that is currently being practiced in 29 other cities around the country.
Gonzalez serves as Executive Director of the Center for Cognition and Recovery in Cleveland, Ohio, and hopes to bring this successful treatment program to the Chicago area. The topic of his discussion and of the technique, “Cognitive Enhancement Therapy: Physical Therapy for the Brain” ignited strong support from the 150 attendees, who expressed unanimous interest in seeing the program established locally.
Although Cognitive Enhancement Therapy (CET) is a non-medication treatment geared primarily toward remediation of the underlying disabilities of schizophrenia, it is also a promising approach in the treatment of other cognitive disorders.
Like Cognitive Behavioral Therapy, Cognitive Enhancement Therapy works to remediate the brain, and is a form of cognitive remediation that supplements standard drug therapies. Since patients are initially reluctant to accept their diagnoses and further frustrated by the side effects they experience from their medications, Gonzalez opened his explanation of CET with the popular industry quip that “the best medication is the one the patient takes.” Nevertheless and to complete his point, Gonzalez quoted the words of Dr. William McFarlane, M.D., who specified that it also “takes more than a pill to really recover” from mental illness. CET is meant to fill in the gaps left by traditional treatments alone, namely medication and talk therapy.
CET works on the premise that people can and do recover if they have the proper and necessary treatment. According to Gonzalez, CET is a year-long one-time intervention that focuses on improving social cognition and quality of life. It is “an active treatment, a very hopeful intervention” that mitigates the social isolation that is part and parcel of experiencing schizophrenia and other psychiatric illnesses. Perhaps above all, CET focuses on how to keep people who are struggling to recover from schizophrenia and bipolar disorder from being lifelong or institutionalized mental health patients. CET participants enjoy both measurable and immeasurable improvement, with graduation and attendance rates of 85%.
Because overcoming stigma and social isolation are secondary but important hallmarks of persistent and severe mental illnesses and disabilities, CET works largely on the premise that the best mental exercise is social interaction. CET accomplishes this task primarily with weekly social cognition groups, as well as computer exercises similar to popular interactive computer programs that focus on brain exercises; yet, adds to that activity the crucial supportive component of active weekly coaching and feedback by trained CET therapists.
In the social cognition group sessions, participants work together on teams with their assigned partner to solve interesting and engaging cognitive tasks. This un-intimidating and manageable pairing into groups of two aids in achieving a higher sophistication of socialization than the participants typically enjoy. In many cases, an assigned CET partner represents the first real friend the patient has had in many years, or possibly ever. It has been proven that such groupings also begin to awaken each participant’s capacity for bonding, intimacy and empathy–all higher level states of cognition and behavior that otherwise generally escape these individuals.
The goal of such an active, evidence-based practice is to gradually integrate the individual back into society, hopefully to function on a level high enough to maintain employment.
It is thought that CET may increase gray matter through the increase in the number of new synaptic connections. CET not only improves socialization, but also works on other modalities that increase self-esteem and self-confidence. Areas of improvement include awareness of one’s physical health and hygiene, cognitive processing speed, motivation/ initiative and energy, attention, concentration, memory, problem solving, abstract thinking, role flexibility, sense of joy, sense of humor and spontaneity, to name a few.
Success in CET has proven to be long-range, not just short-term. Some individuals tested were able to maintain functionality as much as twelve years post-CET. Many participants had not only obtained but also maintained employment, and relationships had radically improved to the point that some had even married. CET is currently available in specified areas, but one of the primary purposes of Gonzalez’s visit was to elicit interest in expansion, specifically to the Chicago area and throughout the state of Illinois.
In recognition of their dissemination of CET, the Center for Cognition and Recovery received the 2011 SAMHSA Science and Service Award. SAMHSA also recently awarded a Primary Care & Behavioral Health Care Integration Grant to Didi Hirsch, a large CMHC in Los Angles. The grant included funding for them to use CET in their Health Home Initiative. CET is being used to improve their clients’ processing speed, working memory and executive functioning so that they can better communicate with their primary health care providers.
CET is currently available in specified locations to qualifying individuals living with schizophrenia and schizoaffective disorder, as well as other related mental disorders. Participants must be 18 years of age or older and medication compliant. Currently, participants must also be fluent in English, and able to read at a fourth-grade level. The program takes 48 weeks (3 ½ hours per session), and participants continue to develop over time. The CET group is no fewer than 8 and no more than 12 participants, both male and female. CET is strongly recovery-oriented, and in current locations is covered by Medicare, and by Medicaid in 10 states. Many attendees at the meeting stayed to the very end of the question-and-answer session. NAMI hopes to help expose more providers to CET, and to bring CET to the area as soon as possible.
To learn more about CET, go to www.cetcleveland.org. Or, to help assist in bringing this exciting and much anticipated treatment to Illinois, contact Hugh Brady at firstname.lastname@example.org, or Ray Gonzalez at email@example.com.
The next NAMI speaker will be Dr. Nausheen Din on March 18. Dr. Din is a Barrington psychiatrist whose presentation will feature ways to facilitate success for college-aged student sufferers of depression, anxiety, substance abuse, and other psychological concerns. The meeting takes place in Barrington Village Hall from 7-9 p.m. There is no charge for this event, and all are welcome to attend.
@ Debra A. Valentino, all rights reserved.