Non-pharmacological interventions to improve cognitive impairment and psychosocial functioning in schizophrenia: a critical review

Cognitive impairment represents one of the core features of Schizophrenia Spectrum Disorders (SSD) and has a significant negative impact on psychosocial functioning and real-world outcomes of people living with SSD. While currently available pharmacological treatments do not appear to provide significant improvements in cognitive performance, some non-pharmacological interventions have shown to reliably provide cognitive gains and consequent improvements of psychosocial functioning in SSD. The present critical review focuses on the evidence of effectiveness and on the limitations of these interventions. Cognitive remediation and physical exercise-based interventions appear to provide improvements in both cognitive performance and psychosocial functioning, with clear moderators of effects and with abundant scientific evidence supporting their clinical usefulness. Non-invasive brain stimulation techniques such as transcranial direct current stimulation and transcranial magnetic stimulation appear as promising interventions, but more research is currently needed to better assess the optimal modalities of delivering these treatments to people with SSD. More research is currently needed to better understand barriers and facilitators of implementation in clinical practice of these interventions, and more organization, policymakers and clinicians efforts are required to deliver them to people living with SSD in a consistent manner.