Cognitive adaptation training

Domain II · Behavioural & cognitive · Velligan · 2000 · San Antonio

What it is

Cognitive adaptation training (CAT) is a home-based, manualised psychosocial treatment for people with schizophrenia and other serious mental illness. It does not try to retrain cognition. It works around ("bypasses") cognitive and motivational impairments by changing the person's surroundings:…

Format

• Format and dose
• Individual sessions in the client's home, and at work or day programmes where relevant. Remote delivery is possible (see 4.27).

Who practises it, and how they are trained or regulated

• CAT is a single individual treatment with a fixed assessment-to-plan logic. The published papers do not number its phases. The phases below are reconstructed from the trial papers and from the developer's training site, which groups home-visit videos as EFA, early, early-to-middle, and middle-to-late phase.
• Delivered by bachelor's- and master's-level clinicians, occupational therapists, psychiatric nurses or case managers after CAT certification. Certification is an 18-module, 6.5-hour eLearning course or a 2-day live workshop. Supervision is ongoing, and group supervision is used to generate new strategies.
• Goals: build independence (the developers' training lists homework for this), hand over to carers, staff or caseworkers, and plan continued support.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• stove safety (4.25).
• supplies running out. Add a restock cue (4.17).
• checking routines turning into compulsive checking.
• staff doing tasks for the person, or tidying supports away.
• hoarding-level clutter, which needs a separate, graded plan.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.