Cognitive remediation (CIRCuiTS, CRT)

Domain IX · Biomedical, neuro & digital · Til Wykes, Clare Reeder · 2005 · King's College London, UK

What it is

CR is a time-limited programme with a front-loaded assessment and engagement phase, a long massed-practice phase in which strategy work and transfer run throughout, and a planned ending. Phase labels below are a practical synthesis of the developers' descriptions; CIRCuiTS itself presents a…

Format

• CR is a time-limited programme with a front-loaded assessment and engagement phase, a long massed-practice phase in which strategy work and transfer run throughout, and a planned ending. Phase labels below are a practical synthesis of the developers' descriptions; CIRCuiTS itself presents a…
• Format and dose (as published)

Who practises it, and how they are trained or regulated

• Version followed: King's College London Cognitive Remediation Therapy (CRT) as described in the 2007 randomised trial (Wykes, Reeder et al.) and CIRCuiTS (Computerised Interactive Remediation of Cognition – a Training for Schizophrenia) as described by its developers in Reeder et al. 2016 and 2017, and in the ECLIPSE programme (Wykes et al., NIHR 2024); core ingredients follow the 2020 expert working group white…
• What it is. Cognitive remediation (CR) is a structured, therapist-delivered training of thinking skills (attention, memory, executive functions such as flexibility and planning) for people whose cognitive difficulties limit everyday functioning, chiefly people with schizophrenia and other psychoses. The Cognitive Remediation Experts Workshop (CREW, Florence 2010) definition, as cited by its developers, describes it…
• How change is thought to happen. Change comes from four combined ingredients: (1) a trained therapist who facilitates; (2) repeated, graded cognitive exercise (massed practice); (3) learning and monitoring efficient problem-solving strategies, i.e. metacognition, knowing and regulating one's own thinking; and (4) deliberate procedures that carry gains into daily life and personal goals. Computer training alone is…

Evidence status, as the guide reports it

• ECLIPSE: up to 42 sessions; one-to-one about twice weekly; groups of up to four, three times a week for 12 weeks; independent arm with up to 30 minutes of therapist access weekly.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• 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

• drift into general talking therapy or into unsupported drill.
• technical failures eroding motivation; less visibility of distress.
• praise that feels hollow or childish; the person fixating on scores.
• early warning signs of relapse; risk; side effects affecting attention.
• comparison and shame across differing levels; quieter members getting less coaching.

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.