Competence through cognition: cognitive remediation and restoration of trial competence

A new and promising avenue for research into competency restoration treatment is cognitive remediation, which is an empirically-supported set of treatment techniques designed to facilitate cognitive skills development (Medalia, Revheim, & Herlands, 2009). Working with 33 male patients from an inpatient forensic hospital, this randomized control trial was a pilot study to explore the effectiveness of cognitive remediation to improve competence to stand trial. Compared to a control group receiving standard hospital treatment, the treatment group received a supplement of five weeks of cognitive remediation using the NEAR model (Neuropsychological Educational Approach to Cognitive Remediation; Medalia, Revheim, & Herlands, 2009). The researcher compared pre- and post-treatment data for changes in verbal memory, problem-solving, and competence to stand trial, as measured by the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA). Results indicated that cognitive remediation significantly improved the Reasoning ability measured by the MacCAT-CA. Changes on the two other factors of the MacCAT-CA were not significant. No significant changes were found on measures of verbal memory or problem solving. Patients who benefitted most from cognitive remediation were those exhibiting greater need for treatment. Successful treatment participants tended to be more mentally ill, have diagnoses of schizophrenia or another psychosis, and exhibited poor performance on a pre-test measure of competence to stand trial. This pilot investigation provided initial support for the use of cognitive remediation to improve competence to stand trial in individuals with severe mental illness and impaired legal reasoning. (Published By University of Alabama Libraries