# Efficacy of Personalizing Cognitive Remediation for Schizophrenia by Targeting Impairments in Early Auditory Processing

> **NIH NIH R01** · COLUMBIA UNIVERSITY HEALTH SCIENCES · 2022 · $507,962

## Abstract

Schizophrenia is associated with cognitive deficits that negatively impact daily functioning. Interventions
that improve cognitive functioning in schizophrenia are critical to limit long-term disability. Cognitive
remediation (CR) for schizophrenia has low moderate effect sizes on cognitive and functional outcomes, but
therapeutic responses to CR are heterogeneous. Prospective identification of treatment-responsive individuals
and individualized treatment approaches remains an unmet challenge. Our preliminary studies using
personalized CR approaches for schizophrenia indicate that baseline early auditory processing (EAP), which is
impaired in about half of people with schizophrenia, is a good neurobehavioral marker for informing treatment
strategy. We found that people with baseline impaired EAP improve significantly more on cognitive outcomes
when CR includes EAP training, and this facilitates larger functional gain. However, there is no added benefit
to giving this training to people with baseline intact EAP. Subgroup specificity of therapeutic mechanism is
suggested by the positive association of auditory processing gain with cognitive improvement among EAP
impaired versus the negative or non-significant association among those who are EAP intact. These findings
support the importance of addressing basic auditory processing deficits when attempting to remediate higher
order auditory impairments such as verbal learning. In addition, they highlight the need for routine assessment
of EAP in CR participants, so treatment can be personalized. Pilot data from an ongoing center grant project
indicates that clinicians are able to assess EAP status and use it to personalize treatment to either include or
exclude EAP training. Thus it is feasible to implement this kind of personalized CR in public clinic settings.
 The proposed study uses a treatment controlled randomized design, first stratifying subjects by EAP
status and then randomizing to EAP enhanced CR, regular CR, or treatment as usual. The study will be
conducted in community clinics using the infrastructure of the ongoing center grant CR project. Cognition will
be the primary outcome with functional capacity the secondary outcome. Mobile EEG administered to CR
participants will examine neurophysiologic markers of need for and response to EAP training. Mediation
analysis will examine whether gains in cognition mediate the relationship between gains in EAP and functional
outcome. This will inform our understanding of EAP as the therapeutic change mechanism for about half of CR
participants and confirm that EAP training need not be given to those CR participants with baseline intact EAP.
 The goal of this study is to enhance CR outcomes in schizophrenia spectrum disorders by identifying a
scalable approach to optimizing and personalizing treatment. By facilitating a better understanding of EAP as a
neurobehavioral marker, early auditory processing as mechanism of change, and the essential CR trea...

## Key facts

- **NIH application ID:** 10456117
- **Project number:** 5R01MH123561-03
- **Recipient organization:** COLUMBIA UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** Alice Medalia
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $507,962
- **Award type:** 5
- **Project period:** 2020-08-15 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10456117

## Citation

> US National Institutes of Health, RePORTER application 10456117, Efficacy of Personalizing Cognitive Remediation for Schizophrenia by Targeting Impairments in Early Auditory Processing (5R01MH123561-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10456117. Licensed CC0.

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