Cognitive Remediation in Forensic Mental Health Care

NCT ID: NCT04610697

Last Updated: 2025-12-12

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

30 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-02-10

Study Completion Date

2026-02-10

Brief Summary

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Forensic patients often display cognitive deficits, particularly in the domain of executive functions, that represent a challenge to forensic rehabilitation.

One empirically-validated method to train executive functions is cognitive remediation, which consists of cognitive exercises combined with coaching.

This trial investigates whether cognitive remediation can improve cognitive, functional, and clinical outcomes in forensic inpatients.

Detailed Description

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Forensic patients often display deficits in executive functions, namely difficulties in planning, strategic thinking, problem-solving, and inhibiting inappropriate behavior. Such deficits are transdiagnostic and often underlie behavioral incidents, undermine reintegration into the community, and increase recidivism risk. Despite this, forensic programs usually do not include executive function training.

One approach to train executive functions is cognitive remediation, which consists of behavioral exercises engaging cognitive skills, supported by coaching. In various mental health conditions, cognitive remediation has been repeatedly associated with improvements in cognitive, functional, and clinical outcomes, with small-to-moderate effect sizes. Thus, it should be clarified whether this approach can lead to similar improvements in forensic populations.

In the present trial, we will investigate whether 12 hours over 6 weeks of computerised cognitive remediation administered using tele-health can improve executive functions relative to an active control condition in a sample of 30 forensic inpatients (Aim 1). We will further examine the effect of cognitive remediation (vs. active control) on other variables that are critical for forensic rehabilitation, namely oppositional behaviour, functional capacity, and mental health symptoms (Aim 2). Lastly, we will explore whether any effects persist 12 weeks following cognitive remediation (Aim 3).

Cognitive remediation is an evidence-based inexpensive training method that could be integrated into forensic healthcare practice. In the long term, the expected cognitive, functional, and clinical improvements associated with cognitive remediation have the potential to result in shorter hospitalisations and reduced recidivism rates.

Conditions

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Psychotic Disorders ADHD TBI (Traumatic Brain Injury) Aggression Substance Use Disorders Violence Cognitive Dysfunction Anxiety Depression Schizophrenia Offenders Antisocial

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Double blind randomised controlled trial with active control condition. Given the clinically heterogeneous recruitment pool, pseudo-randomization will be employed to match groups on the main diagnosis.
Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors
Participants and personnel conducting the assessments will be unaware of group assignment.

At the halfway mark of recruitment, we will perform preliminary analyses including intention-to-treat liner mixed models. Study staff performing the assessment visits and participants will remain blinded to the study conditions.

Study Groups

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Cognitive Remediation

Participants in the cognitive remediation condition will complete computerised exercises followed by bridging discussions delivered using tele-heath.

More details regarding treatment and control conditions will be provided following study completion to ensure participant blinding.

Group Type EXPERIMENTAL

Cognitive Remediation

Intervention Type BEHAVIORAL

Cognitive Remediation consists of exercises, preferably supported by coaching, aimed at engaging cognitive skills and, as a result, at improving cognition as well as functional and clinical outcomes.

Active control

Participants in the active control condition will also complete computerised exercises followed by bridging discussions delivered using tele-heath.

More details regarding treatment and control conditions will be provided following study completion to ensure participant blinding.

Group Type ACTIVE_COMPARATOR

Active Control

Intervention Type BEHAVIORAL

Active control condition for cognitive remediation, matched in terms of session modality, number, duration, frequency, and format.

Interventions

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Cognitive Remediation

Cognitive Remediation consists of exercises, preferably supported by coaching, aimed at engaging cognitive skills and, as a result, at improving cognition as well as functional and clinical outcomes.

Intervention Type BEHAVIORAL

Active Control

Active control condition for cognitive remediation, matched in terms of session modality, number, duration, frequency, and format.

Intervention Type BEHAVIORAL

Other Intervention Names

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Neuropsychological Rehabilitation Cognitive Enhancement Cognitive Rehabilitation

Eligibility Criteria

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Inclusion Criteria

i1. Age 18 - 55; i2. Ability to read and speak in fluent English; i3. Current status as inpatient on the Forensic Treatment Unit.

Exclusion Criteria

e1. Intellectual disability; e2. TBI with loss of consciousness followed by known severe neurological sequelae requiring hospitalisation and rehabilitation.
Minimum Eligible Age

18 Years

Maximum Eligible Age

55 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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The Royal Ottawa Mental Health Centre

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Patrizia Pezzoli, PhD

Role: PRINCIPAL_INVESTIGATOR

UCL and The Royal's Institute of Mental Health Research

Locations

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The Royal's Institute of Mental Health Research

Ottawa, Ontario, Canada

Site Status RECRUITING

Countries

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Canada

Central Contacts

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Patrizia Pezzoli, PhD

Role: CONTACT

613-722-6521

Facility Contacts

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Tammy Beaudoin

Role: primary

(613) 722-6521 ext. 6214

Other Identifiers

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TheRoyal

Identifier Type: -

Identifier Source: org_study_id

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