The potential of a revised remote compensatory cognitive training for patients with schizophrenia

The potential of a revised remote compensatory cognitive training for patients with schizophrenia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The potential of a revised remote compensatory cognitive training for patients with schizophrenia Ritsuko Aijo, Mie Matsui This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8545799/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Cognitive impairments in schizophrenia are strongly associated with decreased daily functioning and are a primary target of treatments. The effectiveness of cognitive remediation has been demonstrated; however, access is limited for individuals living in rural areas or those with difficulty commuting to treatment facilities. This study further refined a remote compensatory cognitive training (r-CCT), previously delivered with only the therapist participating remotely, to develop a fully remote version, the revised r-CCT (r-CCTR), enabling all participants to join from home or other locations. We examined its efficacy and feasibility. Methods : Patients with schizophrenia or schizoaffective disorder underwent r-CCTR (12 weeks, weekly 2-h sessions and 13 sessions, including a preparatory phase). Efficacy was assessed by evaluating cognitive function and clinical symptoms before and after the intervention. The primary analysis compared pre- and post-intervention scores among all participants. An exploratory analysis used mixed ANOVAs to compare the intervention group to a pre-intervention waitlist control group. Feasibility was assessed by examining whether the retention rate exceeded 50%. Results : Over 80% of participants completed r-CCTR and met feasibility criteria. Within-group pre–post comparisons revealed significant improvements in attention, learning and memory, and executive function, with moderate to large effect sizes ( d = .48–1.22). No significant changes were observed in non-target domains or psychotic symptoms. Exploratory analyses revealed significant group × time interactions in prospective memory, learning and memory, and executive function. Conclusions : r-CCTR is feasible in a fully remote setting and may improve specific cognitive functions in patients with schizophrenia. Future large-scale studies are warranted. Clinical trial number : Not applicable. schizophrenia compensatory cognitive training remote preliminary efficacy feasibility Figures Figure 1 1. Background Cognitive impairment is a core feature of schizophrenia [ 1 , 2 ]. Several comprehensive reviews consistently showed that patients with schizophrenia exhibit mild to severe impairments compared to healthy individuals [ 3 – 5 ]. Neurocognitive domains associated with cognitive impairment in schizophrenia encompass attention, processing speed, memory, and executive functions [ 6 ], which are a primary target in treatment [ 7 ]. Current treatment guidelines for schizophrenia recommend long-term treatment, combining antipsychotic medications and psychological interventions. Numerous cognitive remediation (CR) therapies (a type of psychological intervention) have been developed to improve cognitive processes with the goal of stability and generalization to everyday life [ 8 ]. The latest meta-analysis on the efficacy of cognitive rehabilitation for patients with schizophrenia reported that CR has a small to moderate effect on cognitive function [ 9 ]. Various studies on CR have employed different intervention approaches. Here, we specifically focus on compensatory cognitive training (CCT), which is a relatively short-term, practical, low-tech, and face-to-face training program for patients with schizophrenia. It is a group-based, manualized, and evidence-based intervention targeting prospective memory, attention, learning and memory, and executive functioning [ 10 ]. Importantly, this training is based on compensatory strategies and environmental building, aiming to compensate impaired functions by advantage or intact abilities in schizophrenia, such as habit learning and imagery [ 10 , 11 ]. Training cognitive skills and strategies within everyday living environments and occupational activities can significantly improve the effectiveness of CR. Nevertheless, many patients with schizophrenia have limited access to CCT, including those living in rural areas with limited resources or access to transportation. Furthermore, traditional interventions require a high scheduling burden, which is unobtainable for those who are in school or employed or who must consider caregiver demands or other medical appointments [ 12 ]. Moreover, stigma regarding mental health treatment may also hinder help-seeking behaviors [ 13 ]. Considering all of the above, we encourage actively promoting CCT in Japan and are currently advancing the project. The first step is to make CCT more accessible. To this end, we have improved the traditional face-to-face CCT and have developed a partially remote CCT (r-CCT), in which only the therapist participates remotely [ 14 ]. Moreover, r-CCT participants could undergo training at locations they frequently visited or felt comfortable in. We observed modest yet positive training effects for targeted cognitive functions, except prospective memory. However, several problems remained with the r-CCT approach: certain participants had to overcome substantial distances to attend the training, support staff was required to establish the online environment, and the online terminal screens for group sessions were difficult to see [ 14 ]. Therefore, as a second step, this study developed a revised r-CCT (r-CCTR), in which all participants received individual trainings in a comfortable location (e.g., their home) without needing to travel long distances. Telemedicine is rapidly growing, and its fundamental purpose is to improve access to healthcare [ 15 ]. Web-based systems offer numerous advantages, including shared information (e.g., sharing of ideas without any constraints), enhanced access for remote areas, and flexible scheduling to balance family, work, and other obligations [ 16 , 17 ]. The r-CCTR is designed to utilize these advantages of telemedicine. Therefore, the primary aim of the present study was to develop a fully remote version of our previously designed cognitive training program, and to examine its feasibility. We compared cognitive performance and clinical symptoms before and after intervention and calculated retention rates. To the best of our knowledge, this study represents the first attempt to develop and implement a Japanese CCT program that enables all participants, including trainers, to engage entirely remotely. 2. Methods 2.1. Participants Participants were recruited from over 20 facilities in Japan. To avoid selection bias, the facility administrators approached the possible participants who met the criteria. The eligibility criteria were as follows: ≥18 years of age, a diagnosis of schizophrenia or schizoaffective disorder based on ICD-10 or DSM-5, and stable symptoms. The exclusion criteria were as follows: head injury, cerebrovascular disease, neurodegenerative disease, dependence on alcohol or other substances, and an estimated pre-onset IQ of < 70 (measured by [ 18 ]). This study was approved by the Kanazawa University Medical Ethics Committee, conducted in accordance with the provisions of the Declaration of Helsinki, and followed Japan’s Ethical Guidelines for Medical and Health Research Involving Human Subjects. The purpose of the study was explained to participants both in writing and verbally, and informed consent was obtained from all participants (approval number: 2020 − 327(089)). Participants did not receive monetary compensation, but intervention sessions and technical support were offered at no cost. 2.2. Design and procedures This study was conducted longitudinally from August 2023 to August 2025 and included 20 patients with schizophrenia. The recruitment, assignment, and intervention process are presented in the study flow diagram (see Fig. 1). Initially, we planned to employ the waitlist control (WLC) design, which establishes an intervention and WLC group [ 19 ]. We assigned 15 participants to the immediate intervention group after assessment (r-CCTR) and five participants to the WLC. However, due to staffing and resource constraints during implementation, the design was ultimately modified to a quasi-experimental design focusing on pre- and post-intervention assessments in the r-CCTR group. A set of t-tests comparing post-intervention outcomes between the r-CCTR and WLC groups were not significantly different ( p s > .11). Thus, we combined 14 participants who completed the intervention in the r-CCTR group and three who completed it in the WLC group (Fig. 1). Participants continued their usual treatments (e.g., medication) while receiving r-CCTR after baseline assessment and underwent reassessment after the intervention ended. 2.3. r-CCTR CCT is structured to improve four targeted cognitive domains by learning and practicing the habitual use of strategies and implementing simple homework assignments (e.g., carrying a calendar daily) [ 10 ]. Strategies to enhance memory involve both internal (e.g., categorizing information) and external methods (e.g., writing information down), which can lead to improvements in cognitive function, social functioning, and quality of life [ 10 ]. Trainings are typically conducted once a week for 2 h over 12 sessions with a small group of participants and therapists [ 10 ]. The workbook and therapist manual were developed in Japanese ( http://www.cogsmart.com/resources ). Previously, we modified the CCT so that only the therapist participated remotely (r-CCT). To further improve the training, we designed r-CCTR so that all participants could join remotely (e.g., from home), and a supplemental session was added to facilitate the online training smoothly. All participants used a tablet or personal computer at a location convenient for them. Before the first session, participants or their support persons checked the workbook, working environment, and operation of the device. All interactions were conducted with Zoom Video Communications. Participants received instructions regarding the setup and use of Zoom in advance. If necessary, participants were loaned an iPad (n = 10) or mobile Wi-Fi (n = 1) and were provided concise instruction manuals. Specifically, we facilitated immediately identifying clickable objects (i.e., making the iPad home screen and illustrations identical while using more illustrations and writing explanations in plain language). Additionally, three modifications were implemented for r-CCTR. First, a preparation session was added under the assumption that participants may be unfamiliar with the operating equipment. This session involved practicing setting up Zoom, i.e., checking audio and video quality, introducing themselves, and, if time permitted, briefly covering some content of the first session. Second, sticky notes were pre-applied for sections lacking page numbers (e.g., the page where training begins). Additionally, the supplementary materials scheduled for distribution in the training had been inserted into the workbooks beforehand. Third, to address comments to each other that might be hard to understand solely through listening, real-time annotation was implemented (e.g., screen sharing and inputting participant responses). 2.4. Outcomes 2.4.1. Cognitive function Cognitive function was assessed using a combination of existing tests corresponding to r-CCTR-targeted and non-targeted cognitive domains (i.e., working and visual memory). These tests were individually administered twice face-to-face by trained personnel following standardized procedures. All cognitive function tests were administered in a fixed order each time. 2.4.1.1. Targeted cognitive domains Prospective memory was assessed using the Belongings task, the Japanese version of the Rivermead Behavioral Memory subtest [ 20 ]. The examiner hid an item the participants possessed (e.g., keys or a wristwatch) in a location invisible to them. Upon completion of the cognitive tests, the participants were asked to recall the hidden item. Their performance was determined by whether they recalled the location and item without hints (two points for each) or with hints (one point for each). Attention was assessed using the Trail Making Test part A (TMT-A) [ 21 ] and Coding subtest and Digit Span subtest from the Wechsler Adult Intelligence Scale (fourth edition) [ 22 ]. The TMT-A measures the time participants need to complete the connecting 25 numbers in sequence. The Coding subtest measures the numbers of symbols participants correctly write down within 2 minutes. The Forward Digit Span subtest measures the maximum number of digits participants reproduce in the correct order from the numbers read aloud. Learning and memory were assessed using the Japanese Verbal Learning Test (JVLT) [ 23 ] and Rivermead Behavioral Memory Test [ 20 ]. The JVLT consists of a list of 16 words divided into four categories. Words were presented orally, and participants were asked to recall the words. The total number of correct recalls across three trials was used for evaluation. The story memory task required participants to memorize and reproduce a short story that was conveyed orally. Executive function was assessed using the Trail Making Test part B (TMT-B) [ 21 ] and Wisconsin Card Sorting Test (WCST) [ 24 ]. The TMT-B measures the time participants need to complete the connecting 13 numbers and 12 hiragana characters alternately and sequentially (e.g., 1–a–2–i–3–u). The WCST uses a set of stimulus cards (n = 4) and response cards (n = 64), which display a unique combination of color, shape, and number. Participants were instructed to place a response card in one of the compartments beneath the stimulus card. In accordance with a previous study [ 25 ], the number of categories was converted into a score (0–6). 2.4.1.2. Non-targeted cognitive domains Working memory was assessed using the Wechsler Adult Intelligence Scale (fourth edition) Backward Digit Span subtest [ 22 ]. This subtest measures the maximum number of digits that could be accurately reproduced in reverse order from a sequence of numbers read aloud. Visual memory was assessed using a Figure Copy task, the Japanese version of the Repeatable Battery for the Assessment of Neuropsychological Status [ 26 ]. A composite figure was presented, and participants were asked to copy it. After completing all cognitive function tests, participants were instructed to recall and draw the presented figures as accurately as possible. 2.4.2. Clinical symptoms The severity of symptoms was assessed using the Scale for the Assessment of Positive [ 27 ] and Negative Symptoms [ 28 ]. Each item was assessed on a scale (0–5) based on observation and interviews, with higher scores indicating greater severity. The Japanese version of the Beck Depression Inventory (second edition) was used to assess depression severity [ 29 ]. This 21-item self-report questionnaire has a scale of 0–3, with higher scores indicating greater severity. 2.5. Feasibility Based on a previous study [ 11 ], we pre-defined the feasibility of r-CCTR with the retention rate. That is, retention is considered if the participant completed (1) more than 50% of a whole session and (2) at least 1 h of treatment with no more than three consecutive absences. The proportion of individuals who met these criteria was calculated as the retention rate. 2.6. Statistical analysis Data analysis was performed using SPSS version 29 (IBM Statistics). First, baseline characteristics of the r-CCTR group and dropouts were examined. Normality was assessed using the Shapiro-Wilk test. To evaluate the effects of r-CCTR, pre- and post-intervention cognitive function and clinical symptoms in the r-CCTR group were compared using paired t-tests or Wilcoxon signed-rank tests. Cohen’s d was used to represent the effect size, with values of 0.2, 0.5, and 0.8 indicating small, medium, and large effects, respectively. Furthermore, exploratory analyses were conducted using pre-intervention data from the initially established WLC group (three participants included in the r-CCTR group were returned to the WLC group). Mixed ANOVAs were performed with the pre-intervention WLC and r-CCTR groups: between-factor (group: r-CCTR vs. WLC) and within-factor (intervention: pre vs. post). Due to the limited sample size, covariates (e.g., age) were not included. Regarding feasibility, we investigated whether the retention rate exceeded 50% [ 30 ]. 3. Results One participant in the r-CCTR group and two participants in the WLC group were unable to complete the training. One participant withdrew immediately after the preparatory phase due to worsening mental symptoms, one chose not to receive any intervention, and one attended several sessions but then stopped without providing a specific reason. Table 1 presents the baseline sociodemographic and clinical characteristics of the r-CCTR group (n = 17) and the dropouts (n = 3). Table 1 Demographic characteristics for the intervention and control groups. r-CCTR (N = 17) Dropout (N = 3) N (%) N (%) Gender Men 12 (70.6) 2 (66.7) Women 5 (29.4) 1 (33.3) Main diagnosis Schizophrenia 16 (94.1) 3 (100.0) Schizoaffective disorder 1 (5.9) 0 (0.0) Online devices currently in use Smartphone 15 (88.2) 1 (33.3) Tablets/iPad 5 (29.4) 1 (33.3) PC 12 (70.6) 1 (33.3) No having 2 (11.8) 2 (66.7) Mean (SD) Mean (SD) Age (years) 44.8 (13.3) 53.7 (5.9) Education (years) 14.3 (2.0) 13.7 (4.7) Age at onset (years) 25.4 (6.5) 23.3 (5.5) Illness duration (years) 19.4 (11.9) 30.0 (9.6) Estimate of premorbid IQ 107.0 (8.7) 102.7 (8.1) Living status Alone 3 (17.6) 2 (66.7) With family 11 (64.7) 1 (33.3) Group home 3 (17.6) 0 (0.0) Median (IQR) Median (IQR) Antipsychotic dose (mg/day) 375.8 (260.0) 875.0 (7800.0) Note. The antipsychotic dose is chlorpromazine equivalent. IQR = interquartile range; r-CCTR = revised remote compensatory cognitive training; SD = standard deviation. 3.1. The effects of r-CCTR Table 2 shows the pre- and post-intervention outcomes in the r-CCTR group. Significant improvements in targeted cognitive functions with moderate to large effect sizes were observed: attention (Digit Symbol, t (16) = −3.49, p < .01, d = .48; Forward Digit Span, t (16) = 2.31, p < .05, d = −.66), learning and memory (JVLT, t (16) = −2.50, p < .05, d = −.61; Story Recall, t (16) = −5.03, p < .01, d = −1.22), and executive function (TMT-B, t (16) = −3.10, p < . 01, d = .73). Although the TMT-A results did not reach statistical significance ( p = .06), their effect size was moderate ( d = .48). Improvements observed with the Belongings task and WCST were not significant, and the effect sizes were small ( p s > .18, d s .12). Table 2 Clinical and cognitive measures pre- and post-intervention (N = 17). Pre-intervention Post-intervention Measures Mean (SD) Mean (SD) t or Z p Cohen’ d Cognitive function target domains Prospective memory Belongings (0–4 points) 3.9 (0.2) 3.9 (0.2) .00 1.00 .00 Attention TMT-A (sec.) 40.3 (11.1) 36.4 (13.2) 1.99 .06 .48 Digit Symbol (0–135 points) 66.7 (16.9) 72.3 (16.1) −3.49 .00 −.85 Forward Digit Span (0–9 digits) 6.4 (1.1) 6.8 (1.2) 2.31 .02 −.66 Learning and memory JVLT (0–48 points) 25.8 (8.8) 28.6 (6.8) −2.50 .02 −.61 Story Recall (0–25 points) 8.1 (4.6) 12.2 (4.6) −5.03 .00 −1.22 Executive function TMT-B (sec.) 70.6 (37.6) 52.5 (18.6) −3.10 .00 .73 WCST (0–6 points) 5.0 (1.9) 5.4 (1.7) 1.34 .18 −.35 Cognitive function non-targeted domains Working memory Backward Digit Span (0–8 digits) 5.0 (1.4) 5.4 (1.6) 1.16 .24 −.30 Visual memory Figure Copy (0–20 points) 13.3 (5.0) 14.2 (4.9) −1.27 .22 −.31 Symptom assessment SAPS (0–150 points) 18.9 (18.8) 16.6 (15.5) −1.48 .14 .19 SANS (0–120 points) 28.5 (12.6) 27.3 (12.4) .52 .61 .13 BDI-Ⅱ (0–63 points) 13.6 (10.3) 11.0 (9.2) 1.62 .12 .39 Note. TMT-A = Trail Making Test part A; JVLT = Japanese Verbal Learning Test; TMT-B = Trail Making Test part B; WCST = Wisconsin Card Sorting Test completed categories; SAPS = Scale of Positive Symptoms; SANS = Scale of Negative Symptoms; BDI-Ⅱ = The Japanese version of the Beck Depression Inventory-second edition (BDI-II); SD = standard deviation. TMT-A, TMT-B, SAPS, and SANS indicate that the lower the score, the better the performance exhibited. Statistically significant values are depicted in bold. 3.2. Supplemental analyses: r-CCTR vs. WLC Although this study ultimately adopted a quasi-experimental design, we conducted supplemental analyses to determine whether the improvements observed in the r-CCTR group were specific to that group. Using the pre-intervention WLC group (n = 5), we conducted mixed ANOVAs with the r-CCTR and group factor (r-CCTR vs. WLC) on the outcomes (Table 3). Significant interactions were observed for five cognitive tests: prospective memory (Belongings task, F (1,13) = 16.68, p < .01, η p ² = .50), learning and memory (JVLT, F (1,13) = 10.89, p < .01, η p ² = .39; Story Recall, F (1,13) = 6.58, p < .01, η p ² = .28), executive function (WCST, F (1,13) = 36.64, p < .01, η p ² = .68), and working memory (Backward Digit Span, F (1,13) = 5.30, p < .03, η p ² = .24). A simple main effect indicated that the performance in story recall was significantly improved in the r-CCTR group ( p .07). Additionally, the results indicated that the Scales for the Assessment of Positive and Negative Symptoms did not differ between pre- and post-intervention. Although a marginal significant interaction was observed for the Beck Depression Inventory (second edition) ( F (1,13) = 4.39, p = .051, η p ² = .21), no significant improvements from baseline at post-intervention were observed for the r-CCTR ( p = .06) and WLC group ( p = .06). Table 3 The results of mixed ANOVAs examining the interaction between intervention and group. r-CCTR (N = 14) WLC (N = 5) Interaction effect Pre Post Pre Post Measure Mean (SD) Mean (SD) Mean (SD) Mean (SD) F (1,13) p ηp² Cognitive function target domains Prospective memory Belongings (0–4 points) 3.9 (0.3) 4.0 (0.0) 4.0 (0.0) 2.6 (1.3) 16.68 <.01 .50 Attention TMT-A (sec.) 40.4 (10.5) 36.0 (13.4) 49.9 (8.4) 49.8 (11.8) .67 .42 .04 Digit Symbol (0–135 points) 65.8 (15.6) 71.4 (14.4) 60.4 (13.3) 64.4 (11.5) .20 .66 .01 Forward Digit Span (0–9 digits) 6.2 (.9) 6.8 (1.1) 6.6 (0.5) 7.2 (.8) .01 .94 .00 Learning and memory JVLT (0–48 points) 25.1 (8.6) 27.4 (5.7) 26.2 (8.2) 21.2 (10.0) 10.89 <.01 .39 Story Recall (0–25 points) 7.7 (4.7) 12.8 (4.8) 4.9 (4.3) 5.1 (6.5) 6.58 <.01 .28 Executive function TMT-B (sec.) 67.4 (28.4) 51.3 (16.5) 131.9 (116.0) 70.9 (22.9) 2.35 .14 .12 WCST (0–6 points) 5.4 (1.7) 5.6 (1.6) 6.0 (0.0) 2.0 (2.3) 36.64 <.01 .68 Cognitive function non-targeted domains Working Memory Backward Digit Span (0–8 digits) 4.9 (1.4) 5.5 (1.7) 5.4 (0.9) 4.6 (1.3) 5.30 .03 .24 Visual memory Figure Copy (0–20 points) 12.8 (5.2) 13.5 (5.0) 16.2 (3.6) 16.2 (5.2) .20 .66 .01 Symptom assessment SAPS (0–150 points) 22.7 (18.6) 19.9 (15.2) 24.0 (27.7) 22.8 (27.8) 0.07 .80 .00 SANS (0–120 points) 29.4 (13.5) 27.1 (12.9) 44.6 (20.2) 37.2 (26.0) .96 .34 .05 BDI-Ⅱ (0–63 points) 14.9 (9.9) 11.2 (9.1) 17.8 (9.8) 21.8 (13.1) 4.39 .05 .21 Note. TMT-A = Trail Making Test part A; JVLT = Japanese Verbal Learning Test; TMT-B = Trail Making Test part B; WCST = Wisconsin Card Sorting Test completed categories; SAPS = Scale of Positive Symptoms; SANS = Scale of Negative Symptoms; BDI-Ⅱ = The Japanese version of the Beck Depression Inventory-second edition (BDI-II); WLC = waitlist control; r-CCTR = revised remote compensatory cognitive training; SD = standard deviation. TMT-A, TMT-B, SAPS, and SANS indicate that the lower the score, the better the condition. Statistically significant values are depicted in bold. 3.3. Retention rate Of the 20 participants, 17 (82.4%) completed at least half of the sessions. The average number of sessions attended per participant was 12.65 (SD = 0.86). 4. Discussion 4.1. The efficacy of r-CCTR Our results reveal that r-CCTR improves certain targeted cognitive functions but, as expected, not non-target cognitive functions. These results are consistent with previous studies [ 11 , 25 ] and suggest that our training may enhance targeted cognitive functions. Notably, large effect sizes were observed for targeted functions, specifically in the learning and memory domains (JVLT, d = − .61; Story Recall, d = − 1.22), which are core features of schizophrenia [ 31 ]. Conversely, performance was not improved in relation to the Belongings task and WCST in the r-CCRT group. The baseline score of the Belongings task had ceiling effects with limited improvements. It is difficult to compare these results with those of prior studies, which typically used different tests for prospective memory (e.g., the Memory for Intentions Test). Similarly, slightly increased performance was observed for WCST, while baseline scores were relatively high, and this insignificant result is consistent with previous research [ 11 , 25 ]. In short, our findings are similar to those in other studies, supporting the preliminary efficacy of r-CCRT [ 11 , 25 ]. Furthermore, to provide supplemental evidence, we compared the outcomes between r-CCTR and WLC. This comparison was the original design, which, however, had to be changed because of certain constraints. Nevertheless, a similar pattern of interaction effects indicated improvements for certain targeted cognitive domains but not for non-target domains, as the above-mentioned analysis. In both analyses, the learning and memory domains were significantly improved in the r-CCTR group (except for JVLT with only marginally significant improvement: p = .08). This pattern aligns with previous strictly controlled studies [ 11 , 25 ] and further supports the efficacy of r-CCTR. Regarding the performance of the prospective memory and executive function domains, no significant effects were observed in the r-CCTR group; however, a significant interaction effect emerged. This is likely due to the decline in performance in the WLC group, making it difficult to conclude that the r-CCTR group benefited from the training. Furthermore, among the targeted cognitive domains, the attention and executive function domains exhibited no significant interaction effects but appeared to improve with r-CCTR when focused patients received the intervention (except for WCST). Overall, our results are consistent with previous findings showing smaller effects on attention and executive function than those on learning and memory [ 8 ]. Although these supplementary analyses may reflect specific effects of r-CCTR, the results should be interpreted with caution due to the small sample size in the WLC group. In summary, the current study demonstrated potential effects of r-CCTR by revealing both expected improvements and non-improvements. Moreover, clinical symptoms did not differ in the r-CCTR group. This is consistent with the results of a meta-analysis [ 8 ], indicating that cognitive enhancement therapy exerts limited effects on symptoms. However, the marginal significant interaction indicated a puzzled pattern for depressive symptoms, with Beck Depression Inventory (second edition) scores that likely improved in the r-CTTR group but worsened in the WLC group. Given that recent research has reported that CR is associated with decreased depressive mood [ 32 ], r-CCTR may also show promising effects for depressive symptoms in patients with schizophrenia. Depressive symptoms in schizophrenia are implicated in disease relapse and impaired social functioning [ 33 ], and the effect of r-CCTR on these symptoms has a clinically significant implication. 4.2. Feasibility The retention rate in this study was 82.4%, which substantially exceeded the pre-defined criteria (i.e., 50%). CR interventions using online technology offer advantages such as ease of access and schedule flexibility compared to face-to-face interventions. Nevertheless, the dropout rate for online CR (32.3%) is slightly higher than that for face-to-face CR (approximately 25%), which might be attributed to factors such as anxiety regarding computer use [ 34 ]. Given these circumstances, our dropout rate of 17.6% is remarkably low. We believe that the underlying reasons include our implementation of the preparatory phase, support for the use of online devices, and enjoyable activities. Motivational disorder is a deficit in schizophrenia and may be significantly influenced by psychosocial transitions and treatment outcomes [ 35 ]. Intrinsic motivation is a crucial component for CR in terms of increased learning motivation and learning persistence [ 35 , 36 ]. We added a preparatory phase to the initial session, during which everyone had time to become familiar with the online tools and the group. Furthermore, based on our preliminary research, we implemented several considerations to mitigate any psychological burdens (e.g., the use of sticky notes on pages requiring attention). These efforts most likely made our participants experience enjoyment and satisfaction, leading to increased intrinsic motivation, which in turn contributed to the low dropout rate. Many overseas training studies rely on extrinsic motivation, such as monetary rewards [ 8 ]. Therefore, the fact that this study achieved a high completion rate without monetary incentives should bring valuable insights. 4.3. Limitations The results of this study indicate therapeutic potential; however, several limitations must be considered. First, we acknowledge that the sample size was small, limiting the statistical power to detect differences. Second, the robustness of our intervention has not been rigorously proven because a randomized controlled trial was not conducted. However, this study involved minimal selection bias and the most natural method possible given the local context, providing valuable insights for future implementation. Third, the potential variables that may affect cognitive function (e.g., age) were not included in the analysis. Future research should include larger samples for more detailed analyses. Fourth, it may be desirable to use tasks with adjusted difficulty levels and to assess actual daily activities. This report focused on the effects of r-CCTR on neurocognitive functions and symptoms; however, its effects on social functioning and quality of life in patients with schizophrenia should also be considered. We are currently exploring these secondary domains and conducting follow-up tests. 5. Conclusion Overall, this study provided the first preliminary evidence regarding the efficacy and feasibility of r-CCTR for Japanese patients with schizophrenia. Our promising findings should encourage further research on remote or online CR, which should include assessments of activities of daily living and quality of life as well as long-term follow-up studies. This study highlighted the provision of r-CCTR via a remote online approach, which shows potential for application to other specialized treatments and could promote equitable access to mental health services. Abbreviations CR Cognitive remediation CCT Compensatory cognitive training JVLT Japanese Verbal Learning Test r-CCT Remote compensatory cognitive training r-CCTR Revised r-CCT TMT-A Trail Making Test part A TMT-B Trail Making Test part B WCST Wisconsin Card Sorting Test WLC Waitlist control Declarations Ethical approval and consent to participate The research was approved by the Kanazawa University Medical Ethics Committee (decision number 2020-327(089)) and was conducted in accordance with the Declaration of Helsinki. All participants provided informed consent before participating in the study. Consent for publication Not applicable. Availability of data and materials The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Competing interest The authors declare that they have no competing interests. Funding This study was supported by JSPS KAKENHI (Grant no. JP 23K09961). The authors declare no conflicts of interest with the sponsor. The funder had no role in the study design; in the collection, analysis, and interpretation of the data; or in the decision to submit the article for publication. Authors’ contributions RA contributed to conceptualization, data curation, funding acquisition, investigation, methodology, project administration, validation, visualization, writing the original draft, and writing – review and editing. MM contributed to investigation and supervision. Acknowledgements We would like to express our sincere gratitude to all individuals who assisted with data collection. We also extend our heartfelt thanks to all the participants, who generously contributed their valuable time and effort. We also thank Yuta Takiguchi for statistical and writing advice. The authors would like to thank Enago (www.enago.jp) for the English language review. References Harvey PD, Strassnig MT, Silberstein J. Prediction of disability in schizophrenia: symptoms, cognition, and self-assessment. J Exp Psychopathol. 2019;10:2043808719865693. doi:10.1177/2043808719865693. Green MF, Kern RS, Braff DL, Mintz J. Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the "right stuff"?. Schizophr Bull. 2000;26:119-36. doi:10.1093/oxfordjournals.schbul.a033430. Bora E, Murray RM. Meta-analysis of cognitive deficits in ultra-high risk to psychosis and first-episode psychosis: do the cognitive deficits progress over, or after, the onset of psychosis?. Schizophr Bull. 2014;40:744-55. doi:10.1093/schbul/sbt085. Fatouros-Bergman H, Cervenka S, Flyckt L, Edman G, Farde L. Meta-analysis of cognitive performance in drug-naïve patients with schizophrenia. Schizophr Res. 2014;158:156-62. doi:10.1016/j.schres.2014.06.034. Grimes KM, Zanjani A, Zakzanis KK. Memory impairment and the mediating role of task difficulty in patients with schizophrenia. Psychiatry Clin Neurosci. 2017;71:600-11. doi:10.1111/pcn.12520. Keefe RSE, Harvey PD. Cognitive impairment in schizophrenia. In: Geyer M, Gross G, editors. Novel antischizophrenia treatments. Handbook of experimental pharmacology, vol 213. Berlin, Heidelberg: Springer; 2012. p. 11-37. doi:10.1007/978-3-642-25758-2_2. Wykes T, Spaulding WD. Thinking about the future cognitive remediation therapy--what works and could we do better?. Schizophr Bull. 2011;37:S80-90. doi:10.1093/schbul/sbr064. Wykes T, Huddy V, Cellard C, McGurk SR, Czobor P. A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. Am J Psychiatry. 2011;168:472-85. doi:10.1176/appi.ajp.2010.10060855. Vita A, Barlati S, Ceraso A, Nibbio G, Ariu C, Deste G, et al. Effectiveness, core elements, and moderators of response of cognitive remediation for schizophrenia: a systematic review and meta-analysis of randomized clinical trials. JAMA Psychiatry. 2021;78:848-58. doi:10.1001/jamapsychiatry.2021.0620. Twamley EW, Savla GN, Zurhellen CH, Heaton RK, Jeste DV. Development and pilot testing of a novel compensatory cognitive training intervention for people with psychosis. Am J Psychiatr Rehabil. 2008;11:144-63. doi:10.1080/15487760801963678. Twamley EW, Vella L, Burton CZ, Heaton RK, Jeste DV. Compensatory cognitive training for psychosis: effects in a randomized controlled trial. J Clin Psychiatry. 2012;73:1212-9. doi:10.4088/JCP.12m07686. Biagianti B, Fisher M, Howard L, Rowlands A, Vinogradov S, Woolley J. Feasibility and preliminary efficacy of remotely delivering cognitive training to people with schizophrenia using tablets. Schizophr Res Cogn. 2017;10:7-14. doi:10.1016/j.scog.2017.07.003. Angermeyer MC, Matschinger H, Schomerus G. Attitudes towards psychiatric treatment and people with mental illness: changes over two decades. Br J Psychiatry. 2013;203:146-51. doi:10.1192/bjp.bp.112.122978. Aijo R, Matsui M. Feasibility and acceptability of remotely accessed compensatory cognitive training for japanese people with schizophrenia: pilot study. JMIR Form Res. 2025;9:e70916. doi:10.2196/70916. Litvak M, Miller K, Boyle T, Bedenbaugh R, Smith C, Meguerdichian D, et al. Telemedicine use in disasters: a scoping review. Disaster Med Public Health Prep. 2022;16:791-800. doi:10.1017/dmp.2020.473. Chumley-Jones HS, Dobbie A, Alford CL. Web-based learning: sound educational method or Hype? A review of the evaluation literature. Acad Med 2002;77:586-93. Cook DA, Garside S, Levinson AJ, Dupras DM, Montori VM. What do we mean by web‐based learning? A systematic review of the variability of interventions. Med Educ. 2010;44:765-74. doi:10.1111/j.1365-2923.2010.03723.x. Matsuoka K, Kin Y. Japanese Adult Reading Test: JART. Tokyo: Shinkou Igaku Shuppan; 2006. Vidarsdottir OG, Roberts DL, Twamley EW, Gudmundsdottir B, Sigurdsson E, Magnusdottir BB. Integrative cognitive remediation for early psychosis: results from a randomized controlled trial. Psychiatry Res 2019;273:690-8. doi:10.1016/j.psychres.2019.02.007. Watamori S, Hara H, Miyamori T, Eto F. The Rivermead Behavioral Memory Test (RBMT). Japanese version. Chiba: Chiba Test Center; 2015. Brain Function Test Committee JSfHBF. Trail Making Test, Japanese edition (TMT-J). Tokyo: Shinkoh Igaku Shuppan Co. Ltd.; 2019. Wechsler D, Coalson DL, Raiford SE. WAIS-IV technical and interpretive manual. Pearson T, editor. San Antonio; 2008. Matsui M, Yuuki H, Kato K, Kurachi M. Impairment of memory organization in patients with schizophrenia or schizotypal disorder. J Int Neuropsychol Soc. 2006;12:750-4. doi:10.1017/S1355617706060905. Greve KW. The WCST-64: a standardized short-form of the Wisconsin card sorting test. Clin Neuropsychol. 2001;15:228-34. doi:10.1076/clin.15.2.228.1901. Otsuka S, Matsui M, Hoshino T, Miura K, Higuchi Y, Suzuki M. The effectiveness and applicability of compensatory cognitive training for Japanese patients with schizophrenia: a pilot study. Adv Psychiatry. 2015;2015:314804. doi:10.1155/2015/314804. Matsui M, Kasai Y, Nagasaki M. Reliability and validity of the Japanese version of the repeatable battery for the assessment of neuropsychological status (in Japanese). Toyama Med J. 2010;21:31-6. Andreasen NC. Scale for the Assessment of Positive Symptoms (SAPS).. Iowa: The University of Iowa; 1984. doi:10.1037/t48377-000. Andresen NC. The Scale for the Assessment of Negative Symptoms (SANS). Iowa: The University of Iowa; 1983. Kojima M, Furukawa TA, Takahashi H, Kawai M, Nagaya T, Tokudome S. Cross-cultural validation of the Beck Depression Inventory-Ⅱ in Japan. Psychiatry Res. 2002;110:291-9. doi:10.1016/s0165-1781(02)00106-3. Poppe A, Bais L, van Duin D, Ćurčić-Blake B, Pijnenborg GHM, van der Meer L. Feasibility and acceptability of combining cognitive remediation and tDCS in long-term psychiatric clinical care. Schizophr Res Cogn. 2025;42:100358. doi:10.1016/j.scog.2025.100358. Kody E, Diwadkar VA. Magnocellular and parvocellular contributions to brain network dysfunction during learning and memory: implications for schizophrenia. J Psychiatr Res. 2022;156:520-31. doi:10.1016/j.jpsychires.2022.10.055. Klojčnik M, Bakracevic K. The effectiveness of computerized cognitive remediation therapy (CCRT) for deficits in attention and executive functions in depression: a pilot study. Appl Neuropsychol. 2023;30:306-14. doi:10.1080/23279095.2021.1941965. Herniman SE, Allott K, Phillips LJ, Wood SJ, Uren J, Mallawaarachchi SR, et al. Depressive psychopathology in first-episode schizophrenia spectrum disorders: a systematic review, meta-analysis and meta-regression. Psychol Med. 2019;49:2463-74. doi:10.1017/s0033291719002344. Jagtap S, Romanowska S, Leibovitz T, Onno KA, Burhan AM, Best MW. Can cognitive remediation therapy be delivered remotely? A review examining feasibility and acceptability of remote interventions. Schizophr Res Cogn. 2022;28:100238. doi:10.1016/j.scog.2022.100238. Choi J, Medalia A. Intrinsic motivation and learning in a schizophrenia spectrum sample. Schizophr Res. 2010;118:12-9. doi:10.1016/j.schres.2009.08.001. Vansteenkiste M, Simons J, Lens W, Sheldon KM, Deci EL. Motivating learning, performance, and persistence: the synergistic effects of intrinsic goal contents and autonomy-supportive contexts. J Pers Soc Psychol. 2004;87:246-60. doi:10.1037/0022-3514.87.2.246. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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Background","content":"\u003cp\u003eCognitive impairment is a core feature of schizophrenia [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Several comprehensive reviews consistently showed that patients with schizophrenia exhibit mild to severe impairments compared to healthy individuals [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Neurocognitive domains associated with cognitive impairment in schizophrenia encompass attention, processing speed, memory, and executive functions [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], which are a primary target in treatment [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Current treatment guidelines for schizophrenia recommend long-term treatment, combining antipsychotic medications and psychological interventions. Numerous cognitive remediation (CR) therapies (a type of psychological intervention) have been developed to improve cognitive processes with the goal of stability and generalization to everyday life [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The latest meta-analysis on the efficacy of cognitive rehabilitation for patients with schizophrenia reported that CR has a small to moderate effect on cognitive function [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eVarious studies on CR have employed different intervention approaches. Here, we specifically focus on compensatory cognitive training (CCT), which is a relatively short-term, practical, low-tech, and face-to-face training program for patients with schizophrenia. It is a group-based, manualized, and evidence-based intervention targeting prospective memory, attention, learning and memory, and executive functioning [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Importantly, this training is based on compensatory strategies and environmental building, aiming to compensate impaired functions by advantage or intact abilities in schizophrenia, such as habit learning and imagery [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Training cognitive skills and strategies within everyday living environments and occupational activities can significantly improve the effectiveness of CR.\u003c/p\u003e \u003cp\u003eNevertheless, many patients with schizophrenia have limited access to CCT, including those living in rural areas with limited resources or access to transportation. Furthermore, traditional interventions require a high scheduling burden, which is unobtainable for those who are in school or employed or who must consider caregiver demands or other medical appointments [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Moreover, stigma regarding mental health treatment may also hinder help-seeking behaviors [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConsidering all of the above, we encourage actively promoting CCT in Japan and are currently advancing the project. The first step is to make CCT more accessible. To this end, we have improved the traditional face-to-face CCT and have developed a partially remote CCT (r-CCT), in which only the therapist participates remotely [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Moreover, r-CCT participants could undergo training at locations they frequently visited or felt comfortable in. We observed modest yet positive training effects for targeted cognitive functions, except prospective memory. However, several problems remained with the r-CCT approach: certain participants had to overcome substantial distances to attend the training, support staff was required to establish the online environment, and the online terminal screens for group sessions were difficult to see [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Therefore, as a second step, this study developed a revised r-CCT (r-CCTR), in which all participants received individual trainings in a comfortable location (e.g., their home) without needing to travel long distances.\u003c/p\u003e \u003cp\u003eTelemedicine is rapidly growing, and its fundamental purpose is to improve access to healthcare [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Web-based systems offer numerous advantages, including shared information (e.g., sharing of ideas without any constraints), enhanced access for remote areas, and flexible scheduling to balance family, work, and other obligations [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The r-CCTR is designed to utilize these advantages of telemedicine.\u003c/p\u003e \u003cp\u003eTherefore, the primary aim of the present study was to develop a fully remote version of our previously designed cognitive training program, and to examine its feasibility. We compared cognitive performance and clinical symptoms before and after intervention and calculated retention rates. To the best of our knowledge, this study represents the first attempt to develop and implement a Japanese CCT program that enables all participants, including trainers, to engage entirely remotely.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Participants\u003c/h2\u003e \u003cp\u003eParticipants were recruited from over 20 facilities in Japan. To avoid selection bias, the facility administrators approached the possible participants who met the criteria. The eligibility criteria were as follows: \u0026ge;18 years of age, a diagnosis of schizophrenia or schizoaffective disorder based on ICD-10 or DSM-5, and stable symptoms. The exclusion criteria were as follows: head injury, cerebrovascular disease, neurodegenerative disease, dependence on alcohol or other substances, and an estimated pre-onset IQ of \u0026lt;\u0026thinsp;70 (measured by [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]).\u003c/p\u003e \u003cp\u003e This study was approved by the Kanazawa University Medical Ethics Committee, conducted in accordance with the provisions of the Declaration of Helsinki, and followed Japan\u0026rsquo;s Ethical Guidelines for Medical and Health Research Involving Human Subjects. The purpose of the study was explained to participants both in writing and verbally, and informed consent was obtained from all participants (approval number: 2020\u0026thinsp;\u0026minus;\u0026thinsp;327(089)). Participants did not receive monetary compensation, but intervention sessions and technical support were offered at no cost.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Design and procedures\u003c/h2\u003e \u003cp\u003eThis study was conducted longitudinally from August 2023 to August 2025 and included 20 patients with schizophrenia. The recruitment, assignment, and intervention process are presented in the study flow diagram (see Fig.\u0026nbsp;1). Initially, we planned to employ the waitlist control (WLC) design, which establishes an intervention and WLC group [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. We assigned 15 participants to the immediate intervention group after assessment (r-CCTR) and five participants to the WLC. However, due to staffing and resource constraints during implementation, the design was ultimately modified to a quasi-experimental design focusing on pre- and post-intervention assessments in the r-CCTR group. A set of t-tests comparing post-intervention outcomes between the r-CCTR and WLC groups were not significantly different (\u003cem\u003ep\u003c/em\u003es\u0026thinsp;\u0026gt;\u0026thinsp;.11). Thus, we combined 14 participants who completed the intervention in the r-CCTR group and three who completed it in the WLC group (Fig.\u0026nbsp;1). Participants continued their usual treatments (e.g., medication) while receiving r-CCTR after baseline assessment and underwent reassessment after the intervention ended.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. r-CCTR\u003c/h2\u003e \u003cp\u003eCCT is structured to improve four targeted cognitive domains by learning and practicing the habitual use of strategies and implementing simple homework assignments (e.g., carrying a calendar daily) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Strategies to enhance memory involve both internal (e.g., categorizing information) and external methods (e.g., writing information down), which can lead to improvements in cognitive function, social functioning, and quality of life [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Trainings are typically conducted once a week for 2 h over 12 sessions with a small group of participants and therapists [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The workbook and therapist manual were developed in Japanese (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.cogsmart.com/resources\u003c/span\u003e\u003cspan address=\"http://www.cogsmart.com/resources\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). Previously, we modified the CCT so that only the therapist participated remotely (r-CCT). To further improve the training, we designed r-CCTR so that all participants could join remotely (e.g., from home), and a supplemental session was added to facilitate the online training smoothly.\u003c/p\u003e \u003cp\u003eAll participants used a tablet or personal computer at a location convenient for them. Before the first session, participants or their support persons checked the workbook, working environment, and operation of the device. All interactions were conducted with Zoom Video Communications. Participants received instructions regarding the setup and use of Zoom in advance. If necessary, participants were loaned an iPad (n\u0026thinsp;=\u0026thinsp;10) or mobile Wi-Fi (n\u0026thinsp;=\u0026thinsp;1) and were provided concise instruction manuals. Specifically, we facilitated immediately identifying clickable objects (i.e., making the iPad home screen and illustrations identical while using more illustrations and writing explanations in plain language).\u003c/p\u003e \u003cp\u003eAdditionally, three modifications were implemented for r-CCTR. First, a preparation session was added under the assumption that participants may be unfamiliar with the operating equipment. This session involved practicing setting up Zoom, i.e., checking audio and video quality, introducing themselves, and, if time permitted, briefly covering some content of the first session. Second, sticky notes were pre-applied for sections lacking page numbers (e.g., the page where training begins). Additionally, the supplementary materials scheduled for distribution in the training had been inserted into the workbooks beforehand. Third, to address comments to each other that might be hard to understand solely through listening, real-time annotation was implemented (e.g., screen sharing and inputting participant responses).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Outcomes\u003c/h2\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.4.1. Cognitive function\u003c/h2\u003e \u003cp\u003eCognitive function was assessed using a combination of existing tests corresponding to r-CCTR-targeted and non-targeted cognitive domains (i.e., working and visual memory). These tests were individually administered twice face-to-face by trained personnel following standardized procedures. All cognitive function tests were administered in a fixed order each time.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section4\"\u003e \u003ch2\u003e2.4.1.1. Targeted cognitive domains\u003c/h2\u003e \u003cp\u003eProspective memory was assessed using the Belongings task, the Japanese version of the Rivermead Behavioral Memory subtest [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The examiner hid an item the participants possessed (e.g., keys or a wristwatch) in a location invisible to them. Upon completion of the cognitive tests, the participants were asked to recall the hidden item. Their performance was determined by whether they recalled the location and item without hints (two points for each) or with hints (one point for each).\u003c/p\u003e \u003cp\u003eAttention was assessed using the Trail Making Test part A (TMT-A) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and Coding subtest and Digit Span subtest from the Wechsler Adult Intelligence Scale (fourth edition) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The TMT-A measures the time participants need to complete the connecting 25 numbers in sequence. The Coding subtest measures the numbers of symbols participants correctly write down within 2 minutes. The Forward Digit Span subtest measures the maximum number of digits participants reproduce in the correct order from the numbers read aloud.\u003c/p\u003e \u003cp\u003eLearning and memory were assessed using the Japanese Verbal Learning Test (JVLT) [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and Rivermead Behavioral Memory Test [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The JVLT consists of a list of 16 words divided into four categories. Words were presented orally, and participants were asked to recall the words. The total number of correct recalls across three trials was used for evaluation. The story memory task required participants to memorize and reproduce a short story that was conveyed orally.\u003c/p\u003e \u003cp\u003eExecutive function was assessed using the Trail Making Test part B (TMT-B) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and Wisconsin Card Sorting Test (WCST) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The TMT-B measures the time participants need to complete the connecting 13 numbers and 12 hiragana characters alternately and sequentially (e.g., 1\u0026ndash;a\u0026ndash;2\u0026ndash;i\u0026ndash;3\u0026ndash;u). The WCST uses a set of stimulus cards (n\u0026thinsp;=\u0026thinsp;4) and response cards (n\u0026thinsp;=\u0026thinsp;64), which display a unique combination of color, shape, and number. Participants were instructed to place a response card in one of the compartments beneath the stimulus card. In accordance with a previous study [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], the number of categories was converted into a score (0\u0026ndash;6).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section4\"\u003e \u003ch2\u003e2.4.1.2. Non-targeted cognitive domains\u003c/h2\u003e \u003cp\u003eWorking memory was assessed using the Wechsler Adult Intelligence Scale (fourth edition) Backward Digit Span subtest [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This subtest measures the maximum number of digits that could be accurately reproduced in reverse order from a sequence of numbers read aloud.\u003c/p\u003e \u003cp\u003eVisual memory was assessed using a Figure Copy task, the Japanese version of the Repeatable Battery for the Assessment of Neuropsychological Status [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. A composite figure was presented, and participants were asked to copy it. After completing all cognitive function tests, participants were instructed to recall and draw the presented figures as accurately as possible.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e2.4.2. Clinical symptoms\u003c/h2\u003e \u003cp\u003eThe severity of symptoms was assessed using the Scale for the Assessment of Positive [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] and Negative Symptoms [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Each item was assessed on a scale (0\u0026ndash;5) based on observation and interviews, with higher scores indicating greater severity. The Japanese version of the Beck Depression Inventory (second edition) was used to assess depression severity [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. This 21-item self-report questionnaire has a scale of 0\u0026ndash;3, with higher scores indicating greater severity.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.5. Feasibility\u003c/h2\u003e \u003cp\u003eBased on a previous study [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], we pre-defined the feasibility of r-CCTR with the retention rate. That is, retention is considered if the participant completed (1) more than 50% of a whole session and (2) at least 1 h of treatment with no more than three consecutive absences. The proportion of individuals who met these criteria was calculated as the retention rate.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e2.6. Statistical analysis\u003c/h2\u003e \u003cp\u003eData analysis was performed using SPSS version 29 (IBM Statistics). First, baseline characteristics of the r-CCTR group and dropouts were examined. Normality was assessed using the Shapiro-Wilk test. To evaluate the effects of r-CCTR, pre- and post-intervention cognitive function and clinical symptoms in the r-CCTR group were compared using paired t-tests or Wilcoxon signed-rank tests. Cohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e was used to represent the effect size, with values of 0.2, 0.5, and 0.8 indicating small, medium, and large effects, respectively.\u003c/p\u003e \u003cp\u003eFurthermore, exploratory analyses were conducted using pre-intervention data from the initially established WLC group (three participants included in the r-CCTR group were returned to the WLC group). Mixed ANOVAs were performed with the pre-intervention WLC and r-CCTR groups: between-factor (group: r-CCTR vs. WLC) and within-factor (intervention: pre vs. post). Due to the limited sample size, covariates (e.g., age) were not included. Regarding feasibility, we investigated whether the retention rate exceeded 50% [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eOne participant in the r-CCTR group and two participants in the WLC group were unable to complete the training. One participant withdrew immediately after the preparatory phase due to worsening mental symptoms, one chose not to receive any intervention, and one attended several sessions but then stopped without providing a specific reason. Table 1\u0026nbsp;presents the baseline sociodemographic and clinical characteristics of the r-CCTR group (n\u0026nbsp;= 17) and the dropouts (n\u0026nbsp;= 3).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"587\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"bottom\" style=\"width: 587px;\"\u003e\n \u003cp\u003eTable 1 Demographic characteristics for the intervention and control groups.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 240px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 153px;\"\u003e\n \u003cp\u003er-CCTR (N = 17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 180px;\"\u003e\n \u003cp\u003eDropout (N = 3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 240px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp; Men\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e(70.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp; Women\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e(29.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003eMain diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp; Schizophrenia\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e(94.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp; Schizoaffective disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e(5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003eOnline devices currently in use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp; Smartphone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e(88.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp; Tablets/iPad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e(29.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp; PC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e(70.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp; No having\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e(11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e(SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e(SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e44.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e(13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e53.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e(5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003eEducation (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e(2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e(4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003eAge at onset (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e25.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e(6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e23.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e(5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003eIllness duration (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e19.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e(11.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e30.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e(9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003eEstimate of premorbid IQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e107.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e(8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e102.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e(8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003eLiving status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp; Alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e(17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp; With family\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e(64.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp; Group home\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e(17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003eAntipsychotic dose (mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e375.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e(260.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e875.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e(7800.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"bottom\" style=\"width: 587px;\"\u003e\n \u003cp\u003eNote. The antipsychotic dose is chlorpromazine equivalent.\u003c/p\u003e\n \u003cp\u003eIQR = interquartile range; r-CCTR = revised remote compensatory cognitive training; SD = standard deviation.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e3.1.\u0026nbsp;The effects of r-CCTR\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 shows the pre- and post-intervention outcomes in the r-CCTR group. Significant improvements in targeted cognitive functions with moderate to large effect sizes were observed: attention (Digit Symbol, \u003cem\u003et\u003c/em\u003e(16) = \u0026minus;3.49, \u003cem\u003ep\u003c/em\u003e \u0026lt; .01, \u003cem\u003ed\u003c/em\u003e = .48; Forward Digit Span, \u003cem\u003et\u003c/em\u003e(16) = 2.31, \u003cem\u003ep\u003c/em\u003e \u0026lt; .05, \u003cem\u003ed\u003c/em\u003e = \u0026minus;.66), learning and memory (JVLT, \u003cem\u003et\u003c/em\u003e(16) = \u0026minus;2.50, \u003cem\u003ep\u003c/em\u003e \u0026lt; .05, \u003cem\u003ed\u003c/em\u003e = \u0026minus;.61; Story Recall, \u003cem\u003et\u003c/em\u003e(16) = \u0026minus;5.03, \u003cem\u003ep\u003c/em\u003e \u0026lt; .01, \u003cem\u003ed\u003c/em\u003e = \u0026minus;1.22), and executive function (TMT-B, \u003cem\u003et\u003c/em\u003e(16) = \u0026minus;3.10, \u003cem\u003ep\u003c/em\u003e \u0026lt; . 01, \u003cem\u003ed\u003c/em\u003e = .73). Although the TMT-A results did not reach statistical significance (\u003cem\u003ep\u003c/em\u003e = .06), their effect size was moderate (\u003cem\u003ed\u003c/em\u003e = .48). Improvements observed with the Belongings task and WCST were not significant, and the effect sizes were small (\u003cem\u003ep\u003c/em\u003es \u0026gt; .18, \u003cem\u003ed\u003c/em\u003es \u0026lt; .02). No significant differences were observed in any of the non-target cognitive domains or psychiatric symptoms (\u003cem\u003ep\u003c/em\u003es \u0026gt; .12).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"869\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" valign=\"bottom\" style=\"width: 869px;\"\u003e\n \u003cp\u003eTable 2 Clinical and cognitive measures pre- and post-intervention (N = 17).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 302px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePre-intervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003ePost-intervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 302px;\"\u003e\n \u003cp\u003eMeasures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e(SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e(SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e or \u003cem\u003eZ\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003eCohen\u0026rsquo; \u003cem\u003ed\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cem\u003eCognitive function target domains\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e \u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003eProspective memory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 302px;\"\u003e\n \u003cp\u003e Belongings (0\u0026ndash;4 points)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\n \u003cp\u003e3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003eAttention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 302px;\"\u003e\n \u003cp\u003e TMT-A (sec.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\n \u003cp\u003e40.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e(11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e36.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e(13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 302px;\"\u003e\n \u003cp\u003e Digit Symbol (0\u0026ndash;135 points)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\n \u003cp\u003e66.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e(16.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e72.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e(16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026minus;3.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.00\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026minus;.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 302px;\"\u003e\n \u003cp\u003e \u0026nbsp;Forward Digit Span (0\u0026ndash;9 digits)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\n \u003cp\u003e6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e(1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e(1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026minus;.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003eLearning and memory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 302px;\"\u003e\n \u003cp\u003e JVLT (0\u0026ndash;48 points)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\n \u003cp\u003e25.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e(8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e28.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e(6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026minus;2.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026minus;.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 302px;\"\u003e\n \u003cp\u003e Story Recall (0\u0026ndash;25 points)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\n \u003cp\u003e8.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e(4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e12.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e(4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026minus;5.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.00\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026minus;1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003eExecutive function\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 302px;\"\u003e\n \u003cp\u003e TMT-B (sec.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\n \u003cp\u003e70.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e(37.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e52.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e(18.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026minus;3.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.00\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 302px;\"\u003e\n \u003cp\u003e WCST (0\u0026ndash;6 points)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e(1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e(1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026minus;.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cem\u003eCognitive function non-targeted domains\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Working memory\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 302px;\"\u003e\n \u003cp\u003e Backward Digit Span (0\u0026ndash;8 digits)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e(1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026minus;.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Visual memory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Figure Copy (0\u0026ndash;20 points)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e(5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e14.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e(4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026minus;1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026minus;.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cem\u003eSymptom assessment\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 302px;\"\u003e\n \u003cp\u003e SAPS (0\u0026ndash;150 points)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\n \u003cp\u003e18.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e(18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e16.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e(15.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026minus;1.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 302px;\"\u003e\n \u003cp\u003e SANS (0\u0026ndash;120 points)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\n \u003cp\u003e28.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e(12.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e27.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e(12.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 302px;\"\u003e\n \u003cp\u003e BDI-Ⅱ\u0026nbsp;(0\u0026ndash;63 points)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\n \u003cp\u003e13.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e(10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e11.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e(9.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" valign=\"bottom\" style=\"width: 99.8808%;\"\u003e\n \u003cp\u003eNote. TMT-A = Trail Making Test part A; JVLT = Japanese Verbal Learning Test; TMT-B = Trail Making Test part B; WCST = Wisconsin Card Sorting Test completed categories; SAPS = Scale of Positive Symptoms; SANS = Scale of Negative Symptoms; BDI-Ⅱ = The Japanese version of the Beck Depression Inventory-second edition (BDI-II); SD = standard deviation.\u003c/p\u003e\n \u003cp\u003eTMT-A, TMT-B, SAPS, and SANS indicate that the lower the score, the better the performance exhibited.\u003c/p\u003e\n \u003cp\u003eStatistically significant values are depicted in bold.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e3.2. Supplemental analyses: r-CCTR vs. WLC\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlthough this study ultimately adopted a quasi-experimental design, we conducted supplemental analyses to determine whether the improvements observed in the r-CCTR group were specific to that group. Using the\u0026nbsp;pre-intervention WLC group (n = 5), we conducted mixed ANOVAs with the r-CCTR and group factor (r-CCTR \u003cem\u003evs.\u003c/em\u003e WLC) on the outcomes (Table 3).\u003c/p\u003e\n\u003cp\u003eSignificant interactions were observed for five cognitive tests: prospective memory (Belongings task, \u003cem\u003eF\u003c/em\u003e(1,13) = 16.68, \u003cem\u003ep\u003c/em\u003e \u0026lt; .01, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003ep\u003c/sub\u003e\u0026sup2; = .50), learning and memory (JVLT, \u003cem\u003eF\u003c/em\u003e(1,13) = 10.89, \u003cem\u003ep\u003c/em\u003e \u0026lt; .01, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003ep\u003c/sub\u003e\u0026sup2; = .39; Story Recall, \u003cem\u003eF\u003c/em\u003e(1,13) = 6.58, \u003cem\u003ep\u003c/em\u003e \u0026lt; .01, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003ep\u003c/sub\u003e\u0026sup2; = .28), executive function (WCST, \u003cem\u003eF\u003c/em\u003e(1,13) = 36.64, \u003cem\u003ep\u003c/em\u003e \u0026lt; .01, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003ep\u003c/sub\u003e\u0026sup2; = .68), and working memory (Backward Digit Span, \u003cem\u003eF\u003c/em\u003e(1,13) = 5.30, \u003cem\u003ep\u003c/em\u003e \u0026lt; .03, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003ep\u003c/sub\u003e\u0026sup2; = .24). A simple main effect indicated that the performance in story recall was significantly improved in the r-CCTR group (\u003cem\u003ep\u003c/em\u003e \u0026lt; .01) but not the WLC group (\u003cem\u003ep\u003c/em\u003e = .24). For the other four cognitive tests, intervention effects were not significant (\u003cem\u003ep\u003c/em\u003es \u0026gt; .07).\u003c/p\u003e\n\u003cp\u003eAdditionally, the results indicated that the\u0026nbsp;Scales for the Assessment of Positive and Negative Symptoms did not differ between pre- and post-intervention. Although a marginal significant interaction was observed for the Beck Depression Inventory (second edition) (\u003cem\u003eF\u003c/em\u003e(1,13) = 4.39, \u003cem\u003ep\u003c/em\u003e = .051, \u003cem\u003e\u0026eta;\u003c/em\u003e\u003csub\u003ep\u003c/sub\u003e\u0026sup2; = .21), no significant improvements from baseline at post-intervention were observed for the r-CCTR (\u003cem\u003ep\u003c/em\u003e = .06) and WLC group (\u003cem\u003ep\u003c/em\u003e = .06).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"14\" valign=\"bottom\"\u003e\n \u003cp\u003eTable 3 The results of mixed ANOVAs examining the interaction between intervention and group.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\"\u003e\n \u003cp\u003er-CCTR (N = 14)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\"\u003e\n \u003cp\u003eWLC (N = 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\"\u003e\n \u003cp\u003eInteraction effect\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMeasure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;Mean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e(1,13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026eta;p\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cem\u003eCognitive function target domains\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003eProspective memory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e Belongings (0\u0026ndash;4 points)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e16.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003eAttention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e TMT-A (sec.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e40.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e36.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(13.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e49.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(8.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e49.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e Digit Symbol (0\u0026ndash;135 points)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e65.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(15.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e71.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e60.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e64.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;Forward Digit Span (0\u0026ndash;9 digits)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003eLearning and memory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e JVLT (0\u0026ndash;48 points)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e25.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e27.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e26.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(8.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e21.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e10.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e Story Recall (0\u0026ndash;25 points)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e6.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003eExecutive function\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e TMT-B (sec.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e67.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(28.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e51.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(16.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e131.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(116.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e70.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e WCST (0\u0026ndash;6 points)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e36.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cem\u003eCognitive function non-targeted domains\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Working Memory\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e Backward Digit Span (0\u0026ndash;8 digits)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e.03\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Visual memory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Figure Copy (0\u0026ndash;20 points)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e16.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e16.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cem\u003eSymptom assessment\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e SAPS (0\u0026ndash;150 points)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e22.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(18.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e19.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e24.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(27.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e22.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e SANS (0\u0026ndash;120 points)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e29.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e27.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e44.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(20.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e37.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(26.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e BDI-Ⅱ\u0026nbsp;(0\u0026ndash;63 points)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e14.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(9.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e11.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e17.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e21.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e(13.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"14\" style=\"width: 99.8808%;\"\u003e\n \u003cp\u003eNote. TMT-A = Trail Making Test part A; JVLT = Japanese Verbal Learning Test; TMT-B = Trail Making Test part B; WCST = Wisconsin Card Sorting Test completed categories; SAPS = Scale of Positive Symptoms; SANS = Scale of Negative Symptoms; BDI-Ⅱ = The Japanese version of the Beck Depression Inventory-second edition (BDI-II); WLC = waitlist control; r-CCTR = revised remote compensatory cognitive training; SD = standard deviation.\u003c/p\u003e\n \u003cp\u003eTMT-A, TMT-B, SAPS, and SANS indicate that the lower the score, the better the condition.\u003c/p\u003e\n \u003cp\u003eStatistically significant values are depicted in bold.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e3.3. Retention rate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the 20 participants, 17 (82.4%) completed at least half of the sessions. The average number of sessions attended per participant was 12.65 (SD = 0.86).\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e4.1. The efficacy of r-CCTR\u003c/h2\u003e \u003cp\u003eOur results reveal that r-CCTR improves certain targeted cognitive functions but, as expected, not non-target cognitive functions. These results are consistent with previous studies [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] and suggest that our training may enhance targeted cognitive functions. Notably, large effect sizes were observed for targeted functions, specifically in the learning and memory domains (JVLT, \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.61; Story Recall, \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;1.22), which are core features of schizophrenia [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConversely, performance was not improved in relation to the Belongings task and WCST in the r-CCRT group. The baseline score of the Belongings task had ceiling effects with limited improvements. It is difficult to compare these results with those of prior studies, which typically used different tests for prospective memory (e.g., the Memory for Intentions Test). Similarly, slightly increased performance was observed for WCST, while baseline scores were relatively high, and this insignificant result is consistent with previous research [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In short, our findings are similar to those in other studies, supporting the preliminary efficacy of r-CCRT [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFurthermore, to provide supplemental evidence, we compared the outcomes between r-CCTR and WLC. This comparison was the original design, which, however, had to be changed because of certain constraints. Nevertheless, a similar pattern of interaction effects indicated improvements for certain targeted cognitive domains but not for non-target domains, as the above-mentioned analysis.\u003c/p\u003e \u003cp\u003eIn both analyses, the learning and memory domains were significantly improved in the r-CCTR group (except for JVLT with only marginally significant improvement: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.08). This pattern aligns with previous strictly controlled studies [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] and further supports the efficacy of r-CCTR. Regarding the performance of the prospective memory and executive function domains, no significant effects were observed in the r-CCTR group; however, a significant interaction effect emerged. This is likely due to the decline in performance in the WLC group, making it difficult to conclude that the r-CCTR group benefited from the training. Furthermore, among the targeted cognitive domains, the attention and executive function domains exhibited no significant interaction effects but appeared to improve with r-CCTR when focused patients received the intervention (except for WCST). Overall, our results are consistent with previous findings showing smaller effects on attention and executive function than those on learning and memory [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Although these supplementary analyses may reflect specific effects of r-CCTR, the results should be interpreted with caution due to the small sample size in the WLC group. In summary, the current study demonstrated potential effects of r-CCTR by revealing both expected improvements and non-improvements.\u003c/p\u003e \u003cp\u003eMoreover, clinical symptoms did not differ in the r-CCTR group. This is consistent with the results of a meta-analysis [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], indicating that cognitive enhancement therapy exerts limited effects on symptoms. However, the marginal significant interaction indicated a puzzled pattern for depressive symptoms, with Beck Depression Inventory (second edition) scores that likely improved in the r-CTTR group but worsened in the WLC group. Given that recent research has reported that CR is associated with decreased depressive mood [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], r-CCTR may also show promising effects for depressive symptoms in patients with schizophrenia. Depressive symptoms in schizophrenia are implicated in disease relapse and impaired social functioning [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], and the effect of r-CCTR on these symptoms has a clinically significant implication.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e4.2. Feasibility\u003c/h2\u003e \u003cp\u003eThe retention rate in this study was 82.4%, which substantially exceeded the pre-defined criteria (i.e., 50%). CR interventions using online technology offer advantages such as ease of access and schedule flexibility compared to face-to-face interventions. Nevertheless, the dropout rate for online CR (32.3%) is slightly higher than that for face-to-face CR (approximately 25%), which might be attributed to factors such as anxiety regarding computer use [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Given these circumstances, our dropout rate of 17.6% is remarkably low. We believe that the underlying reasons include our implementation of the preparatory phase, support for the use of online devices, and enjoyable activities.\u003c/p\u003e \u003cp\u003eMotivational disorder is a deficit in schizophrenia and may be significantly influenced by psychosocial transitions and treatment outcomes [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Intrinsic motivation is a crucial component for CR in terms of increased learning motivation and learning persistence [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. We added a preparatory phase to the initial session, during which everyone had time to become familiar with the online tools and the group. Furthermore, based on our preliminary research, we implemented several considerations to mitigate any psychological burdens (e.g., the use of sticky notes on pages requiring attention). These efforts most likely made our participants experience enjoyment and satisfaction, leading to increased intrinsic motivation, which in turn contributed to the low dropout rate. Many overseas training studies rely on extrinsic motivation, such as monetary rewards [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Therefore, the fact that this study achieved a high completion rate without monetary incentives should bring valuable insights.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e4.3. Limitations\u003c/h2\u003e \u003cp\u003eThe results of this study indicate therapeutic potential; however, several limitations must be considered. First, we acknowledge that the sample size was small, limiting the statistical power to detect differences. Second, the robustness of our intervention has not been rigorously proven because a randomized controlled trial was not conducted. However, this study involved minimal selection bias and the most natural method possible given the local context, providing valuable insights for future implementation. Third, the potential variables that may affect cognitive function (e.g., age) were not included in the analysis. Future research should include larger samples for more detailed analyses. Fourth, it may be desirable to use tasks with adjusted difficulty levels and to assess actual daily activities. This report focused on the effects of r-CCTR on neurocognitive functions and symptoms; however, its effects on social functioning and quality of life in patients with schizophrenia should also be considered. We are currently exploring these secondary domains and conducting follow-up tests.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eOverall, this study provided the first preliminary evidence regarding the efficacy and feasibility of r-CCTR for Japanese patients with schizophrenia. Our promising findings should encourage further research on remote or online CR, which should include assessments of activities of daily living and quality of life as well as long-term follow-up studies. This study highlighted the provision of r-CCTR via a remote online approach, which shows potential for application to other specialized treatments and could promote equitable access to mental health services.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCR Cognitive remediation\u003c/p\u003e\n\u003cp\u003eCCT Compensatory cognitive training\u003c/p\u003e\n\u003cp\u003eJVLT Japanese Verbal Learning Test\u003c/p\u003e\n\u003cp\u003er-CCT Remote compensatory cognitive training\u003c/p\u003e\n\u003cp\u003er-CCTR Revised r-CCT\u003c/p\u003e\n\u003cp\u003eTMT-A Trail Making Test part A\u003c/p\u003e\n\u003cp\u003eTMT-B Trail Making Test part B\u003c/p\u003e\n\u003cp\u003eWCST Wisconsin Card Sorting Test\u003c/p\u003e\n\u003cp\u003eWLC Waitlist control\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was approved by the Kanazawa University Medical Ethics Committee (decision number 2020-327(089)) and was conducted in accordance with the Declaration of Helsinki. All participants provided informed consent before participating in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by JSPS KAKENHI (Grant no. JP 23K09961). The authors declare no conflicts of interest with the sponsor. The funder had no role in the study design; in the collection, analysis, and interpretation of the data; or in the decision to submit the article for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRA contributed to conceptualization, data curation, funding acquisition, investigation, methodology, project administration, validation, visualization, writing the original draft, and writing \u0026ndash; review and editing. MM contributed to investigation and supervision.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our sincere gratitude to all individuals who assisted with data collection. We also extend our heartfelt thanks to all the participants, who generously contributed their valuable time and effort. We also thank Yuta Takiguchi for statistical and writing advice. The authors would like to thank Enago (www.enago.jp) for the English language review.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHarvey PD, Strassnig MT, Silberstein J. Prediction of disability in schizophrenia: symptoms, cognition, and self-assessment. J Exp Psychopathol. 2019;10:2043808719865693. doi:10.1177/2043808719865693.\u003c/li\u003e\n\u003cli\u003eGreen MF, Kern RS, Braff DL, Mintz J. Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the \u0026quot;right stuff\u0026quot;?. Schizophr Bull. 2000;26:119-36. doi:10.1093/oxfordjournals.schbul.a033430.\u003c/li\u003e\n\u003cli\u003eBora E, Murray RM. Meta-analysis of cognitive deficits in ultra-high risk to psychosis and first-episode psychosis: do the cognitive deficits progress over, or after, the onset of psychosis?. 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Compensatory cognitive training for psychosis: effects in a randomized controlled trial. J Clin Psychiatry. 2012;73:1212-9. doi:10.4088/JCP.12m07686.\u003c/li\u003e\n\u003cli\u003eBiagianti B, Fisher M, Howard L, Rowlands A, Vinogradov S, Woolley J. Feasibility and preliminary efficacy of remotely delivering cognitive training to people with schizophrenia using tablets. Schizophr Res Cogn. 2017;10:7-14. doi:10.1016/j.scog.2017.07.003.\u003c/li\u003e\n\u003cli\u003eAngermeyer MC, Matschinger H, Schomerus G. Attitudes towards psychiatric treatment and people with mental illness: changes over two decades. Br J Psychiatry. 2013;203:146-51. doi:10.1192/bjp.bp.112.122978.\u003c/li\u003e\n\u003cli\u003eAijo R, Matsui M. Feasibility and acceptability of remotely accessed compensatory cognitive training for japanese people with schizophrenia: pilot study. JMIR Form Res. 2025;9:e70916. doi:10.2196/70916.\u003c/li\u003e\n\u003cli\u003eLitvak M, Miller K, Boyle T, Bedenbaugh R, Smith C, Meguerdichian D, et al. Telemedicine use in disasters: a scoping review. Disaster Med Public Health Prep. 2022;16:791-800. doi:10.1017/dmp.2020.473.\u003c/li\u003e\n\u003cli\u003eChumley-Jones HS, Dobbie A, Alford CL. Web-based learning: sound educational method or Hype? A review of the evaluation literature. Acad Med 2002;77:586-93.\u003c/li\u003e\n\u003cli\u003eCook DA, Garside S, Levinson AJ, Dupras DM, Montori VM. What do we mean by web‐based learning? A systematic review of the variability of interventions. Med Educ. 2010;44:765-74. doi:10.1111/j.1365-2923.2010.03723.x.\u003c/li\u003e\n\u003cli\u003eMatsuoka K, Kin Y. Japanese Adult Reading Test: JART. Tokyo: Shinkou Igaku Shuppan; 2006.\u003c/li\u003e\n\u003cli\u003eVidarsdottir OG, Roberts DL, Twamley EW, Gudmundsdottir B, Sigurdsson E, Magnusdottir BB. Integrative cognitive remediation for early psychosis: results from a randomized controlled trial. Psychiatry Res 2019;273:690-8. doi:10.1016/j.psychres.2019.02.007.\u003c/li\u003e\n\u003cli\u003eWatamori S, Hara H, Miyamori T, Eto F. The Rivermead Behavioral Memory Test (RBMT). Japanese version. Chiba: Chiba Test Center; 2015.\u003c/li\u003e\n\u003cli\u003eBrain Function Test Committee JSfHBF. Trail Making Test, Japanese edition (TMT-J). Tokyo: Shinkoh Igaku Shuppan Co. Ltd.; 2019.\u003c/li\u003e\n\u003cli\u003eWechsler D, Coalson DL, Raiford SE. WAIS-IV technical and interpretive manual. Pearson T, editor. San Antonio; 2008.\u003c/li\u003e\n\u003cli\u003eMatsui M, Yuuki H, Kato K, Kurachi M. Impairment of memory organization in patients with schizophrenia or schizotypal disorder. J Int Neuropsychol Soc. 2006;12:750-4. doi:10.1017/S1355617706060905.\u003c/li\u003e\n\u003cli\u003eGreve KW. The WCST-64: a standardized short-form of the Wisconsin card sorting test. Clin Neuropsychol. 2001;15:228-34. doi:10.1076/clin.15.2.228.1901.\u003c/li\u003e\n\u003cli\u003eOtsuka S, Matsui M, Hoshino T, Miura K, Higuchi Y, Suzuki M. The effectiveness and applicability of compensatory cognitive training for Japanese patients with schizophrenia: a pilot study. Adv Psychiatry. 2015;2015:314804. doi:10.1155/2015/314804.\u003c/li\u003e\n\u003cli\u003eMatsui M, Kasai Y, Nagasaki M. Reliability and validity of the Japanese version of the repeatable battery for the assessment of neuropsychological status (in Japanese). Toyama Med J. 2010;21:31-6.\u003c/li\u003e\n\u003cli\u003eAndreasen NC. Scale for the Assessment of Positive Symptoms (SAPS).. Iowa: The University of Iowa; 1984. doi:10.1037/t48377-000.\u003c/li\u003e\n\u003cli\u003eAndresen NC. The Scale for the Assessment of Negative Symptoms (SANS). Iowa: The University of Iowa; 1983.\u003c/li\u003e\n\u003cli\u003eKojima M, Furukawa TA, Takahashi H, Kawai M, Nagaya T, Tokudome S. Cross-cultural validation of the Beck Depression Inventory-Ⅱ in Japan. Psychiatry Res. 2002;110:291-9. doi:10.1016/s0165-1781(02)00106-3.\u003c/li\u003e\n\u003cli\u003ePoppe A, Bais L, van Duin D, Ćurčić-Blake B, Pijnenborg GHM, van der Meer L. Feasibility and acceptability of combining cognitive remediation and tDCS in long-term psychiatric clinical care. Schizophr Res Cogn. 2025;42:100358. doi:10.1016/j.scog.2025.100358.\u003c/li\u003e\n\u003cli\u003eKody E, Diwadkar VA. Magnocellular and parvocellular contributions to brain network dysfunction during learning and memory: implications for schizophrenia. J Psychiatr Res. 2022;156:520-31. doi:10.1016/j.jpsychires.2022.10.055.\u003c/li\u003e\n\u003cli\u003eKlojčnik M, Bakracevic K. The effectiveness of computerized cognitive remediation therapy (CCRT) for deficits in attention and executive functions in depression: a pilot study. Appl Neuropsychol. 2023;30:306-14. doi:10.1080/23279095.2021.1941965.\u003c/li\u003e\n\u003cli\u003eHerniman SE, Allott K, Phillips LJ, Wood SJ, Uren J, Mallawaarachchi SR, et al. Depressive psychopathology in first-episode schizophrenia spectrum disorders: a systematic review, meta-analysis and meta-regression. Psychol Med. 2019;49:2463-74. doi:10.1017/s0033291719002344.\u003c/li\u003e\n\u003cli\u003eJagtap S, Romanowska S, Leibovitz T, Onno KA, Burhan AM, Best MW. Can cognitive remediation therapy be delivered remotely? A review examining feasibility and acceptability of remote interventions. Schizophr Res Cogn. 2022;28:100238. doi:10.1016/j.scog.2022.100238.\u003c/li\u003e\n\u003cli\u003eChoi J, Medalia A. Intrinsic motivation and learning in a schizophrenia spectrum sample. Schizophr Res. 2010;118:12-9. doi:10.1016/j.schres.2009.08.001.\u003c/li\u003e\n\u003cli\u003eVansteenkiste M, Simons J, Lens W, Sheldon KM, Deci EL. Motivating learning, performance, and persistence: the synergistic effects of intrinsic goal contents and autonomy-supportive contexts. J Pers Soc Psychol. 2004;87:246-60. doi:10.1037/0022-3514.87.2.246.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"schizophrenia, compensatory cognitive training, remote, preliminary efficacy, feasibility","lastPublishedDoi":"10.21203/rs.3.rs-8545799/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8545799/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e:\u003c/strong\u003e Cognitive impairments in schizophrenia are strongly associated with decreased daily functioning and are a primary target of treatments. The effectiveness of cognitive remediation has been demonstrated; however, access is limited for individuals living in rural areas or those with difficulty commuting to treatment facilities. This study further refined a remote compensatory cognitive training (r-CCT), previously delivered with only the therapist participating remotely, to develop a fully remote version, the revised r-CCT (r-CCTR), enabling all participants to join from home or other locations. We examined its efficacy and feasibility.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e: \u003c/strong\u003ePatients with schizophrenia or schizoaffective disorder underwent r-CCTR (12 weeks, weekly 2-h sessions and 13 sessions, including a preparatory phase). Efficacy was assessed by evaluating cognitive function and clinical symptoms before and after the intervention. The primary analysis compared pre- and post-intervention scores among all participants. An exploratory analysis used mixed ANOVAs to compare the intervention group to a pre-intervention waitlist control group. Feasibility was assessed by examining whether the retention rate exceeded 50%.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e:\u003c/strong\u003e Over 80% of participants completed r-CCTR and met feasibility criteria. Within-group pre–post comparisons revealed significant improvements in attention, learning and memory, and executive function, with moderate to large effect sizes (\u003cem\u003ed \u003c/em\u003e= .48–1.22). No significant changes were observed in non-target domains or psychotic symptoms. Exploratory analyses revealed significant group × time interactions in prospective memory, learning and memory, and executive function.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e:\u003c/strong\u003e r-CCTR is feasible in a fully remote setting and may improve specific cognitive functions in patients with schizophrenia. Future large-scale studies are warranted.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e:\u003c/strong\u003e Not applicable.\u003c/p\u003e","manuscriptTitle":"The potential of a revised remote compensatory cognitive training for patients with schizophrenia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-27 00:07:37","doi":"10.21203/rs.3.rs-8545799/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d72da8ae-c716-495f-81be-7df72bb5ef56","owner":[],"postedDate":"January 27th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Rejected","date":"2026-05-04T07:16:17+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-02T13:55:24+00:00","index":49,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T07:25:57+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-27 00:07:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8545799","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8545799","identity":"rs-8545799","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}