Can Cognitive Training Decrease Reactive Aggression?

Neurocognitive and social cognitive impairments are contributors to negative emotionality and
impulsive aggression in people with schizophrenia. Impulsive aggression poses several
challenges to the care of people with schizophrenia. These include a greater risk of
rehospitalization and longer hospital stays, involvement with the criminal justice system,
and increased risk of recidivism. The investigators recently found that schizophrenia
patients with aggression history experienced improvements in neurocognition as well as
decreased hostility/agitation and incidents of verbal and physical aggression after
participating in cognitive remediation training (CRT). Based on these findings, it is
hypothesized that improving neurocognition through CRT may have enhanced the capacity of
schizophrenia patients to inhibit aggression through improved emotion regulation capacity and
impulse control. It is also postulated that the addition of Social Cognition Training (SCT)
to CRT would provide greater benefits on emotion regulation and impulse control over CRT
alone. To test the hypotheses, the investigators will conduct a clinical trial that compares
two configurations of cognitive training--CRT plus SCT versus CRT plus control computer
games. The goal of the study is to examine the comparative benefits of the two configurations
of cognitive training on outcomes that include neurocognition, social cognition, emotion
regulation, impulse control, and reactive aggression. Participants assigned to the CRT plus
SCT group will complete 24 hours of CRT and 12 hours of SCT. Participants assigned to the CRT
only group will complete 24 hours of CRT and 12 hours of control computer activities. Emotion
regulation, impulse control, and reactive aggression will be indexed using laboratory-based
challenges. The investigators will recruit and characterize 90 study participants on
demographic and clinical variables including age, gender, education, aggression history, and
medications. Study outcome measures will be administered at baseline and posttreatment to
participants randomized to the study groups. In a subsample of 32 patients, the study
investigators will further examine changes in the neural network of emotion regulation and
impulsivity before and after cognitive training.

Inclusion Criteria:

- diagnosis of schizophrenia or schizo-affective disorder

- Age 18-60

- Mini Mental Status Exam score greater/equal to 24 at screening

- Auditory and visual acuity adequate to complete cognitive tests

- At least a score of 5 or more on the Life History of Aggression (LHA) aggression items
or one confirmed assault in the past year

- Capacity and willingness to give consent

Exclusion Criteria:

- Inability to read or speak English

- Documented significant disease of the Central Nervous System (CNS)

- History of intellectual impairment predating psychosis (e.g., a diagnosis of
developmental disability)