Cognitive remediation of distraction to reduce striatal dysregulation and improve clinical outcomes for individuals with psychosis

The ability to ignore distracters is impaired for individuals with psychosis. This impairment negatively impacts treatment effectiveness and the ability of individuals with psychosis to function fully. Recent work has shown that the striatum, a brain region beneath the surface of the brain, is the locus of a pronounced dopamine abnormality when comparing individuals with psychosis to those without – dopamine is a neurotransmitter that is thought to play an important role in psychotic symptoms. We have shown previously that this brain region also may play an important role in our ability to remember goals and ignore distracters. Improving the ability to ignore distracters for individuals with psychosis through brain training could reduce symptom severity and improve treatment outcomes. The current study proposes to further examine the relationship between striatal dysregulation, distraction, and symptom expression. We will also attempt to remediate distracter susceptibility through a cognitive training intervention. Individuals with psychotic symptoms and non-psychotic controls will undergo clinical assessment, cognitive testing, and an fMRI scan to establish a baseline of behavioral and neural functioning. Some participants will take part in a cognitive remediation intervention, where they will be trained to ignore visual and auditory distraction. After the completion of this training period participants will undergo a second instance of clinical assessment, cognitive testing, and an fMRI scan. We predict that individuals who underwent training will show an improvement of distracter resistance, and patients in particular will show decreased subcortical brain activity during distracter presentation as well as reduced symptom expression. If successful, this training regiment could improve the likelihood that individuals with psychosis will be able to find and hold gainful employment, reach their academic goals, and reduce the frequency of hospitalizations.