Cognitive remediation therapy in low-and-middle-income countries (LAMICs) for people with psychosis: a systematic review of its efficacy on functional and cognitive outcomes

Soc Psychiatry Psychiatr Epidemiol. 2026 Jun 11. doi: 10.1007/s00127-026-03136-x. Online ahead of print.

ABSTRACT

PURPOSE: Cognitive difficulties are commonly present in people with psychosis and are associated with poor functional outcomes. Evidence from high-income countries (HICs) indicates that cognitive remediation (CR) is an effective treatment for cognitive difficulties. Evidence from low and middle-income countries (LAMICs) is emerging. This study reviews the evidence for CR for people with psychosis in LAMICs.

METHODS: Seven databases (GIM, SCOPUS, WoS, APA PsycINFO, Global Health, Medline(R), and Embase) were searched. Two reviewers screened the studies retrieved independently against the eligibility criteria. Risk of bias was assessed using ROB 2.0 and ROBINS-I. The results on CR efficacy, alongside application and delivery, were synthesised narratively.

RESULTS: Fourteen studies from countries in Africa, Asia and South America were included. CR delivery modality and settings varied, including those delivered at home and by caregivers and health care workers. Thirteen studies showed that CR was beneficial for cognition, with small to large effect sizes. Nine studies showed that CR can improve functioning, with small to moderate effect sizes. The studies showed that CR was safe and well-tolerated. The effect of CR did not differ by setting, dosage, delivery agent or mode of delivery.

CONCLUSIONS: CR could be a useful approach to reduce the burden of cognitive difficulties in people with psychosis in LAMIC. The adaptations to CR evaluated by the included studies could be used and further evaluated globally to provide novel, culturally acceptable and scalable implementation approaches for CR.

PMID:42274736 | DOI:10.1007/s00127-026-03136-x