Thursday, May 21, 2015

Cognitive Enhancement Therapy for Schizophrenia: Interview with Shaun Eack, Ph.D.

[Episode 98] Today’s episode of the Social Work Podcast is about Cognitive Enhancement Therapy (Eack, 2012) - a relatively new approach to addressing some of the most persistent and intractable problems faced by people with schizophrenia. In order to learn more CET, I spoke with Shaun Eack, Ph.D. Dr. Eack has been involved in most of the clinical research on CET. He is the David E. Epperson Associate Professor of Social Work and Psychiatry at the University of Pittsburgh, and the director of the ASCEND Program, which stands for "Advanced Support and Cognitive Enhancement for Neurodevelopmental Disorders.
Download MP3 [36:08]

I spoke with Shaun at the 2015 Society for Social Work and Research conference. In our interview, Shaun talks about the development of CET, the computer exercises and group therapy - the two components of the treatment, some amazing research findings, and how social workers can get trained in CET.


Shaun M. Eack, Ph.D. is David E. Epperson Associate Professor of Social Work and Psychiatry at the University of Pittsburgh. His primary research focus is on the development, implementation, and evaluation of psychosocial treatment methodologies for persons with severe mental illness. His recent work focuses on the application of Cognitive Enhancement Therapy, a neurocognitive and social-cognitive rehabilitation program, to persons with schizophrenia and autism spectrum disorders. He has published papers on the efficacy of Cognitive Enhancement Therapy in both chronic and early course schizophrenia patients, and is now studying the neurobiologic effects of the treatment in both schizophrenia and autism. In addition, he has published papers on factors affecting various psychosocial outcomes among individuals with schizophrenia, particularly quality of life and functional outcome. Dr. Eack also maintains a broad interest in treatment dissemination and implementation, and has published papers on the development of the behavioral health workforce and implementation of standardized assessment tools in routine community mental health settings.

Download MP3 [36:08]



Jonathan Singer: Today’s episode of the Social Work Podcast is about Cognitive Enhancement Therapy (Eack, 2012) - a relatively new approach to addressing some of the most persistent and intractable problems faced by people with schizophrenia. Here’s how we typically think of schizophrenia: It is a severe brain disorder which may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior. We talk about Positive symptoms: the presence of sensations - hallucinations, beliefs - delusions, and behaviors that would not normally occur. Negative symptoms: the lack of abilities, lack of energy, difficulty engaging in social activities, poor motivation, difficulty making friends or functioning in psychosocial contexts. Traditional treatments have targeted the positive and negative symptoms. But, even when the hallucinations and delusions are being managed – often times by medication, and people have opportunities and supports to engage in social activities, some people with schizophrenia continue to have problems acting wisely and appropriately in social situations. So, why aren't people with schizophrenia getting better? Today’s guest, Shaun Eack, suggests that a third group of symptoms - cognitive symptoms - has been largely ignored by treatments. He makes the VERY important point that if you can improve cognitions in people early on in the course of schizophrenia you increase the likelihood that they will be able to be gainfully employed, live independently, and have successful interpersonal relationships. Recognizing the power of addressing cognitive and social skills deficits, social work researcher Gerry Hogarty developed Cognitive Enhancement Therapy (Hogarty 1999).

In order to learn more CET, I spoke with Shaun Eack, Ph.D. I spoke with Shaun in Episode 45 about Schizophrenia.  At the end of that conversation he mentioned this new psychosocial intervention he’d been working on – Cognitive Enhancement Therapy. At the time I really wanted Shaun to talk more about CET. But, he was a doctoral student, finishing up his Ph.D. and didn't feel quite ready to be "the voice" of CET. Seven years later, he’s done some incredible, groundbreaking research on CET, and is considered one of the leading experts in the world.  He has published over 70 peer-reviewed journal articles in the top journals in social work, psychiatry, and psychology. In 2013 he co-authored the Sage Publication text, Mental Health Case Management: A Practical Guide, with Carol Anderson and Catherine Greeno.  Today he is David E. Epperson Associate Professor of Social Work and Psychiatry at the University of Pittsburgh, and the director of the ASCEND Program, which stands for "Advanced Support and Cognitive Enhancement for Neurodevelopmental Disorders."

I met up with Shaun in New Orleans at the 2015 Society for Social Work and Research conference. In between trips to Cafe du Monde to eat beignets and drink cafe au lait, Shaun and I managed to have a fascinating conversation about the development of CET, the computer exercises and group therapy - the two components of the treatment, some research findings that frankly blew my mind, and how social workers can get trained in CET.

Note: About nine minutes into the interview Shaun is talking about the development of CET. I call it "version 1." Shaun politely ignores me and continues talking. After I turned off the tape Shaun clarified that there is only one version of CET that has been evaluated in treatment studies. So, it is a little misleading to say “version 1,” because at the time of the interview there wasn’t a “version 2.” And now, without further ado, on to episode 98 of the Social Work Podcast: Cognitive Enhancement Therapy for Schizophrenia: Interview with Shaun Eack, Ph.D.


Jonathan Singer: Shaun thanks so much for being here on the Social Work Podcast and talking with us about cognitive enhancement therapy. What’s the idea behind cognitive enhancement therapy?

Shaun Eack: Well cognitive enhancement therapy as it was originally developed for people with schizophrenia, is really designed to address an important unmet therapeutic need. One of the challenges that people in the field have observed is that even after individuals are able to get a good response from the medicine they are taking and get good support to help them get back on track in terms of their lives after a hospitalization. They still are having a trouble with building a better quality of life, building a fuller recovery and of course we all thought that for many, many years that if you take your medicine, get good social work help, help broker resources to you, you should be able to get back on the horse and be all better.

Jonathan Singer: It’s just that you’re having these hallucinations and that’s the problem and if you don’t have them that’s fine.

Shaun Eack: That’s the idea, that’s the prevailing view for the last 100 years on schizophrenia. But many of the people who have schizophrenia beg to differ, so of course medication carry with them some challenges as well. In addition even people who faithfully take them, and manage the symptoms still have problems making friends, still have trouble holding information in their mind in order to complete a task something as simple remember a phone number to dial a friend or so forth or even keeping up with the flow of information in an interview and with a back and forth conversation is very difficult for people with schizophrenia. These challenges are heightened in the acute phase of the illness are psychotic and sadly don’t go away when the positive symptoms, the psychotic symptoms go away. At the moment there aren’t any good treatments available in terms of medication treatments for people with schizophrenia in terms of treating these types of challenges. These challenges that I am talking about, I haven’t actually used the term yet, are often referred to as cognitive problems and are sometimes called cognitive impairments and are sometimes called cognitive deficits I liked to refer to them as more as challenges.  But in general people with schizophrenia are left with reduced psychotic symptoms but a lot of difficulty with understanding the world and processing information. A lot of us think that this is due to around the time schizophrenia develops, it develops late adolescence, early adulthood a lot of important things are coming on line in terms of cognition at this point and boom here comes this condition kind of hits people hard and knocks them off their horse and what’s left after people have become stabilized are really these difficulties in thinking and cognition.

Jonathan Singer [8:00]: So what your saying is that up until the age of lets say 14 everything is fine and then maybe some symptoms and then by early twenties he met criteria for full blown schizophrenia, was on medication, positive symptoms were reduced, would this have been a kid who would have been able to handle these social situations prior to schizophrenia or are these kids that always had challenges in these areas?

Shaun Eack: Yeah, that’s a great question I think the jury is still out I cant give you a definite answer, and with most things I cant. But the weight of the evidence seems to suggest these cognitive challenges come on far before somebody has a full-blown episode of schizophrenia. And if you test their siblings and even their parents or their children you will see an inkling of the cognitive challenges that a person with schizophrenia is challenged within their family.

Jonathan Singer [9:03]: So that’s interesting cognitive symptoms are not necessarily the result of schizophrenia, maybe an exacerbation?

Shaun Eack: Yeah, what the field has generally thought of is there is early markers of schizophrenia there is early markers for other conditions to, but what we know is that people who develop this condition, they have these challenges oftentimes but often not to the same degree when they are fully ill but they have a hint of these challenges many times before they become ill then after they become ill then it becomes horrific and they have a lot of difficulty and once they become stabilized these challenges become persistent.

Jonathan Singer [9:53]: So this has become known about people with schizophrenia for about 100 years, so what got you interested in this particular part of schizophrenia?

Shaun Eack: What got us interested in it and what got the developer of cognitive enhancement therapy interested in it was one of our own Gerry Hogarty, not only was the persistency of these symptoms intriguing but what hooked us and what I think hooked Gerry was the fact that these symptoms will predict how well you will do when you leave the hospital even better than the cardinal psychotic symptoms.

Jonathan Singer [10:36]: Really?

Shaun Eack: That’s why I said! It’s just amazing, now there have been many, many studies maybe over a hundred now demonstrating this effect.

Jonathan Singer [10:47]: So when you say predicting better outcomes, what outcomes are you talking about?

Shaun Eack: Pick an outcome you care about as a social worker, cognition is related to it, employment, social behavior, ability to make friends, getting along with your family. All of these have been studied.

Jonathan Singer [11:05]: Medication adherence?

Shaun Eack: Medication adherence! Absolutely! In fact there is an excellent program, maybe you could do a podcast on Dawn Velligan cognitive adaptation therapy, which is designed solely to address cognitive problems and to improve medication adherence. The impotence really arose by the degree of, magnitude that these impairments had on these peoples ability to recover and function after they left the hospital, which the largest share of people with schizophrenia as the hospitals have closed and become acute care centers. So now if your keeping up with me Jonathon, we’ve got two problems here we have the strongest predictor we know of functional outcome when people leave the hospital and we don’t have a medicine to treat it, enter cognitive enhancement therapy, that was the situation that Professor Hogarty encountered and was trying to address when he created cognitive enhancement therapy.

Jonathan Singer [12:02]: So how do you enhance cognitions?

Shaun Eack: Well there is a lot of ways you can enhance cognition and enhance thinking. What Gerry did was he looked at the literature on brain injury which is not in the same field as schizophrenia and psychiatry, but people who have a traumatic brain injury have very serious cognitive impairment and their was an outfit at New York University by Yehuda Ben-Yishay that was very successfully improving people’s cognitive abilities who had focal brain damage and how they were doing this was…

Jonathan Singer [12:43]: Wait let me ask what is focal brain damage?

Shaun Eack: So people who have had a localized lesion, possibly due to a stroke. Usually if you have gross brain damage you likely wouldn’t survive so individuals who had fallen off a motorcycle and gotten a head injury and individuals that have had a stroke and part of their brain had died, these were the things that Ben-Yishay was treating initially with computer exercises, so in traumatic brain injury the way they have been treating and improving people’s cognition was we will give you computer exercises that are designed to challenge the areas that you have difficulty in with cognition and if we can teach you to practice that over and over again what we call drill and practice in cognitive enhancement therapy and teach you how to solve cognitive problems strategically by knowing your own strengths and challenges, perhaps we could improve that at a very substantial level. And over course they were doing that in traumatic brain injury and there was no reason to suggest it could be tried or be fruitful with people with schizophrenia, they have many of the same cognitive impairments that people with traumatic brain injury have. The first iteration of cognitive enhancement therapy was taking this work that was developed out of traumatic brain injury and taking it and making is useful for people with schizophrenia.

Jonathan Singer [14:13]: Version 1 was computer games

Shaun Eack: And another important part to CET, which was a group. In order to explain why we do these two things, I have to tell you about the nature of the cognitive challenges of people with schizophrenia have, they have broad difficulty in two domains: one is processing basic information that is difficulty in attending information, remembering it, and solving problems we call that a neurocognitive deficit. Don’t let these terms fool you, these challenges are in the brain but this one is called a neurocognitive deficit. This is not the only challenge that people with schizophrenia have, the other challenge that we discussed when we started this interview is a difficulty understanding other people, getting along with others, and knowing how to act wisely in interpersonal situations, something we could always use a little help with. This is an area that is kind of a new topic called social cognition and this it turns out is problematic in schizophrenia and this area is primed for targeting and improving areas that we are interested in as social workers.

Jonathan Singer [15:30]: So the first area of problem solving you could do this by yourself, that second one social skills, that is inherently a two person job or more.

Shaun Eack: At least.

Jonathan Singer [15:47]: Is that why there is a computer game and a group?

Shaun Eack: That’s right. So to us and to Gerry his vision of cognitive enhancement therapy was that the basic problems in neurocognition that people with schizophrenia had was really addressing a means to an end of improving social cognition which wouldn’t improve all by itself but if you cant pay attention its hard to pick up a social cue, right? If you can’t remember what’s going on in a conversation, it is really hard to get the gist of the conversation and be able to contribute. And the idea was that these things would work synergistically, so that’s why in cognitive enhancement therapy we don’t have a do it yourself version of the computer work cognitive training, that’s why participants, there’s actually a lot of reason why we do this but participants actually do the computer work together and in pairs and with someone we call a coach. A coach is someone who would be a therapist but we refer to him or her as coaches who provide CET because the role is different. Its more guided, its more hands off, its gives the opportunity for people to be challenged without recusing them because what we see over and over again with schizophrenia is if you give them the opportunity to be challenged they will surprise you and they are capable of a lot more than people give them credit for.

Jonathan Singer [17:13]: So my characterization of someone siting in a chair and problem solving on their own does not really fit in terms of what your talking about in terms of these problem solving skills you see that also as done in relationship.

Shaun Eack: we do, we see that as the best way to practice it if were every going to move this social cognitive challenge that people have. Working on these games, computer exercises there hardly games and the young and younger people always laugh when they see them we have to let them know that they are oldies but goodies right.

Jonathan Singer [17:46]: when you say younger you mean the people with schizophrenia not the coaches.

Shaun Eack: that’s right, but some of the coaches do raise an eyebrow to, but that’s not allowed in my program. So these games are more like exercises and it’s a lot like going to the gym except its going to the gym for your brain. Who goes to the gym more often either by themselves or with their buddy, so if you have a buddy and a personal trainer as well your more likely to put a lot of effort into it, you sometimes may compete a little, maybe push yourself further than you would have this is kind of like what we do in CET in terms of computer training.

Jonathan Singer [18:31]: What are some of the effects that you found in the people that are doing these computer exercises?

Shaun Eack: Well it’s an interesting question that you ask because CET is an integrative program because it contains two parts that occur simultaneously the computer training the neurocognitive training and the social cognitive training. Were not able to isolate the effects of just doing the computer work or just doing the group the social cognitive groups, but the effects that we have seen when we put these two together is pretty remarkable. The first study was published in 2004 with 121 people with schizophrenia who had been ill for many years on average about 15 years and the level of improvement that was seen in terms of basic neurocognitive ability 2-3 times better than the medication effect that was observed. So on average anti psychotic medication improve cognition about two standard deviations.

Jonathan Singer [19:36]: What does that mean?

Shaun Eack: two tenths of a standard deviation, there is the average level of cognitive ability among people with schizophrenia, which falls at about one standard deviations below people who do not have schizophrenia. So if you move up two tenths of a point its not very close to a full point to what we call people if they did not have this condition.  So the average effect of CET on that first study was a standard deviation.  Not only were we able to improve people to a level that was as good as before they got the illness or perhaps before they deteriorated, we may be able to teach them new skills they may cause them to be better than that. And as the studies go on CET gets a little bit more refined every time, we get better at knowing how to do it, what should stay in and what shouldn’t, so it was streamlined a little bit after that first study. So we started the second study with people in the early course of schizophrenia with the idea being if we could improve outcomes for people who have been ill for so long, why should we wait 15 years to give it to them. What was interesting in that study, when you treat individuals that are young with this condition, when you get to them early there are all these barriers that are removed that are in the way for them to get better. So for example individuals that have been ill for a very long time are often times on the disability system, I think about 100% of our sample was involved in the disability system and there was a lot of disincentives for going to work if your in that system. These young individuals we see were on mom and dads insurance, they were not entrenched in a mental health or disability system yet, and that was kind of part of the idea also for this study and at the end of the study not only were we happy to present that cognition improved but these young individuals were going back to work and going back to school. I mean one of the follow up interviews when I was a student working with Gerry on this project was we followed individuals after they completed treatment and a year later asked how they were doing and this individual sticks particularly in my mind he said, “things are great I just go back from my honeymoon” and me this was sometime ago when this study was conducted and this was when I was still wet behind the ears and I had never seen a person with schizophrenia get married and go on a honeymoon. This was amazing and we really go something here, Gerry was really onto something. Sadly he passed away before that study ended, and myself and his colleague Matt had to complete it, and we were so glad that we could because after seeing how well people did in this intervention we knew we had something that could really help these individuals.

Jonathan Singer [22:46]: So there is an intervention that uses computer games, it uses a group setting, you talked about the computer games, what does the group do?

Shaun Eack: Glad you asked! In CET the computer work is important but its not the heart of the program, the heart of the program is the group. The group is what Professor Hogarty would refer to as secondary socialization which is an interesting concept it comes out of sociology, broadly the idea is that you learn best by interacting with others and observing people do well and succeed in a safe environment where you have the opportunity to mess up and nobody is going to get on your case about it and were just going to give you an opportunity to do better next time. And so the groups are structured around that philosophy, the content is all about social cognition. There are 45 group sessions, very structured, it’s a lot more like a class than a therapy we all talk about social cognition, recovery, the function outcomes the people who participate are those who are the most interested in.

Jonathan Singer [23:58]: Are there 45 different topics covered?

Shaun Eack: There are.

Jonathan Singer: Whoa!

Shaun Eack: Yep it’s a big program, its comprehensive in nature, there are 45 topics they range from learning how to take the perspective of other people to getting the gist of conversations, to something we call emotional temperature taking, nonverbal cues, reading facial expressions of emotions, its broken up to a variety of modules the third module is dedicated entirely to application and one of the exercises in it I love, I don’t think our group members love it when they first start but when they get good at it they do CET to help a friend where they had to actually CET to somebody else who is having a problem that is of course a social problem that has unique opportunities to use the CET strategies to learn throughout the group.

Jonathan Singer [24:50]: These 45 different topics are these things that Gerry came up with, you came up with, the standard treatment in traumatic brain injury like where does this information come from?

Shaun Eack: I can take no credit for the design of any of these sessions, Professor Hogarty developed a share of it, but what you see is that the early sessions really build on previous treatments, it can include a lot from personal therapy, family psycho education, and even the early thorozene studies he conducted back in the 50s/60s I probably got the date wrong.  So they really give people a solid base of understanding their condition, the role medicine has to play in it, the limitations on it, and other things that would be helpful like psycho social treatment, stress management, those things are what the first couple sessions of CET addresses. So you can see they are not squarely on social cognition, there laying the foundation on this and we do that and I think Gerry structured it that way because we see so many people that haven’t gotten that already we see many people who don’t even know what there condition is and the thing that has been giving them so much trouble for so long. So that part of the work came from his early developments and treatments and the rest of it he was inspired by his own creativity. So, Gerry read a lot, if Gerry was alive today I don’t think he would let me say that I think Gerry would have given credit to a lot of other people who have written about this and one in particular I should mention people Salomon wrote a book called “Making a friend in youth” Salomon was like a developmental sociologist the furthest thing from schizophrenia that you can ever think of so Gerry is reading this book and he said “this is what we need to teach the people that we work with about how to make friends and improve social cognition, this is how we should structure our curriculum” , so I think he was inspired by so many people that worked hard in this field that he really put it into practice.

Jonathan Singer: I can almost imagine everyone benefiting from this kind of group, we all have our own social skills deficit, and I know my wife would tell me that I have deficits in social skills areas.

Shaun Eack: Mine as well.

Jonathan Singer [27:13]: Have you ever had students or coaches come in saying “Oh man, I learned something today”?

Shaun Eack: Absolutely, all of us have admitted that CET has been beneficial to provide as well as receive. Gerry would always say to me when I was his student “never give a treatment that wouldn’t be beneficial to you”. CET fits into that regard a lot, to give you some idea of the broad applicability of CET though, we have taken it to more than just schizophrenia. There are groups of people that struggle with the social challenges that we talked about and something that is similar and also face the same social challenges that people experience is autism spectrum disorder.  Many people don’t know, but of course family members with a child with autism would know many practitioners would not know any evidence based treatment for adults with autism and very few treatments that target social cognition. And so we have begun the first set of studies adapting cognitive advancement therapy to adults with autism spectrum disorder with really great success. The studies are still ongoing so I cannot really report on the findings yet, but the people who have come to the groups and participated in the program they stay, do well, enjoy it and we see real important movement in individuals. There are a lot of antidotes that I can give you but I will wait for the scientific papers to come out instead.

Jonathan Singer: And after they come out we will do an interview about CET with people with autism.

Shaun Eack: Wonderful.

Jonathan Singer [28:51]: So is there any hard data that you have about CET and the effectiveness?

Shaun Eack: Well I always thought that employment data was hard data personally, but I understand what you mean by hard data. There are different things that people consider to be convincing evidence.

Jonathan Singer: And with employment I will just throw out, I can hear skeptics say they got a job because they have a cousin that got them a job and you have a 127 people and you have 10 people with parents that will give them a job that will throw off your data and when you have something that isn’t going to be influenced by daddy wanting to give Johnny a job.

Shaun Eack: Absolutely, of course the employment data was not characterized like that all of the jobs people got were real jobs for real money.

Jonathan Singer: Not to diminish it of course…

Shaun Eack: I understand exactly what you mean. We have a program to improve thinking and cognition, are hard data should rely on what is happening to the brain. We have now published the first study showing that social work intervention, a non-drug social work intervention, can protect against brain tissue loss in schizophrenia. In 2010 we did an analysis of individuals who went through CET showed and unlike people who didn’t receive CET who displayed what is typical in the early stages of schizophrenia which is a progressive loss of brain tissue, gray matter in areas of the brain that were particularly associated with understanding and thinking of other people. People who received CET showed no such loss, exactly what were trying to target. And what was so fascinating about it was that not only was there this neruo protective effect but the protection against that loss was directly related to their social and improvements. So we know have really hard data. We don’t know what all that means. If you asked a neuroscientist is bigger better, is smaller better I mean it really depends on a lot of things and I wont claim to be an expert on any of that. What we do know is that there is a signal in the brain and that signal is related to improved outcomes, and we currently have a study that is going to investigate what the signal mean. Perhaps the brain and schizophrenia are far more plastic, far more amendable to treatment, perhaps its not as damaged as people might think, and could be shaped and improved in a psychosocial and environmental and hopefully pharmological interventions.

Jonathan Singer [31:37]: I spoke with Larry Steinburg, developmental psychologist and that was one of the things he talked about over and over and particularly for the adolescent brain and the adolescent brain being up to 25 about the plasticity and how malleable it was. Hearing you talk about this I’m thinking about folks in the early stages there brains are in the under 25 age range right?

Shaun Eack: absolutely and you may recall schizophrenia use to be considered a static encephalopathy right? That is a brain damage that is not changing, least not for the better. So our hope is that people do these studies and our people contribute that minor part of that area that people will have a renewed optimism for schizophrenia and people stop thinking of it as a brain disorder that has to be static. It is a brain condition but it seems like something that we can really move.

Jonathan Singer: This is great Shaun, I mean when you think about social work and the impact we have its hard for practitioners to say researcher is directly applicable to what I do. But what your saying is that people in the early stages of schizophrenia and the people who have been diagnosed for many years responded incredibly well and at the end of the say that is what social workers want, they want there clients to respond well.

Shaun Eack: absolutely, and the social workers we trained to provide CET they always enjoy the process of providing treatment but what they enjoy the most is seeing the people they work with that have these conditions really improve. Not everyone improves to the same degree, everyone is on their own journey in terms of recovery, but they see sides with the people they work with that they have never seen before, and I did like with the individual who came back from the honeymoon and that makes it so rewarding. I think that brings it home to practitioners who are really interested in making a difference for their patients.

Jonathan Singer [33:47]: So you mentioned training social workers if I was listening to this podcast and I worked with people with schizophrenia and I thought hey I am going to get some of that CET in my agency how could I do that?

Shaun Eack: That’s a great question, so I am pleased to report that cognitive enhancement therapy has been approved by SAMSA as evidence based practice.

Jonathan Singer: Congratulations. That is huge.

Shaun Eack: Thank you so much it was quite a review process, and I think that opened a lot of doors to the possibility to reimbursement, people are happy to pay for it, in terms of training there is a comprehensive manual available for some training of course this isn’t something we do so we can only take so many but were building up training centers so we can respond to the interest and the need that is out there.

Jonathan Singer [34:29]: and when you say we, who is we?

Shaun Eack: there is a side; there is a business that is run by Gerry Hogarty’s wife who is also a psychiatric nurse specialist, Susan Hogarty, and a long time colleague of his Debra Greenwald called CET training LLC and people who want training usually go to our website and they contact Dr. Greenwald or Mrs. Hogarty and either obtain the manual or work on obtaining in person training.

Jonathan Singer [35:11]: So the manual is available through the website?

Shaun Eack: It is, yes you can get it through the website, its modestly priced this is work were not trying to profit off of. It was funded by public tax payer dollars so we like it to be available to as many people as possible cause that’s our hope

Jonathan Singer: Thanks so much Shaun, for spending the time to talk to us about cognitive enhancement therapy. It was inspiring

Shaun Eack: Thanks so much Jonathan.

Audio transcribed by Isabel Silverstein.


  • Eack, S. M., Anderson, C. M., & Greeno, C. G. (2012). Mental Health Case Management: A Practical Guide. Thousand Oaks, CA: Sage Publications. 
  • Hogarty, G., & Flesher, S. (1999). Practice principles of cognitive enhancement therapy for schizophrenia. Schizophrenia Bulletin, 25, 693-708. Full text retrieved from
  • Hogarty, G. E., Flesher, S., Ulrich, R., Carter, M., Greenwald, D., Pogue-Geile, M., … Zoretich, R. (2004). Cognitive enhancement therapy for schizophrenia: Effects of a 2-year randomized trial on cognition and behavior. Archives of General Psychiatry, 61, 866.
  • Selman, R. L. (1998). Making a friend in youth: Developmental theory and pair therapy. New York: Aldine de Gruyter.


APA (6th ed) citation for this podcast:

Singer, J. B. (Producer). (2015, May 21). #98 - Cognitive enhancement therapy for schizophrenia: Interview with Shaun Eack, Ph.D. [Audio Podcast]. Social Work Podcast. Retrieved from


She Rides a Bike said...

This was truly an excellent podcast and so relevant to my work evaluating programs for people living with an SMI and COD.

Unknown said...

We need you in the uk ..