Thinking Outside the Box to Treat Serious Mental Illness

Not long ago, I attended an educational program on cognitive enhancement therapy, or CET. Chances are you may not be familiar with this type of treatment. It’s a rehabilitation-focused approach which has been shown to improve thinking, memory, attention and other brain functions among individuals with schizophrenia or other serious mental illnesses such as severe depression, schizoaffective disorder or bipolar disorder.

According to Ray Gonzalez, Executive Director of the Center for Cognition and Recovery in Cleveland, Ohio, CET is “physical therapy for your brain,” since it targets many of the common cognitive (thinking) difficulties seen among people with these types of serious mental health conditions.

Studies have shown that 84% of persons recovering from schizophrenia have significant impairment in cognitive functions. These include reduced attention, increased distractibility, poor memory, and slower processing of information.

In an inspiring video, actual CET participants gave testimonials about how the therapy has helped them significantly. Some of the benefits cited from CET included increased confidence, improved communication, increased attention span, and being more focused.

But that’s not all. They went on to say how the therapy helped them manage stress better, have more satisfying relationships, stay more stable, have more hope and to “have my life back.”

Thinking outside the box

Gonzalez said that CET forces both mental health consumers and health care providers to think outside the box regarding our usual expectations for recovery from mental illness. Many traditional mental health treatments, including psychiatric medications, have focused more on management of symptoms as opposed to providing active treatment to improve overall quality of life and day-to-day functioning.

Consequently, people with serious mental illness are often seen as limited in their ability to hold down jobs, complete their education, sustain meaningful relationships and contribute to society. Stigma and discrimination from being seen as “mentally ill” further creates a downward spiral of decreased expectations, self-doubt, poor self-esteem and hopelessness.

Also, long-held views of the brain have suggested that the brain does not change and it can’t recover once damaged, particularly among older adults. Newer research now shows that improved brain function is possible at all ages and that the brain can continue to create well over 1000 new neurons per day.

CET goals and format

The overall goals of CET are to improve brain functioning so that participants will have increased capacity for learning, remember what they learn, improve functioning in social situations, and have increased hope.

Given the newfound understanding of the brain’s ability to adapt and recover, CET sessions use  group-based interactive computer games and tasks, peer-to-peer feedback and support, and assistance from trained coaches to stimulate problem solving, memory, and increased attention. CET  also includes group education on various topics such as decision making, improving interpersonal skills, coping with stigma, and living with a disability.

The current CET treatment program is conducted in 48 once-a-week sessions of about three hours each. Rates of attendance and graduation from the program are in the 70 to 90 percent range. Several research studies have shown that CET is very effective in improving the cognitive skills it targets, as noted above. Moreover, people who have completed the program maintain these gains or even continue to improve even a year later.

CET received the 2011 Science and Service Award from the US Substance Abuse and Mental Health Services Administration (SAMHSA), and the approach is listed in SAMHSA’s National Registry of Evidence-Based Programs and Practices (NREPP).

How to learn more

There are currently 12 states and 31 mental health organizations across the US using CETCLEVELAND, the form of CET taught by the Center for Cognition and Recovery. Agencies which wish to bring CET to their area may contact the center for information about training and program implementation.

Although not yet widely available in some areas, new CET programs are being implemented in additional sites each year. CET is certainly an innovative and effective form of treatment which brings great potential to help people with serious mental illnesses improve their lives and their relationships with others.

Here’s a question: Who do you know that might benefit from CET? Please leave a comment. Also, please subscribe to my blog and feel free to follow me on Twitter, “like” my Facebook page, or connect on LinkedIn. Thanks!

  • RecoveryPatience

    I could benefit from CET! I live in NYC… where can I find someone who does this?

  • Here’s a map of the current sites in the CETCLEVELAND network, but you may be able to google for other CET programs in your area.

  • upsideout

    What exactly is it? I didn’t get that.

  • Jo Sicinski

    Yes! I have Bipolar II and have nearly exhausted pharmaceutical options even having had the GeneSight swab done. I’ve lost nearly everything and all control of my life. Diagnosed 12 years ago, at age 42, I have now been in a major depressive state for 5 years.

  • Joy Hibbins

    Is this available in the U.K. yet, David? I am asking both from a personal perspective (I have a diagnosis of bipolar disorder) but also because I feel that this could be helpful to so many people who are experiencing cognitive difficulties as a result of significant mental health challenges. I run a charity in the UK. I’ve just tried to connect with you on linkedin but experienced some difficulties – they requested that I give your email address to prove a prior connection to you.

  • Hi Jo, I’m sorry to hear things have been so challenging for you. I would hope you have a good psychotherapist who you can talk to and who can help you explore other treatment options.

  • Hi Joy,
    I’m not really sure if it’s available in the UK. If you email the folks at, they might know about existing or planned CET programs there. Also, I sent you a LinkedIn invitation. Thanks for contacting me.

  • Joy Hibbins

    Thank you, David

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