Introduction

The late nineteenth century saw thebeginning of the scientific understanding of how the brain functions, with the work of Broca(1865) and Wernicke(1874) andtheir findings on brain injury cases. This is referred toas a localizationist or pluripotentialist perspective of the brain. Eachbehavioral function was believed to be assigned to a certainarea of the brain. The proof that sensory and motorstrips had distinct regions that corresponded to feeling and movementin certain body parts provided more evidence for this claim. With the emergence of another viewpoint that challenges the localizationistview, Lashley et al. (1938) believed that the brain’smass action and that it functions as an equipotentiality, thatis, all brain regions perform the same functions and thatthe degree of deficit was related to the amount oftissue lost rather than the location of the damaged tissue. (Podd, 2012). Other evidence emerged, such as Goldstein(1939) andAlexander Luria(1948, 1966, 1973), which acknowledged the brain’sability to automatically reorganize so that a different region couldtake over the function of the damaged region and thatthe patient could be taught to use strategies instead ofthe strategies he was learning with, and a treatment plancould be devised to develop and teach alternate functional systems. In their book on neurotraining, released in1981, Craine andGudeman outline their strategy for cognitive remediation (CR) andsuggest“off-the-shelf” games that may be customized tohelp individuals with brain injury restore their cognitive performance. Theintroduction of personal computers, Lynch(1979) suggested Atari games and, subsequently, Apple II games that would be beneficial for peoplewith cognitive impairment. Neuropsychologists started creating their own computer-assistedcognitive rehabilitation systems (e.g., Ben-Yishay et al. 1987; Bracy1985; Gianutsos and Klitzner1981). Although there was alot of interest at the time, research was not doneto a great amount, and neuropsychologists began to doubt theeffectiveness of cognitive rehabilitation. With the accumulation of research onCR and its effectiveness, (Ponsford and Kinsella, 1988; Cicerone etal. 2000, 2005; Podd and Krehbiel, 2006) proved the effectivenessof CR on several aspects, such as cognitive, psychological, andsocial. (Podd, 2012). This study aimed to highlight the conceptof through a conceptual background through a description and reviewapproach. We will introduce CR as a new therapeutic approachin neuropsychological interventions designed to improve cognition. We will providea general overview of CR; determine the target aspects forimprovement in CR, as well as the most important modelsand approaches used in CR and its interventions, and exploringthe effectiveness of CRT on neuropsychiatric diseases by providing asummary of some of the literature.

Definition of CR

CRfirst began in World Wars I and II. Techniques havebeen developed to improve the attention and memory problems seenin military veterans after brain damage. (Boake, 1991). We willtry to present and discuss various definitions of CR bypresenting different definitions. The goal of CR is to enhancecognitive functioning and rehabilitate cognitively compromised individuals. By enhancing deficiencyfunctions or creating new cognitive strategies, CR enables the therapyof cognitive deficits. Remediation might mean that a cognitive skilldoes not improve enough; it may have been better beforeand deteriorated. (Medalia, Revheim, & Herlands, 2009). All of these definitionsemphasize improving cognitive processes through techniques to enhance them whilealso concentrating on restoring damaged Cognitive Functions(CFs). According toMedalia, Revheim, & Herlands(2009), CR is a behavioral therapy forpeople whose cognitive impairment interferes with daily functioning. Dandil, Smith, Kinnaird, Toloza, & Tchanturia(2020) suggest that CR interventions are ageneral term for psychological interventions that employ cognitive training exercisesto address issues with Social Cognition(SC) and neuropsychologicalfunctioning.

CFs, Metacognitive, and SC as goals for improvement of CR

CFs

Cognition is a set of diverse abilities thatallow an individual to recognize process and respond to theinformation provided. CFs are involved in daily activities, and CFsis an important factor for individuals (Kim et al., 2018). The focus is on the area of EFs (also calledexecutive control) and refers to the set of higher mentalprocesses necessary to focus and process information to automatically continueany activity, and to select and control behaviors that facilitatethe achievement of goals, there is general agreement that thereare three basic EFs according to (Lehto et al., 2003, Miyake et al., 2000); which are: 1)Inhibition or attentionalcontrol, 2)Working Memory (WM), 3) cognitive flexibility. Throughthese high-level jobs, higher skills are built, such asthinking, problem solving and planning, which are generally considered essentialskills for mental health and cognitive, social and psychological development(Diamond, 2012); As such, CFs are crucial todaily life. Thus, cognitive deficiencies affect a wide range ofdomains such as daily life, academic, professional and personal domains; Cognitive impairment is a common feature of various mental disorders; Cognitive deficits can be one of many symptoms of thesedisorders, or they can involve the ongoing change caused bythe disorder (Kim, et al., 2018)

Metacognitive skills

Metacognition refersto a higher level of thinking that includes active controlof cognitive processes. Activities such as planning how to approacha particular learning task, monitoring comprehension, and evaluating progress towardcompleting the task are metacognitive skills. Since metacognitive plays animportant role in successful learning, it is It is importantto study metacognitive activity to determine how to teach peopleto use their cognitive resources better through metacognitive control (Livingston, 2003), unconsciousness of wrong decisions (possibly as a result ofneurocognitive impairment) may lead to inaccurate social interpretations and poorbehavioral response choices that reinforce functional impairment (Davies, Fowler, & Greenwood, 2017).

SC

SC includes emotion recognition, theory ofmind, empathy, explanatory style and insight. The SC function allowsindividuals to act in accordance with social norms and participatein determining other people’s attitudes or intentions, and isalso linked to professional and social functioning and a person’s relationships (Pinkham & Penn, 2006), “The goal of social cognitionis to provide a mechanism for action-oriented explanations ofcomplex social phenomena”; When we interact with the environment westart from the input where we sense signals originating fromthe environment, and the sensations are detected by our senseorgans such as the eyes, the sensations (such as lightof a certain wavelength) are converted into perceptions (such asthe color of fruit) based on prior knowledge and currentcontext, after so decisions are made about what to dobest; In response to these perceptions (e.g. is thefruit ripe? Should I eat it?), actions are planned andproduction begins in the form of bodily movements (e.g. catching the fruit), within this general framework of stimulus andresponse, we can have a subset of the processes involvedwith social stimuli (such as reading facial expressions), social decisions(such as: Should I trust this person?), and social responses(making facial expressions) (Harvey & Bowie, 2012)

CR Approaches

Schwalbe & Medalia(2007) argue that CR techniques were initially designed to helpimprove cognitive performance in people who have had neurological injuries, when research showed that impairment at the neuropsychological level isalso present in mental illnesses such as schizophrenia, researchers andclinicians began to investigate and apply Different types of CRapproaches on samples of people with mental and psychological disorders, many models of CR used with mental and psychiatric disordersare based on the initial approaches developed for brain injurypatients.

The Neuropsychological Educational Approach to CR (NEAR) Model

Thisapproach, developed by Medalia, Revheim, & Herlands(2002), is a CRtherapy technique specifically designed for cognitive dysfunction, and repairing, renewingand restoring abilities for use in cases of mental andpsychological disorders who suffer from cognitive deficits. In contrast tocases of brain and neurological injuries, who usually have motivationto recover, cases of mental and psychological disorders, who areusually unmotivated and the source of their motivational difficulties fromthe disease itself or from possible repeated failures in learningsituations. They are usually not motivated to participate in cognitiveactivities that includes repetitive exercises; to make such cognitive tasksintrinsically engaging for mental and psychiatric cases, the NEAR isdesigned to be more stimulating, dynamic, and enjoyable. (Schwalbe & Medalia, 2007). The NEAR, as stated by (Medalia, Revheim, & Herlands2009; Medalia, & Freilich, 2008; Schwalbe & Medalia, 2007), focuses on individual trainingconducted in groups, combining techniques developed in both neuropsychological andEducational models to target neuropsychological deficiencies as they affect informationprocessing and cognitive functioning. The NEAR it is group therapythat provides a high-level individual education, by allowing everyonein the group to work at their own pace incarefully selected tasks to participate and support his cognitive needs(Medalia, Revheim, & Herlands, 2009). In addition, CR is an educationalactivity using educational techniques developed in the field of educationknown to enhance learning; for example, training tasks involve manyskills simultaneously, and presented in a real-life context. Wheninformation is learned in a context (e.g.: attention skillsare activated in the context of a driving simulation experienceas opposed to a set of flashing colored circles) ithas been shown that learning is bigger and more sustainable(Schwalbe & Medalia, 2007)

Compensatory and Restorative Approaches

According to Kimet al. (2018), many therapeutic approaches have been developed forCR; because of the interest in its effectiveness first withcases of brain and neurological injuries to improve cognitive impairmentresulting from brain injuries. The interest increased when the samecognitive impairment was discovered in mental and psychiatric disorders; Asa result, different types of therapy have been developed inCR. It can be divided into compensatory approaches and restorativeapproaches, depending on the intervention. The compensatory approach is designedto help treat cognitive impairment by acquiring new skills orchanging the environment, with the aim of improving behavioral adaptation. On the other hand, the restorative approach aims to restoreand renovate CFs through repetitive practice based on brain flexibility. In addition, CR uses a variety of learning strategies suchas: error-free learning, behavioral reinforcement, and group learning. Thesestrategies are applied differently depending on the type of intervention.

CR approach based on neuropsychology/neuroplasticity-based cognitive training

Accordingto Biagianti, Castellaro & Brambilla(2021), most research on CR inneuropsychiatric diseases has been on schizophrenia. It examined a varietyof rehabilitation approaches including computer-based training, educational programs softwaresand therapist-guided strategy coaching in problem-solving tasks. Biagianti, Castellaro & Brambilla(2021) assume that CR methods are based ontwo foundations, the first is a CR based on aneuropsychological model of brain function; all CFs are considered separatein the brain and can therefore be evaluated independently ofeach other through a training approach, there are many programsthat represent this model, including COGPACK, COGREHAB, Computer Assisted CognitiveRehabilitation (CACR). These programs are based on the principle offocus on tasks, gradation in the level of difficulty ofexercises, and intensive and regular practice on tasks. Subjects undergoingthese programs show improvements in verbal learning, WM, processing speed, executive functioning, attentional abilities, and work outcomes, the second isa neuroplasticity-based cognitive training (NBCT) is a form ofCR that bases its theoretical principles on the concept ofcerebral plasticity and neurogenesis. In NBCT, intact brain plasticity mechanismsare harnessed via computerized exercises to promote healthier neural systemfunctioning (both in terms of increases in gray matter volumeand plastic changes in cortical activation patterns). These neuroplastic changeslead to better cognition, increased resiliency to stressors, and overallimproved functioning (Biagianti, Castellaro & Brambilla, 2021)

CR goals

CR aims to:

Improving, restoring, retrieving, and developing cognitive skillsand increasing cognitive efficiency to improve independence, adaptation, and qualityof life (Demily et al., 2016). Individuals adaptto the difficulties faced by individuals in daily life byenhancing abilities and skills by focusing on the strengths ofeach individual (Demily et al., 2016); either by training cognitivedeficit functions or by allowing patients to learn strategies formaking the best use of their residual functions, with thegoal of improving how patients face their daily lives. (Frank, 2012), and these skills can be transferred toimprove daily functioning (Emily, 2016).

To encourage patientsto reflect on their thinking patterns and to plan anddevelop strategies to enable them to make behavioral changes (Dandil, Smith, Kinnaird, Toloza, & Tchanturia, 2020).

Bolger(1981) argued that thegoal of CR“is to increase the mental capacity ofthe individual to process larger amounts of stimuli with greateraccuracy and with greater attention to subtleties.” Such an increasein the patient’s ability to process information is viewedas a necessary component in the performance of complex cognitivetasks. (Kenneth, Barbara, Renee, & Raymond, 1997). For Bolger(1981), remedial tasks that focus on rudimentary (e.g., perceptualand attentional) processes as well as higher cortical functions arepresented to the patient continuously throughout the rehabilitation program. Theessential feature of the program is the emphasis on thepatient’s ability to integrate this higher-level CFs (Lawrence, 1997).

The purpose of CR, which is a new psychologicaltreatment, is to improve coping and compensation abilities and, asa matter of fact, psychosocial function (Hajri et al., 2016).

Principles of CR Practice

Shaun(2012) observes that the groupof treatment approaches collectively referred to as CR can varysubstantially and ranges from completing Sudoku exercises to using highlysophisticated computerized programs designed to enhance specific domains of CFs. Some approaches are completed individually, some with a therapist orcoach, and some in groups. Some CR programs focus onlyon neurocognition (Fisher, Holland, Merzenich, & Vinogradov, 2009; Wykes et al., 2007), while others focus on social cognition (Horan et al., 2009), and still others focus on an integration of thetwo during treatment (Hogarty et al., 2004). Although not allCR programs focus on multiple cognitive abilities, the most effectiveprograms target broad cognitive domains (McGurk, Twamley, Sitzer, McHugo, & Mueser, 2007). Eack(2012) adds that cognitive abilities are not targetedat random but in a hierarchical fashion from lower-orderto higher-order CFs. This is based upon information processingmodels that indicate the need for simple cognitive abilities (e.g., attention) to support more complex information processing, such asreasoning, problem-solving, and other EFs. The belief is thathigher-order cognitive abilities cannot be fully remediated unless thebasic building blocks of cognition are also improved. Some CRprograms also use cueing and fading from learning theory tohelp shape cognitive performance and progressively increase the difficulty ofcognitive exercises. Cueing refers to the use of visual orauditory stimuli or external aids to help increase individuals’ performanceon a particular exercise; the techniques used in CR aredesigned to adapt to the difficulty of the exercises fromthe initial level until the development of each person’sability. In this way, CR is usually adaptive and focuseson providing enough challenge for people to participate and exercisetheir cognitive abilities. Eack(2012) summarizes some of the principlesof CR through the principles of practice with individuals withschizophrenia, including:

Developmental strategies to improve cognitive performance and taskcompletion.

Repeat cognitive exercises for several sessions until performance improves.

Targets the development of basic cognitive abilities into more complexones.

The application of external supports (usually auditory or visual)to improve cognitive performance.

The gradual removal of cues andexternal aids in cognitive exercises increases the difficulty.

Adjust thedifficulty of cognitive exercises to remain challenging and engaging.

Connectingcognitive exercises to“real-world” behaviors and domains that workin the domains they support.

Use additional treatments and supportto maximize the benefits of CR.

Methods of CR

Thescientific literature has detailed a wide range of distinct cognitiverehabilitation techniques. The Wisconsin Card Sorting Test can be taughtto help persons with schizophrenia perform better, according to someof the earlier research. Programs were then created to addressthe cognitive deficiencies linked to schizophrenia. The two main methodologiesused by CRT programs are rehearsal learning and strategy coaching. Both of these strategies can be used in combination. Theadvantage of using computerized procedures is that they are moreeffective and standardized. Computer-based applications called Cogpack and Cogrehabtarget a variety of cognitive processes. Interactive training programs areused to target cognitive areas such as memory, attention, visualinformation processing, language, and motor performance. With the use ofthese tools, rehabilitation may be prolonged through personal computer-basedexercise. With the use of these tools, rehabilitation may beprolonged through personal computer-based exercise. (Galletly & Rigby, 2013). Accordingto Harvey and Bowie(2012), bottom-up training aims toimprove basic sensory processes while top-down training focuses onhigher-level cognitive skills. All of the effective strategies shareseveral features that are important. Some studies have used mixedapproaches, and others have used different approaches. Other attempts toimprove functioning take compensatory approaches to adapt the environment tothe individual’s cognitive limitations. Harvey and Bowie(2012) believethat there is a set of intervention strategies, including:

Dynamic titration of difficulty

Task demands and requirements adapt based onpatients’ performance levels. There are optimum degrees of task complexitythat result in the highest amounts of brain activity. Withor without distracting stimuli, stimuli can be provided at differentrates. Multiple settings in computer-based drill and practice activitiescan frequently be changed to get the best level.

Dosing considerations

Many interventions offer two30-to-60-minute trainingsessions each week. Better improvements result from intervention sessions thatare completed more successfully. Since the1950s, it has beenshown that spaced practice results in superior learning outcomes. Althoughthe dose might be fairly low in some circumstances, thereis a distinct dose response.

Strategic monitoring

Patients areencouraged to explain their thought processes and try other tactics, such as making verbal associations with the use of strategicmonitoring. Contrary to the rote computerized drill and practice procedures, this part of cognitive rehabilitation is significantly more therapist-dependent. If people learn flexible problem-solving techniques, improvements in awider variety of cognitive skills and the daily behaviors associatedwith those abilities may be more possible.

Between-session application

Some interventions have a defined curriculum focused on the applicationof the gained abilities in regular functional situations because itis believed that training a skill does little good withoutknowledge about its applicability. Some therapies have a structured curriculumintended to apply the gained skills in real-world situations. These“bridging groups” are a regular component of these interventions; however, it is not quite apparent what kind of bridgingis necessary.

CR interventions: The Different Programs

Based on whatDemily et al. (2016) mentioned there are many programs andinterventions within the scope of CR in several cognitive domainssuch as memory, attention, and metacognition; they listed a setof programs with evidence and experimental findings. In memory programs, Hulme and Mackenzie used a cumulative repetition technique to focuson an articulatory recapitulation approach. Teenagers with intellectual impairments (aged13to18) participated in this program. The memory spansignificantly improved, according to the authors. Then, Comblain improved thisapproach by suggesting30-minute weekly individual training sessions withpeople who have Down syndrome (with increasing difficulty). Bussy etal. showed a lengthening of the verbal span and anexpansion of the passive vocabulary using this methodical technique. Inthe metacognitive program“Découvrez vos capacités, rEalisez vos possibilités, pLanifiezvotre démarche, soyez créatiFs” (DELF), is a metacognitive program thatseeks to identify a subject’s strengths and showcase theindividual. When included in a regular educational program, deliberative thinkingskills are enhanced. This curriculum is utilized in groups andteaches more specific methods, such as how to better useWM so as not to overload memory, as well asmetacognitive strategies (anticipation, planning, and control). In virtual reality, virtualreality’s potential for treating people with intellectual impairments hasreceived less attention in research. Rose et al. made thepoint that active exploration using a joystick in a virtualworld is more relevant than passive exploration accomplished by simpleobservation. The respondents were able to better retain the environment’s spatial information by using a joystick. Thus, the creationof virtual reality applications would let users enhance their spatialabilities. In the Attentional Program, Galbiati et al. (2009) suggestedtreatment for kids and teens with traumatic brain injuries whoare also dealing with attentional problems and minor intellectual disabilityand are between the ages of6and18yearsold. Utilizing metacognitive techniques, the program utilized targeted attentional capacities. Four45-minute individual weekly meetings with a therapist werepart of the six-month course of treatment. The taskswere computerized for30minutes, paper, and pencil for15minutes each during the sessions. Daily progress was made bythe participants in terms of their ability to focus andadjust. On the other hand, according to Harvey and Bowie(2012), there are other programs for CR including“Cognitus & Moi”, “COG PAC” and“Posit-Science Brain Fitness program”, “Cognitive remediationtherapy”, “Integrated psychological treatment” and“Cognitive adaptation training”.

Cognitus & Moi

Cognitus & Moi was developed in France through the collaboration betweenthe GénoPsy center, the EDR-Psy research team (headed byPr. Nicolas Franck), and the SBT Company (headed by Pr. F. Tarpin-Bernard), by trained therapists for CR. The“Cognitus& Moi” program targets attentional and visuospatial functions. Cognitive goals areembedded in two different modules: attention (hearing attention, visual attention, and divided attention, double attentional tasks) and visuospatial (eye tracking/gaze direction, spatial orientation, visuospatial memory, mental imagery, and visuospatialconstruction), and the level of these modules is chosen accordingto the child’s key difficulties. Therapists utilize methods thatare effective in helping people with cognitive disorders recover. “Cognitus& Moi” targets a single-impaired cognitive area. Children aged5to13who may or may not have intellectual disabilitiesare the target audience. The program’s cartoon character Cognitusserves as its mascot. (To find out more, see Demilyet al., 2016).

COG PAC

In Germany, Marker Softwarecreated the“COG PAC” system. The executive functioning, processing speed, and other skills like WM are stimulated by a varietyof diverse visually presented stimuli in this program. Since thereare several distinct exercises, some of which (such as identifyingcurrency) do not seem to have the ability to improveCFs, this top-down software must be personalized to eachuser.

Posit-Science Brain Fitness program

Numerous cognitive-improving modules, such as auditory and visual exercises, are offered by the“Posit-Science Brain Fitness program” There is also a modulefor driving simulation. The auditory training routines, which were createdusing knowledge about the anatomy and operation of the auditorycortex, were employed in earlier investigations of this program withschizophrenia patients. This strategy is designed to enhance perceptual signal-to-noise processing.

Cognitive remediation therapy (CRT)

By Delahunty andMorice, CRT was created. It consists of three components thateach target WM, planning, and cognitive flexibility. Individual sessions forremediation are held, and exercises using paper and pencil areused. The therapist’s job is to support patients increating their own plans for resolving issues while offering suggestionsfor action when necessary. In terms of WM and cognitiveflexibility, this program’s effectiveness has been demonstrated in adultsand adolescents, respectively. According to new research, CRT has beenlinked to long-lasting enhancements in memory and social functioning. The topic of social cognition is not covered by thissimple-to-use tool, which is designed for executive processes. As a result, at the very least, support psychotherapy mustfinish its activities. (Demily & Franck, 2008)

Integrated psychological treatment

InBern, Brenner and Volker Roder created the first treatment regimenfor schizophrenia known as IPT (Switzerland).  It incorporates social skillsinstruction and cognitive rehabilitation. IPT consists of five subprograms: cognitivedifferentiation, social perception, verbal communication, and social skills training. IPTenhances the encoding abilities, executive functions, personal autonomy, and interpersonalrelationships of schizophrenia patients. Patients who get cognitive rehabilitation throughIPT are taught abstraction, conceptual organization, fundamental perception, and communicationtechniques. IPT also promotes long-lasting improvement in patients’ mentalhealth. (Demily & Franck, 2008)

Cognitive adaptation training

Behavioral principlesare set up to cue appropriate behaviors, discourage distraction, andmaintain goal-directed activity. The training uses environmental support andadaptations in association with target behaviors. Adaptations are customized forspecific cognitive deficits in attention, memory, and fine motor control. Treatment strategies imply an assessment of cognitive functioning, behavior, andthe environment. CAT is not a CR program but rathera compensatory method. The goal of this program is toimprove functional outcomes rather than cognitive functioning. (Demily & Franck, 2008)

The effectiveness of CRT

CR is a useful and practicaltool for the therapist and patient as it focuses onthe cognitive-functional aspect. CR is a flexible tool thatfocuses on CFs, psychosocial abilities, adaptation, and occupational aspects. Itdepends on neuroplasticity, cognitive flexibility, the brain’s ability totrain and learn, and its impact on the nervous system. According to Harvey & Bowie(2012), Additional research has revealed thatCR may have an impact on the central nervous system(CNS). For instance, Vinogradov et al(2009) reported that patientswho received CR manifested an improvement in their serum levelsof brain-derived neurotrophic factor (BDNF). Additional studies have shownthat CR has potential central nervous system (CNS) effects. Patientsreceiving the inactive treatment did not change at all. Ina study of CR in dyslexia, according to Keller andJust’s2009research, a structured intervention designed to boostreading also leads to structural brain changes. Cases that gotthe therapy and had positive treatment responses showed an improvementin regional fractional anisotropy. As a result, following remediation treatment, the cortical white matter became more cohesive and structured. Muchevidence has proven their effectiveness, especially in the field ofsevere mental illness in general and schizophrenia in particular, inthe cognitive, psychological, social, adaptive, and professional aspects. CR hasa direct and positive impact on the neurocognitive, psychological, social, and functional aspects of schizophrenia. CR is considered the primaryreference for the application of CR in computerized and non-computerized programs. The majority of studies found that schizophrenics’ executivefunctions, CFs, and metacognitive strategies improved after exposure to CR. A CR program based on metacognition had a positive effecton the cognitive and EFs of schizophrenics. CR stimulates andinteracts with patients more. (Choi et al., 2018; Cella etal., 2019).

Discussion

CRT is characterized as one of thetherapeutic interventions in cognitive training and rehabilitation directed at enhancingneurocognitive and metacognitive abilities and social functioning, including social cognition, by enhancing strong cognitive capability to recover impairments’ capacities orfocusing on impairments’ abilities to improve their performance. CRT isbased on the perspective of neurocognitive plasticity and the abilityof the brain to compensate and multifunction, and that behaviorallearning makes the brain capable of reorganizing automatically, as assumedby Goldstein(1939) and Alexander Luria(1948, 1966, 1973), wherea different region can take over the function of thedamaged region and the patient can be taught to usestrategies in place of the ones he was learning, anda treatment plan can be developed to develop and teachalternative functional systems. Taking into consideration that the methods ofCR are based on the neuropsychological basis of brain function, neuroplasticity, and brain plasticity, cognitive training is based on brainneurological changes arising from the exercises and tasks provided byCRT. What distinguishes CRT approaches is that they are basedon an orientation to rehabilitate the cognitive impairments of patientswith psychiatric diseases. Based on information processing and cognitive functioning, as well as their neurocognitive, psychosocial, and functional abilities, theseapproaches are based on the educational environment and new stimulito help patients learn new strategies, adapt, and be flexibleto new situations in daily life. By relying on adaptiveand stimulating behaviors for recovery, participation in educational activities, reinforcementof learning, and the provision of training tasks, many skillsare acquired at one time and presented in the contextof real life with the use of a variety oflearning strategies such as error-free learning, behavioral reinforcement, grouplearning, and the acquisition of skills in a new andchanging environment with a focus on tasks, gradation in thelevel of difficulty of exercises, and intensive and regular practiceon tasks. On the other hand, therapeutic interventions for cognitiverehabilitation are computerized programs that include interactive exercises that focuson executive and cognitive functions, metacognitive skills, and functional socialperformance, based on gradations in the difficulty of exercises andtheir simulation of real life. This contributes to training andrehabilitating patients to adapt to and integrate into real life. In terms of the future of CRT, it is stillemerging in therapeutic interventions, and it needs more research andapplication. According to Wykes’s writing in Nature(2010), amore individualized strategy is the way of the future forCRT. She advises stratifying study participants in order to determinethe approaches that are most successful given their unique characteristics, such as age or learning style. An ideal remediation programwould be created specifically for each person. Investigating how CRTaffects brain function may involve using biomarkers or brain imaging. Galletly & Rigby(2013) assume that the development of successful programsthat include CRT with psychosocial and vocational rehabilitation is mostlikely where CRT’s clinical future lies. The most likelyscenario for CRT’s future is its integration with psychologicaland vocational rehabilitation. Future studies should continue to examine thebest CRT method and assess its effects on overall functionaloutcomes. Clinical programs presented by clinicians are largely utilized forresearch, while computerized programs are more likely to be usedin clinical practice. When the outcomes of clinician-delivered programsare compared to those of computerized CRT programs, it appearsthat, despite the differences in outcome metrics, the computerized programsare typically just as successful