Social Work’s Shaun Eack Advances Effective Nondrug Treatment for Schizophrenia

Marked by delusions, hallucinations, and disorganized thinking, schizophrenia causes people to lose contact with reality, seeing or hearing things that don’t exist, retreating into fantasies, and even believing they’re being persecuted. So far, the primary treatment for schizophrenia is drug therapy, which often works effectively to control hallucinations and delusions. However, this also can have debilitating side effects. More importantly, drug regimens are not a remedy for the full spectrum of schizophrenia’s disordered cognition. Now it appears that a different approach to the disease may offer surprising new benefits. Shaun M. Eack, an assistant professor in the University of Pittsburgh’s School of Social Work, is evaluating an unconventional nondrug therapy. The results, so far, have been groundbreaking.

Eack comes from a family of social workers, so it’s no surprise that, from a young age, he wanted to help others, especially the underserved and disenfranchised. He earned a bachelor’s degree in psychology at the University of Illinois, Urbana-Champaign, in 2002 and then pursued a Master of Social Work degree there with a specialization in community mental health, which increased his encounters with the disease of schizophrenia.

When Eack arrived at Pitt in 2003 to begin doctoral studies in social work, he worked with a research program led by Gerard E. Hogarty, who was then a professor of psychiatry at the University of Pittsburgh School of Medicine. Hogarty—who had also studied social work—was a leading scholar in the psychological treatment of schizophrenia. He was especially known for his innovative work to improve cognition in schizophrenia through Cognitive Enhancement Therapy (CET), based on treatments originally used to rehabilitate people with traumatic brain injuries.

CET as developed by Hogarty was designed as a cognitive intervention involving individual treatment sessions with computer-based exercises geared toward improving basic cognitive functions like attention, memory, situational behavior, problem solving, and communication. Additional individual and group sessions were used to stimulate more demanding and complex social-cognition functions.

In essence, Hogarty’s CET intervention sought to lessen whole-brain damage and regenerate healthy brain function. As he theorized, there are similarities in the damage caused by traumatic brain injury and by schizophrenia. It turns out that, in both cases, the brain can be retrained to restore function. Specifically, CET targets core brain-function and cognition impairments that limit recovery.

The therapy takes advantage of the brain’s neuroplasticity—its ability to change and adapt in response to enriched cognitive experiences. “Neuroplasticity is, essentially, your brain repairing itself or changing itself for the better,” says Eack. “Every time you learn something, your brain changes a little bit. By offering mentally stimulating experiences, challenges, and exercises to those with schizophrenia, our study has the effect of working out the brain much like a muscle. In response, the brain can repair areas damaged by schizophrenia or grow new areas to compensate for those problems.”

During his days at Pitt as a doctoral student, Eack joined Hogarty and his colleague, physician Matcheri S. Keshavan, in an initial CET study to see whether cognitive remediation could improve outcomes in schizophrenia. At the time, it was widely believed the disease was a static brain disorder that would only respond to medications. Remarkably, though, the CET study showed that social functioning and adaptive behavior in schizophrenia could be improved through computer exercises that targeted certain areas of the brain.

Even after Hogarty’s death in 2006, Eack and Keshavan continued the study, gathering additional physical evidence that showed CET was producing positive results against the disease. Study participants agreed to neuroimaging scans of their brains before and after CET. The “before” scans showed areas of brain atrophy, even in those who had been stabilized on drug therapies. The “after” scans revealed that CET lessened atrophy and led to the growth of new brain tissue. This was the first evidence ever of a clear structural neurobiologic effect on the brain using nondrug treatment in those with schizophrenia.

The initial University of Pittsburgh research using CET to treat schizophrenia has shown such compelling promise that, earlier this year, Eack received a $3.1 million grant from the National Institutes of Mental Health to continue and extend his study. While the original CET clinical trial was conducted with people who had been ill for an average of 15 years, the new five-year study is seeking participants who were diagnosed fewer than eight years ago.

“There was really a dramatic reduction in disability,” Eack says of an initial study in early-course schizophrenia. “Over 50 percent of the young people who were treated with CET ended up getting employed during the course of the study.” On average, most studies find that less than 20 percent of those with schizophrenia are employed. Among the many other benefits found in the initial study were improvements in work readiness, social functioning, role functioning, task performance, and activities of daily living.

The study proved it was possible to enhance cognition in people with schizophrenia, resulting in improvements in their adjustment, social functioning, and adaptive behavior. The new research asks: What might be possible by intervening sooner in the disease’s course?

Today, Eack is using the National Institute of Mental Health grant to focus on the next phase of the research, known as the ESSENCE Program, which is being carried out at Pitt as well as in Boston in collaboration with Matcheri S. Keshavan, who is now vice chair of the public psychiatry department at Boston’s Beth Israel Deaconess Medical Center. Given the original results, Eack is eager to gather more evidence of CET’s effectiveness. The possibility of dramatic progress against the devastation of schizophrenia is real and long awaited.

(This article was excerpted from Pitt Magazine, Fall 2013 issue.)