Barcelona snapshots

Prof. Rafael Penadés

Rafael Penadés psychiatrist Controversies Psiquiatry Barcelona
Universitat de Barcelona, Spain & IDIBAPS
Talk Cognitive remediation and improving social skills as a tertiary prevention for psychosis
Date Friday, September 17th, 2021
Time 17:30 - 18:15
Round Table 4. Psychotic disorders


Rafael Penadés is a Clinical Psychologist working at the Hospital Clínic of Barcelona. He is currently in charge of the neuropsychology and psychological treatments area at the Barcelona Clinic Schizophrenia Unit (BCSU). He is an associate professor in the Department of Medicine –area of Medical Psychology- at the University of Barcelona. He is also a researcher at the August Pi i Sunyer Biomedical Research Institute (IDIBAPS) in the area of "Biological bases of mental disorders" and is a member of Group 4 in the area of schizophrenia of the Network Research Center in Mental Health (CIBERSAM).

His research interests are neuropsychology, neuroimaging, genetics and psychological treatments applied to serious mental disorders. He has conducted different projects being supported by national and international funding, including a 2016 NARSAD Independent Investigator Award by the Brain and Behaviour Research Foundation (US). He has written 2 books on the subject and numerous chapters, and articles published in international journals.

He has a degree in psychology from the University of Valencia and a doctorate in psychology from the University of Barcelona (granted with the extraordinary doctorate award). He is certified as a clinical neuropsychologist (COP) and as a psychotherapist (EuroPsy). He undertook specialist training in Clinical Psychology at the Hospital Clinic of Barcelona. He undertook short research fellowships at different centres: Hospital Aita Menni Mondragón, The Canberra Hospital, Institute of Psychiatry at Kings College London, and Université Paris X Nanterre. He also obtained a master's degree in affective neuroscience from the University of Maastricht.


Cognitive impairments are an essential characteristic of psychotic disorders as they are present even before psychosis symptom onset and persist throughout the course of illness. These impairments include deficits in different domains such as verbal learning and memory, speed processing, executive functions, and attention. The treatment of cognitive dysfunctions has been posited to be critical in the treatment of the different psychotic syndromes, owing to they are strongly associated with high levels of social and functional disability and they are the key factor that contributes to such disability. Cognitive remediation is a psychological intervention aimed at treating the cognitive dysfunctions associated with psychotic disorders. Taking into account that pharmacological treatment has a very limited effect on cognitive dysfunctions and clinical remission does not necessarily result in functional recovery, the use of cognitive rehabilitation treatment is crucial to improve functional disability and achieve personal recovery goals of the patient. A large body of literature in chronic psychotic disorders suggests that cognitive remediation is a most valuable treatment for people with schizophrenia, proven to be effective in ameliorating cognitive performance and psychosocial functioning. Cognitive improvement obtained in global cognition is similar to that obtained in most cognitive domains. The effects of treatment on global cognition appear to be long-lasting in the periods studied, between six months and two years. Furthermore, recent studies have suggested that cognitive remediation has an impact on brain functioning. Significant improvements in neuroactivation patterns and neuroconnectivity has been described although underlying neurobiologial mechanisms of cognitive recovery are not completely understood yet. From a different and much more practical perspective, some meta-analytic studies have shown that effects of cognitive remediation could be maximized when specific patients’ demographic and clinical characteristics, particular modalities of cognitive remediation delivery variables are took into account. Finally, the role of the rehabilitative context in which cognitive remediation is implemented is relevant and determine the functional outcomes. In order to achieve a meaningful and relevant impact in the daily life of participants, cognitive remediation needs to be complemented with other interventions like skills training. Social and work skills training are both evidence-based psychological interventions that aims to improve psychosocial competence by means of learning new behavioural abilities. Considering the personal and individual characteristics of the patient and particularly their personal recovery goals could be the central feature in designing relevant interventions and assuring that the intervention will impact on daily functioning. To that end, a model to implement cognitive remediation with other interventions will be presented and discussed.


Bowie, C. R., Bell, M. D., Fiszdon, J. M., Johannesen, J. K., Lindenmayer, J. P., McGurk, S. R., Medalia, A. A., Penadés, R., Saperstein, A. M., Twamley, E. W., Ueland, T., & Wykes, T. (2020). Cognitive remediation for schizophrenia: An expert working group white paper on core techniques. Schizophrenia research, 215, 49–53.

Penadés, R., Segura, B., Inguanzo, A., García-Rizo, C., Catalán, R., Masana, G., Bernardo, M., Junqué, C. (2020). Cognitive remediation and brain connectivity: A resting-state fMRI study in patients with schizophrenia. Psychiatry research. Neuroimaging, 303, 111140.

Penadés, R., Franck, N., González-Vallespí, L., Dekerle, M. (2019). Neuroimaging Studies of Cognitive Function in Schizophrenia. Advances in Experimental Medicine and Biology. 1118:117-134.

Vita, A., Barlati, S., Ceraso, A., Nibbio, G., Ariu, C., Deste, G., & Wykes, T. (2021). Effectiveness, Core Elements, and Moderators of Response of Cognitive Remediation for Schizophrenia: A Systematic Review and Meta-analysis of Randomized Clinical Trials. JAMA psychiatry, e210620.