Review article Attention training in the cognitive rehabilitation of schizophrenic patients: a review of ef®cacy studies Suslow T, Schonauer K, Arolt V. Attention training in the cognitive rehabilitation of schizophrenic patients: a review of ef®cacy studies. Acta Psychiatr Scand 2001: 103: 15±23. # Munksgaard 2001. Objective: To review the literature on effects of attention and cognitive training on attentional functioning in schizophrenic patients. Method: Relevant ef®cacy studies were identi®ed by literature searches (in Medline, Current Contents, Psyclit, and Psyndex databases) and through the reference lists of key papers. Results: Re-examination of ®ndings from nine methodologically adequate studies using computer-based or non-computer-based training procedures provided inconsistent results. On 16 of 35 outcome measures signi®cant performance improvements were observed from pre-treat- ment to post-treatment but on the majority of the applied measures no performance improvement could be determined. In general, treatment effect sizes but also power of tests were low. For nearly all the outcome measures for which differential training effects were reported there also exist contradictory outcome results. Conclusion: There is inconclusive evidence that attention training is effective in schizophrenia. Longitudinal ef®cacy studies are needed in which different aspects of attention are systematically exercised and assessed. T. Suslow, K. Schonauer, V. Arolt Department of Psychiatry, School of Medicine, University of Mu Ènster, Mu Ènster, Germany Key words: schizophrenia; attention; rehabilitation Thomas Suslow, Department of Psychiatry, School of Medicine, University of Mu Ènster, Albert-Schweitzer- Str. 11, 48149 Mu Ènster, Germany Accepted for publication May 30, 2000 Introduction In the past decade computer-based cognitive train- ing programs have been developed to ameliorate the cognitive de®cits associated with schizophrenia (1, 2). Frequently, residual cognitive impairments stand as impediments to a full recovery from schizophre- nia. The novel approach gave rise to great hopes that de®cits in various aspects of information-processing could be substantially reduced in schizophrenia. In so far as attention processes seem to be building blocks necessary for learning as well as for adequate social and general functional outcome (3, 4), it appears a matter of priority to focus rehabilitation efforts on the remediation of these processes. The Integrated Psychological Therapy Program for Schizophrenic Patients (IPT) of Brenner et al. (5), for example, starts from the assumption that cogni- tive impairments have to be recti®ed in order to achieve effective psychosocial rehabilitation. Computer-based training programs appear to have advantages as compared to paper±pencil methods: e.g. the possibility to systematically change levels of dif®culty (individual guidance of learning), ef®cacy in overcoming motivational problems, immediate feedback, various forms of reinforcement and relief of therapists, in particular in case of training organised in a group format. Until now there exist only few investigations on the ef®cacy of computer-based training. Studies of psychotic and clinically remitted schizophrenic patients and their biological relatives indicate that de®cits in attentional processes may be critical components of neuropsychological vulner- ability to schizophrenic disorders (6±8). Among the Acta Psychiatr Scand 2001: 103: 15±23 Printed in UK. All rights reserved Copyright # Munksgaard 2001 ACTA PSYCHIATRICA SCANDINAVICA ISSN 0001-690X 15