Applying cognition-focused interventions to trial competency restoration: A quasi-experimental study of an integrative treatment program.

Abstract

Objective: Cognitive deficits are common among defendants adjudicated incompetent to stand trial, although cognition-focused interventions for this population have not been researched extensively. This quasi-experimental study examined the effectiveness of a program that integrates cognitive training and competency restoration treatment for individuals with cognitive deficits.

Methods: Participants in a state hospital were enrolled in the program and assigned to naturally occurring full (n = 53) or limited (n = 29) access conditions. The program was delivered in a group format with semiweekly sessions over the course of 12 weeks. All participants had continuous access to standard competency restoration treatment.

Results: Participants in the full access condition demonstrated greater progress in most areas of competency, were more likely to be restored to competence, and had a shorter length of stay than participants in the limited access condition. Increases in all areas of competency progress were associated with restoration of competence. Improved ability to consult with counsel, free recall of information about the adjudicative process, and overall competency progress were associated with shorter length of stay. A reduction in positive, but not negative, symptoms of psychosis was observed across conditions. Although psychosis was negatively associated with restorability and positively associated with length of stay, no significant associations were found between changes in psychosis and these outcomes.

Conclusions and implications for practice: Findings of the present study provide supportive evidence for integrating cognitive interventions and competency restoration treatment. This approach has promise for improving outcomes for forensically committed individuals with cognitive deficits. (PsycInfo Database Record (c) 2025 APA, all rights reserved).