15| Interventional Neuropsychology: Compensatory Cognitive Training – A Conversation With Dr. Beth Twamley

Compensatory Cognitive Training (CCT) is a growing area of research and clinical practice for neuropsychologists in academic and rehabilitation settings.  CCT leverages intact brain networks in order to teach skills that can improve someone’s ability to function independently in day-to-day life, despite the presence of other disrupted brain networks.  CCT has wide-reaching applications and can be beneficial for many of the clinical populations neuropsychologists already work with, including individuals with traumatic brain injury, severe mental illness, mild cognitive impairment, and dementia.  In this episode, we will talk to Elizabeth Twamley, Ph.D., about CCT: how it is applied, similarities to cognitive rehabilitation, who benefits most, where the field is going, and much more.

A pdf of the transcript for this episode is available here.

If you’d like to receive APA-approved CE credit for listening to this episode, click here.

Topics Covered (with time stamps)

  • How to capitalize on spared memory systems such as the neostriatal habit learning system (4:24)
  • Cognitive abilities that are targeted in compensatory cognitive training (CCT): prospective memory, attention and vigilance, learning and memory, and executive functioning (7:08)
  • Dosage effects in conventional CCT interventions (i.e., do we need to deliver a 10-12-week intervention in order to see positive effects?) (11:35)
  • Importance of psychoeducation (12:49)
  • Delineating important terminology in the CCT literature (i.e., difference between cog rehab, remediation, enhancement, etc.) (15:54)
  • CCT in severe mental illness, traumatic brain injury, hoarding disorder, autism spectrum disorder, depression, and neurodegenerative diseases (18:58)
  • How baseline cognitive functioning moderates CCT outcomes (29:52)
  • Restorative versus compensatory approaches to cognitive training (34:44)
  • Advice for clinicians who are interested in implementing CCT in their practices (43:05)
  • Whether or not it would be helpful to add CCT to typical psychological treatments for mood disorders (44:15)
  • Patient characteristics that may serve as barriers to CCT success (e.g., anosognosia, defeatist beliefs) (54:25)
  • Benefits and challenges to a scientific career spanning multiple clinical populations (1:00:41)
  • A brief overview of the process of writing a treatment manual (1:02:30)
  • How neuropsychologists can benefit from functioning as interventionists (in addition to assessors) in their professional lives (1:05:38)

Free access to CCT manuals and other resources: www.cogsmart.com

About Beth

Dr. Twamley is a neuropsychologist and Professor of Psychiatry at UC San Diego.  Much of her work is based at the VA San Diego Healthcare System, where she is a Research Health Scientist and the Director of the Clinical Research Unit of the Center of Excellence for Stress and Mental Health.  Dr. Twamley’s research has focused on cognitive training and other interventions to improve real-world functioning for individuals with severe mental illnesses, traumatic brain injuries, and other cognitive impairments.  She has developed and evaluated Compensatory Cognitive Training (CCT) and Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) with funding from NIH, VA, DoD, BBRF/NARSAD, and UC San Diego grants.  These treatment manuals and other clinical materials are available at no charge on her website, www.cogsmart.com.

Selected References

Ayers, C. R., Saxena, S., Espejo, E., Twamley, E. W., Granholm, E., & Wetherell, J. L. (2014). Novel treatment for geriatric hoarding disorder: an open trial of cognitive rehabilitation paired with behavior therapy. The American Journal of Geriatric Psychiatry22(3), 248-252.

Caplan, B., Bogner, J., Brenner, L., Storzbach, D., Twamley, E. W., Roost, M. S., … & Turner, A. P. (2017). Compensatory cognitive training for operation enduring freedom/operation iraqi freedom/operation new dawn veterans with mild traumatic brain injury. Journal of Head Trauma Rehabilitation32(1), 16-24.

Caplan, B., Bogner, J., Brenner, L., Twamley, E. W., Thomas, K. R., Gregory, A. M., … & Lohr, J. B. (2015). CogSMART compensatory cognitive training for traumatic brain injury: effects over 1 year. Journal of Head Trauma Rehabilitation30(6), 391-401.

Choi, J., & Twamley, E. W. (2013). Cognitive rehabilitation therapies for Alzheimer’s disease: a review of methods to improve treatment engagement and self-efficacy. Neuropsychology review23(1), 48-62.

Thomas, K. R., Puig, O., & Twamley, E. W. (2017). Age as a moderator of change following compensatory cognitive training in individuals with severe mental illnesses. Psychiatric rehabilitation journal40(1), 70-78.

Twamley, E. W., Burton, C. Z., & Vella, L. (2011). Compensatory cognitive training for psychosis: who benefits? Who stays in treatment?. Schizophrenia bulletin37(suppl_2), S55-S62.

Twamley, E. W., Jak, A. J., Delis, D. C., Bondi, M. W., & Lohr, J. B. (2014). Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) for veterans with traumatic brain injury: pilot randomized controlled trial. Journal of Rehabilitation Research & Development51(1).

Twamley, E. W., Savla, G. N., Zurhellen, C. H., Heaton, R. K., & Jeste, D. V. (2008). Development and pilot testing of a novel compensatory cognitive training intervention for people with psychosis. American journal of psychiatric rehabilitation11(2), 144-163.

Twamley, E. W., Thomas, K. R., Burton, C. Z., Vella, L., Jeste, D. V., Heaton, R. K., & McGurk, S. R. (2019). Compensatory cognitive training for people with severe mental illnesses in supported employment: a randomized controlled trial. Schizophrenia research203, 41-48.

Twamley, E. W., Vella, L., Burton, C. Z., Heaton, R. K., & Jeste, D. V. (2012). Compensatory cognitive training for psychosis: effects in a randomized controlled trial. The Journal of clinical psychiatry73(9), 1212-1219.

Walter, K. H., Jak, A. J., & Twamley, E. W. (2015). Psychiatric comorbidity effects on compensatory cognitive training outcomes for veterans with traumatic brain injuries. Rehabilitation psychology60(3), 303-308.



  1. Thank you, Dr. Twamley and NavNeuro. I can’t believe I stumbled upon this podcast. It’s the first time I’ve heard of CCT, and I believe it might be a promising path to help my brother – he was diagnosed with schizophrenia, which he’s managing well with medication. I’ve been digging into neuropsych testing to figure out how best to help with what I suspect are severe gaps in his learning abilities. This podcast touched on so many of my questions and doubts about his behavior, and gave me some hope that there is help for him. Really well done.

    1. Thanks for the very kind comment Kevin. We wish you and your brother the very best.

  2. Thank you Dr Twamley and Nav Neuro. You have been a great professional inspiration.
    I have just graduated in Psychiatric Rehabilitation Technique and in my degree thesis I have deepened and applied Compensatory Cognitive Training, available in Italy from January 2021. The CCT has proved to be a valid cognitive rehabilitation tool, also effective for improving functioning psychosocial of patients.

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