To explore the application effect and underlying mechanisms of mHealth app-based cognitive remediation therapy on the cognitive function of patients with stable schizophrenia.

This study was a randomized controlled trial, patients received either treatment as usual or mHealth app-based cognitive remediation therapy. Guided by the theoretical framework integrating the MCI theoretical model of rehabilitation, we examined the mediating roles of self-efficacy and negative emotion in the relationship between intervention subgroups and cognitive functioning. These outcome indicators were assessed at baseline, the primary endpoint, and the follow-up endpoint. Linear mixed-effects modeling was employed to compare these measures between the two patient groups, with all analyses adhering to the intention-to-treat principle. Mediation analyses were conducted using the PROCESS. The significance of mediation effects was assessed through bias-corrected nonparametric percentile bootstrap analysis.

Linear mixed-effects models revealed statistically significant group*time interaction effects at both the primary endpoint (post-intervention) and the follow-up endpoint (3-month post-intervention) for cognitive functioning ( P  = 0.001), psychiatric symptoms ( P   <  0.001), self-efficacy ( P   <  0.001), and negative emotions ( P   <  0.001). Analysis of these interactions indicated that, compared to the TAU group, the CRT group demonstrated significantly greater improvement in cognitive function and self-efficacy, and significantly greater reduction in psychiatric symptoms and negative emotions over time. Mediation analyses further indicated that self-efficacy scores partially mediated the relationship between the intervention groupings and cognitive function scores (indirect effect of 0.237, 95 % CI [0.073, 0.414]). Similarly, negative emotion scores were found to partially mediate this relationship (indirect effect of 0.154, 95 % CI [0.029, 0.323]).

Cognitive remediation therapy delivered through mHealth app for patients with stable schizophrenia has been shown to effectively improve cognitive functioning. Moreover, this intervention may exert an indirect positive effect on cognitive performance mediated by negative emotions and self-efficacy.