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PubMed1999

Cognitive behavioral therapy of childhood OCD.

Obsessive-compulsive disorder is a chronic, recurrent, and often disabling disorder in childhood. Comorbid emotional and behavioral disturbance and family dysfunction are common and can serve to complicate both course of illness and treatment outcome. Although traditional psychotherapies have not been shown to be effective for treating core OCD symptoms, controlled trials with adults have shown cognitive-behavioral approaches that include ERP to be highly effective in treating the disorder. The recent development and open evaluation of a handful of standardized and developmentally sensitive ERP-based treatment protocols for childhood OCD indicates that this treatment approach is similarly effective and well-tolerated in teh younger age group. These studies also suggest that adjunctive interventions including family involvement in treatment, anxiety management training, cognitive restructuring, contingency management, and supportive therapy may enhance the efficacy of ERP through the enhancement of treatment compliance and motivation. More study is needed to evaluate the best use of medication and CBT in children and adolescents.

Adolescent↗

PubMed2002

The effect of cognitive education on the performance of students with neurological developmental disabilities.

A cognitive education program was developed to facilitate acquisition of cognitive skills and address the learning deficits of adolescent students with neurological, developmental disabilities, and autism. This study examined the outcomes of incorporating mediated cognitive education into special education classrooms. Cognitive education provided cognitive training utilizing REHABIT materials through mediated teaching. Following a matched pair model, forty-six students were assigned to either a treatment or a control group. All students received weekly instruction in Individual Educational Program (IEP) goals. Curriculum areas included IEP objectives in reading, math, social skills, health, science and social studies. Students in the control group received regular classroom instruction. Students in the treatment group participated in cognitive educated one hour per week replacing thirty minutes of reading and thirty minutes of math. Pre and posttest comparisons on measures of intelligence, achievement and adaptive behavior showed those students in the treatment group attained higher scores across measures.

Adolescent↗

PubMed2001

One session cognitive behavioural therapy for elderly patients with chronic obstructive pulmonary disease.

BACKGROUND: We hypothesized that compared to an educational intervention, a single 2 h session of cognitive behavioural therapy (CBT), with 6-week follow-up, would reduce anxiety and depression, improve physical and mental functioning, and lead to a better quality of life and greater satisfaction with treatment in older patients with chronic obstructive pulmonary disease (COPD). METHODS: Fifty-six subjects were recruited from a large, urban, academically affiliated Veterans Affairs (VA) Hospital, a non-profit private hospital, and a local newspaper, for a single blind randomized controlled clinical trial. One 2 h session of group CBT was designed to reduce symptoms of anxiety, with specific components including relaxation training, cognitive interventions, and graduated practice, followed by homework and weekly calls for 6 weeks. This was compared to a group that received 2 h of COPD education, followed by weekly calls. Pre- and post-intervention subjects in both groups were administered SF-36, Geriatric Depression Scale, Beck Anxiety Inventory, 6 min walk test, and the FEV-1. Following the intervention, both groups completed the Client Satisfaction Questionnaire. RESULTS: When compared with a group that received education about COPD, 2 h CBT group showed decreased depression and anxiety. Contrary to our hypothesis, despite the decrease in depression and anxiety, there was no change in the physical functioning of the patients. CONCLUSIONS: Twenty to 40% of patients with COPD have high levels of anxiety and depression. Our study finds that as little as 2 h of CBT administered in a group setting is able to reduce these anxious and depressive symptoms.

Aged↗

PubMed2006

Cognitive retraining for organizational impairment in obsessive-compulsive disorder.

Individuals with obsessive-compulsive disorder (OCD) have difficulties in organizing information during encoding associated with subsequent memory impairments. This study was designed to investigate whether impairments in organization in individuals with OCD can be alleviated with cognitive training. Thirty-five OCD subjects and 36 controls copied and recalled the Rey-Osterrieth Complex Figure Test (RCFT) [Osterrieth, P.A., 1944. Le test de copie d'une figure complexe: Contribution a l'étude de la perception et de la memoire (The test of copying a complex figure: A contribution to the study of perception and memory). Archive de Psychologie 30, 286-350.] before being randomly assigned to a training or non-training condition. The training condition was designed to improve the ability to organize complex visuospatial information in a meaningful way. The intervention phase was followed by another copy and recall trial of the RCFT. Both OCD and control subjects who underwent training improved more in organization and memory than subjects who did not receive organizational training, providing evidence that the training procedure was effective. OCD subjects improved more in organizational during encoding than control subjects, irrespective of whether or not they had received training. This suggests that organization impairment in OCD affects primarily the ability to spontaneously utilize strategies when faced with complex, ambiguous information but that the ability to implement such strategies when provided with additional trials is preserved. These findings support a distinction in OCD between failure to utilize a strategy and incapacity to implement a strategy.

Adult↗

PubMed2002

[Psychosocial therapy of patients with dementia].

The progressive cognitive and behavourial disturbancies in dementia diseases cause great emotional burden to patients, their families and caregivers. To relief this burden and to facilitate adequate coping strategies, psychosocial therapies intend to improve cognitive functions, self care abilities and emotional wellbeing of dementia patients. The therapeutic interventions address the patients, their caregivers and the adaption of the environment. Psychosocial therapies can be divided into cognitive training methods, behaviour orientated concepts, emotional orientated approaches and family interventions (1, 2, 12, 19). Most of these psychosocial therapies are only poor validated in randomized controlled trials. Nevertheless, they hold great promise to improve the quality of life and wellbeing of dementia patients and their caregivers. Thus they should be considered to be an integral part of a comprehensive therapeutic approach to dementia patients and their families.

Activities of Daily Living↗

PubMed1978

A description of an intensive treatment project for the rehabilitation of severely brain-injured soldiers.

Thirteen severely brain-injured veterans are currently participating in an intensive rehabilitation project. This is a one-year vocational rehabilitation project conducted 30 hours weekly in a therapeutic workshop environment, in which all aspects of the patient's rehabilitation needs are dealt with. The three major goals of this project are: (a) Changing and modifying the behavior of the individual through the use of psychotherapy, cognitive training, training in the use of prosthetic devices and vocational training; (b) creating a supportive environment within the project in which staff and patients live together for a few hours daily and where patients are treated in groups; (c) generalizing the therapeutic effects to the community at large. This includes work with the social environment of the patient: family, friends, employer and rehabilitation workers of the Ministry of Defense. Preliminary results indicate that considerable therapeutic gains could be achieved while the patient is in a sheltered therapeutic milieu. However, there is less success in generalizing these effects to the behavior of the patient outside the sheltered environment.

Adult↗

PubMed1999

[Neurocognitive and pharmacological approach to specific learning disorders].

INTRODUCTION: Specific learning disorders are distinguished from general development disorders since, in general, only a certain number of processing mechanisms are involved whilst the remainder are unaffected. DEVELOPMENT: The classification proposed by the DSM-IV takes a step towards clinical understanding and use of a common nomenclature. However, neuropsychological assessment is essential to understanding clinical subtypes. The neuro-cognitive approach, when taking into account the processing systems affected or involved, should include the strategies and principles of a cognitive-behavioural approach, accompanied by computerized cognitive training. Pharmacological treatment uses drugs with different modes of action depending on the specific neuropsychological characteristics of each type of disorder of nerve development. We discuss the clinical use of various drugs in view of investigations, present and past: methylphenidate for the dys-attentional subtype of ADHD; piracetam in developmental dyslexia of dysideatic type; citocolina in the infantile dysphasias of sensory input predominance, thiapride in dysfluencial and combined subtype of ADHD; pipamperona in behaviour disorders and the hyperactive-impulsive subtype of ADHD, with or without associated and selegilina in the dysattention subtype of ADHD and the dysgraphias of the subtype with predominance of calligraphy and spatial disorders.

Child↗

PubMed1981

Senile dementia: combined pharmacologic and psychologic treatment.

Either supportive counseling (SC) or cognitive training (CT) was used in an attempt to enhance the efficiency of a standard pharmacologic treatment for dementia, viz, dihydroergotoxine mesylate (DEM, Hydergine). DEM was administered orally to 21 moderately demented subjects, in a dosage of 1 mg three times daily; and SC or CT was conducted for one hour every two weeks for a total of 12 weeks. The CT was designed to enhance memory and other intellectual functions by the teaching of organizational schemes and mnemonic devices. Outcome measurements included the Sandoz Clinical Assessment-Geriatric (SCAG), a behavioral rating scale measuring selected symptoms and signs of dementia; the Hamilton Rating Scale for Depression (HRSD); and the Buschke Selective Reminding Scale (BSRT), a psychometric test of memory and learning. The DEM + CT group of patients improved more than did the DEM + SC group for the measures of memory and learning (BSRT). However, no differences between groups were noted for the HRSD or SCAG behavioral measures.

Aged↗

PubMed2000

[From program to metaphor--managing the needs of children in a separation or divorce process involving their parents].

In German-speaking regions there are several independent intervention programs, derived from concepts originating in the USA, which are designed to assist children whose parents are separated or divorced. Two of these programs will be presented here. Consistent with the thematic implication that divorce entails trauma and stress, the childrens' need of advice and help is placed at the conceptual center of the intervention. This results in a behavioral-cognitive training program, which should enable children to overcome the stress of their situation. In contrast to these two programs, an understanding of divorce may be achieved, through phenomenological analysis, which gives due consideration to the various aspects and meanings of the divorce process. The concept of intervention derived from this approach is to assist children in further developing their own search for solutions, focused on the parents-child-relation. The primary emphasis of this approach is not the childrens' difficulty in dealing with their parents' separation and divorce, but rather their own attempt to deal with the problem, as is visible in the metaphor of their spontaneous descriptions and images of experiences and events. The central concept of the proposed course is the further development of this creative process in the form of a dynamic-communicative group happening. Furthermore it is shown how children can be assisted in a practical way, and encouraged to create their individual and personally adequate solution to the experience of divorce.

Adaptation, Psychological↗

PubMed2003

Experience with V-STORE: considerations on presence in virtual environments for effective neuropsychological rehabilitation of executive functions.

The paper discusses the use of immersive virtual reality systems for the cognitive rehabilitation of dysexecutive syndrome, usually caused by prefrontal brain injuries. With respect to classical P&P and flat-screen computer rehabilitative tools, IVR systems might prove capable of evoking a more intense and compelling sense of presence, thanks to the highly naturalistic subject-environment interaction allowed. Within a constructivist framework applied to holistic rehabilitation, we suggest that this difference might enhance the ecological validity of cognitive training, partly overcoming the implicit limits of a lab setting, which seem to affect non-immersive procedures especially when applied to dysexecutive symptoms. We tested presence in a pilot study applied to a new VR-based rehabilitation tool for executive functions, V-Store; it allows patients to explore a virtual environment where they solve six series of tasks, ordered for complexity and designed to stimulate executive functions, programming, categorical abstraction, short-term memory and attention. We compared sense of presence experienced by unskilled normal subjects, randomly assigned to immersive or non-immersive (flat screen) sessions of V-Store, through four different indexes: self-report questionnaire, psychophysiological (GSR, skin conductance), neuropsychological (incidental recall memory test related to auditory information coming from the "real" environment) and count of breaks in presence (BIPs). Preliminary results show in the immersive group a significantly higher GSR response during tasks; neuropsychological data (fewer recalled elements from "reality") and less BIPs only show a congruent but yet non-significant advantage for the immersive condition; no differences were evident from the self-report questionnaire. A larger experimental group is currently under examination to evaluate significance of these data, which also might prove interesting with respect to the question of objective-subjective measures of presence.

Cognition Disorders↗

PubMed1987

[Experiences with an integrated psychological therapy program for training communication and cognitive abilities in the rehabilitation of severely ill chronic schizophrenic patients].

A therapy study was conducted with 17 seriously chronically ill schizophrenic patients. Ten patients (Experimental Group) received a psychological therapy program of training in cognitive and communication/social skills (58 sessions of 60 min.). Seven further patients constituted a Control Group. Researched was the question of the potential for change of basic disorders respectively symptoms, and its effect on social behavior. In individual cases significant changes were recorded. As to the therapeutic effects, significant findings were obtained only conditionally. Implications and consequences are discussed in the résumé.

Adult↗

PubMed1984

In vivo distraction-coping in the treatment of test anxiety: a 1-year follow-up study.

Data obtained from 19 clinically test anxious students supported the efficacy of an 8-week treatment program that combined relaxation skill training, cognitive restructuring, and systematic desensitization for the reduction of test anxiety in a previous study by Thyer , Papsdorf , Himle , McCann , Caldwell, and Wickert (1981). Significant reductions in test, state, and trait anxiety, and increases in the rationality of personal belief systems were observed. Cognitive performance on an anagram solution task and behavioral performance on a test of manual dexterity also were improved posttreatment. In this present study, 12-month follow-up data on 14 (73.6%) of the original Ss are reported. The results indicate a maintenance of the significantly decreased levels of test anxiety and continued reductions in trait anxiety and irrationality . The significance of these findings is discussed.

Anxiety Disorders↗

PubMedDate not supplied

Chronic toxic encephalopathy: social consequences and experiences from a rehabilitation program.

This study evaluates a rehabilitation program designed to address the social function issues of patients with solvent-induced chronic toxic encephalopathy (TE) and their families. Fourteen newly diagnosed men and their spouses participated in group sessions. The patients were given cognitive training, and crisis intervention measures were implemented. Their spouses were given information about the disease and had an opportunity to talk about their emotions and the disease's impact on the family's functioning. Interviews after the program showed that patients and their spouses were experiencing less psychological distress and increased social activity and had begun reestablishing contacts with friends. Their psychiatric symptoms, measured during a structured interview by a nurse, decreased significantly immediately after the treatment period but increased again after 6 months. Only a long-term follow-up study comparing the experiences of these patients with those of untreated TE patients can determine whether improvement can be sustained over the long term.

Adult↗

PubMed1998

Inductive Reasoning in Third Grade: Intervention Promises and Constraints

The results of two evaluation studies with respect to a programme for enhancing inductive reasoning ability of third grade students are presented. The programme is a classroom version of the German programme 'Denktraining für Kinder 1' (Cognitive training for children; Klauer, 1989). In the first formative evaluation study, two experimental groups with 30 students in total and one control group with 9 students were involved. Observations during the lessons, and teachers' reports showed that teachers were able to implement the programme. Both experimental groups significantly outperformed the control group on a posttest immediately after the programme and on a follow-up test 3 1/2 months later. Further analyses of the data revealed tentative evidence of the superiority of a direct teaching method. In the second summative evaluation study, the same programme was applied to a larger sample (experimental groups: n = 99 in total; and control groups: n = 232 in total) of third grade students. On the basis of Study 1, the programme instructions were slightly changed. The experimental groups scored significantly higher on a posttest three months after completion of the programme. Copyright 1998 Academic Press.

Journal Article↗

PubMed2005

Effects of errorless and errorful face-name associative learning in moderate to severe dementia.

BACKGROUND AND AIMS: The prevention of errors during learning has been found to be effective in overcoming memory problems in patients with amnesia compared with errorful or trial-and-error learning, possibly as a result of intact implicit memory function. Although errorless learning is a clinically promising technique used in cognitive training settings, to date only a few studies have examined errorless learning in patients with dementia. METHODS: The current study examined errorless and errorful learning using a face-name associative memory task in a group of moderate to severe dementia patients suffering from probable Alzheimer's disease (MMSE < or = 22; n = 10) using a fully counterbalanced within-subject design. RESULTS: Errorless learning had a significantly beneficial effect after two consecutive learning trials (p = 0.01). However, after an unfilled delay of 10 minutes, no significant differences in memory performance were found between errorless and errorful learning. Furthermore, current effects were much smaller compared with previous findings in healthy adults and early-stage dementia patients. CONCLUSIONS: Although errorful learning resulted in better performance in a face-name associative memory task in patients with dementia, this effect was only short-lived. Thus, the beneficial effects of errorless learning are probably not due to intact implicit memory function, but may also be subserved by explicit memory, a memory system that is typically impaired in dementia. Also, the clinical applicability of errorless learning in teaching patients with moderate to severe dementia face-name associations is limited.

Aged↗

PubMed2003

[Learning in old age: The importance of self-initiated structuring].

The purpose of the present study was to assess the role of memory, inhibition efficiency and self-initiated structuring of learning material in predicting age-related effects in learning performance. 47 young ( M = 23.3; SD = 3.8) and 52 old adults ( M = 64.5; SD = 5.2) took part in the current study. Tests assessing memory span, inhibition efficiency and a recall test requiring the participants to structure their learning material were administered. The results reveal that most of the age-related variance in learning performance can be explained by inhibition efficiency, memory span and-particularly-by the quality of structuring learning material. Furthermore, the results indicate that in order to recall the content of categories it is important to remember the categories formed during the learning period. The study emphasizes the importance of teaching strategies for organizing learning material in the context of cognitive trainings for the elderly.

Adult↗

PubMed1999

Differential therapy effects of psychoeducational psychotherapy for schizophrenic patients--results of a 2-year follow-up.

There is increasing evidence of the efficacy and effectiveness of psychosocial interventions in schizophrenic patients. However, little research has been done on differential therapy effects. In a prospective, randomized clinical trial we carried out psychoeducational medication management training, cognitive psychotherapy, and key-person counseling. The patients of the control group participated in structured free-time activities for control of therapeutic commitment. Data from a total of 156 schizophrenic patients (DSM-III-R, no first-admissions) were available at 2-year follow-up. We analyzed in this study whether there are differential therapy effects of these interventions, depending on patient characteristics at baseline. There was a significant statistical interaction between treatment condition (specific/non-specific) and prognosis with respect to treatment outcome. Patients with a favorable prognosis and better social functioning had a better course under the specific treatment but a less favorable outcome in the non-specifically treated control group. These results suggest that more vulnerable patients are not sufficiently capable of learning and using coping strategies for relapse prevention. We need to learn more about differential indications for psychosocial treatment.

Adult↗

PubMed2002

[Vocabulary of young children with sensorineural deafness].

UNLABELLED: The primary aim of the study was to measure the receptive and expressive vocabulary with respect to clinical parameters and selected socio-demographic variables and to assess whether the size of vocabulary could be predicted by certain variables in a consecutive series of children identified as having bilateral sensorineural hearing loss ("Göttinger Hör-Sprachregister"). METHOD: All children aged between 2;6 to 6;3 years diagnosed in the Department of Phoniatrics/Pedaudiology of the University Göttingen as having a permanent bilateral sensorineural hearing impairment ("Göttinger Hör-Sprachregister") in a defined period (july 1995-september 2000) were examined with standardized receptive and expressive vocabulary tests as well as a nonverbal intelligence test (on average 5.5 months after diagnosis and 2.9 months after fitting with hearing aids). SAMPLE: 37 children (20 boys, 17 girls). Mean age at diagnosis: 48.5 (SD 15.9; min. 18, max. 75) months, mean age at hearing aid fitting: 51 months (SD 15.2). Multiple handicapped children, children with additional conductive hearing impairment and those with postnatal losses were excluded. The sample as a whole demonstrated lexical deficits of varying severity that were greater in the expressive than in the receptive vocabulary, depending on the clinical parameter. Children with congenital hearing impairment, with severe-to-profound hearing impairment (> 70 dB) and bilingual children demonstrated on average the smallest receptive and expressive vocabulary. An early fitting with hearing aids did not correspond with a better lexical development when a severe-to-profound hearing impairment existed. Severity of a hearing impairment and nonverbal intelligence significantly predicted the average size of the receptive vocabulary. A moderate hearing impairment, high non-verbal intelligence, and gender (female) emerged as the strongest significant predictors of the expressive vocabulary. The vocabulary test result of a bilateral sensorineurally hearing-impaired child may be an indicator for early cognitive training.

Child↗