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PubMedDate not supplied

The role of self-directed in vivo exposure in combination with cognitive therapy, relaxation training, or therapist-assisted exposure in the treatment of panic disorder with agoraphobia.

The effects of self-directed in vivo exposure in the treatment of panic disorder with agoraphobia were examined. Seventy-four chronic and severe agoraphobic subjects were randomly assigned to Cognitive Therapy plus graded exposure. Relaxation Training plus graded exposure, or therapist-assisted graded exposure alone. Treatment consisted of 16 weekly 2.5-hour sessions. All subjects received programmed practice instructions for engaging in self-directed exposure as a concomitant strategy to their primary treatment. All subjects were instructed to keep systematic behavioral diary recordings of all self-directed exposure practice. The diary data were analyzed across and within treatments and assessment phases. Statistically significant findings were obtained across all diary measure domains with powerful repeated measures effects observed across all treatments. Significant between group effects and treatment x repeated measures interactions were obtained across the diary measure domains. Multiple linear regressions of in vivo anxiety levels and, to a lesser extent, frequency of self-directed exposure practice were found to be significantly associated with global assessment of severity at posttreatment and 3-month follow-up assessments. Furthermore, depression and marital satisfaction were significantly associated with in vivo anxiety. These and other findings are discussed with regard to their conceptual and clinical implications.

Adult↗
PubMed2000

Cognitive models in training health professionals to protect patients' confidential information.

Recent advances in theories of learning and knowledge acquisition in culturally-situated environments have illuminated the role of cognition in changing behavior, and in turn on influencing performance for the long term. One such advance focuses on the relationship between explicit formal training and implicit knowledge acquired through daily interactive activities in schools and organizations. The former relates more to instruction regarding the policy issues whereas the latter is tied closely to cultural, moral and organizational values. In this paper, we draw on these theories of cognition and learning to show the shift in thinking that is needed regarding education of health professionals, including steps required to assure that the protection of confidential information becomes part of their routine practices. Illustrative examples are used to show the nature of conceptual change in the health professional's knowledge organization and reasoning strategies that is necessary for more sustained behavior change with regards to protecting data confidentiality and privacy of individual patients. This re-conceptualization is intended to be reflected at various levels of training and education for health professionals, including influences on personal and organizational practices as well as revisions in medical-school and graduate-medical curricula.

Cognition↗
PubMedDate not supplied

Driving to learn: a new concept for training children with profound cognitive disabilities in a powered wheelchair.

Analysis of the case studies of two preschool children with profound cognitive disabilities indicates that training in a powered wheelchair can increase wakefulness and alertness, stimulate a limited use of the arms and hands, and promote the understanding of very simple cause-and-effect relationships. The enhanced activity level had a positive influence on the children's ability to react to external stimuli and invitations to interact. These effects in turn promoted the development of initiative and exploratory behavior. Because of their profound cognitive disabilities, neither of the children was able to reach the normative training goal-to be able to drive purposefully and safely. In this paper the target group is defined according to criteria for the prescription of powered wheelchairs and the resulting new concept of 'driving to learn' is described and discussed from different aspects.

Auditory Perceptual Disorders↗
PubMed1991

Iliad training effects: a cognitive model and empirical findings.

Iliad is a diagnostic expert system consisting of an "inference engine" (collection of rules and procedures for making decisions) and a "knowledge base" (collection of medical facts). Iliad's internal medicine knowledge base recognizes 5000 medical findings and covers 1150 diagnostic conditions in 10 subspecialty fields. We used Iliad's simulator mode to train diagnostic skills in junior-year medical students. The results corroborate previous findings documenting Iliad's teaching efficacy. Recent developments in cognitive psychology provide a framework for explaining Iliad's training effects.

Clinical Clerkship↗
PubMed1996

Social skills training for young adolescents: cognitive and performance components.

An assertiveness training curriculum that was an expansion of two previous programs with young adolescents (Thompson, Bundy, & Broncheau, 1995; Wise, Bundy, Bundy, & Wise, 1991) was presented to 22 fifth graders. Cognitive acquisition and retention of the symbolic assertiveness information were measured with multiple-choice pre- and posttests used in the two prior programs. The performance components, including verbal (word choice) and non-verbal (body orientation, posture, and gestures) aspects of assertive behavior were measured in pretest and posttest role-play situations, with the posttest administered at two levels of motivation. When trained students were compared to control groups on the cognitive measures, a significant effect for treatment (p < or = .000); a significant effect for measures (p < or = .000); and a significant Treatment x Measures interaction (p < or = .000) were found. However, the results did not show that training facilitated assertiveness on the performance components. When trained and control subjects' performance scores were combined, a significant effect for measures was found across role-play tests on some of the performance measures. Discussion focuses on factors that facilitate adolescents' appropriate application of stored symbolic information regarding assertiveness. Suggestions are offered for designing programs aimed at developing adolescents' assertive behavior in ways that will generalize to their lives beyond the training context.

Adolescent↗
PubMed1993

Efficacy of cognitive therapy for chronic low back pain.

The effects of outpatient group cognitive therapy, relaxation training, and cognitive therapy in combination with relaxation training on chronic low back pain and associated physical and psychosocial disability were evaluated and compared. One-hundred and two mildly disabled chronic low back pain patients were assigned randomly to a waiting-list (WL) control condition and the 3 treatments. Patient self-report and observational measures were obtained pretreatment and post-treatment for all conditions, and at 6- and 12-month follow-ups for the treatment conditions. Pain intensity decreased significantly pre- to post-treatment for patients in all 3 treatment conditions, but not the WL condition. Depressive symptoms and disability improved significantly in all conditions (including the waiting list) from pretreatment to post-treatment, with no statistically significant differences among treatments. At both follow-ups, all 3 treatment groups remained significantly improved from pretreatment, with no statistically significant differences between treatments.

Adaptation, Psychological↗
PubMed2005

Cognitive rehabilitation combined with drug treatment in Alzheimer's disease patients: a pilot study.

OBJECTIVE: To study the efficacy of cognitive rehabilitation combined with acetylcholinesterase inhibitor (AChE-I) treatment in patients with mild Alzheimer's disease and their relatives. METHOD: Thirteen patients with mild Alzheimer's disease treated with rivastigmine 6-12 mg/day for more than two months started cognitive rehabilitation training. Before and after the cognitive rehabilitation training patients were assessed through cognitive tests, activities of daily living scale, neuropsychological battery and scales to evaluate caregivers' depressive and anxiety symptoms. Six patients were randomized to a combined treatment group (AChE-I plus cognitive rehabilitation and caregiver support) and seven patients to a control group (AChE-I only) and followed up for five months. RESULTS: Mini-Mental State Examination (MMSE) scores (p = 0.047) and backward digit span scores (p = 0.018) were significantly different between the groups on follow-up. The combined treatment group showed a better positive treatment effect on cognitive and neuropsychological tests applied to patients and reduction of psychiatric symptoms was observed in their caregivers (nonsignificant). CONCLUSION: Cognitive rehabilitation associated with AChE-I treatment can potentially be useful to stabilize or improve cognitive and functional performance of patients with mild Alzheimer's disease and can reduce caregivers' psychiatric symptoms.

Activities of Daily Living↗
PubMed2004

The adult learner rediscovered: psychiatry residents' push for cognitive-behavioral therapy training and a learner-driven model of educational change.

OBJECTIVE: This study surveyed residents' experiences learning an emerging area of demand in psychiatry at a time when there is a lag in training resources. Unexpectedly, the data generated useful evidence in support of adult learning theory. The result is a post hoc examination of learner attitudes and activities during the spread of a new medical content domain. Implications of the results for adult learning theory are considered. METHODS: A survey evaluating interest, motivation, perceptions, and barriers toward learning cognitive-behavioral therapy (CBT) was given to 85 psychiatry residents at a single institution, with a 95% return rate and even distribution across years of training. RESULTS: The vast majority of residents were highly interested and motivated to learn CBT. One hundred percent considered CBT clinically useful, and 99% anticipated using it in future practice. Consistent with the model of adult learning theory, reasons for seeking CBT training tended to focus on personal interest (86%), motivation (81%), and opinion of its clinical usefulness (68%). Only a minority considered training requirements a motivation for seeking training (44%). The most commonly reported difficulty in gaining exposure to CBT was supervisor availability (65%). CONCLUSIONS: Residents exhibited qualities of adult learners for whom personal interests were more important than training requirements with regard to seeking training in new modes of treatment. In the wake of recent theoretical scrutiny of adult learning and its applicability to undergraduate medicine, these results suggest that postgraduate medicine might be uniquely suited to the study of adult learning theory.

Adult↗
PubMed2001

Training in cognitive-behavioural therapy for mental health professionals: a pilot study of videoconferencing.

A foundation course in cognitive-behavioural therapy (CBT) was developed specifically for delivery via videoconferencing at 256 kbit/s. A two-part, 20-week programme was evaluated at seven sites, with a total of 12 participants, in rural and remote Western Australia. Eleven of the participants completed a pre- and post-training knowledge test. There was a significant improvement in their knowledge of CBT after training. Ten participants also completed a satisfaction questionnaire. The majority were satisfied with the training they received and stated that the training had given them greater confidence in their ability to use CBT with their patients. This study lends support to the use of videoconferencing in the training of rural and remote mental health practitioners.

Attitude of Health Personnel↗
PubMed2005

Treatment of panic disorder.

Panic disorder with or without agoraphobia occurs commonly in patients in primary care settings. This article assesses multiple evidence-based reviews of effective treatments for panic disorder. Antidepressant medications successfully reduce the severity of panic symptoms and eliminate panic attacks. Selective serotonin reuptake inhibitors and tricyclic antidepressants are equally effective in the treatment of panic disorder. The choice of medication is based on side effect profiles and patient preferences. Strong evidence supports the effectiveness of cognitive behavior therapy in treating panic disorder. Family physicians who are not trained in cognitive behavior therapy may refer patients with panic disorder to therapists with such training. Cognitive behavior therapy can be used alone or in combination with antidepressants to treat patients with panic disorder. Benzodiazepines are effective in treating panic disorder symptoms, but they are less effective than antidepressants and cognitive behavior therapy.

Antidepressive Agents↗
PubMed1993

Visual memory and visual spatial functions in the rat following parietal and temporal cortex injuries.

Adult rats were prepared with either posterior parietal, temporal, or sham neocortical lesions, and after assessing gross locomotor functions, trained in cognitive visual tasks. Training was conducted in a modified circular water maze wherein the water was made opaque with a white nontoxic powder paint. The order of the tasks was counterbalanced within groups. One task was a visual matching-to-sample problem with an intertrial interval of 20 s. The second task was a visual spatial conditional problem in which visual stimuli (white or gray cards) cued spatial choices in a T maze that was inserted into the tank. After completing these tasks, the animals were trained on a simple visual pattern discrimination and a simple position habit. Both lesion groups demonstrated significant deficits on both cognitive tasks. Since gross visual perceptual, spatial, and motor abilities were found to be unaffected by the lesions, it is suggested that a generalized retardation in cognitive functions follows injuries in these sites. Also, qualitative evidence supported the conclusion that posterior parietal cortex plays an important role in integrating visuospatial stimuli with motor responses.

Animals↗
PubMed2007

The effect of a single aerobic training session on cognitive flexibility in late middle-aged adults.

Research has shown that aerobic exercise enhances cognitive function, specifically executive functions. This study examines the effect of acute aerobic exercise on cognitive flexibility - an executive function - in late middle-aged individuals. Fourteen men and 45 women aged 50 - 64, were randomly assigned to moderate exercise (60 % of heart rate reserve), moderately-intense (70 % of heart rate reserve) exercise, and movie-watching control groups after a maximal exercise test. Prior to and following the exercise or control sessions participants performed two cognitive tasks: the Alternate Uses assessing cognitive flexibility and the Digit Span Forward subtest from the Wechsler Adult Intelligence Scale - Revised assessing attention span. Results indicated significant improvement in Alternate Uses in the exercise groups but not in the control group. No group differences were indicated on the Digit Span. These results provide partial support for the benefit of acute aerobic exercise on cognitive flexibility.

Analysis of Variance↗