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PubMed2005

Dual-task training reduces impact of cognitive task on postural sway.

Postural sway increases when a cognitive task is performed concurrently with a postural task. The author examined the hypothesis that following dual-task training, a concurrent cognitive task would not amplify postural sway. Participants (N = 18) were assigned to no-training, single-task training, or dual-task training groups. Single-task training consisted of 3 sessions in which the postural task, quiet standing on a compliant surface, and the cognitive task, counting backward by 3s, were practiced separately. Dual-task training consisted of 3 sessions of concurrent practice of the cognitive and postural tasks. After training, performance of a concurrent cognitive task increased postural sway in the no-training and single-task training groups but not in the dual-task training group. Results suggest that dual-task practice improves dual-task performance.

Adolescent↗
PubMed1995

Cognitive behavior therapy, relaxation training, and tricyclic antidepressant medication in the treatment of depression.

Outcomes of seven treatment trials comparing cognitive behavioral therapy to treatment with tricyclic antidepressant medication in major depressive disorder have been quite similar to one another. This led us to question whether treatment outcome in time-limited studies reflected a unique effect of cognitive behavioral therapy. To test the uniqueness hypothesis, relaxation training, a nonpharmacologic, noncognitive treatment, was chosen as a comparison for cognitive behavioral therapy as well as drug therapy. Treatment duration was 16 weeks. The sample of 37 patients treated for major depressive disorder was less depressed than those previously studied. For both cognitive behavioral therapy and relaxation training, outcome of depression was superior to that of tricyclic antidepressant medication by endpoint analysis. The posttreatment scores on the Beck Depression Inventory of 82% of the group receiving cognitive behavioral therapy improved to a Beck Depression Inventory score < or = 9 which was not significantly greater than that for the group receiving relaxation training (73%), so a unique effect was not demonstrated for cognitive behavioral therapy. The outcome for tricyclic antidepressant medication (29% improved to criteria) was significantly worse than that for cognitive behavioral therapy. The patient's pretreatment initial expectancy was not predictive.

Adolescent↗
PubMed1985

Stress management training as a prevention program for heavy social drinkers: cognitions, affect, drinking, and individual differences.

The effectiveness of cognitive-affective stress management training (SMT) as a drinking reduction program for heavy social drinking college students was investigated. The SMT package included muscle relaxation and meditation training, cognitive restructuring, and coping skill rehearsal during induced affect. Treated and control subjects rated the frequency and intensity of their anxiety, anger and depression and recorded their alcohol consumption on a daily basis over a 6-month period. SMT significantly reduced posttreatment daily anxiety ratings and was associated with changes in four of ten irrational beliefs and a shift toward more internal locus of control in treated subjects. Reduction in anxiety was no longer evident at the 2 1/2- and 5 1/2-month follow-ups. The men in the SMT group showed a significant decrease in daily drinking rates at posttreatment and at the 2 1/2-month follow-up, but drinking returned to baseline levels by 5 1/2 months for the group as a whole. However, significant improvement variance in daily moods and in drinking rates over all posttreatment periods was accounted for by individual difference variables in the trained subjects but not in the control group, suggesting that these cognitive, personality, and social support variables are associated with response to stress management training. Implications of these results for future prevention research are discussed.

Adult↗
PubMed1993

Cognitive distraction and relaxation training for the control of side effects due to cancer chemotherapy.

Sixty cancer chemotherapy patients were randomly assigned to one of six conditions formed by a 3(cognitive distraction, relaxation training, no intervention) x 2(high anxiety, low anxiety) factorial design. All patients were followed for five consecutive chemotherapy sessions. Outcome measures included patient reports, nurse observations, and physiological indices. Results indicated that distraction patients reported less nausea prior to chemotherapy and lower systolic blood pressures after chemotherapy than controls. Relaxation training patients reported less nausea prior to chemotherapy and exhibited lower systolic and diastolic blood pressures after chemotherapy than control patients. There were no significant differences between distraction and relaxation training patients on any measure. Patients with high initial levels of anxiety exhibited continually elevated levels of distress throughout the chemotherapy experience; however, anxiety level did not interact with the effectiveness of the treatment interventions. Overall, the data support the use of both cognitive distraction and relaxation training for reducing the distress of chemotherapy with both high and low-anxiety patients and suggest that at least some of the effects of relaxation training can be achieved with distraction alone.

Adult↗
PubMed2005

We don't train in vain: a dissemination trial of three strategies of training clinicians in cognitive-behavioral therapy.

There has been little research on the effectiveness of different training strategies or the impact of exposure to treatment manuals alone on clinicians' ability to effectively implement empirically supported therapies. Seventy-eight community-based clinicians were assigned to 1 of 3 training conditions: review of a cognitive-behavioral therapy (CBT) manual only, review of the manual plus access to a CBT training Web site, or review of the manual plus a didactic seminar followed by supervised casework. The primary outcome measure was the clinicians' ability to demonstrate key CBT interventions, as assessed by independent ratings of structured role plays. Statistically significant differences favoring the seminar plus supervision over the manual only condition were found for adherence and skill ratings for 2 of the 3 role plays, with intermediate scores for the Web condition.

Adult↗
PubMed2005

Cognitive strategies versus self-management skills as adjunct to vocational rehabilitation.

Cognitive dysfunctions and negative symptoms are "rate-limiting factors" for community outcome and response to psychosocial intervention in people with schizophrenia. Therefore, two cognitive-behavioral group therapies were developed-computer-assisted cognitive strategy training (CAST) and training of self-management skills for negative symptoms (TSSN)-to target these barriers to rehabilitation readiness. One hundred thirty-eight DSM-IV schizophrenia inpatients on a rehabilitation ward were randomly assigned to CAST plus vocational rehabilitation, TSSN plus vocational rehabilitation, or vocational rehabilitation alone. CAST included computer-based training in coping strategies focusing on deficits in attention, verbal memory, and planning. TSSN focused on social withdrawal/social anhedonia, lack of drive/volition, and affect flattening using techniques such as time scheduling, mastery, and pleasure techniques. Treatment outcome was assessed at intake and at discharge after 8 weeks. Analyses of covariance controlling for basis-level functioning demonstrated that patients receiving CAST plus vocational rehabilitation showed greater improvement on attention and verbal memory but not on planning ability. Patients receiving TSSN plus vocational rehabilitation failed to demonstrate improvement in negative symptoms. CAST plus vocational rehabilitation was found to be associated with a higher rate of successful job placement at the 12-month followup interval. Hierarchical logistic regression analyses demonstrated that improvement in short- and long-term verbal memory predicted a higher proportion of variance of successful job placement in the followup than pretreatment history of employment alone. Cognitive training as an adjunct to inpatient vocational rehabilitation demonstrated cognitive improvement, which was found to be associated with successful job placement in the followup. TSSN's efficacy was less clear; reasons for this uncertainty are provided.

Adult↗
PubMed2000

Randomized controlled trial of the use of compensatory strategies to enhance adaptive functioning in outpatients with schizophrenia.

OBJECTIVE: Cognitive adaptation training is a novel psychosocial treatment approach designed to improve adaptive functioning by using compensatory strategies in the home or work environment to bypass the cognitive deficits associated with schizophrenia. The authors tested the effect of cognitive adaptation training on level of adaptive functioning in outpatients with schizophrenia. METHOD: Forty-five patients with DSM-IV schizophrenia or schizoaffective disorder were randomly assigned for 9 months to one of three treatment conditions: 1) standard medication follow-up, 2) standard medication follow-up plus cognitive adaptation training, and 3) standard medication follow-up plus a condition designed to control for therapist time and provide environmental changes unrelated to cognitive deficits. Comprehensive assessments were conducted every 3 months by raters who were blind to treatment condition. RESULTS: Significant differences were found between the three treatment groups in levels of psychotic symptoms, motivation, and global functioning at the end of the 9-month study period. Patients in the cognitive adaptation training group overall had higher levels of improvement, compared with those in the remaining treatment conditions. In addition, the three groups had significantly different relapse rates over the 9-month study: 13% for the cognitive adaptation training group, 69% for the group in which therapist time and environmental changes were controlled, and 33% for the group who received standard follow-up only. CONCLUSIONS: Compensatory strategies may improve outcomes for patients with schizophrenia.

Adult↗
PubMed2003

An application of cognitive-behavioral anger management training in a military/occupational setting: efficacy and demographic factors.

OBJECTIVE: This treatment outcome study evaluated the efficacy of a cognitive-behavioral psychoeducational anger management training application offered in a military/occupational setting. Additionally, demographic factors were analyzed to identify any relationship among age, gender, occupational/educational status, and anger subscale scores or treatment effects. METHOD: The State-Trait Anger Expression Inventory was used as a pretest/post-test measure for 91 total participants in a series of four-session cognitive behavioral anger management training groups conducted through Francis E. Warren Air Force Base mental health clinic over an 18-month period. RESULTS: Significant improvements (p < 0.05) on all State-Trait Anger Expression Inventory anger scales were noted for the 46 participants who completed the program. Post hoc comparisons of demographic factors yielded no significant differences. CONCLUSIONS: The results are consistent with previously published findings insofar as the intervention was effective in reducing self-reported anger as measured by the State-Trait Anger Expression Inventory. The present study affirms the efficacy of a brief cognitive-behavioral psychoeducational approach to treat problem anger in a noncontrolled community/occupational sample.

Adult↗
PubMed2006

Use of environmental supports among patients with schizophrenia.

OBJECTIVE: Cognitive adaptation training is a psychosocial treatment that uses individually tailored environmental supports, such as signs, calendars, hygiene supplies, and pill containers, to cue and sequence adaptive behavior in the client's home environment. Generic environmental supports offer a less costly treatment that provides a predetermined package of helpful supports to clients at the time of their routine clinic visit. Previous studies have demonstrated the efficacy of cognitive adaptation training. The study reported here examined the extent to which environmental supports are used by clients. METHODS: As part of an ongoing study, persons with schizophrenia were randomly assigned to one of three conditions: cognitive adaptation training, generic environmental supports, or assessment only. Rates of use of supports for the first three months of treatment were examined for the first 64 patients assigned to the first two groups. RESULTS: Rates of overall use averaged approximately 80 percent for cognitive adaptation training and 44 percent for generic environmental supports. Specific categories of supports were also significantly more likely to be used by patients who were receiving cognitive adaptation training. More than 66 percent of patients in cognitive adaptation training were classified as high users of supports (used more than 75 percent of supports provided appropriately), compared with only 13 percent of those who were receiving generic environmental supports. CONCLUSIONS: Environmental supports have been found to improve functional behaviors for patients with schizophrenia. However, supports are not likely to be used unless they are customized for individual clients and set up in the home environment.

Adaptation, Psychological↗
PubMed1982

Social skills problems in neurotic outpatients. Social skills training with and without cognitive modification.

Twenty-two "socially dysfunctional" outpatients had 12 1 1/2-hour sessions of social skills training either alone or combined with cognitive modification (each, n = 11). Two raters who were blind to the treatment regimen significantly differentiated the two treatments, as judged from audiotapes of treatment sessions. Measurement was by an independent assessor in a structured interview, by self-monitoring of several activities and of anxiety felt during them, and by self-rated questionnaires. In each treatment regimen, patients' conditions improved significantly and equally on reported behavioral and cognitive measures both during and after treatment, and at six-month follow-up. Outcome did not differ significantly between the two treatment conditions at any time on any measure. Patients reported increased levels of social activities and less anxiety during these, less isolation, better relations with their colleagues at work, less depression, and loss of many irrational social beliefs. During multiple baseline monitoring for up to nine weeks, no improvement occurred. Performance of each social task or "target" increased significantly after training was begun for it, and subjective anxiety decreased similarly during social performance. Untreated targets improved much less, and more slowly. Social skills training was followed by lasting and worthwhile improvement that was not enhanced by the addition of cognitive modification.

Adult↗
PubMed1984

Predicting differential response to EMG biofeedback and relaxation training: the role of cognitive structure.

Analyzed treatment outcome data for 102 headache patients who had been assigned randomly to receive either EMG biofeedback (N = 70) or relaxation training (N = 32). It was hypothesized that a measure of cognitive structure would differentially predict success at the two training tasks and that patients high in cognitive structure would derive more benefit from the more structured relaxation task and less benefit from the biofeedback task. This hypothesis was confirmed (p less than .01). The analysis also demonstrated that relaxation training was significantly more effective than biofeedback (p less than .05) and that mixed headache patients improved significantly less (p less than .05) than either migraine or muscle-contraction headache patients.

Biofeedback, Psychology↗
PubMed2004

The role of blood glucose availability and fatigue in the development of cognitive impairment during combat training.

INTRODUCTION: The aim of this study was to determine whether inadequate nutrition would produce a reduction in the blood glucose concentration and impair cognitive function. METHODS: Energy intake, blood glucose, and cognitive function were measured in 18 male subjects during a 4-d military field exercise. Baseline measures of fasting blood glucose, body mass, cognitive function, and mood were taken before the start of combat training. Measurements of blood glucose, cognition, and well-being were then repeated during every subsequent 24 h period. Activity levels were monitored continuously using wrist-worn activity monitors. RESULTS: Subjects experienced an increase in symptoms relating to hypoglycemia after 24 h in the field (p < 0.01), vigor decreased (p < 0.001), and fatigue increased (p < 0.001). After 48 h, subjects reported feelings of depression (p < 0.05), anger (p < 0.01), and confusion (p < 0.001). Delayed memory recall was significantly impaired after 48 h (p < 0.05), and there was a decrease in vigilance (p < 0.01). Between 48 and 72 h, there was a decrease in immediate memory recall (p < 0.05). Delayed memory recall and vigilance remained impaired, but did not deteriorate further. When subjects were extracted from the field after 96 h, nude BM had decreased by 2% (p < 0.05). CONCLUSION: Although it was possible to reproduce the symptoms and cognitive impairment associated with hypoglycemia, there was no change in blood glucose concentration throughout the 4-d period. The impairment in cognitive function is likely to have been the result of significant sleep deprivation.

Adult↗