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PubMedDate not supplied

Evaluation and correction for a 'training effect' in the cognitive assessment of older adults.

BACKGROUND: Repeated administration of psychometric instruments frequently results in a higher score on retesting, the so-called training effect. Yet, a training effect has been poorly considered in longitudinal studies of cognitive changes in older persons. METHODS: We investigated the presence, magnitude and potential adjustments for training effect in the older participants of the Systolic Hypertension in the Elderly Program (SHEP). SHEP evaluated the cognitive status effects of a diuretic-based treatment of isolated systolic hypertension versus placebo. Changes in the short Comprehensive Assessment and Referral Evaluation (short-CARE) questionnaire score, from baseline through 4 years of follow-up, were assessed in 4,718 participants. In this study, we used two regression techniques to adjust data for the training effect. RESULTS: In both study groups, a training effect was evident as a progressive improvement in the short-CARE score throughout year 1. Thereafter, cognitive scores tended to deteriorate, more in the placebo than in the active treatment group (p = 0.055). When follow-up scores were adjusted based upon baseline data, the difference between the study groups reached statistical significance (p = 0.019), but the apparent overall trend towards deterioration in cognitive score was no longer observed. Adjustment of baseline data preserved this apparent temporal course, but did not improve the discrimination between the two study groups (p = 0.165). CONCLUSIONS: In SHEP, repeated cognitive assessments were likely biased by a training effect which could be only partially corrected by statistical techniques. Studies of changes in the cognitive status of older persons should be designed appropriately to estimate and minimize the consequences of a training effect in follow-up data.

Aged↗
PubMed1991

Computer-assisted attention training in schizophrenics. A comparative study.

The evaluation of a computer-assisted attention training program is compared with a cognitive group training program. Both programs were devised to reduce cognitive deficits in schizophrenics. The training programs were given to 30 acute schizophrenics and 30 healthy subjects. Both were shown to be effective in reducing distraction of schizophrenics in reaction-time tasks. By means of training, schizophrenics may attain the same results in reaction time tasks as healthy individuals. The results are discussed under theoretical, methodical and practical aspects.

Acute Disease↗
PubMed2005

Treatment of attention deficit hyperactivity disorder in adults.

A number of medication and psychologic treatment options for adults with attention deficit hyperactivity disorder have become available during the past 5 years, while others are under investigation. This review describes the safety and effectiveness of the stimulants (i.e., methylphenidate and dexedrine), and particularly the newer long-acting stimulants (i.e., Concerta) and Adderall XR) in the treatment of this population. Some nonstimulant/nonantidepressants, particularly atomoxetine, have also been shown to improve attention deficit hyperactivity disorder symptoms. Combination treatment of stimulants and antidepressants require more study with regard to safety and efficacy. Psychosocial interventions (e.g., cognitive behavioral therapy, mindfulness training and cognitive remediation) can also benefit adults with attention deficit hyperactivity disorder. Cognitive behavioral therapy combined with medication is more effective than either intervention alone, especially for addressing the emotional and functional aspects of peoples lives and thus improving occupational, interpersonal and emotional outcomes.

Antidepressive Agents↗
PubMed1996

Cognitive assessment of USAF pilot training candidates.

BACKGROUND: Most intellectual and cognitive assessment of pilots is done with locally developed assessment devices. The United States Air Force currently uses the recently developed CogScreen (Aeromedical Edition) to assess these areas. HYPOTHESES: There will be differences on the CogScreen across USAF student pilot candidates and commercial pilots. METHODS: This paper presents the test scores of 512 USAF pilot training candidates who were tested with this commercially available, "off-the-shelf" product. Comparison data was abstracted from the test manual on commercial pilots. RESULTS: Data from the new CogScreen (Aeromedical Edition) is provided and shows consistent differences between pilot training candidates and commercial pilots across reaction time, accuracy, throughput, and process measures. DISCUSSION: The new CogScreen appears to be an appropriate device for the assessment of pilot candidates, student pilots, and pilots.

Adult↗
PubMed1998

Effectiveness of cognitive therapy with coping training for persistent auditory hallucinations: a retrospective study of attenders of a psychiatric out-patient department.

Recent studies have suggested positive effects of cognitive therapy on psychotic symptoms. However, the effects of coping training are less clear, and generalization to daily functioning has not been attempted for either intervention. A total of 40 patients with therapy-refractory auditory hallucinations received standard care plus cognitive therapy with coping training. In a retrospective, descriptive study, multiple assessments of outcome were measured. The experimental therapy seems to improve both overall symptomatology and quality of life, and is acceptable to both patients and relatives. Generalization to daily functioning and continuation over time was observed. Improvements with regard to the occurrence of hallucinations, fear, disturbance of thought, social interactions and daily activities were significant. Complete disappearance of hallucinations occurred in 20% of participants, and in 40% of those who were regularly discharged from treatment. The level of satisfaction with therapy was high (78%), and the drop-out rate was low (9%). Improvement was not significantly correlated with psychiatric diagnosis (schizophrenia vs. other diagnoses), and was sustained at follow-up after 1 year.

Adaptation, Psychological↗
PubMed2002

Supervisor tolerance-responsiveness to substance abuse and workplace prevention training: use of a cognitive mapping tool.

Supervisor tolerance-responsiveness, referring to the attitudes and behaviors associated with either ignoring or taking proactive steps with troubled employees, was investigated in two studies. The studies were conducted to help examine, understand and improve supervisor responsiveness to employee substance abuse. Study 1 examined supervisor response to and tolerance of coworker substance use and ways of interfacing with the Employee Assistance Program (EAP) in two workplaces (n = 244 and 107). These surveys suggested that engaging supervisors in a dialogue about tolerance might improve their willingness to use the EAP. Study 2 was a randomized control field experiment that assessed a team-oriented training. This training adopted a cognitive mapping technique to help improve supervisor responsiveness. Supervisors receiving this training (n = 29) were more likely to improve on several dimensions of responsiveness (e.g. likely to contact the EAP) than were supervisors who received a more didactic, informational training (n = 23) or a no-training control group (n = 17). Trained supervisors also showed increases in their own help-seeking behavior. Procedures and maps from the mapping activity (two-stage conversational mapping) are described. Overall, results indicate that while supervisor tolerance of coworker substance use inhibits EAP utilization, it may be possible to address this tolerance using team-oriented prevention training in the work-site.

Adult↗
PubMed1994

Changes in premenstrual symptoms and irrational thinking following cognitive-behavioral coping skills training.

Women reporting severe premenstrual symptoms were allocated nonrandomly to a cognitive-behavioral coping skills treatment (n = 13), a nonspecific treatment (n = 12), or a waiting-list group (n = 12). Repeated measures analyses of variance showed that, compared with control subjects, the coping skills group reported significant reductions in premenstrual symptomatology and irrational thinking at posttreatment and at 9-month follow-up. There were no significant differences between the waiting-list and control intervention groups at any time of testing. It was suggested that the increased irrationality reported at pretreatment should be viewed not as a "cause" of premenstrual problems but as a product of the stresses experienced in the premenstruum phase. The findings of this study indicated that cognitive-behavioral coping skills treatments can reduce the negative effects of premenstrual symptoms and that those reductions can be maintained over time.

Adaptation, Psychological↗
PubMed1982

Reducing motion sickness: a comparison of autogenic-feedback training and an alternative cognitive task.

Eighteen men were randomly assigned to three groups matched for susceptibility to Coriolis motion sickness. All subjects were given six Coriolis Sickness Susceptibility Index (CSSI) tests separated by 5-d intervals. Treatment Group I subjects were taught to control their own autonomic responses before the third, fourth, and fifth CSSI tests (6 h total training). Group II subjects were given "sham" training in an alternative cognitive task under conditions otherwise identical to those of Group I. Group III subjects received no treatment. Results showed that Group I subjects could withstand the stress of Coriolis acceleration significantly longer after training. Neither of the other two groups changed significantly.

Adult↗
PubMed1989

An evaluation of cognitive-behavioral therapy for training resistance to visually-induced motion sickness.

This investigation examined the techniques for reducing visually-induced motion sickness. On the basis of their responses to a motion sickness history questionnaire, 32 subjects were selected and assigned to 1 of 4 groups such that the groups were matched on the basis of their ability to tolerate visually-induced apparent motion (VM). One group received 10 sessions of desensitization training only (DT); a second group received 10 sessions of cognitive therapy only (CT); a third group received 10 sessions of combined desensitization and cognitive therapy treatment (CG); and a fourth group received no treatment (C). (There are many speculations about why and how an individual's response changes with repeated stimulation. We have arbitrarily selected the term desensitization to connote the decrease in sensitivity over time with repeated exposures). The results indicated that only the groups which received cognitive therapy (i.e., CT and CG) exhibited significant increases in tolerance to VM when pretreatment measures were compared to posttreatment measures. No significant differences in pre- vs. posttreatment measures were observed in the desensitization only or control groups (i.e., DT and C). A similar pattern of results was obtained with the symptomatology data.

Adolescent↗
PubMed2006

Cognitive versus technical debriefing after simulation training.

BACKGROUND: Recent literature describes "cognitive dispositions to respond" (CDRs) that may lead physicians to err in their clinical reasoning. OBJECTIVES: To assess learner perception of high-fidelity mannequin-based simulation and debriefing to improve understanding of CDRs. METHODS: Emergency medicine (EM) residents were exposed to two simulations designed to bring out the CDR concept known as "vertical line failure." Residents were then block-randomized to a technical/knowledge debriefing covering the medical subject matter or a CDR debriefing covering vertical line failure. They then completed a written survey and were interviewed by an ethnographer. Four investigators blinded to group assignment reviewed the interview transcripts and coded the comments. The comments were qualitatively analyzed and those upon which three out of four raters agreed were quantified. A random sample of 84 comments was assessed for interrater reliability using a kappa statistic. RESULTS: Sixty-two residents from two EM residencies participated. Survey results were compared by technical (group A, n = 32) or cognitive (group B, n = 30) debriefing. There were 255 group A and 176 group B comments quantified. The kappa statistic for coding the interview comments was 0.42. The CDR debriefing group made more, and qualitatively richer, comments regarding CDR concepts. The technical debriefing group made more comments on the medical subjects of cases. Both groups showed an appreciation for the risk of diagnostic error. CONCLUSIONS: Survey data indicate that technical debriefing was better received than cognitive debriefing. The authors theorize that an understanding of CDRs can be facilitated through simulation training based on the analysis of interview comments.

Cognition↗
PubMedDate not supplied

[Treatment effects of combined cognitive behavioral therapy with parent training in hyperkinetic syndrome].

In the past cognitive behavioral treatment concepts failed to demonstrate their clinical effectiveness in the treatment of ADHD children. We combined a cognitive treatment package (CBT) with a special focus on self-instructional and self-management skills with a subsequent parent management training (PMT) in order to reduce academic problems and oppositional/aggressive behavior. 18 children with a diagnosis of ADHD combined type and Oppositional Defiant Disorder participated in the study. In an A-B study design the effects of a 12 weeks treatment phase (6 weeks CBT; 6 weeks PMT) were compared with a preceding 4 weeks baseline. Core symptoms of ADHD, conduct and homework problems were assessed by weekly administration of parent and teacher questionnaires. CBT was effective in reducing the core symptoms of ADHD at home, in school and concerning homework problems. Moreover conduct problems at home and in school were reduced. PMT resulted in a further amelioration of the cited symptoms. We conclude that CBT is an important component in the treatment of ADHD provided that aspects of generalization are considered. PMT is a useful adjunct to CBT due to its effectiveness in situations where children still have problems of self guidance.

Aggression↗
PubMed1999

Attention fixation training: training people to form cognitive maps help to control symptoms of panic disorder with agoraphobia.

Nine individuals diagnosed with panic with agoraphobia received three elements of Attentional Fixation Training (AFT): Directed attention to the external environment, directed topographical synthesis, and directed orientation in space-time to control characteristics of panic. They then walked a standard 2.5 km route and practiced these elements upon entering one of the five panic-inducing situations: (a) walking alone near a busy street with the examiner following at 20 m, (b) walking alone near a busy street with the examiner out of client's visual field, (c) shopping with the examiner present, (d) traveling on a bus alone, and (e) shopping alone. Heart rate was monitored in each of these five situations. Except for the case of using public transport, heart rate activity decreased to a considerable extent during AFT practice suggesting AFT elements provided a good way to control symptoms of panic in vivo. Results were discussed within the confines of a model suggesting that an attentional deficit, which produces a spatial disorientation disorder that maintains both panic and agoraphobia, can efficiently be overcome by means of all three AFT tools.

Adult↗
PubMed2004

Relaxation training methods for nurse managers in Hong Kong: a controlled study.

Nurse managers are under increased stress because of excessive workloads and hospitals' restructuring which is affecting their work tasks. High levels of stress could affect their mental health. Yet, few stress management training programmes are provided for this population. The purpose of this study was to apply stretch-release relaxation and cognitive relaxation training to enhance the mental health for nurse managers. A total of 65 nurse managers in Hong Kong were randomly assigned to stretch-release relaxation (n = 17), cognitive relaxation (n = 18), and a test control group (n = 35). Mental health status was assessed using the Chinese version of State-Trait Anxiety Inventory and the Chinese version of the General Health Questionnaire. Participants were assessed at the pretreatment session, the fourth posttreatment session, and at the 1-month follow-up session. The results revealed both the stretch-release and cognitive relaxation training enhanced mental health in nurse managers in Hong Kong. The application of relaxation training in enhancing mental health status for nurses and health professionals is discussed.

Adult↗
PubMed1998

Cognitive-behavioral pain management for elderly nursing home residents.

A cognitive-behavioral pain management program for elderly nursing home residents with chronic pain was compared with an attention/support control treatment in a randomized pre-/post-comparison group design with follow-up. Thirteen women and nine men, ranging in age from 61 to 98 (M = 77.2), from two large nursing homes participated in the treatment programs through 10 weekly group sessions. Results revealed that the subjects who received the cognitive-behavioral training reported less pain and pain-related disability, although the two programs were perceived as equally credible both before and after treatment. No significant treatment effects were found for depression and physician medication ratings. Treatment effects were maintained at 4-month follow-up, despite an overall increase in reported pain. Findings indicate that elderly nursing home residents with chronic pain and without serious cognitive impairment can benefit substantially from training in cognitive and behavioral pain management strategies that are known to be effective with younger age groups and the community-resident elderly population.

Aged↗