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PubMed1998

[Evaluation of a group therapy program for anxious children].

In this study 14 children with different anxieties attended in small groups a cognitive-behavioral training program. The groups met once a week over a period of ten weeks. Outcome was evaluated with different questionnares for children and parents and interviews at the beginning and the end of training and ten weeks later. The different measures showed a significant reduction of self-reported anxiety. Anxious, avoident and social insecure behaviour was also reduced. Further the negative self-talk of the children changed into more appropriate positive self-talk. As it was not possible to use an appropriate control group, the results can just be seen as hints for the effectivity of a cognitive-behavioral orientated group therapy program for the treatment of various childhood anxieties. Further research under controlled conditions is necessary.

Anxiety Disorders↗
PubMed2000

Cognitive task analysis and innovation of training: the case of structured troubleshooting.

Troubleshooting is often a time-consuming and difficult activity. The question of how the training of novice technicians can be improved was the starting point of the research described in this article. A cognitive task analysis was carried out consisting of two preliminary observational studies on troubleshooting in naturalistic settings, combined with an interpretation of the data obtained in the context of the existing literature. On the basis of this cognitive task analysis, a new method for the training of troubleshooting was developed (structured troubleshooting), which combines a domain-independent strategy for troubleshooting with a context-dependent, multiple-level, functional decomposition of systems. This method has been systematically evaluated for its use in training. The results show that technicians trained in structured troubleshooting solve twice as many malfunctions, in less time, than those trained in the traditional way. Moreover, structured troubleshooting can be taught in less time than can traditional troubleshooting. Finally, technicians learn to troubleshoot in an explicit and uniform way. These advantages of structured troubleshooting ultimately lead to a reduction in training and troubleshooting costs.

Cognitive Science↗
PubMedDate not supplied

[The treatment of social phobias: efficacy of cognitive and and behavioral group therapy].

55 patients with social phobias were given group cognitive-behavioural therapy. The study protocol comprised three phases: (1) the pre-inclusion phase with 5 individual consultations before group treatment; (2) the group phase itself, comprising 20 weekly sessions of 2 hours each and (3) the post-therapy phase, comprising a 6 month follow-up group session, and 2 evaluation sessions 6 and 12 months after the end of group therapy. The techniques used were assertiveness training and cognitive therapy. Assessments were carried out using the Rathus Assertiveness Schedule (23), Brief standard self rating for phobic patients (Marks) (19) and Beck Depression Inventory Scores (1), at specified times during the study: at the start of the individual phase; at the start, in the middle and at the end of the group phase, as well as at 6 month and 1 year follow-up. The results are interesting. Follow-up was very good, with 54 out of 55 patients finishing the group treatment, and with 50 patients being evaluated at 6 and 12 months. Global analysis of the results showed that at the end of group therapy, there was a statistically significant improvement in the score on the Rathus Assertiveness Schedule, on the social sub-score, on the brief standard self rating for phobic patients (Marks). The improvement in these variables was maintained at 6 and 12 month follow-up.

Adult↗
PubMed1998

Virtual environments in brain damage rehabilitation: a rationale from basic neuroscience.

The potential of virtual environments in assessment and training of cognitive function is a more than adequate reason for their application to neurorehabilitation. However, there is a more fundamental justification, and one which is firmly rooted in the neuroscience literature. Over the last half century there has been a wealth of published evidence that enriching the environments of laboratory rats stimulates neuroplastic change in the cerebral cortex, enhances learning and problem solving in normal rats and reduces cognitive impairment in brain damaged rats. Central to all three effects of enrichment are the increased levels of interaction with the physical environment engendered by enrichment. Placing humans who have damaged brains in virtual environments is one way of enhancing their levels of environmental interaction which, because of cognitive impairments and sensory and motor disabilities, is otherwise difficult to achieve. In this chapter we explore the potential of virtual environments as enriched environments within the rehabilitation regime. The underlying assumption, that interaction with a virtual environment is functionally equivalent to interaction with a real environment, is examined. Three lines of relevant evidence are reviewed, neuroimaging studies and psychophysiological studies of people in virtual environments and studies of transfer of training from virtual to real tasks. An agenda for future research in this are is proposed.

Animals↗
PubMed2006

Differential contributions of dopaminergic D1- and D2-like receptors to cognitive function in rhesus monkeys.

RATIONALE: Dopaminergic neurotransmission is critically involved in many aspects of complex behavior and cognition beyond reward/reinforcement and motor function. Mental and behavioral disorders associated with major disruptions of dopamine neurotransmission, including schizophrenia, attention deficit/hyperactivity disorder, Parkinson's disease, Huntington's disease, and substance abuse produce constellations of neuropsychological deficits in learning, memory, and attention in addition to other defining symptoms. OBJECTIVE: To delineate the role dopaminergic D1- and D2-like receptor subtypes play in complex brain functions. MATERIALS AND METHODS: Monkeys (N = 6) were trained on cognitive tests adapted from a human neuropsychological assessment battery (CAmbridge Neuropsychological Test Automated Battery). The battery included tests of spatial working memory (self-ordered spatial search task), visuo-spatial associative memory and learning (visuo-spatial paired associates learning task, vsPAL) and motivation (progressive ratio task, PR). Tests of motor function (bimanual motor skill task, BMS; rotating turntable task, RTT) were also included. The effects of the dopamine D2-like antagonist raclopride (10-56 microg/kg, i.m.) and the D1-like antagonist SCH23390 (SCH, 3.2-56 microg/kg, i.m.) on cognitive performance were then determined. RESULTS: Deficits on PR, RTT, and BMS performance were observed after both raclopride and SCH23390. Spatial working memory accuracy was reduced to a greater extent by raclopride than by SCH, which was unexpected, given prior reports on the involvement of D1 signaling for spatial working memory in monkeys. Deficits were observed on vsPAL performance after raclopride, but not after SCH23390. CONCLUSIONS: The intriguing results suggest a greater contribution of D2- over D1-like receptors to both spatial working memory and object-location associative memory.

Animals↗
PubMed2007

Cognitive rehabilitation in the elderly: effects on memory.

This study reports the effects of a 12-week multimodular cognitive rehabilitation training program on memory performance in two groups of older adults. In the Memory Training module, participants were instructed on the nature of memory and how to improve memory performance; internal and external strategies were described and practiced over the training sessions. Memory performance was assessed by four tests: Alpha Span, Brown-Peterson, Hopkins Verbal Learning Test - Revised (HVLT-R), and Logical Stories. One group received training on entry into the study (Early Training Group, ETG), the other after a 3-month delay (Late Training Group, LTG). The results showed no training-related improvement in working memory (Alpha Span), primary memory (Brown-Peterson, HVLT-R), or recognition memory (HVLT-R). While the most direct analyses of a training effect (analyses of covariance) rarely demonstrated significant effects, exploratory analyses provided some evidence for a training benefit in several measures of secondary memory (Logical Stories; HVLT-R) and strategic processing (Brown-Peterson; Logical Stories; HVLT-R). Positive results were largely restricted to the ETG, possibly because the LTG lost motivation as a consequence of their delayed training. The results need to be treated with caution, but are promising for the rehabilitation of memory functioning in older adults.

Aged↗
PubMed1996

Cognitive gender differences in very young children parallel biologically based cognitive gender differences in monkeys.

Infant humans were trained on 2 cognitive tests that have previously revealed, in infant monkeys, a double dissociation that was reversible by perinatal manipulations of androgens and ablations of specific brain sites. Children showed the same sex-linked behavior found with infant monkeys: young boys were superior on the object reversal task and young girls were superior on the concurrent discrimination task. As happened previously with infant monkeys, the gender difference was not apparent in older human subjects. Thus, early in ontogeny, cognitive gender differences have now been discovered in both humans and monkeys, probably a result of gender differences in androgens that influence the maturation rate of specific brain systems.

Adolescent↗
PubMed1990

Intensity versus type of affect elicited by dissociative cognitions in moderating acute pain.

75 undergraduates were trained to use cognitions that elicited either high or low pleasure, high or low fear, or received an expectancy manipulation. Groups high in pleasure showed greater tolerance for pressure pain than other treatment groups but did not differ from expectancy; differences were not found on discomfort ratings. Results were not attributable to differential compliance with instructions, perceived effectiveness of cognitions used, or the number of cognitions used. The percentage of time during stimulation that assigned cognitions were used appeared to mediate tolerance. Expectations for improved tolerance elicited by appealing cognitions and compelling placebos may also mediate tolerance.

Adolescent↗
PubMed2004

Skills training for people with severe mental illness.

There is a growing empirical literature on psychosocial rehabilitation strategies for schizophrenia and other severe mental illnesses. Three of the best-supported and most promising approaches were reviewed: social skills training (SST), cognitive behavior therapy (CBT), and cognitive remediation (CR). Of the three, SST has the strongest empirical support and can be considered an evidence-based treatment. However, it is appropriate as a targeted treatment for social impairment, not as a broad based treatment for schizophrenia. CBT has only recently been applied to patients with psychotic disorders and the preliminary results are promising for reducing distress associated with residual psychotic symptoms. All but a handful of trials have been carried out in the context of the public health system in the UK with specially selected patients. Consequently, it is not yet clear if it would be effective in public health systems in the US, with highly impaired patients, or for patients with comorbid substance abuse. There is an extensive literature documenting that a variety of training techniques can improve performance on neuropsychological tests, and there is a growing literature of more clinically relevant CR trials that have produced small to medium effect sizes. No studies have yet demonstrated a clinically significant effect on community functioning. This is a promising area for further research, but CR, like CBT, does not have a sufficient evidentiary base for widespread dissemination to the public mental health system at this time.

Aptitude↗
PubMed1995

Emotional self-regulation therapy for smoking reduction: description and initial empirical data.

Self-regulation therapy (Amigó, 1992) is a set of procedures derived from cognitive skill training programs for increasing hypnotizability. First, experiences are generated by actual stimuli. Clients are then asked to associate those experiences with various cues. They are then requested to generate the experiences in response to the cues, but without the actual stimuli. When they are able to do so quickly and easily, therapeutic suggestions are given. Studies of self-regulation therapy indicate that it can be used successfully to treat smoking.

Arousal↗
PubMed1984

A cognitive-behavioral approach to social skills training with shy persons.

Developed, implemented, and evaluated a social skills training program for shy persons. Twelve Ss (6 males and 6 females) were given 9 hours of social skills training, while 12 other Ss (6 males and 6 females) served as a wait-list control group. Prior to and immediately after training, Ss completed self-report measures to assess social anxiety, cognitive self-statements, and perceived ability to participate actively in social situations. Results indicated that Ss in the experimental group, relative to the control group, significantly: (a) decreased their level of social anxiety; (b) decreased their negative self-statements; and (c) increased their perceived ability to participate actively in social situations. Discussion focused on directions of future research in the area of shyness.

Adult↗
PubMed1997

An evaluation of peer and professional trainers in a union-based occupational health and safety training program.

Social cognitive theory posits that behavior can be changed by observing others perform or describe performance of behaviors. This framework was applied to understanding health behavior change associated with workplace health and safety training. Questionnaires were developed and administered to 426 workers at a United Automobile Worker's Union health and safety training program. Participants received training from one of three trainers: (1) local union discussion leaders (LUDLs), (2) professional staff trainers, or (3) LUDLs with professional staff trainers. Data were collected in three phases: before, after, and three months post-training. Findings show that subjects trained by LUDLs identify most closely with their instructors, whereas subjects trained by staff trainers identify least closely with them. In addition, workers trained by LUDLs reported changing behavior as a result of training more often than workers trained by others.

Adult↗
PubMed1992

Cognitive problem-solving skills training and parent management training in the treatment of antisocial behavior in children.

This study evaluated the effects of problem-solving skills training (PSST) and parent management training (PMT) on children (N = 97, ages 7-13 years) referred for severe antisocial behavior. Children and families were assigned randomly to 1 of 3 conditions: PSST, PMT, or PSST and PMT combined. It was predicted that (a) each treatment would improve child functioning (reduce overall deviance and aggressive, antisocial, and delinquent behavior, and increase prosocial competence); and (b) PSST and PMT combined would lead to more marked, pervasive, and durable changes in child functioning and greater changes in parent functioning (parental stress, depression, and overall symptoms). Expectations were supported by results at posttreatment and 1-year follow-up. PSST and PMT combined led to more marked changes in child and parent functioning and placed a greater proportion of youth within the range of nonclinic (normative) levels of functioning.

Adolescent↗
PubMed1991

Effects of a school-based cognitive-behavioral intervention for ADHD children.

Two variations of school-based cognitive-behavioral training (CBT) program were compared to each other and to a waiting-list control condition in the treatment of children with attention-deficit hyperactivity disorder (ADHD). The experimental interventions included a multicomponent condition that provided coordinated training programs for parents, teachers, and children and a teacher-only condition that offered training for classroom teachers only. Evaluation of outcome occurred at pre-intervention, post-intervention and at 6-week followup periods. Depedent measures included classroom behavior observations, teacher ratings of child behavior, child self-report, and teacher ratings of adjustment. The multicomponent CBT condition was significantly better than the other conditions at improving observed off-task/disruptive behavior at post-test. This improvement was maintained at followup, although treatment condition differences were no longer significant. There were no treatment condition differences on any other measures at post-intervention or followup. It was concluded that the intervention had minimal short-term effects on the ADHD children. The results are discussed within the context of several methodological limitations of the study which serve as proposals for continued research in this area.

Attention Deficit Disorder with Hyperactivity↗
PubMed2005

Heart rate variability biofeedback as a behavioral neurocardiac intervention to enhance vagal heart rate control.

BACKGROUND: Patients with coronary heart disease (CHD) who experience depressed mood or psychological stress exhibit decreased vagal control of heart rate (HR), as assessed by spectral analysis of HR variability (HRV). Myocardial infarction and sudden cardiac death are independently associated with depression and stress, as well as impaired vagal HR control. This study examined whether a behavioral neurocardiac intervention to reduce stress or depression can augment cardiovagal modulation in CHD patients. We hypothesized that (1) cognitive-behavioral training with HRV biofeedback would augment vagal recovery from acute stress, and (2) vagal regulation of HR would be inversely associated with stress and depression after treatment. METHODS: This randomized controlled trial enrolled 46 CHD patients from 3 clinics of CHD risk reduction in Toronto and Vancouver, Canada. Subjects were randomized to five 1.5-hour sessions of HRV biofeedback or an active control condition. Outcome was assessed by absolute and normalized high-frequency spectral components (0.15-0.50 Hz) of HRV, and by the Perceived Stress Scale and Centre for Epidemiologic Studies in Depression scale. RESULTS: Both groups reduced symptoms on the Perceived Stress Scale (P = .001) and Centre for Epidemiologic Studies in Depression scale (P = .004). Hierarchical linear regression determined that improved psychological adjustment was significantly associated with the high-frequency index of vagal HR modulation only in the HRV biofeedback group. Adjusted R 2 was as follows: HRV biofeedback group, 0.86 for stress (P = .02) and 0.81 for depression (P = .03); versus the active control group, 0.04 (P = .57) and 0.13 (P = .95), respectively. CONCLUSION: A novel behavioral neurocardiac intervention, HRV biofeedback, can augment vagal HR regulation while facilitating psychological adjustment to CHD.

Biofeedback, Psychology↗
PubMed1999

Age-related macular degeneration: a randomized clinical trial of a self-management intervention.

The purpose of this study was to conduct a randomized clinical trial to assess whether a self-management group intervention can improve mood, self-efficacy, and activity in people with central vision loss due to age-related macular degeneration (AMD). Ninety-two elderly patients with AMD (average age = 79) from a university ophthalmology clinic were randomly assigned to the self-management intervention (n = 44) or to a wait-list (n = 48). All patients were legally blind in at least one eye. The intervention consisted of 6 weekly 2-hour group sessions providing education about the disease, group discussion, and behavioral and cognitive skills training to address barriers to independence. All participants eventually completed the intervention allowing pre-post comparisons for all patients. The battery of measures included the Profile of Mood States (POMS); Quality of Well-Being Scale; and assessments of self-efficacy, participation in activities, and use of vision aids. Participants' initial psychological distress was high (mean total POMS = 59.72) and similar to distress experienced by other serious chronic illness populations (e.g. cancer, bone marrow transplant). Analysis of covariance testing the primary hypothesis revealed that intervention participants experienced significantly (p = .04) reduced psychological distress (pre mean = 61.45; post mean = 51.14) in comparison with wait-list controls (pre mean = 57.72; post mean = 62.32). Intervention participants also experienced improved (p = .02) self-efficacy (pre mean = 70.16; post mean = 77.27) in comparison with controls (pre mean = 67.71; post mean = 69.07). Further, intervention participants increased their use of vision aids (p < .001; pre mean = 3.37, post mean = 6.69). This study demonstrates that a relatively brief behavioral intervention can substantially reduce psychological distress and increase self-efficacy in elderly adults experiencing vision loss due to macular degeneration. Self-management intervention appears to improve mood, self-efficacy, and use of vision aids, further enhancing the lives of poorly sighted individuals with AMD.

Adaptation, Psychological↗
PubMed2005

Psychiatric disorders and mental health service use in patients with advanced cancer: a report from the coping with cancer study.

BACKGROUND: Psychological morbidity has been proposed as a source of distress in cancer patients. This study aimed to: 1) determine the prevalence of diagnosable psychiatric illnesses, and 2) describe the mental health services received and predictors of service utilization in patients with advanced cancer. METHODS: This was a cross-sectional, multi-institutional study of 251 eligible patients with advanced cancer. Eligibility included: distant metastases, primary therapy failure, nonpaid caregiver, age > or =20 years, stamina for the interview, English or Spanish-speaking, and adequate cognitive ability. Trained interviewers administered the Structured Clinical Interview for the Diagnostic Statistical Manual IV (DSM-IV) modules for Major Depressive Disorder, Generalized Anxiety Disorder, Panic Disorder, Post-Traumatic Stress Disorder, and a detailed questionnaire regarding mental health service utilization. RESULTS: Overall, 12% met criteria for a major psychiatric condition and 28% had accessed a mental health intervention for a psychiatric illness since the cancer diagnosis. Seventeen percent had discussions with a mental health professional; 90% were willing to receive treatment for emotional problems. Mental health services were not accessed by 55% of patients with major psychiatric disorders. Cancer patients who had discussed psychological concerns with mental health staff (odds ratio [OR] = 19.2; 95% confidence interval [95% CI], 8.90-41.50) and non-Hispanic white patients (OR = 2.7; 95% CI, 1.01-7.43) were more likely to receive mental health services in adjusted analysis. CONCLUSIONS: Advanced cancer patients experience major psychiatric disorders at a prevalence similar to the general population, but affected individuals have a low rate of utilizing mental health services. Oncology providers can enhance utilization of mental health services, and potentially improve clinical outcomes, by discussing mental health concerns with their patients.

Adaptation, Psychological↗