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PubMed1996

Training case managers in cognitive-behaviour therapy.

Four case managers with a nursing background took part in a 26 week in-service programme aimed at developing basic skills in cognitive-behaviour therapy. The programme occupied about 5 hours each week and included directly supervised therapy with at least 4 patients having serious mental illness. Patients' symptoms improved significantly after an average of less than 12 one hour therapy sessions. After the programme, case managers began treating patients autonomously, although all recognised the need for some continuing supervision and the necessity of referring unusually complex or challenging cases to clinical psychologists or others highly skilled in the area.

Adult↗
PubMed1997

[The diagnostic process in nursing].

The aim of this investigation was to uncover the reason of difficulties nurses have in defining the patient's problem. For this reason the diagnostic process of nurses caring for patients in pain was investigated in the field. Observations, interviews and questionnaires were analysed in a qualitative and quantitative way. The analysis of the data shows that the observed nurses didn't value the information received by using the problem solving process and didn't use it to define the nursing problem. But the results also point out that nurses have the ability to gather information in the direct contact with the patient. The question is: could there be a lack of training in cognitive processes?

Cognition↗
PubMed1997

[Distance disturbance as a major problem in mental retardation. A case study].

Although "lack of distance" (indiscriminately friendly, attention-seeking behavior) is a wellknown problem behavior in children with psychiatric disorders and in those with mental retardation there is no exact definition of this behavior disorder and there are only vague indications as to its origins and how it is maintained. For a 14-year-old mentally retarded girl with frequent provocative-aggressive attention-seeking behavior we operationalized the disturbed behavior after observation of the phenomenology and frequency in different situations. Treatment began with training in cognitive discrimination of "known" adults and strangers, as part of pictures showing social interaction were used. This discrimination was then practiced with in-vivo therapy in everyday situations; in particular, unambiguous reactions to contacts with "known" adults and strangers were practiced. Correct responses (contact with "known" adults, turning away from strangers) were immediately reinforced socially and materially, and mistakes (i.e. making contract with strangers) were punished with time-out. In the course of these in-vivo sessions, behavior lacking distance ceased. Furthermore, the success of the therapy generalized well in everyday situations, which was assessed by another baseline assessment, and the effect on the girl's behavior in the home environment and at school was also stable.

Adolescent↗
PubMed1990

Learning mnemonics: roles of aging and subtle cognitive impairment.

Previously validated methods of memory training were used in conjunction with the Folstein Mini-Mental State Examination (MMSE) to explore the relationship between complexity of learned mnemonic, aging, and subtle cognitive impairment. Subjects were 218 community-dwelling elderly. Treatment included imagery mnemonics for remembering names and faces and lists. There was a significant interaction among age, type of learning task (face-name vs. list), and improvement when controlling for MMSE score. There was also a significant interaction among MMSE score, type of learning task, and improvement when controlling for age. Scores on the more complex list-learning mnemonic were more affected by age and MMSE scores than were scores on the face-name mnemonic. Implications of the findings for cognitive training of the old old and the impaired are discussed.

Aged↗
PubMedDate not supplied

Effects of aerobic fitness training on human cortical function: a proposal.

We briefly review the extant human and animal literature on the influence of fitness training on brain, cognition and performance. The animal research provides clear support for neurochemical and structural changes in brain with fitness training. The human literature suggests reliable but process specific changes in cognition with fitness training for young and old adults. We describe a research program which examines the influence of aerobic fitness training on the functional activity of the human using event-related functional magnetic resonance imaging, of humans in fitness interventions.

Adult↗
PubMed2005

Cognitive functions in severe congestive heart failure before and after an exercise training program.

BACKGROUND: Congestive heart failure is associated with cognitive impairment, particularly of attentional skills. We assessed, in a hypothesis-generating study, the effect of an exercise training program on cognitive functions among patients with severe congestive heart failure. METHODS: Patients with severe congestive heart failure (n=20; New York Heart Association functional class III; left ventricular ejection fraction < or =35%) were evaluated before and following a standardized and supervised exercise training program (x2/week for 18 weeks; exercise group), while 5 additional patients did not undergo an exercise training program (control group). A battery of cognitive tests was used to assess cognitive functions. Physical performance was assessed by the 6-min walk test and the modified Bruce exercise test, cardiac index and systemic vascular resistance using thoracic electrical bioimpedance, and cerebral vasomotor reactivity to hypercapnia by means of the breath-holding index using transcranial Doppler. RESULTS: Time of completion of the trail making A (105+/-116 to 75+/-52; p=0.02) and B (169+/-100 to 119+/-65; p=0.002) tests, and of the Stroop part A (40+/-13 to 37+/-13; p=0.04) was shorter in patients completing the exercise training program, but not in control patients, while the other neuropsychological measures remained unchanged in both groups. Cerebral vasomotor reactivity to hypercapnia remained diminished (breath-holding index 0.64+/-0.27 vs. 0.68+/-0.37) despite significant improvements in exercise capacity (6-min walk test 308+/-87 to 423+/-91 m, p<0.001; modified Bruce exercise test 5.6+/-3.8 to 9.8+/-3.4 min, p<0.001). CONCLUSIONS: Patients with severe congestive heart failure undergoing an exercise training program improve in some measures of cognitive functions that are limited to general attention and psychomotor speed. Based on these preliminary findings, further evaluations are designed within the framework of a larger controlled clinical trial.

Adult↗
PubMed2005

Development and analysis of the effects of caregiver training program on aggressive behavior in elders with cognitive impairment.

PURPOSE: The purposes of this study were to 1) describe the type and frequency of aggressive behavior of cognitively impaired nursing home resident, 2) develop a caregiver training program on prevention and management of aggressive behavior, 3) examine the effects of caregiver training program on the incidence of aggressive behavior of cognitively impaired nursing home resident, and 4) examine the effects of caregiver training program on nursing staff's aggressive behavior management skills. METHODS: One-group, time series, quasi-experimental design with a pre-test and two post-tests was used. Data were collected from cognitively impaired home residents (N=32) and nursing staff (N=36) in a proprietary nursing home using Ryden Aggression Scale I, II, and Aggressive Behavior Management Scale. Data were entered and analyzed by descriptive statistics and repeated measures ANOVA. RESULTS: Incidence of aggressive behavior was high with a mean score of 3.09 (SD=3.11) at baseline. Caregiver training program was developed based on Progressively Lowered Stress Threshold (PLST) model and gerontological and psychiatric literature. The mean scores of aggressive behavior at baseline, Post I, and II did not differ significantly although the difference approached to the significant level (F=2.925, p=.066). Nursing staff's aggressive behavior management skills increased at Post I, and at Post II when compared to baseline, and the difference was significant (F=12.736, p=<.001). CONCLUSION: Caregiver training program showed potential impact on reduction of aggressive behavior in elders with cognitive impairment and was effective in increasing nursing staff's aggressive behavior management skills.

Adult↗
PubMed1977

Training disadvantaged preschoolers on various fantasy activities: effects on cognitive functioning and impulse control.

Preschool children were trained in 1 of 3 different types of fantasy activities over a school year. The effects of this training were evaluated over a variety of tasks measuring cognitive development and impulse control. The same basic experiment was replicated over 3 different years. Results indicated that physical enactment of fantasy experiences (viz., acting fairy tales or enacting previous experiences) had a sizable effect on many of these variables; while simply listening and discussing was often no more effective than the control condition that merely cut, pasted, etc. Evidence suggested that fantasy play remoter from reality was more facilitative for development than more realistically oriented fantasy play.

Child, Preschool↗
PubMed2006

Simulated train driving: fatigue, self-awareness and cognitive disengagement.

Fatigue is a serious issue for the rail industry, increasing inefficiency and accident risk. The performance of 20 train drivers in a rail simulator was investigated at low, moderate and high fatigue levels. Psychomotor vigilance (PVT), self-rated performance and subjective alertness were also assessed. Alertness, PVT reaction times, extreme speed violations (>25% above the limit) and penalty brake applications increased with increasing fatigue level. In contrast, fuel use, draft (stretch) forces and braking errors were highest at moderate fatigue levels. Thus, at high fatigue levels, errors involving a failure to act (errors of omission) increased, whereas incorrect responses (errors of commission) decreased. The differential effect of fatigue on error types can be explained through a cognitive disengagement with the virtual train at high fatigue levels. Interaction with the train reduced dramatically, and accident risk increased. Awareness of fatigue-related performance changes was moderate at best. These findings are of operational concern.

Awareness↗
PubMed1992

Improving memory and control beliefs through cognitive restructuring and self-generated strategies.

Memory problems are a major source of concern among older adults. The goal of this research was to evaluate methods for improving memory performance and beliefs about memory ability and control. Men and women between the ages of 60 and 85 were randomly assigned to one of five treatment groups: (1) cognitive restructuring to promote adaptive beliefs about memory, (2) memory skills training, (3) combined cognitive restructuring and memory skills training, (4) practice on memory tasks, and (5) a no-contact control group. Beliefs about memory (ability and control) and memory performance (working memory, recall of text materials, categorizable word list, and names and faces) were assessed at a pretest and two posttests. As predicted, those receiving the combined treatment showed the greatest increases in their sense of control and perceived ability to improve memory. Results indicated that all groups improved equally on the memory tasks, although those who had received memory training were more likely to report at the second posttest that they had begun using new strategies for remembering things.

Adaptation, Psychological↗
PubMed2005

Behavioral headache treatment: history, review of the empirical literature, and methodological critique.

Theoretical developments and burgeoning research on stress and illness in the mid-20th century yielded the foundations necessary to conceptualize headache as a psychophysiological disorder and eventually to develop and apply contemporary behavioral headache treatments. Over the past three decades, these behavioral headache treatments (relaxation training, biofeedback, cognitive-behavioral therapy, and stress-management training) have amassed a sizeable evidence base. Meta-analytic reviews of the literature consistently have shown behavioral interventions to yield 35% to 55% improvements in migraine and tension-type headache and that these outcomes are significantly superior to control conditions. The strength of the evidence has lead many professional practice organizations to recommend use of behavioral headache treatments alongside pharmacologic treatments for primary headache. The present overview was prepared as a companion article to and intended to provide a background for the Guidelines for Trials of Behavioral Treatments for Recurrent Headache also published within this journal supplement. This article begins with a synopsis of key historical developments leading to our current conceptualization of migraine and tension-type headache as psychophysiological disorders amenable to behavioral intervention. The evolution of the behavioral headache literature is discussed, exemplified by publication trends in the journal Headache. Leading empirically-based behavioral headache interventions are described, and meta-analytic reviews examining the migraine and tension-type headache literatures are summarized, compared, and contrasted. A critique of the methodological quality of the clinical trials literature is presented, highlighting the strengths and weaknesses in relation to recruitment and selection of patients, sample size and statistical power, the use of a credible control, and the reproducibility of the study interventions in clinical practice.

Behavior Therapy↗
PubMed1993

Specific cognitive flexibility rehabilitation in schizophrenia.

A Cognitive Shift neurocognitive training module was developed in the attempt to ameliorate cognitive flexibility deficits in chronic schizophrenic patients. A procedural training approach hypothesized the exercise of specific neural network processes, identified from theories of frontal and prefrontal lobe functioning. Three male patients who underwent the intensive program demonstrated significant gains in Wisconsin Card Sorting Test performance, gains that were maintained at a six month reassessment. Expanded Brief Psychiatric Rating Scale (a measure of symptomatology) and Life Skills Profile (a measure of daily functioning) measures showed smaller improvements. The ability to improve cognitive flexibility could have important implications for the treatment of schizophrenia.

Adult↗
PubMed2002

Sociocultural Learning Theory in Practice: Implications for Athletic Training Educators.

OBJECTIVE: To discuss cognitive and sociocultural learning theory literature related to athletic training instructional and evaluation strategies while providing support for the application of these practices in the didactic and clinical components of athletic training education programs. DATA SOURCES: We searched Educational Resources Information Center (ERIC) and Education Abstracts from 1975-2001 using the key words social cognitive, sociocultural learning theory, constructivism, and athletic training education. Current literature in the fields of educational psychology and athletic training education provides the foundation for applying theory to practice with specific emphasis on the theoretic framework and application of sociocultural learning theory strategies in athletic training education. DATA SYNTHESIS: Athletic training educators must have a strong fundamental knowledge of learning theory and a commitment to incorporate theory into educational practice. We integrate literature from both fields to generate practical strategies for using sociocultural learning theory in athletic training education. CONCLUSIONS/RECOMMENDATIONS: Social cognitive and sociocultural learning theory advocates a constructive, self-regulated, and goal-oriented environment with the student at the center of the educational process. Although a shift exists in athletic training education toward more active instructional strategies with the implementation of competency-based education, many educational environments are still dominated by traditional didactic instructional methods promoting student passivity. As athletic training education programs strive to increase accountability, educators in the field must critically analyze teaching and evaluation methods and integrate new material to ensure that learning is maximized.

Journal Article↗
PubMed2005

Effects of music training on the child's brain and cognitive development.

Research has revealed structural and functional differences in the brains of adult instrumental musicians compared to those of matched nonmusician controls, with intensity/duration of instrumental training and practice being important predictors of these differences. Nevertheless, the differential contributions of nature and nurture to these differences are not yet clear. The musician-nonmusician comparison is an ideal model for examining whether and, if so, where such functional and structural brain plasticity occurs, because musicians acquire and continuously practice a variety of complex motor, auditory, and multimodal skills (e.g., translating visually perceived musical symbols into motor commands while simultaneously monitoring instrumental output and receiving multisensory feedback). Research has also demonstrated that music training in children results in long-term enhancement of visual-spatial, verbal, and mathematical performance. However, the underlying neural bases of such enhancements and whether the intensity and duration of instrumental training or other factors, such as extracurricular activities, attention, motivation, or instructional methods can contribute to or predict these enhancements are yet unknown. Here we report the initial results from our studies examining the brain and cognitive effects of instrumental music training on young children in a longitudinal study and a cross-sectional comparison in older children. Further, we present a comparison of the results in these children's studies with observations from our cross-sectional studies with adults.

Adolescent↗
PubMedDate not supplied

[Cognitive structure of family doctors in training concerning the doctor-patient relationship].

OBJECTIVES: To find and compare thought structures of family doctors in training concerning the doctor-patient relationship. DESIGN: Qualitative and descriptive. SETTING: Primary care. PARTICIPANTS: 10 first-year residents selected through intentional sampling. MEASUREMENTS: Piaget interview modified by Pinies evaluated with the propositional analysis technique of concepts and conceptual maps. Five thematic areas concerning doctor-patient relationship were defined: importance and repercussions, characteristics and requisites, model of relationship, patient behaviour and doctor's behaviour. RESULTS: The concepts were not sufficiently elaborated. The importance of the doctor-patient relationship was recognised, but not all its repercussions. Its most oft cited desirable requisite was patient confidence. Those interviewed opted for a relationship in which the patient is passive, although they were aware of the danger of leading questions. The personality of the patient was the most commonly cited determinant of his/her behaviour, but other determinants were mentioned, such as beliefs and expectations. The decision to go for a consultation was not seen just as a product of the symptoms. Denial was the most widely recognised defence mechanism. The role of the doctor's feelings was indicated, but not about how to neutralise them. Training was not emphasised, either. CONCLUSIONS: There was insufficient appreciation of the practical importance of the doctor-patient relationship. A directive model of relationship was most common, lacking any biopsychosocial orientation. Training in this area, even though its need is not perceived, should be prioritised. The kind of knowledge underlying doctors' cognitive structure and its role in their behaviour should be investigated.

Cognition↗
PubMedDate not supplied

Supporting command and control training functions in the emergency management domain using cognitive systems engineering.

The design and implementation of MERMAIDS, a computer-based training system in the domain of emergency command and control, is described. The research investigates the use of cognitive systems engineering and information management tools for modelling and representing training knowledge of emergency system operators. We propose a decision-centric human-computer interface as a new method of supporting computer-based modelling in the domain of emergency systems. Several interacting themes in information management relevant to emergency response planning are discussed.

Cognition↗
PubMed1996

Research update on the psychosocial treatment of schizophrenia.

OBJECTIVE: This review is an update on the research evidence supporting psychosocial treatment for schizophrenia. It extends previous review articles by summarizing the literature on social skills training, family interventions, cognitive rehabilitation, and coping with residual positive symptoms. METHOD: The authors reviewed controlled treatment outcome studies of social skills training and family interventions. Different models of family therapy were contrasted. The current literature on cognitive rehabilitation and coping with residual positive symptoms was also examined. RESULTS: Social skills training produces improvement on specific behavioral measures, although changes in symptoms and community functioning are less pronounced. Family interventions (i.e., family psychoeducation and behavioral family therapy) are highly effective for reducing families' expressed emotion and improving patients' relapse rates and outcomes. Furthermore, family interventions are also associated with reduced family burden. Cognitive rehabilitation and training in coping with positive symptoms appear to be promising interventions, but more controlled, group trials are needed before definite conclusions can be drawn. CONCLUSIONS: The efficacy of a variety of different family intervention models, as well as social skills training, is supported by a large body of research. Future work needs to address improving delivery of existing psychosocial interventions, integrating these interventions with other psychosocial approaches (e.g., vocational rehabilitation and case management), identifying which patients will benefit from which treatments, isolating the "active" ingredients of family interventions (i.e., psychoeducation versus behavioral intervention), and identifying the amount of treatment (e.g., number of sessions) needed before treatment response is expected.

Adaptation, Psychological↗