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PubMed1996

Piagetian principles: simple and effective application.

A simplified version of Piaget's sensorimotor levels was employed to teach a group of 25 extremely impaired individuals who live in a large residential facility. Throughout the facility, all available formal assessments using the Vineland Adaptive Behaviour Scales (VABS) were compared. Using this tool, an average of 13% of individuals from the common population pool increased their scores over a 6-year time period. All of the individuals who received training within the experimental group demonstrated increased scores. Scores increased such that an average gain of nearly 1 month in overall age equivalency per individual per year was realized. A matched group comparison, a prediction test for like sensorimotor skill attainment (the primary distinction of this curriculum methodology), and an historical review of subject skill training, all support the cognitively geared methodology as being primarily responsible for this accelerated progress.

Activities of Daily Living↗

PubMed2006

[Normal aging and cognition].

It is now well documented that normal aging modifies the cognitive functioning and most observations suggest that cognition evolves in the direction of deterioration. The more frequently impaired functions are memory, attention and visual-spatial abilities. On the other hand, some abilities seem to increase, such as vocabulary. Considering the aging effect on cognition, questions remain regarding directionality, universality and reversibility. A great variability in aged related impacts is observed among subjects and among cognitive domains. Some individuals evolved more rapidly than others. Some cognitive functions are more affected by aging than others. General and specific factors are hypothesized to explain the aged related cognitive decline. Among them, educational level, health, cognitive style, life style, personality, are likely to modulate the aged related cognitive evolution by influencing attentional resources and cerebral plasticity. Cognitive resources are essential to develop adaptative strategies. During the life span, resources are activated and increased by learning and training. Considering the role of cognitive resources, successful aging is dependent on several conditions : absence of disease leading to a loss of autonomy, maintenance of cognitive and physical activities, and active and social engaged lifestyle.

Aged↗

PubMed2001

The effect of biofeedback in hypertension.

The purpose of this study was to determine the effectiveness of biofeedback in the treatment of stages 1 and 2 essential hypertension via meta-analytical methods. A utilization-focused integrative review was limited to adult randomized clinical trials, and study groups were categorized into biofeedback, active control, and inactive control. Both biofeedback and active control treatments resulted in a reduction in systolic blood pressure (SBP) and diastolic blood pressure (DBP). Only biofeedback (with related cognitive therapy and relaxation training) showed a significantly greater reduction in both SBP (6.7 mm Hg) and DBP (4.8 mm Hg) when compared with inactive control treatments. Nurses in practice settings should consider biofeedback therapy for their hypertensive clients.

Biofeedback, Psychology↗

PubMed1990

The impact of community-based groups to help persons reduce HIV infection risk behaviours.

In addition to widescale AIDS education campaigns, interventions are also needed which can directly assist in the development of skills to reduce HIV infection. Cognitive-behavioural and skills training approaches have long been used to help individuals learn to change other behaviour patterns related to health and can be applied to AIDS. Several approaches (self-management skills training, assertiveness training, and problem-solving) are discussed in relation to HIV risk reduction counselling. Examples and outcome data from prior risk reduction groups for gay men are summarised. Involvement in multiple-session group intervention can produce rapid and clinically meaningful changes in high-risk behaviour patterns. Issues pertinent to the field implementation of such interventions are discussed.

Group Processes↗

PubMed2006

Long-term cognitive treatment of Alzheimer's disease: a single case study.

The effects of long-term treatment in a demented patient were evaluated in this study. One individual diagnosed with Alzheimer's dementia (AD) was treated with neuropsychological rehabilitation techniques as well as drugs for a period of 2 years and 10 months. An A-B-A-B design was performed for the cognitive treatment. Neuropsychological treatment consisted of a combination of direct re-training and training in activities of daily living. Cognitive performance was monitored with the Mattis Dementia Rating Scale. Results showed improvement and a slower decline during the treatment phases (A) as compared to the no-treatment phases (B). The Conceptualisation and Attention subscales benefited most followed by the Memory subscale. Long-term treatment was shown to be effective in AD. Although cognitive drugs may have been beneficial neuropsychological rehabilitation played an important role in the success of this treatment, appearing as a necessary condition.

Activities of Daily Living↗

PubMed1996

Non-drug treatment for social phobia.

When controlled studies on currently available non-drug treatments for social phobia were reviewed, short-term effectiveness was evident for social skills training, exposure therapy and cognitive therapy. The combination of exposure and cognitive therapy may have some superiority over the separate treatments. Group therapy and individual therapy did not differ clearly in outcome, while attempts to match treatment and patient characteristics have so far failed to produce consistently better results. With follow-up periods of either less than a year or more than a year, the therapies reviewed appeared to lead to stable results, although the available data allowed no firm conclusions because of attrition and additional treatments during the follow-up period. Except for the recent landmark study by Heimberg and Liebowitz, cognitive behavior therapy has not been adequately compared to medication. Studies are needed to assess the value of cognitive behavior therapy in combination with medication and to explore the possibilities of self-help manuals in such combination studies.

Behavior Therapy↗

PubMed2006

Efficacy of telephone counseling for pregnant smokers: a randomized controlled trial.

OBJECTIVE: Reducing tobacco use in pregnancy is a public health priority. Brief smoking counseling during prenatal care is effective but generates modest cessation rates. Telephone counseling is an effective smoking cessation method that could offer pregnant women convenient access to more intensive smoking cessation counseling. METHODS: The efficacy of proactive pregnancy-tailored telephone counseling for smoking cessation was compared with a "best-practice" brief-counseling control in a randomized controlled trial of 442 pregnant smokers referred by prenatal providers and a managed care plan. Trained counselors using cognitive-behavioral and motivational interviewing methods called intervention subjects throughout pregnancy and for 2 months postpartum (mean = 5 calls, mean total contact = 68 minutes). Controls received one 5-minute counseling call. RESULTS: Cotinine-validated 7-day tobacco abstinence rates in intervention and control groups were 10.0% and 7.5% at end of pregnancy (odds ratio [OR] 1.37, 95% confidence interval [CI] 0.69-2.70; number needed to treat = 40) and 6.7% versus 7.1% at 3 months postpartum (OR 0.93, 95% CI 0.44-1.99). The intervention increased end-of-pregnancy cessation rates among 201 light smokers (< 10 cigarettes/day at study enrollment) (intervention 19.1% versus control 8.4%; OR 2.58, 95% CI 1.1-6.1; number needed to treat = 9.3) and among 193 smokers who attempted to quit in pregnancy before enrollment (intervention 18.1% versus control 6.8%; OR 3.02, CI 1.15-7.94; number needed to treat = 8.8); 63% of the sample (n = 267) was in one of these subgroups. CONCLUSION: Proactive pregnancy-tailored telephone counseling did not outperform a brief "best practice" intervention among pregnant smokers. The intervention had efficacy in light smokers and in women who had attempted cessation earlier in pregnancy. Future studies should confirm whether telephone counseling benefits these groups of pregnant smokers. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, #NCT00181909. LEVEL OF EVIDENCE: I.

Adult↗

PubMed1992

The teacher's role in facilitating memory and study strategy development in the elementary school classroom.

The efforts of 69 elementary school teachers to instruct children in cognitive processing activities were observed. Although the teaching of such activities was relatively infrequent, it varied by grade (occurring more often in grades 2-3 than in higher or lower grades) and by the content of instruction. Teachers of grade 4 and above more often provided rationales for the use of cognitive strategies than did teachers of younger children. In a second study, children of three achievement levels were selected from classrooms in which teachers varied in their use of suggestions regarding cognitive processes. Subsequent to training in the use of a memory strategy, children's performance on a maintenance trial was evaluated: Among average and low achievers, those whose teachers were relatively high in strategy suggestions showed better maintenance and more deliberate use of the trained strategy than did children whose teachers rarely made strategy suggestions. The role of school experience in the development of children's memory skills is discussed.

Achievement↗

PubMed2006

Psychological treatment of recurrent headache in children and adolescents--a meta-analysis.

Psychologically based interventions such as relaxation training, biofeedback and cognitive-behavioural therapy are increasingly discussed as options for the treatment of migraine and tension-type headache in children and adolescents. In order to determine the state of evidence regarding the efficacy of these treatments, a meta-analysis of randomized controlled studies was conducted. In a comprehensive literature search including data from 1966 to 2004, 23 studies were found meeting the inclusion criteria. Due to the application of the random effects model, generalization of the results is possible. Specific statistical procedures were used to account for a possible publication bias. Significantly more patients improved to a clinically relevant extent (headache reduction > or =50%) in treatment conditions compared with waiting list conditions (high effect sizes). Long-term stability was also confirmed. The analysed treatments lead to improvement (up to 1 year) in headache status in children and adolescents with primary headache. However, more well-designed studies are needed to support and consolidate the conclusions of this meta-analysis and to compare the effects of psychological treatment with those of prophylactic medical interventions (in migraine), to examine potential differences between treatments, to identify moderators of efficacy and to determine effects of treatment on other health-related variables such as quality of life.

Adolescent↗

PubMed1983

Amount of therapist contact and outcome in a multidimensional depression treatment program.

An 8-week multidimensional program of behavioral management, cognitive restructuring, and assertiveness training was administered to depressed outpatients either individually with a single therapist (n = 12), in two small groups (n = 11), or one large group (n = 11), or as bibliotherapy (n = 12). A randomly assigned waiting list control group was also included (n = 10). Follow-up assessments were conducted at 18 weeks. Principal findings were that 1) there were no significant pretreatment differences among groups, 2) all treated groups including bibliotherapy improved substantially over the course of treatment, 3) the waiting list control group was unchanged during this same period, 4) there were no significant differences among treated groups at termination or at follow-up, nor did these groups change significantly over the period of follow-up. Thus the effectiveness of this multidimensional program was supported, but its efficacy was not systematically influenced by amount of therapist contact.

Adult↗

PubMed1998

The treatment of social phobia: a critical assessment.

This article critically reviews the effects of psychological treatment (exposure, cognitive restructuring, social skills training) and pharmacological treatment (MAOIs, reversible MAOIs, anxiolytics and SSRIs) of social phobia. Only controlled studies have been included, and their outcomes were assessed for improvement in anxiety and avoidance, social functioning and clinical status. Both psychological and pharmacological treatments resulted in a significant and meaningful reduction in anxiety and, in most cases, a weakening of the tendency to avoid. Although useful, the effects were not of such a magnitude as to result in remission. Reduction in anxiety was long-lasting in patients treated by psychological methods. The lessening of anxiety did not necessarily lead to meaningfully improved social functioning. The combination of psychological and pharmacological treatments was disappointing, and did not exceed the effects of psychological treatments alone. However, the most promising medications were not tested. Subtype of social phobia and additional diagnoses did not determine the response to treatment.

Behavior Therapy↗

PubMedDate not supplied

Comparing efficacies of neurocognitive treatment and homework assistance programs for children with learning difficulties.

The purpose of the study was to analyze the relative efficacies of two treatments for children with learning difficulties. The first treatment consisted of multiple training components targeting specific cognitive and behavioral factors; the second treatment provided emotional support and supervision of school tasks. The participants were 94 Chilean schoolchildren (6 to 11 years of age). The efficacies were compared on (a) neurocognitive tests, (b) school achievement tests, and (c) behavior in school and at home. The results indicated that both groups improved on most of the outcome measures. The first group showed best results in parents' rating of home behavior, and the second group in reading. The findings also emphasized the importance of emotional support and the inclusion of a parents' group in treatment for children with learning difficulties.

Achievement↗

PubMed2002

Can communication skills training alter physicians' beliefs and behavior in clinics?

PURPOSE: To measure the psychosocial attitudes and beliefs of physicians working within oncology in the United Kingdom and to examine whether beliefs alter after communication skills training. Additionally, to investigate whether physicians' attitudes are reflected in communication behaviors with patients during interviews. METHODS: Ninety-three physicians completed a 32-item Physician Psychosocial Belief (PPSB) questionnaire at baseline (T1) before randomization to attendance at a 3-day residential communication skills course (n = 48) or a control group (n = 45). Three months later (T2), both groups completed another PPSB and a self-assessment questionnaire recording perceived changes in communication with patients. At both time points, physicians' consultations with two consenting patients were videotaped. Communication behaviors were measured using the Medical Interaction Processing System. RESULTS: Physicians who attended the course showed significantly improved attitudes and beliefs toward psychosocial issues compared with controls (P =.002). This improvement was reflected in the analysis of the videotaped recordings of their communication behaviors with patients. Expressions of empathy were more likely for the course group at T2 than the controls (P =.02), as were open questions (P =.001), appropriate responses to patient cues (P =.005), and psychosocial probing (P =.041). These objective findings were supported by physicians' self report of changes in communication style during interviews with patients. CONCLUSION: Our results show that a communication skills training intervention using behavioral, cognitive, and affective components not only increases potentially beneficial and more effective interviewing styles but can also alter attitudes and beliefs, thus increasing the likelihood that such skills will be used in the clinical setting.

Attitude of Health Personnel↗

PubMed1996

Landmark stability: studies exploring whether the perceived stability of the environment influences spatial representation.

To investigate whether spatial learning complies with associative learning theories or with theories of cognitive mapping, rats were trained in three experiments exploring the effect of variations in spatial predictive relationships. In experiment 1, it was found that making one of two landmarks the sole spatial predictor of reward, by varying the spatial relationship between reward and other cues, reduced the control over search exerted by that landmark compared with that observed when the landmark and context cues were both reliable predictors of reward location. This requirement for landmark stability rather than predictive power appears to contradict results obtained in conventional conditioning paradigms. Discrimination learning was unaffected, suggesting a dissociation between discrimination and spatial learning with respect to the influence of geometric stability. Further experiments used arrays of both single and multiple landmarks. Experiment 2 revealed that the stability of a single landmark improved accuracy of search, but also showed that local stability between a pair of landmarks that moved around the arena together was sufficient to support spatial learning. Experiment 3 examined landmark stability using fixed directional cues in the absence of vestibular disorientation. This also revealed a relative advantage of stable landmarks, but animals presented with a landmark that moved from trial to trial did show some evidence of learning. Parametric manipulation of landmark stability offers an intriguing way of influencing the process of spatial representation and thus understanding better the processes through which egocentric representations of perceived space are transformed into allocentric representations of the real world.

Journal Article↗

PubMed1998

Physical exertion in simple reaction time and continuous attention of sport participants.

To investigate the effect of physical exertion on simple reaction time and continuous attention of sport participants, an experiment was conducted with 46 male university students and 12 male cyclists. The subjects were assigned to three experimental and two control groups. The subjects of the experimental groups were asked to perform, following a 5-min, period of warming up, a high intensity exercise protocol for 5 min., on a mechanically braked cycle ergometer (Group A) or a moderate intensity exercise protocol for 30 min, on the same cycle ergometer (Groups B and C). Shortly before and immediately after the physical exercise subjects of all groups were asked to perform a test of simple reaction time and continuous attention. The subjects of the control groups were asked to perform at rest both tests of the simple reaction time and the continuous attention twice, with a 10-min. and a 35-min. interval between the first and second attempts, respectively. The results did not support the notion that exercise of moderate or high intensity influences significantly the cognitive performance of aerobically trained or untrained subjects. The results are discussed in the light of the current research findings concerning exertion and human psychomotor performance.

Adolescent↗

PubMed1995

A study of planning and mathematics instruction for students with learning disabilities.

The purpose of this study was to extend research in training the use of cognitive strategies or planning to mathematical computation for 4 students with specific learning disabilities. A cognitive education method utilized in previous research was duplicated. It was expected that students would find the instruction differentially effective based upon their initial scores on a measure of planning. Using the Planning, Attention, Simultaneous, Successive model as a base, a cognitive instruction which facilitated planning was provided to two students with low scores on planning, obtained using an experimental version of the Das-Naglieri Cognitive Assessment System, and two students with average planning scores. All students completed three sessions of baseline and seven sessions of cognitive instruction in addition and multiplication. During the cognitive instruction phase, 5-min. sessions of self-reflection and verbalization of strategies about the mathematics problems were conducted after each initial 10-min. session of mathematics. Scores on addition problems showed that all students improved. On multiplication, however, 2 students with low planning scores improved considerably but not 2 with higher planning scores. Implications are provided.

Child↗

PubMed1994

Behaviorally conditioned modulation of natural killer cell activity: enhancement of baseline and activated natural killer cell activity.

Natural killer (NK) cells comprise a sub-population of lymphocytes functionally defined by their ability to spontaneously lyse select tumor and virally infected cells. NK cell lytic function is sensitive to modulation by cytokines and neuroendocrine mediators. Behavioral conditioning trains an animal to cognitively associate a novel environmental cue (i.e. odor) with a physiologically active agent (i.e. Polylnosinic:PolyCytidilic acid, Poly I:C). Poly I:C induces interferon production resulting in activation of NK cells and enhanced NK cell lytic activity. Subsequent to behavioral conditioning, independent presentation of the odor should elicit similar responses (enhanced NK cell activity). We have shown that animals pre-exposed to the conditioning apparatus or manual restraint prior to behavioral conditioning demonstrate enhanced baseline NK cell activity or no effects respectively. To assess the influence of NK cell activation in conjunction with behavioral conditioning, we have re-presented the odor to animals with activated or baseline NK activity. Lymphocytes were then incubated for five days with IL-2 and cellular cytotoxic activity re-assessed. Behavioral conditioning significantly enhanced baseline and activated NK cell activity in animals previously exposed to the conditioning apparatus. No differences in lytic activity versus NK sensitive targets were observed following IL-2 activation. In contrast, animals manually restrained prior to conditioning showed no differences in baseline or in vivo activated NK activity, but previously non-activated lymphocytes stimulated with IL-2 demonstrated significantly higher lytic activity in conditioned animals re-presented with the odor. These results demonstrate central nervous system (CNS) modulation of NK cell activity and the presence of an interplay between cytokine activation and responsiveness to CNS immunoregulatory signals.

Animals↗

PubMed1988

Behavioural therapy in the clinical management of tinnitus.

Behavioural therapy was given to reduce discomfort and annoyance associated with severe tinnitus in 75 consecutive patients. Treatment was conducted within the routine clinical management. It included information and discussion about tinnitus, behavioural analysis and relaxation training combined with various cognitive strategies. The method of treatment was thus a form of coping technique. Self-recordings showed significant reductions of 'discomfort from tinnitus' as well as significant elevations in 'general mood' over a 3-month follow-up period. Interview findings indicated strong overall positive effects of treatment, as well as other positive side-effects on complaints such as tension headaches, dizziness, muscle tension and sleep disturbances. Implications for the clinical management of tinnitus sufferers are discussed.

Adult↗