Everyday Impact of Cognitive Interventions in Mild Cognitive Impairment: a Systematic Review and Meta-Analysis

Cognitive interventions in Mild Cognitive Impairment (MCI) seek to ameliorate cognitive symptoms in the condition. Cognitive interventions may or may not generalize beyond cognitive outcomes to everyday life. This systematic review and meta-analysis sought to assess the effect of cognitive interventions compared to a control group in MCI on generalizability outcome measures [activities of daily living (ADLs), mood, quality of life (QOL), and metacognition] rather than cognitive outcomes alone. PRISMA guidelines were followed. MEDLINE and PsychInfo were utilized as data sources to locate references related to cognitive interventions in individuals with MCI. The cognitive intervention study was required to have a control or alternative treatment comparison group to be included. Thirty articles met criteria, including six computerized cognitive interventions, 14 therapist-based interventions, and 10 multimodal (i.e., cognitive intervention plus an additional intervention) studies. Small, but significant overall median effects were seen for ADLs (d = 0.23), mood (d = 0.16), and metacognitive outcomes (d = 0.30), but not for QOL (d = 0.10). Computerized studies appeared to benefit mood (depression, anxiety, and apathy) compared to controls, while therapist-based interventions and multimodal interventions had more impact on ADLs and metacognitive outcomes than control conditions. The results are encouraging that cognitive interventions in MCI may impact everyday life, but considerably more research is needed. The current review and meta-analysis is limited by our use of only PsychInfo and MEDLINE databases, our inability to read full text non-English articles, and our reliance on only published data to complete effect sizes.     

Can psychological interventions increase optimism? A meta-analysis

Greater optimism is related to better mental and physical health. A number of studies have investigated interventions intended to increase optimism. The aim of this meta-analysis was to consolidate effect sizes found in randomized controlled intervention studies of optimism training and to identify factors that may influence the effect of interventions. Twenty-nine studies, with a total of 3319 participants, met criteria for inclusion in the analysis. A significant meta-analytic effect size, g = .41, indicated that, across studies, interventions increased optimism. Moderator analyses showed that studies had significantly higher effect sizes if they used the Best Possible Self intervention, provided the intervention in person, used an active control, used separate positive and negative expectancy measures rather than a version of the LOT-R, had a final assessment within one day of the end of the intervention, and used completer analyses rather than intention-to-treat analyses. The results indicate that psychological interventions can increase optimism and that various factors may influence effect size.     

Motivational climate interventions in physical education: A meta-analysis

Objective

The purpose of this study was to synthesize findings from motivational climate interventions employing [Ames, 1992a] and [Ames, 1992b] and [Epstein, 1988] and [Epstein, 1989] TARGET framework within school-based physical education contexts.

Design

The present study employed a quantitative research synthesis design. Meta-analysis uses empirical studies to summarize past research by drawing overall conclusions from separate investigations. This research design highlights important and unsolved issues related to motivational climate interventions within physical education.

Methods

Standard meta-analytic procedures incorporating inclusion and exclusion criteria, literature search, coding procedures, and statistical methods were used to identify and synthesize 22 studies with 24 independent samples. Cohen’s (1988) criteria for effect sizes were used to interpret and evaluate results.

Results

There was an overall small positive treatment effect (g = 0.103) for groups exposed to mastery motivational climates. Outcome analyses identified the most consistent and largest overall treatment effects for behavioral outcomes (g = 0.39–0.49) followed by affective outcomes (g = −0.27 to 0.59) and cognitive outcomes (g = −0.25 to 0.32). Moderator analyses were directed by study heterogeneity and identified several trends in intervention features and study features with the most substantial trend for participant features as elementary students had the largest overall treatment effect (g = 0.41).

Conclusions

Outcome and moderator analyses identified several trends in methodological features, participant features, and study features that should be addressed in future physical education motivational climate interventions.     

Perceptions of the roles of behaviour and genetics in disease risk: Are they associated with behaviour change attempts

Objective: We examined selected survivor characteristics to determine what factors might moderate the response to two psychosocial interventions.

Design: Seventy-one prostate cancer survivors (PCSs) were randomly assigned to either a telephone-delivered health education (THE) intervention or a telephone-delivered interpersonal counselling (TIP-C) intervention.

Measures: Psychological quality of life (QOL) outcomes included depression, negative and positive affect, and perceived stress.

Results: For three of the psychological outcomes (depression, negative affect and stress), there were distinct advantages from participating in THE. For example, more favourable depression outcomes occurred when men were older, had lower prostate specific functioning, were in active chemotherapy, had lower social support from friends and lower cancer knowledge. Participating in the TIP-C provided a more favourable outcome for positive affect when men had higher education, prostate specific functioning, social support from friends and cancer knowledge.

Conclusion: Unique survivor characteristics must be considered when recommending interventions that might improve psychological QOL in PCSs. Future research must examine who benefits most and from what components of psychosocial interventions to enable clinicians to recommend appropriate psychosocial care.     

Strategy-Based Cognitive Training for Improving Executive Functions in Older Adults: a Systematic Review

Given projected increases in dementia prevalence, emphasising earlier stages of cognitive impairment in older adults enables targeted early intervention strategies. Strategy-based cognitive training (SCT) is a remedial approach involving guidance and practice in compensatory techniques to improve cognition, including memory and attention. It may also be effective for improving executive functions (EF) integral to everyday tasks. This review systematically evaluates SCT effects on EF in older adults without dementia. Following PRISMA guidelines, we reviewed eligible trials according to pre-defined criteria, differentiating SCT from other cognitive interventions and stipulating total EF-focused intervention time, study design and target population (healthy older adults or mild cognitive decline). We then evaluated trials according to design, methodological quality and outcomes. Unfortunately, with too few studies in mild cognitive impairment, we refocused our review only on healthy older adults. Thirteen studies with 4120 participants in total were included, primarily targeting inductive reasoning. Despite heterogeneous study designs and SCT programs, 11/13 trials reported significant EF improvements, generally of moderate effect size (Hedges’ g > 0.3). Four studies reported sustained benefits from one month to 10 years. There was some evidence of far transfer. We conclude that there is promising evidence for SCT as a targeted intervention for EF in healthy older adults and preliminary evidence for maintaining effects over time. Fewer trials have investigated far transfer (e.g. improved everyday functioning) or capacity to delay/prevent dementia, which are most relevant to clinical utility. Limitations include the inability to calculate effect sizes for four studies and absence of statistical meta-analysis.     

The effectiveness of psychological skills training and behavioral interventions in sport using single-case designs: A meta regression analysis of the peer-reviewed studies

We used a novel meta regression analysis approach to examine the effectiveness of psychological skills training and behavioral interventions in sport assessed using single-case experimental designs (SCEDs). One hundred and twenty-one papers met the inclusion criteria applied to eight database searches and key sport psychology journals. Seventy-one studies reported sufficient detail for effect sizes to be calculated for the effects of psychological skills training on psychological, behavioral, and performance variables. The unconditional mean effect size for weighted (Δ = 2.40) and unweighted (Δ = 2.83) models suggested large improvements in psychological, behavioral, and performance outcomes associated with implementing cognitive-behavioral psychological skills training and behavioral interventions with a SCED. However, meta-regression analysis revealed important heterogeneities and sources of bias within this literature. First, studies using a group-based approach reported lower effect sizes compared to studies using single-case approaches. Second, the single-case studies, (over 90 per cent the effect sizes), revealed upwardly biased effect sizes arising from: (i) positive publication bias such that studies using lower numbers of baseline observations reported larger effects, while studies using larger numbers of baseline observations reported smaller – but still substantial – effects; (ii) not adopting a multiple baseline design; and (iii) not establishing procedural reliability. We recommend that future researchers using SCED’s should consider these methodological issues.     

Alleviation of Side Effects and Distress in Breast Cancer Patients by Cognitive-Behavioral Interventions: A Systematic Review and Meta-analysis

Cognitive and behavioral interventions (CBI) have been used for breast cancer patients with various stages of the disease or undergoing different treatments. However, no quantitative review has summarized their efficacy on the side effects of treatment, distress, and quality of life in the acute treatment setting after diagnosis. This meta-analysis synthesizes data from 19 randomized clinical trials in order to: (a) provide an estimation of overall effect of CBI in breast cancer patients during treatment for breast cancer, i.e., neo-adjuvant and adjuvant treatment; (b) provide average effect sizes on side effects of treatment, distress, and quality of life; and (c) test possible moderators of effect size. The results show that CBI yielded a small effect size overall, specifically on general side effects of treatment, nausea, vomiting, distress, and quality of life. Individual and behavioral interventions seem to elicit better results on distress and on general side effects of treatment, respectively. While more studies are needed with regard to specific side effects (i.e., fatigue, pain, and sleep disturbance), the overall results clearly support the use of CBI in breast cancer patients during treatment.     

Narrative of “Here-and-Now”: Cancer Survivors in a Group Psychotherapy Using SCT® (Systems-Centered Therapy)1,2

This study focused on “here-and-now” narrative and examined the process of group psychotherapy for cancer survivors using systems-centered therapy (SCT). In contemporary society, cancer survivors have a vital need for psychological support, and group psychotherapy and peer support are used as part of this need. In most of these interventions, participants are encouraged to speak freely and share their experience of cancer. This generally means speaking about “there-and-then” experience. It has been argued that one reason that narrative therapy produces a psychological effect is that the meaning of an experience changes when the experience is spoken about. SCT differs significantly from other group interventions in that it requires participants to talk about their here-and-now experience through the format of SCT's “functional subgrouping.” Functional subgrouping requires participants to listen, reflect, and build on similarities in their experience. In this study, we qualitatively examined how participants' experiences unfolded in the SCT group by directly addressing the group process. The study findings revealed that even though the participants did not directly share their cancer experiences in the group, they experienced an inexplicable sense of connectedness that had a positive psychological effect on them. They also experienced deep emotions through talking while using the SCT narrative style. In the process, the effects of the SCT narrative were discussed.     

Identifying Effective Components of Child Maltreatment Interventions: A Meta-analysis

There is a lack of knowledge about specific components that make interventions effective in preventing or reducing child maltreatment. The aim of the present meta-analysis was to increase this knowledge by summarizing findings on effects of interventions for child maltreatment and by examining potential moderators of this effect, such as intervention components and study characteristics. Identifying effective components is essential for developing or improving child maltreatment interventions. A literature search yielded 121 independent studies (N = 39,044) examining the effects of interventions for preventing or reducing child maltreatment. From these studies, 352 effect sizes were extracted. The overall effect size was significant and small in magnitude for both preventive interventions (d = 0.26, p < .001) and curative interventions (d = 0.36, p < .001). Cognitive behavioral therapy, home visitation, parent training, family-based/multisystemic, substance abuse, and combined interventions were effective in preventing and/or reducing child maltreatment. For preventive interventions, larger effect sizes were found for short-term interventions (0–6 months), interventions focusing on increasing self-confidence of parents, and interventions delivered by professionals only. Further, effect sizes of preventive interventions increased as follow-up duration increased, which may indicate a sleeper effect of preventive interventions. For curative interventions, larger effect sizes were found for interventions focusing on improving parenting skills and interventions providing social and/or emotional support. Interventions can be effective in preventing or reducing child maltreatment. Theoretical and practical implications are discussed.     

Effect of treatments for depression on quality of life: a meta-analysis*

Cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are the two first-line treatments for depression, but little is known about their effects on quality of life (QOL). A meta-analysis was conducted to examine changes in QOL in adults with major depressive disorder who received CBT (24 studies examining 1969 patients) or SSRI treatment (13 studies examining 4286 patients) for their depression. Moderate improvements in QOL from pre to post-treatment were observed in both CBT (Hedges’ g = .63) and SSRI (Hedges’ g = .79) treatments. The effect size remained stable over the course of the follow-up period for CBT. No data were available to examine follow-ups in the SSRI group. QOL effect sizes decreased linearly with publication year, and greater improvements in depression were significantly associated with greater improvements in QOL for CBT, but not for SSRIs. CBT and SSRIs for depression were both associated with moderate improvements in QOL, but are possibly caused by different mechanisms.     

A Meta-Analysis of Research on Hindsight Bias

We conducted a meta-analysis of research on hindsight bias to gain an up-to-date summary of the overall strength of hindsight effects and to test hypotheses about potential moderators of hindsight distortion. A total of 95 studies (83 published and 12 unpublished) were included, and 252 independent effect sizes were coded for moderator variables in 3 broad categories involving characteristics of the study, of measurement, and of the experimental manipulation. When excluding missing effect sizes, the overall mean effect size was Md = .39 with a 95% confidence interval of .36 to .42. Five main findings emerged: (a) effect sizes calculated from objective probability estimates were larger than effect sizes calculated from subjective probability estimates; (b) effect sizes of studies that used almanac questions were larger than effect sizes of studies that used real-world events or case histories; (c) studies that included neutral outcomes resulted in larger effect sizes than studies that used positive or negative outcomes; (d) studies that included manipulations to increase hindsight bias resulted in significantly larger effect sizes than studies in which there were no manipulations to reduce or increase hindsight bias; and (e) studies that included manipulations to reduce hindsight bias did not produce lower effect sizes. These findings contribute to our understanding of hindsight bias by updating the state of knowledge, widening the range of known moderator variables, identifying factors that may activate different mediating processes, and highlighting critical gaps in the research literature.     

Cognitive-behavior therapy for depressed cancer patients in a medical care setting

Major depression is the most common psychiatric disorder among cancer patients and is associated with decreased quality of life, significant deterioration in recreational and physical activities, relationship difficulties, sleep problems, more rapidly progressing cancer symptoms, and more metastasis and pain relative to nondepressed cancer patients. Although some research has explored the utility of psychological interventions with cancer patients, only one study to date has explored the potential benefits of cognitive-behavior therapy among cancer patients with well-diagnosed depression. Addressing this gap in the literature, this study represents an open clinical trial to assess the effectiveness of a brief Cognitive-Behavioral Treatment for Depression (CBTD) among depressed cancer patients in a medical care setting. Results revealed strong treatment integrity, good patient compliance, excellent patient satisfaction with the CBTD protocol, and significant pre-post treatment gains across a breadth of outcome measures assessing depression, anxiety, quality of life, and medical outcomes. These gains also were associated with strong effect sizes and generally maintained at 3-month follow-up. Behavioral activation interventions, especially when paired with cognitive techniques, may represent a practical medical care treatment that may improve psychological outcomes and quality of life among cancer patients. Study limitations and future research directions are discussed.     

Say something nice: A meta-analytic review of peer reporting interventions

Peer reporting interventions (i.e., Positive Peer Reporting and tootling) are commonly used peer-mediated interventions in schools. These interventions involve training students to make reports about peers' prosocial behaviors, whether in oral or written form. Although peer reporting interventions have been included in meta-analyses of group contingencies, this study is the first meta-analytic review of single-case research focusing exclusively on peer reporting interventions. The literature search and application of inclusion criteria yielded 21 studies examining the impact of a peer reporting intervention on student behavior compared to baseline conditions. All studies used single-case experimental designs including at least three demonstrations of an effect and at least three data points per phase. Several aspects of studies, participants, and interventions were coded. Log response ratios and Tau were calculated as effect size estimates. Effect size estimates were synthesized in a multi-level meta-analysis with random effects for (a) studies and (b) cases within studies. Overall results indicated peer reporting interventions had a non-zero and positive impact on student outcomes. This was also true when data were subset by outcome (i.e., disruptive behavior, academically engaged behavior, and social behavior). Results were suggestive of more between- than within-study variability. Moderator analyses were conducted to identify aspects of studies, participants, or peer reporting interventions associated with differential effectiveness. Moderator analyses suggested published studies were associated with higher effect sizes than unpublished studies (i.e., theses/dissertations). This meta-analysis suggests peer reporting interventions are effective in improving student behavior compared to baseline conditions. Implications and directions for future investigation are discussed.     

The Integration of a Family Systems Approach for Understanding Youth Obesity,Physical Activity,and Dietary Programs

Rates of overweight in youth have reached epidemic proportions and are associated with adverse health outcomes. Family-based programs have been widely used to treat overweight in youth. However, few programs incorporate a theoretical framework for studying a family systems approach in relation to youth health behavior change. Therefore, this review provides a family systems theory framework for evaluating family-level variables in weight loss, physical activity, and dietary approaches in youth. Studies were reviewed and effect sizes were calculated for interventions that manipulated the family system, including components that targeted parenting styles, parenting skills, or family functioning, or which had novel approaches for including the family. Twenty-one weight loss interventions were identified, and 25 interventions related to physical activity and/or diet were identified. Overall, family-based treatment programs that incorporated training for authoritative parenting styles, parenting skills, or child management, and family functioning had positive effects on youth weight loss. Programs to improve physical activity and dietary behaviors that targeted the family system also demonstrated improvements in youth health behaviors; however, direct effects of parent-targeted programming is not clear. Both treatment and prevention programs would benefit from evaluating family functioning and parenting styles as possible mediators of intervention outcomes. Recommendations are provided to guide the development of future family-based obesity prevention and treatment programs for youth.     

Psychosocial Conditions of Quality of Life Among Undergraduate Students: A Cross Sectional Survey

Quality of life (QOL) in the context of education is an understudied topic and research related to its’ relation to the sense of coherence (SOC), level of optimism (LOO) and self-efficacy (SE) among students seems to be missing. The rationale for this survey was to fill this gap in knowledge and therefore, the aim of the study is to examine the relationship between students’ QOL and psychological variables such as SOC, LOO and SE, and social ones such as type of faculty, students’ social background and sex. The quantitative cross sectional survey has been conducted at three higher education institutions in Poland in January 2006. The random sample of 396 undergraduate students (average age was 20.5 years) representing 5 different faculties namely physiotherapy, physical education, tourism and recreation, English and Polish philology has been selected and participated in the study. Four reliable and validated research tools have been used to collect the data. These included the SF-36, SOC-29, Seligman’s scale, and GSES. The results have shown to indicate that different variables had a significant effect on particular subscales of the QOL outcomes. For example, among social variables faculty had a significant effect on physical functioning, role limitation due to physical functioning, and changes in health. Sex had a significant effect on role limitation due to emotional problems, social functioning, and energy vitality. Social background had a significant effect on general health. Among psychological variables the sense of coherence was significantly related to all subscales of QOL. A significant effect was noted by self-efficacy on physical and social functioning. Level of optimism had a significant effect on energy-vitality and general health. This research survey has suggested that changes in academic curriculum might be implemented to improve students QOL.     

Quantifying the effects of the differential outcomes procedure in humans: A systematic review and a meta‐analysis

We present a systematic review and a meta‐analysis comparing the differential outcomes procedure to a nondifferential outcomes procedure among clinical and nonclinical populations. Sixty distinct experiments were included in the systematic review, 43 of which were included in the meta‐analysis. We calculated pooled effect sizes for accuracy (overall accuracy, test accuracy, transfer accuracy) and acquisition outcomes (latency, errors, and trials to mastery). The meta‐analysis revealed significant medium‐to‐large effect sizes for all three accuracy measures (pooled effect size range, 0.57 to 1.30). We found relatively greater effect sizes among clinical populations (effect size = 1.04). The single‐subject experimental literature included in the systematic review was consistent with the findings from the group studies, demonstrating improvements in accuracy and speed of learning for the majority of participants. Moderator and subgroup analyses suggest that discrimination difficulty may induce relatively larger differential outcomes effects. The results indicate that the differential outcomes procedure can be a valuable addition to reinforcement‐based interventions.     

Ingroup role models and underrepresented students’ performance and interest in STEM: A meta-analysis of lab and field studies

This meta-analysis synthesizes research on using ingroup role models to improve the performance and interest of underrepresented students in science, technology, engineering, and math (STEM). A systematic literature search resulted in forty-five studies that met the selection criteria, including the presence of a comparison group. Both lab and field studies suffered from small sample bias, with smaller sample sizes predicting larger effect sizes among lab studies, but smaller effect sizes among field studies. Correcting for small sample bias, ingroup role models had a small, but significant positive overall effect (d?=?0.20) among field studies and a non-significant overall effect (d?=?0.04) among lab studies. The only significant moderator was level of interaction, with in-person role models having smaller effects among lab studies (p?=?.008). Implications for interventions to increase the representation of female and underrepresented minority students in STEM and future directions for research are discussed.

     

Psychological interventions for arthritis pain management in adults: a meta-analysis.

CONTEXT: The psychosocial impact of arthritis can be profound. There is growing interest in psychosocial interventions for managing pain and disability in arthritis patients. OBJECTIVE: This meta-analysis reports on the efficacy of psychosocial interventions for arthritis pain and disability. DATA SOURCES: Articles evaluating psychosocial interventions for arthritis were identified through Cochrane Controlled Trials, EMBASE, Ovid MEDLINE, and Ovid PsycINFO data sources. STUDY SELECTION: Randomized controlled trials testing the efficacy of psychosocial interventions in arthritis pain management were reviewed. DATA EXTRACTION: Twenty-seven randomized controlled trials were analyzed. Pain intensity was the primary outcome. Secondary outcomes included psychological, physical, and biological functioning. DATA SYNTHESIS: An overall effect size of 0.177 (95% CI=0.256-0.094) indicated that patients receiving psychosocial interventions reported significantly lower pain than patients in control conditions (combined p=.01). Meta-analyses also supported the efficacy of psychosocial interventions for the secondary outcomes. CONCLUSIONS: These findings indicate that psychosocial interventions may have significant effects on pain and other outcomes in arthritis patients. Ample evidence for the additional benefit of such interventions over and above that of standard medical care was found.     

The nature and severity of cognitive impairment associated with adjuvant chemotherapy in women with breast cancer: a meta-analysis of the current literature

OBJECTIVE: Several studies have identified that adjuvant chemotherapy for breast cancer is associated with cognitive impairment; however, the magnitude of this impairment is unclear. This study assessed the severity and nature of cognitive impairment associated with adjuvant chemotherapy by conducting a meta-analysis of the published literature to date. METHOD: Six studies (five cross-sectional and one prospective) meeting the inclusion criteria provided a total of 208 breast cancer patients who had undergone adjuvant chemotherapy, 122 control participants and 122 effect sizes (Cohen's d) falling into six cognitive domains. First, the mean of all the effect sizes within each cognitive domain was calculated (separately for cross-sectional and prospective studies); second, a mean effect size was calculated for all of the effect sizes in each cross-sectional study; and third, regression analyses were conducted to determine any relationships between effect size for each study and four different variables. RESULTS: For the cross-sectional studies, each of the cognitive domains assessed (besides attention) showed small to moderate effect sizes (-0.18 to -0.51). The effect sizes for each study were small to moderate (-0.07 to -0.50) and regression analysis detected a significant negative logarithmic relationship (R2 = .63) between study effect size and the time since last receiving chemotherapy. For the prospective study, effect sizes ranged from small to large (0.11-1.09) and indicated improvements in cognitive function from the beginning of chemotherapy treatment to 3 weeks and even 1 year following treatment. CONCLUSION: This meta-analysis suggests that cognitive impairment occurs reliably in women who have undergone adjuvant chemotherapy for breast cancer but that the magnitude of this impairment depends on the type of design that was used (i.e., cross-sectional or prospective). Thus, more prospective studies are required before definite conclusions about the effects of adjuvant chemotherapy on cognition can be made.