Does mindfulness improve inhibitory control in psychotic disorders? A randomized controlled clinical trial

Background/Objective: Impaired Inhibitory Control (IC) is a core feature of psychotic disorders and is related with impaired social functioning in people experiencing psychosis. Despite research showing the benefits of mindfulness over IC in the general population, no study has assessed its effects on IC in psychoses. The aim of our study was to assess the effectiveness of a mindfulness-based intervention combined with integrated rehabilitation treatment in a sample of people diagnosed of psychotic disorders. Method: Fifty-six patients diagnosed with psychotic disorder were recruited and randomly allocated either to integrated rehabilitation treatment or integrated rehabilitation treatment enhanced with 26 mindfulness group sessions. Measures comprised PANSS interview, MAAS scale, and Stroop Color Word Test (SCWT). The primary outcome variable was the performance in the non-congruent trials of the SCWT. Results: There were no differences between groups at baseline. At post-treatment patients allocated to mindfulness group increased their scores in non-congruent trials of SCWT and in MAAS. At post-treatment mindfulness group scored higher than integrated rehabilitation treatment in MAAS. Conclusions: Data suggest that mindfulness added to integrated rehabilitation treatment may improve IC in psychosis. Results are convergent with prior works about the effect of mindfulness over cognitive performance in general population.     

A First Step Toward Cognitive Remediation of Voices: a Case Study

Several studies have shown that source‐monitoring errors are related to verbal hallucinations in schizophrenia. An exploratory pilot study has been carried out to investigate the possibility of training patients in how to avoid errors in source‐monitoring. One patient with paranoid schizophrenia and persistent thought insertions was trained for 6?hours to use mnemonic techniques to compensate specific deficits in source‐monitoring. Results show that the patient was able to improve his performance and maintain the acquired progress at a 1‐month follow‐up assessment. These preliminary results are interesting for developing a larger controlled study of cognitive remediation of source‐monitoring deficits.     

Modification of performance on the Span of Apprehension Task in a group of young people with early onset psychosis

The aim of the study was to examine the effect of contingent monetary reinforcement and enhanced instructions on Span of Apprehension (SPAN) performance in a group of young people with early onset psychosis. Twenty-five participants (mean age 16.7) received a 3- and 12-letter version of the SPAN task six times: baseline, three x intervention, post-test, and 10-day follow-up. No significant effects of time were found in the 3-letter condition, indicating a ceiling effect for accuracy. In the 12-letter condition detection rates improved significantly reaching a maximum at the third intervention (p < 0.001). Performance showed a temporary decline at post-test, but performance returned to the maximum level at the 10-day follow-up. The study suggests that SPAN performance can be improved in young people with early onset psychosis using relatively simple interventions and that performance gains are relatively durable.     

Effects of reinforced directed rehearsal on expressive sign language learning by persons with mental retardation

This study used a multielement design to compare standard training (prompting and reinforcement) with and without reinforced directed rehearsal as a correction procedure in teaching expressive sign language to 10 nonverbal students with moderate to severe mental retardation. Standard training consisted of either sequential prompting or graduated guidance and 5 students were randomly assigned to each condition. Directed rehearsal involved 10 practices of the correct sign contingent on an error or no response; praise was given during directed rehearsal for cooperation and attempted signing. A stimulus control analysis revealed that only 6 of the 10 students (3 from each standard training condition) completely discriminated the trained signs within the maximum training period of 160 trials (3 of the 4 students who failed the stimulus control test were hearing impaired; the remaining 6 who showed stimulus control were not). Using only these six students' data, we found that directed rehearsal increased: (a) accuracy (percent correct), (b) speed of learning (required fewer trials to criterion), (c) efficiency (decreased total instruction time), and (d) generalization (across trainers, objects, and settings). There were no obvious interactions between directed rehearsal and the type of prompting strategy employed. Very little agitated behavior occurred in any of the sessions, and a treatment acceptability survey indicated that 10 of 14 direct-care staff and the trainers in this study preferred corrective directed rehearsal (as used in this study) over standard training alone. The results indicate that directed rehearsal may be a valuable adjunct to sign language training with nonverbal students with mental retardation.     

Language learning impairment: Integrating research and remediation

Timing cues present in the acoustic waveform of speech provide critical information for the recognition and segmentation of the ongoing speech signal. Research has demonstrated that deficient temporal perception rates, that have been shown to specifically disrupt acoustic processing of speech, are related to specific language-based learning impairments (LLI). Temporal processing deficits correlate highly with the phonological discrimination and processing deficits of these children. Electrophysiological single cell mapping studies of sensory cortex in brains of primates have shown that neural circuitry can be remapped after specific, temporally cohesive training regimens, demonstrating the dynamic plasticity of the brain. Recently, we combined these two lines of research in a series of studies that addressed whether the temporal processing deficits seen in LLIs can be significantly modified through adaptive training aimed at reducing temporal integration thresholds. Simultaneously, we developed a computer algorithm that expanded and enhanced the brief, rapidly changing acoustic segments within ongoing speech and used this to provide intensive speech and language training exercises to these children. Results to date from two independent laboratory experiments, as well as a large national clinical efficacy trial, demonstrate that dramatic improvements in temporal integration thresholds, together with speech and language comprehension abilities of LLI children, results from training with these new computer-based training procedures.     

Cognitive training programs for childhood cancer patients and survivors: A critical review and future directions

A robust literature has developed documenting neurocognitive late effects in survivors of leukemia and central nervous system (CNS) tumors, the most frequent cancer diagnoses of childhood. Patterns of late effects include deficits in attention and concentration, working memory, processing speed, and executive function, as well as other domains. As childhood cancer survivors are living longer, ameliorating deficits both in broad and specific neurocognitive domains has been increasingly recognized as an endeavor of paramount importance. Interventions to improve cognitive functioning were first applied to the field of pediatric oncology in the 1990s, based on strategies used effectively with adults who had sustained a traumatic brain injury (TBI). Compilation and modification of these techniques has led to the development of structured cognitive training programs, with the effectiveness and feasibility of such interventions currently an active area of research. Consequently, the purpose of this critical review is to: (1) review cognitive training programs intended to remediate or prevent neurocognitive deficits in pediatric cancer patients and survivors, (2) critically analyze training program strengths and weaknesses to inform practice, and (3) provide recommendations for future directions of clinical care and research.     

The efficacy of a pilot pediatric cognitive remediation summer program to prepare for transition of care

This study assessed the efficacy of a time-sensitive cognitive remediation summer program (CRSP) that provided patients and their families with tools to help mitigate neurocognitive deficits and promote independence to foster precursor transition of medical care skills. A total of 38 participants (aged 9–15) were included in one of the CRSPs offered yearly from 2013 to 2016. A longitudinal design was employed and at each evaluation time point, one week before start of the CRSP (pre-testing) and within three weeks after the end of the program (post-testing)), participants were administered measures of executive functioning in addition to parent ratings of behavior, executive functioning, and adaptive skills (Year 1–Year 4). In Year 4, additional measures were collected, including parenting style and parent engagement and involvement in the program. Results from Year 1 to Year 4 (n = 35) demonstrated that participants in the CRSP showed significant improvement on neuropsychological testing in sustained and selective attention, planning, and cognitive flexibility. Robust changes in parent ratings of adaptive functioning from pre- to post-treatment were also found. Specific to Year 4 (n = 13), results revealed that participants showed improvement in levels of independence with at least one of the individualized goals focused on during the program. This study provided a systematic method to gauge the levels of instruction necessary to reach goals, a crucial tool in skill-teaching. Overall, our study provides evidence for the efficacy of the CRSP and validates a feasible intervention that can be integrated into standard of care for pediatric medical populations.     

INCREASING SPELLING ACHIEVEMENT: AN ANALYSIS OF TREATMENT PROCEDURES UTILIZING AN ALTERNATING TREATMENTS DESIGN

Two studies which examine the effectiveness of spelling remediation procedures are reported. In both studies, an alternating treatment design was employed. In the first study, positive practice overcorrection plus positive reinforcement was compared to positive practice alone and a no-remediation control condition. In the second study, positive practice plus positive reinforcement was compared to a traditional corrective procedure plus positive reinforcement and a traditional procedure when used alone. Results of both studies indicated that the combined positive practice plus positive reinforcement procedure was more efficient and that it was preferred by the children. Following brief training under this combined procedure, all children demonstrated 100% spelling accuracy.     

A Neo-Lurian Approach to Assessment and Remediation

The first part of this article presents an operational battery of tasks for measuring the four cognitive processes of Planning, Arousal–Attention, and Simultaneous and Successive processing (PASS) not only based on the qualitative data provided in Luria's syndrome analysis, but also taken from tasks in experimental cognitive psychology and neuropsychology. The second part of the article presents a remedial program based on PASS for enhancement of reading. Because this part provides in some detail the efficacy of the remedial procedure, it simultaneously validates the PASS constructs as well. In both parts of the article, I have been unmistakably guided by Luria's views: Tests are approaches to investigating cognitive functions, and the purpose of testing is to guide rehabilitation.     

论心理契约的动态过程

本文对心理契约的形成、改变、破裂和补救的动态过程的研究现状进行了综述和分析,特别就研究中有关心理契约的形成规律和补救方式方面存在的问题进行了分析,并针对如何结合我国国情开展深入的实证研究提出了建议。