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Psychology & Neuroscience of Psychosis > Cognitive remediation > Flashcards

Cognitive remediation Flashcards

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1
Q

What is a cost-effective psychological treatment?

A

In which the cost of the therapist’s time is outweighed by the benefits (e.g. time in hospital, QoL)

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2
Q

What are the three psychological treatment that have a long history of development and evidence collection?

A
  • Cognitive behaviour therapy (CBT)
  • Family therapy
  • Social skills training
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3
Q

Why was family therapy developed?

A
  • Individuals returning to their family had higher relapse rate
  • Higher stress produced by expressed emotion
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4
Q

What is the aim of family therapy?

A
  • For the family and the Individual to understand the nature and symptoms of psychosis (e.g. apathy)
  • Negotiate a new relationship
  • > Reducing interpersonal stress and decreasing the risk of relapse
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5
Q

Why was social skills training developed?

A

Individuals removed from large hospitals and then back into the community lacked social skills

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6
Q

What is the aim of social skills training?

A

Teach individuals how to:
- recognise expressions

  • initiate conversations
  • respond appropriately
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7
Q

What is the aim of CBT?

A

Explore the beliefs of patients and come to a resolution so these beliefs do not interfere with personal goals

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8
Q

What does the evidence on the efficacy of CBT for psychosis suggest?

A

Very strong evidence
- particularly for those with chronic disorders

  • delusional conviction is reduced
  • relapse is reduced
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9
Q

Why was cognitive remediation developed?

A

As a response to cognitive problems, notably in psychosis

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10
Q

What did Emil Kraepelin and Eugen Bleuler think about cognition and psychosis?

A

Individuals with psychosis have cognitive difficulties

- but no knowledge if problems worsen over time

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11
Q

What does the literature suggest on cognition and psychosis?

A

People suffering from schizophrenia have cognitive problems in many domains

  • verbal memory
  • visual memory
  • executive functions
  • attention / processing speed
  • language
  • sensory motor
  • general verbal ability
  • visual processing

In early stages, Individuals experiencing psychotic illness are aware of changes in their cognition

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12
Q

Is there a difference in the severity of cognitive problems in the early stages of psychotic illness and in chronic schizophrenia (McCleery et al., 2014)?

A
  • Little change in cognition over time
  • Little difference between those who were tested on various cognition domains at early stage (first episode) and those with chronic schizophrenia
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13
Q

What does newer evidence suggest about cognitive difficulties in children that are going to develop psychosis?

A
  • Cognitive development 6-18 months behind typical development between age 8 to 21
  • Higher symptom severity related to more cognitive impact
  • Children who later develop psychosis demonstrate significant cognitive impairments from 3 years old
  • Those who go on to develop psychosis show severe cognitive difficulties years prior to acute episode, to a point of cognitive deficit
    (1 standard deviation below average)
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14
Q

In longitudinal studies, why is it important to collect the data before the appearance of psychotic symptoms and before pharmacological treatment?

A

Psychotic symptoms and medication may affect cognition

-> confounding factors

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15
Q

How is cognition related to the costs of care (Patel et al., 2006; Wykes et al. 2003)?

A

Cognitive problems predict the cost of care

  • cognitive impairments -> use more residential / inpatient services
    = higher costs
  • Severity of cognitive difficulties predicts cost of health and social care
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16
Q

What did the study of Goldberg and colleagues (1987) reveal about cognitive training?

A

Wisconsin Card Sorting Task

  • without support individuals went back to poor performance
  • > this study produced an industry of studies for different types of training, some showing improvements even after end of training
  • > Therapeutic optimism -> Cognitive remediation
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17
Q

What do people with psychosis want (Rethink, 2009)?

A
  • Work
  • Social skills
  • Life skills
  • Independence
  • > functional outcomes
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18
Q

How does cognition play a part in work (Bell and Bryson, 2001)?

A

Rehabilitation programme at Yale, for a year

  • aimed to get people into paid employment
  • > improved cognitive variables: memory, attention, flexibility, learning
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19
Q

How does cognition play a part in social skills (Smith et al., 2002)?

A
  • Social behaviour during recovery
  • 1 year follow-up after inpatient treatment
  • Individuals with poor working memory recover less in social functioning
  • > Maximise recovery by incorporating cognitive skills (e.g. memory) as targets for improvement in rehabilitation programmes
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20
Q

What is working memory important for?

A
  • Holding complex social cues

- Integrating various information in order to select appropriate social responses

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21
Q

How does cognition play a part in life skills (Velligan et al., 1997)?

A

Cognition play a part in cooking, catching the bus, paying bills

  • cognitive problems limit the amount that individuals learnt from a rehabilitation programme
22
Q

How does cognition play a part in independence (Wykes et al., 1992)?

A

Effects of good rehabilitation programme following closure of Netherne hospital:

  • level of independence achieved depended on specific aspects of cognition, particularly mental flexibility
  • psychotic symptoms accounted less than cognition for the variance in outcome
  • ability to benefit from good recovery programmes depend a lot on cognition
23
Q

What does cognitive remediation therapy (CRT) consist of?

A
  • Helping someone achieve functional, recovery-based goals
  • Teaching individuals how to make use of their personal strengths, how to develop new cognitive skills and strategies to improve performance
24
Q

What is the role of the therapist in cognitive rumination therapy (CRT)?

A
  • Ensures the learning is personalised and motivating

- That the clients have the opportunities to transfer and practice new skills in everyday life

25
Q

What is the role of learning principles in cognitive remediation therapy (CRT)?

A

Learning principles:

  • underlie cognitive remediation
  • provide optimal learning environment
  • particularly effective for learners with psychosis
26
Q

What are the learning principles in cognitive remediation therapy (CRT)?

A
  • Massed practice
  • Errorless learning
  • Verbal monitoring
  • Scaffolding
  • Using strategies
27
Q

What is the learning principle of massed practice?

A
  • Tasks repeated
  • Difficulty gradually increases
  • Develop cognitive skills that become automatic
  • Learn broad principles applicable to numerous situations
28
Q

What is the principle of errorless learning?

A
  • Ensure that individuals do not learn errors
  • Correct performance is clear
  • Keep the learning accurate
  • Keep reinforcement and motivation high
29
Q

What is the learning principle of verbal monitoring?

A

Remember tasks instructions by encouraging individuals to overly and eventually internally verbalise them

30
Q

What is the learning principle of scaffolding?

A
  • Learning support so tasks are manageable but challenging

- Learning support is gradually withdrawn and people learn to self-scaffold

31
Q

What is the learning principle of using strategies?

A

Teaching people how to improve task performance through the use of strategies
(e.g. visualise, rehearse)

32
Q

What is the effectiveness of cognitive remediation therapy (CRT) (Wykes et al., 2011)?

A

Meta-analysis: lots of different types of cognitive remediation, using pencil and paper or computer

  • overall, cognitive remediation improved cognition (ES: 0.45)
33
Q

What is the effect of cognitive remediation therapy (CRT) on functioning (Wykes et all., 2011)?

A

CRT improves overall functioning and symptoms

34
Q

What is the durability of the outcomes of cognitive remediation therapy (CRT) (Wykes et all., 2011)?

A

Durable changes in cognition and functioning

35
Q

What is required of cognitive remediation programmes so they have a significant functional effect (Wykes et al., 2011)?

A

A strategic approach to cognitive remediation

-> must teach strategy

36
Q

What is the benefit of adding rehabilitation to cognitive remediation (Wykes et al., 2011)?

A

Adding psychiatric rehabilitation to cognitive rehabilitation increases functional gains

37
Q

To whom is cognitive remediation most beneficial (Bell et al., 2014)?

A

More effective for low-functioning individuals

  • improves work outcome for those who are likely to fail in supported work programmes
38
Q

What is the benefit of providing cognitive remediation therapy and a second course of supported employment in people who failed in a supported work programme (McGurk et al., 2015)?

A

These people were
- more likely to get and keep a job

  • achieved higher pay
  • worked more hours
39
Q

What is the effect of cognitive remediation therapy (CRT) on cost outcomes (Reeder et al., 2014)?

A

Improved cognition changes costs of care

40
Q

What are the effects of cognitive remediation therapy (CRT) on the brain (Penadés et al., 2013; Eack et al., 2010; Wykes et al., 2002)?

A
  • Amount of cognitive improvement is related to amount of change in brain activity
  • Those who received cognitive remediation had preserved grey matter compared to loss of grey matter in those who only received support
41
Q

What may mediate the effect of improved cognition on improved functioning (Wykes et al., 2012)?

A

Model needs to take into account metacognition

42
Q

What is metacognition?

A

“thinking about thinking”

  • knowledge and beliefs about your own thinking
43
Q

What is metacognitive knowledge?

A

Knowledge of what affects your thinking and others tinking

44
Q

What is metacognitive regulation?

A

Ability to reflect on your thinking skills, and plan, monitor, evaluate and adjust them

45
Q

What is the role of metacognition in change (Wykes and Reeder, 2005)?

A

Metacognition knowledge and regulation both play a role in helping people apply strategies in real life
-> change their behaviour

-> Improving metacognition might be incorporated into therapy process and then transferred into everyday life in order to achieve goals

46
Q

What is the state of metacognition in people with psychosis?

A

They do not recognise that they have cognitive difficulties
- regulation often difficult

  • they exhibit a lack of strategy use, rather than an inability to use strategies
  • > if you provide them with a strategy, they will be able to remember
47
Q

What is CIRCuiTS (Reeder et al., 2016)?

A

Computerised Interactive Remediation of Cognition and Thinking Skills

  • computerised training programme based on empirical evidence on what is useful
48
Q

What does CIRCuiTS consist of (Reeder et al., 2016)?

A

Tasks relating to 4 main cognitive domains:
- executive functioning

  • working memory
  • long-term memory
  • attention

Client learns cognitive skills in basic tasks (to aid transfer)

49
Q

What is the role of metacognition in the effect of cognitive remediation on functioning?

A

Metacognition has an effect on how cognitive improvements are used in everyday life

50
Q

What are other important factors, besides metacognition, in the effect of cognition on functioning?

A

Motivation and age

Psychology & Neuroscience of Psychosis (16 decks)

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