B-04 Combining tDCS and Cognitive Training for People with Severe Mental Illness: Preliminary Feasibility and Acceptability Findings

Abstract Objective Technological advances in neuromodulation and cognitive remediation provide opportunities to develop novel interventions, though a critical first determination is whether such treatments are feasible and acceptable to participants. This study evaluated a combined transcranial direct current stimulation (tDCS) and computerized cognitive training intervention for individuals with severe mental illness; we examined participant recruitment, retention, and adherence to the interventions, along with qualitative feedback. Method Participants included adults with schizophrenia-spectrum or bipolar disorder and impaired working memory (performance ≤1 standard deviation below average of healthy individuals on a spatial span or letter-number span test). In this randomized crossover study, all participants received the combined intervention (ten tDCS sessions in the clinic concurrent with cognitive training), and ten hours of at-home training, and completed neuropsychological and clinical assessments at three time points. Results To date, thirteen participants provided informed consent. Seven participants were screened out; five exceeded the cognitive cutoff and one did not meet the diagnostic criterion. No remaining participants have withdrawn prior to study completion. Four participants completed all tDCS sessions, and one completed 80%. No tDCS session has been discontinued. At-home training has proven more challenging; only one participant completed all ten hours, and three did not complete any at all. Participant feedback has been positive; all expressed satisfaction with both treatments though some said symptoms or busy schedules interfered with at-home training. Conclusions Combining tDCS with computerized cognitive training appears feasible and acceptable. Strategic recruitment efforts to capture those with cognitive impairment appears necessary, as well as troubleshooting barriers to at-home training.

Download Full-text

COMPUTERIZED COGNITIVE TRAINING, WITH OR WITHOUT EXERCISE, TO PROMOTE COGNITIVE FUNCTION: A RANDOMIZED TRIAL

Innovation in Aging ◽

10.1093/geroni/igz038.215 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S55-S56

Author(s):

Lisanne F ten Brinke ◽

John R Best ◽

Joey L Chan ◽

Cheyenne Ghag ◽

Kirk I Erickson ◽

...

Keyword(s):

Older Adults ◽

Physical Exercise ◽

Executive Functions ◽

Cognitive Training ◽

Verbal Learning ◽

Stroop Test ◽

Community Dwelling ◽

Computerized Cognitive Training ◽

Improved Performance ◽

At Home

Abstract Given the world’s aging population, it is important to identify strategies that promote healthy cognitive aging. Computerized cognitive training (CCT) may be a promising method to combat cognitive decline in older adults. Moreover, physical exercise immediately prior to CCT might provide additional cognitive benefits. We conducted a randomized controlled trial to examine the effect of a CCT intervention, alone or preceded by physical exercise, on memory and executive functions in older adults. 124 community-dwelling older adults aged 65-85 years were randomly assigned to either 8-weeks of: 1) 3x/week group-based CCT plus 3x/week CCT sessions at home; 2) 3x/week group-based CCT combined with a 15-minute brisk walk (Ex-CCT) plus 3x/week Ex-CCT sessions at home; or 3)3x/week group-based sham exercise and education sessions (CON). At baseline and 8-weeks standard neuropsychological tests of verbal memory and learning and executive functions were administered, including the Rey Auditory Verbal Learning Test (RAVLT), Stroop test, Flanker test, Trail Making Tests (TMT B-A), and Dimensional Change Card Sort (DCCS) Test. At trial completion, there were no differences in RAVLT performance. Compared with CON, FBT and Ex-FBT participants significantly improved performance on the Stroop test (p = .001 and p = .023, respectively). Additionally, those randomized to Ex-CCT improved performance on the Flanker test (p = .002), TMT B-A (p = .047), and the DCCS Test (p = .023) compared with BAT. These findings suggest that an 8-week CCT program could benefit executive functions, and that implementing exercise immediately prior to CCT could provide broader benefits.

Download Full-text

Cognitive remediation to improve the vocational outcomes of people with severe mental illness

Neuropsychological Rehabilitation ◽

10.1080/09602011.2019.1692671 ◽

2019 ◽

pp. 1-23 ◽

Cited By ~ 1

Author(s):

Francisco Rodríguez Pulido ◽

Nayra Caballero Estebaranz ◽

Enrique González Dávila ◽

Maria Jesús Melián Cartaya

Keyword(s):

Mental Illness ◽

Severe Mental Illness ◽

Cognitive Remediation ◽

Vocational Outcomes

Download Full-text

An Overview of Cognitive Remediation Therapy for People with Severe Mental Illness

ISRN Rehabilitation ◽

10.1155/2013/984932 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

Cherrie Galletly ◽

Ashlee Rigby

Keyword(s):

Mental Illness ◽

Cognitive Function ◽

Mental Disorders ◽

Severe Mental Illness ◽

Cognitive Deficits ◽

Cognitive Remediation ◽

Mental Illnesses ◽

Cognitive Remediation Therapy ◽

Severe Mental Disorders ◽

Varying Length

Cognitive remediation refers to nonpharmacological methods of improving cognitive function in people with severe mental disorders. Cognitive remediation therapy (CRT) can be delivered via computerised programs, of varying length and complexity, or can be undertaken one-on-one by a trained clinician. There has been a considerable interest in cognitive remediation, driven by recognition that cognitive deficits are a major determinant of outcome in people with severe, chronic mental illnesses. CRT has been shown to be effective, especially if combined with vocational rehabilitation.

Download Full-text

The impact of employment on recovery among individuals who are homeless with severe mental illness in the Vancouver At Home/Chez Soi trial

Social Psychiatry and Psychiatric Epidemiology ◽

10.1007/s00127-020-01887-9 ◽

2020 ◽

Vol 55 (12) ◽

pp. 1619-1627

Author(s):

Kiana Yazdani ◽

Mohammadali Nikoo ◽

Eric C. Sayre ◽

Fiona Choi ◽

Kerry Jang ◽

...

Keyword(s):

Mental Illness ◽

Severe Mental Illness ◽

The Impact ◽

At Home

Download Full-text

Comparison of Black and White participants with severe mental illness in response to cognitive remediation as an augmentation of vocational rehabilitation

Schizophrenia Research ◽

10.1016/j.schres.2021.09.001 ◽

2021 ◽

Author(s):

N.R. DeTore ◽

O. Balogun-Mwangi ◽

K.T. Mueser ◽

S.R. McGurk

Keyword(s):

Mental Illness ◽

Vocational Rehabilitation ◽

Severe Mental Illness ◽

Cognitive Remediation ◽

Black And White

Download Full-text

M12. The Role of Clinician in Learning and Motivation During Cognitive Remediation for People With Severe Mental Illness

Schizophrenia Bulletin ◽

10.1093/schbul/sbx022.011 ◽

2017 ◽

Vol 43 (suppl_1) ◽

pp. S215-S215 ◽

Cited By ~ 1

Author(s):

Jin-Suk Kang ◽

Eunjin Kim ◽

Jaeyeong Park ◽

Alice Medalia ◽

Kee-Hong Choi

Keyword(s):

Mental Illness ◽

Severe Mental Illness ◽

Cognitive Remediation

Download Full-text

Neurocognition and social cognition training as treatments for violence and aggression in people with severe mental illness

CNS Spectrums ◽

10.1017/s1092852919001214 ◽

2019 ◽

Vol 25 (2) ◽

pp. 145-153

Author(s):

Mackenzie T. Jones ◽

Philip D. Harvey

Keyword(s):

Mental Illness ◽

Social Cognition ◽

Severe Mental Illness ◽

Cognitive Training ◽

Social Cognitive ◽

Violent Behavior ◽

Everyday Functioning ◽

Social Cognitive Deficits ◽

Psychotic Features ◽

Social Cognition Training

Aggressive and violent behavior, including both verbal and physical aggression, have considerable adverse consequences for people with schizophrenia. There are several potential causes of violent behavior on the part of people with severe mental illness, which include intellectual impairments, cognitive and social-cognitive deficits, skills deficits, substance abuse, antisocial features, and specific psychotic features. This review explores the interventions that have been tested to this date. Computerized Cognitive Training (CCT) or Computerized Social-Cognitive Training (CSCT) have been associated with reductions in violence. Combined CCT and CSCT have been found to improve social cognition and neurocognition, as well as everyday functioning when combined with rehabilitation interventions. These interventions have been shown to reduce violence in schizophrenia patients across multiple environments, including forensic settings. The reductions in violence and aggression have manifested in various ways, including reduced violent thinking and behavior, reduced physical and violent assaults, and reduced disruptive and aggressive behaviors. Effects of cognitive training may be associated with improvements in problem-solving and the increased ability to deploy alternative strategies. The effect of social cognition training on violence reduction appears to be direct, with improvements in violence related to the extent of improvement in social cognition. There are still remaining issues to be addressed in the use of CCT and CSCT, and the benefits should not be overstated; however, the results of these interventions are very promising.

Download Full-text

Additional Interventions to Enhance the Effectiveness of Individual Placement and Support: A Rapid Evidence Assessment

Rehabilitation Research and Practice ◽

10.1155/2012/382420 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 7

Author(s):

Naomi Boycott ◽

Justine Schneider ◽

Mary McMurran

Keyword(s):

Mental Illness ◽

Cognitive Training ◽

Empirical Studies ◽

Cognitive Remediation ◽

Skills Training ◽

Conclusive Evidence ◽

Psychological Interventions ◽

Individual Placement And Support ◽

Work Related ◽

Individual Placement

Topic. Additional interventions used to enhance the effectiveness of individual placement and support (IPS).Aim. To establish whether additional interventions improve the vocational outcomes of IPS alone for people with severe mental illness.Method. A rapid evidence assessment of the literature was conducted for studies where behavioural or psychological interventions have been used to supplement standard IPS. Published and unpublished empirical studies of IPS with additional interventions were considered for inclusion.Conclusions. Six published studies were found which compared IPS alone to IPS plus a supplementary intervention. Of these, three used skills training and three used cognitive remediation. The contribution of each discrete intervention is difficult to establish. Some evidence suggests that work-related social skills and cognitive training are effective adjuncts, but this is an area where large RCTs are required to yield conclusive evidence.

Download Full-text

Computerized Cognitive Training for Amelioration of Cognitive Late Effects Among Childhood Cancer Survivors: A Randomized Controlled Trial

Journal of Clinical Oncology ◽

10.1200/jco.2015.61.6672 ◽

2015 ◽

Vol 33 (33) ◽

pp. 3894-3902 ◽

Cited By ~ 79

Author(s):

Heather M. Conklin ◽

Robert J. Ogg ◽

Jason M. Ashford ◽

Matthew A. Scoggins ◽

Ping Zou ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Standard Deviation ◽

Magnetic Resonance ◽

Cognitive Training ◽

Childhood Cancer Survivors ◽

Functional Magnetic Resonance ◽

Resonance Imaging ◽

Spatial Span ◽

Computerized Cognitive Training ◽

Cognitive Problems

Purpose Children receiving CNS-directed therapy for cancer are at risk for cognitive problems, with few available empirically supported interventions. Cognitive problems indicate neurodevelopmental disruption that may be modifiable with intervention. This study evaluated short-term efficacy of a computerized cognitive training program and neural correlates of cognitive change. Patient and Methods A total of 68 survivors of childhood acute lymphoblastic leukemia (ALL) or brain tumor (BT) with identified cognitive deficits were randomly assigned to computerized cognitive intervention (male, n = 18; female, n = 16; ALL, n = 23; BT, n = 11; mean age ± standard deviation, 12.21 ± 2.47 years) or waitlist (male, n = 18; female, n = 16; ALL, n = 24; BT, n = 10; median age ± standard deviation, 11.82 ± 2.42 years). Intervention participants were asked to complete 25 training sessions at home with weekly, telephone-based coaching. Cognitive assessments and functional magnetic resonance imaging scans (intervention group) were completed pre- and postintervention, with immediate change in spatial span backward as the primary outcome. Results Survivors completing the intervention (n = 30; 88%) demonstrated greater improvement than controls on measures of working memory (mean ± SEM; eg, Wechsler Intelligence Scale for Children [fourth edition; WISC-IV] spatial span backward, 3.13 ± 0.58 v 0.75 ± 0.43; P = .002; effect size [ES], 0.84), attention (eg, WISC-IV spatial span forward, 3.30 ± 0.71 v 1.25 ± 0.39; P = .01; ES, 0.65), and processing speed (eg, Conners' Continuous Performance Test hit reaction time, −2.10 ± 1.47 v 2.54 ± 1.25; P = .02; ES, .61) and showed greater reductions in reported executive dysfunction (eg, Conners' Parent Rating Scale III, −6.73 ± 1.51 v 0.41 ± 1.53; P = .002; ES, 0.84). Functional magnetic resonance imaging revealed significant pre- to post-training reduction in activation of left lateral prefrontal and bilateral medial frontal areas. Conclusion Study findings show computerized cognitive training is feasible and efficacious for childhood cancer survivors, with evidence for training-related neuroplasticity.

Download Full-text