Cognitive remediation Flashcards
(50 cards)
What is a cost-effective psychological treatment?
In which the cost of the therapist’s time is outweighed by the benefits (e.g. time in hospital, QoL)
What are the three psychological treatment that have a long history of development and evidence collection?
- Cognitive behaviour therapy (CBT)
- Family therapy
- Social skills training
Why was family therapy developed?
- Individuals returning to their family had higher relapse rate
- Higher stress produced by expressed emotion
What is the aim of family therapy?
- 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
Why was social skills training developed?
Individuals removed from large hospitals and then back into the community lacked social skills
What is the aim of social skills training?
Teach individuals how to:
- recognise expressions
- initiate conversations
- respond appropriately
What is the aim of CBT?
Explore the beliefs of patients and come to a resolution so these beliefs do not interfere with personal goals
What does the evidence on the efficacy of CBT for psychosis suggest?
Very strong evidence
- particularly for those with chronic disorders
- delusional conviction is reduced
- relapse is reduced
Why was cognitive remediation developed?
As a response to cognitive problems, notably in psychosis
What did Emil Kraepelin and Eugen Bleuler think about cognition and psychosis?
Individuals with psychosis have cognitive difficulties
- but no knowledge if problems worsen over time
What does the literature suggest on cognition and psychosis?
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
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)?
- 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
What does newer evidence suggest about cognitive difficulties in children that are going to develop psychosis?
- 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)
In longitudinal studies, why is it important to collect the data before the appearance of psychotic symptoms and before pharmacological treatment?
Psychotic symptoms and medication may affect cognition
-> confounding factors
How is cognition related to the costs of care (Patel et al., 2006; Wykes et al. 2003)?
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
What did the study of Goldberg and colleagues (1987) reveal about cognitive training?
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
What do people with psychosis want (Rethink, 2009)?
- Work
- Social skills
- Life skills
- Independence
- > functional outcomes
How does cognition play a part in work (Bell and Bryson, 2001)?
Rehabilitation programme at Yale, for a year
- aimed to get people into paid employment
- > improved cognitive variables: memory, attention, flexibility, learning
How does cognition play a part in social skills (Smith et al., 2002)?
- 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
What is working memory important for?
- Holding complex social cues
- Integrating various information in order to select appropriate social responses
How does cognition play a part in life skills (Velligan et al., 1997)?
Cognition play a part in cooking, catching the bus, paying bills
- cognitive problems limit the amount that individuals learnt from a rehabilitation programme
How does cognition play a part in independence (Wykes et al., 1992)?
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
What does cognitive remediation therapy (CRT) consist of?
- 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
What is the role of the therapist in cognitive rumination therapy (CRT)?
- Ensures the learning is personalised and motivating
- That the clients have the opportunities to transfer and practice new skills in everyday life
