Cognitive Remediation Therapy
Encyclopedia
Cognitive rehabilitation therapy
Cognitive rehabilitation therapy is a program to help brain-injured or otherwise cognitively impaired individuals to restore normal functioning, or to compensate for cognitive deficits. It entails an individualized program of specific skills training and practice plus metacognitive strategies...
developed at King's College
King's College London
King's College London is a public research university located in London, United Kingdom and a constituent college of the federal University of London. King's has a claim to being the third oldest university in England, having been founded by King George IV and the Duke of Wellington in 1829, and...
in London designed to improve neurocognitive
Neurocognitive
Neurocognitive is a term used to describe cognitive functions closely linked to the function of particular areas, neural pathways, or cortical networks in the brain substrate layers of neurological matrix at the cellular molecular level...
abilities such as attention
Attention
Attention is the cognitive process of paying attention to one aspect of the environment while ignoring others. Attention is one of the most intensely studied topics within psychology and cognitive neuroscience....
, working memory
Working memory
Working memory has been defined as the system which actively holds information in the mind to do verbal and nonverbal tasks such as reasoning and comprehension, and to make it available for further information processing...
, cognitive flexibility
Cognitive flexibility
Cognitive flexibility is the term used to describe one of the executive functions; a function which is an important component of human behavior; the ability to switch behavioral response according to the context of the situation...
and planning
Planning (cognitive)
Cognitive planning is one of the executive functions, it encompases the neurological processes involved in the formulation, evaluation and selection of a sequence of thoughts and actions to achieve a desired goal...
, and executive functioning which leads to improved social functioning.
CRT has been used in the treatment of schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
with positive results. In studies conducted at Kings College London with adults with anorexia nervosa
Anorexia nervosa
Anorexia nervosa is an eating disorder characterized by refusal to maintain a healthy body weight and an obsessive fear of gaining weight. Although commonly called "anorexia", that term on its own denotes any symptomatic loss of appetite and is not strictly accurate...
CRT was shown to be beneficial in treatment,, and in Poland among adolescents with anorexia nervosa, in the United States clinical trials are still being conducted by the National Institute of Mental Health
National Institute of Mental Health
The National Institute of Mental Health is one of 27 institutes and centers that make up the National Institutes of Health...
on adolescents age 10-17 and Stanford University
Stanford University
The Leland Stanford Junior University, commonly referred to as Stanford University or Stanford, is a private research university on an campus located near Palo Alto, California. It is situated in the northwestern Santa Clara Valley on the San Francisco Peninsula, approximately northwest of San...
in subjects over 16 as a conjunctive therapy with Cognitive behavioral therapy.. Research at King's College London further explains that people with eating disorders such as anorexia nervosa
Anorexia nervosa
Anorexia nervosa is an eating disorder characterized by refusal to maintain a healthy body weight and an obsessive fear of gaining weight. Although commonly called "anorexia", that term on its own denotes any symptomatic loss of appetite and is not strictly accurate...
, are considered to be cognitively inflexible
Cognitive flexibility
Cognitive flexibility is the term used to describe one of the executive functions; a function which is an important component of human behavior; the ability to switch behavioral response according to the context of the situation...
with their perspectives of food. Psychologist, Kate Tchanturia aims to correct the thinking of patients with eatting disorders via Cognitive Remediation Therapy
Cognitive Remediation Therapy
Cognitive Remediation Therapy is a cognitive rehabilitation therapy developed at King's College in London designed to improve neurocognitive abilities such as attention, working memory, cognitive flexibility and planning, and executive functioning which leads to improved social functioning.CRT...
simultaneously with dietary modification and therapy.
CRT has also been shown to be useful in both children and adults with ADHD., as well as for cognitive deficits associated with Major depressive disorder CRT has also been used in a subset of pediatric cancer survivors who experienced cognitive impairment due to the effects of cancer or cancer treatment
Post-chemotherapy cognitive impairment
Post-chemotherapy cognitive impairment describes the cognitive impairment that can result from chemotherapy treatment. Approximately 20–30% of people who undergo chemotherapy experience some level of post-chemotherapy cognitive impairment...
on cognitive functioning. Clinical trials are slated to begin in 2010 in the United States by the National Institute of Health and the National Institute of Drug Abuse on the efficacy of cognitive remediation upon the cognitive deficits associated with drug abuse
Drug abuse
Substance abuse, also known as drug abuse, refers to a maladaptive pattern of use of a substance that is not considered dependent. The term "drug abuse" does not exclude dependency, but is otherwise used in a similar manner in nonmedical contexts...
.
CRT is usually administered via use of a computer, with the tasks appearing on the monitor.
Cognitive flexibility
Purple Blue Purple----
Blue Purple Red
Green Purple Green
----
Naming the color of the first set of words is easier and quicker than the second.
- Hayling Sentence Completion TaskHayling and Brixton testsThe Hayling and Brixton tests are neuropsychological tests of executive function created by psychologists Paul W. Burgess and Tim Shallice.It is composed of two tests, the Hayling Sentence Completion Test and the Brixton Spatial Awareness Test....
(Burgess & Shallice, 1996):is a measure of response initiation and response suppression. It consists of two sets of 15 sentences each having the last word missing. In the first section the examiner reads each sentence aloud and the participant has to simply complete the sentences, yielding a simple measure of response initiation speed.The second part of the Hayling requires subjects to complete a sentence with a nonsense ending word (and suppress a sensible one), giving measures of response suppression ability and thinking time. - Controlled Oral Word Fluency TestVerbal fluency testVerbal fluency tests are a kind of psychological test in which participants have to say as many words as possible from a category in a given time . This category can be semantic, such as animals or fruits, or phonemic, such as words that begin with letter p.The semantic fluency test is sometimes...
(Spreen & Benton, 1977).Used for assessing verbal fluency and how easily a person can think of words that begin with a specific letter. - Stroop Neuropsychological Screening Test (Trenerry et al, 1989). Used to test for neurological deficits, ages 18–79. Consists of two parts. The Color Task, consists of a list of 112 color names, printed in a different color, the subject repeats the color name. In the Color-Word Task, the subject names the color of ink in which the color names are printed.
Memory
- Visual span: subjects are required to reproduce increasingly complex figures presented on a grid from memory. The key measure is the highest level at which two out of four figures are correctly recalled.
- Sentence span: based on the Daneman & Carpenter (1980) Sentence Span task. Groups of sentences are read to the subject, who then must recall the last word of each sentence . With each subsequent group the number of sentences is increased.
- Digit spanMemory spanIn psychology and neuroscience, memory span is the longest list of items that a person can repeat back in correct order immediately after presentation on 50% of all trials. Items may include words, numbers, or letters. The task is known as digit span when numbers are used. Memory span is a common...
: from the Wechsler Adult Intelligence ScaleWechsler Adult Intelligence ScaleThe Wechsler Adult Intelligence Scale intelligence quotient tests are the primary clinical instruments used to measure adult and adolescent intelligence. The original WAIS was published in February 1955 by David Wechsler, as a revision of the Wechsler-Bellevue Intelligence Scale...
— Revised (Wechsler, 1981). Digit span is the longest list of numbers that a person can repeat back in correct order immediately after presentation on 50% of all trials. - Dual Span (Della Sala et al, 1995): measures Baddeley's (1986) conception of working memory as the ability to process two tasks simultaneously ( tracking and remembering numbers).
Cognitive activation tasks
| Two back n-back task |
| A Q R Q Z V Z D X D L P L |
| A Q R Q Z V Z D X D L P L |
- Working memory conditionWorking memoryWorking memory has been defined as the system which actively holds information in the mind to do verbal and nonverbal tasks such as reasoning and comprehension, and to make it available for further information processing...
(task) using the "Two back n-back task" The subject is presented with a sequence of letters on a computer screen; the task consists of indicating when the current letter matches the one from 2 steps earlier in the sequence this requires subjects to keep a current record of the previous two letters and to compare the present letter on the screen with that occurring two before. Example:the red letters correspond to the blue letters, which are "two back".
- Vigilance condition (look for X): subjects view a series of letters presented in alphabetical order and indicate when the letter X appears out of sequence (e.g. A—B—X).
- Baseline condition: for this, subjects simply view a blank screen.
- A message on the screen (‘Look for X’ or ‘Task’) appears and subjects are asked to say each letter (subvocallySubvocalizationSubvocalization, or silent speech, is defined as the internal speech made when reading a word, thus allowing the reader to imagine the sound of the word as it is read. This is a natural process when reading and helps to reduce cognitive load, and it helps the mind to access meanings to enable it to...
) as it appears on the screen in both the vigilance and working memory conditions. The letters appear at the rate of (one every 1.2 s) and the frequency of target responses (two or three in each 15-letter epoch) are the same in the vigilance and working memory conditions. Both of these tasks require the subject to pay attention to the screen.