Cognitive Procedures Research Articles

Behavioral and cognitive treatments of geriatric insomnia.

Geriatric insomnia is a prevalent problem that has not received adequate controlled evaluation of psychological treatments. The present study evaluated behavioral and cognitive methods, relative to a wait-list control condition, for treating 27 elderly subjects (mean age = 67 years) with sleepmaintenance insomnia. Both treatment methods, stimulus control and imagery training, produced significant improvement on the main outcome measure of awakening duration. Stimulus control yielded higher improvement rates than either imagery training or the control condition on awakening duration and total sleep-time measures. Sleep improvements were maintained by the two treatment methods at 3- and 12-month follow-ups. The results were corroborated by collateral ratings obtained from significant others. Subjective estimates of awakening duration and sleep latency correlated highly with objective measures recorded on an electromechanical timer. The findings suggest that geriatric insomnia can be effectively treated with psychological interventions and that behavioral procedures are more beneficial than cognitive procedures for sleep maintenance problems. Insomnia is a widespread health problem among the elderly. More than 25% of people aged 60 years or older report difficulty initiating and/or maintaining sleep (Mellinger, Baiter, & Uhlenhuth, 1985). Insomnia complaints increase with age, and disorders of maintaining sleep are especially prevalent among the elderly (Dement, Miles, & Carskadon, 1982; Webb & Campbell, 1980). Sleep-maintenance insomnia is a more pervasive and debilitating condition than onset insomnia and has proved refractory to treatment (Bootzin, Engle-Friedman, & Hazelwood, 1983). Pharmacotherapy is the most widely used method for treating insomnia. Thirty-nine percent of prescriptions for hypnotics are written for persons over 60 years of age (Institute of Medicine, 1979) and, in nursing facilities, 94% of the elderly have been prescribed sedative hypnotics (U.S. Public Health Service, 1976). Most sleeping medications are effective only temporarily, impair cognitive and psychomotor functions, and alter the sleep architecture (Morin & Kwentus, 1988). They are especially hazardous to health in older people because of the reduced metabolic functioning that results with age and the higher incidence of sleep-related respiratory impairments (Mendelson, 1980). Although their short-term use may be indicated as an adjunct for acute insomnia, alternative nonpharma

A review of behavioral treatments for bulimia nervosa.

Despite early pessimism regarding its prognosis, behavior therapy has proven to be an effective treatment for bulimia nervosa. The average reduction in vomiting achieved at the end of behavioral treatment is 70%, with about 44% of patients completely abstinent. Even greater improvements are found in studies that use cognitive and behavioral procedures over a longer period and emphasize relapse prevention. Patients treated with behavior therapy also exhibit improvement on measures of psychological symptoms, self-esteem, and social relationships, though the focus of treatment may be on binge eating and vomiting. Nevertheless, a significant minority of individuals drop out of treatment prematurely or remain unimproved. Still in its early stage, behavior therapy for bulimia nervosa needs much more empirical development and evaluation.

Bulimia: A case illustration of the superiority of behavioral over cognitive treatment

The present study compared the relative efficacy of two major clinical procedures previously used in multicomponent cognitive-behavioral programs for treating bulimia. A single-subject experimental design was used and the results showed that the behavioral procedure of exposure plus response prevention was more effective than the cognitive procedure in reducing binge and vomit episodes as well as the urges to bing-vomit. These results suggest that the exposure plus response prevention component is more relevant for cognitive as well as behavior changes in treating bulimia.

Intelligence testing of children

PreviewPhysicians are often called on to interpret a patient's intelligence test results. In this article, Drs Kaufman and Sengstock provide the information necessary to understand the relative merits of the most commonly used cognitive assessment procedures. They discuss the nature-nurture controversy, advantages of individual over group IQ tests, and fluctuation in test scores over time. They also point out that physicians may find results of IQ tests important in diagnosis and treatment of a variety of conditions, including suspected CNS impairment, mental retardation, learning disabilities, and attention deficit disorder.

Procedural debiasing

This paper presents two experiments that illustrate how Bayesian inferences can be debiased by analyzing and correcting the cognitive procedures that lead to the biases. In the first experiment, a training procedure is used that corrects a common error in the adjustment process used by subjects when integrating evidence. In the second experiment, a focusing technique is used to improve the relative weighting of samples in the overall judgment. These results are discussed in terms of a model of the judgment process comprising four basic stages: (a) initial scanning of stimulus information; (b) selection of items for processing in order of importance; (c) extraction of scale values on the judgment dimension; and (d) adjustment of a composite value that summarizes already-processed components.

Two Consultations: Cognitive Services vs Procedures

To the Editor.— While I am sympathetic to the plight of Dr Cowan 1 and the time he spent treating a sick patient with prostatic carcinoma, I do not understand the events surrounding the placement of the pulmonary artery catheter in the second patient. Since he describes the entire procedure as taking only five minutes, he must have performed this dangerous, invasive procedure without a thorough chart review and examination of the patient. Several questions arise: Did the patient really need a pulmonary artery catheter? Who obtained informed consent? Was there a concomitant coagulopathy or dysrhythmia that would have precluded the procedure? Did anyone check the postinsertion chest x-ray film for position of the catheter? If not Dr Cowan, who managed the patient after the catheter was placed? Was it the primary physician, who obviously did not know how to insert the device? I wonder

Representation of similar well-learned cognitive procedures

Continued practice on a task is characterized by several quantitative and qualitative changes in performance. The most salient is the speed-up in the time to execute the task. To account for these effects, some models of skilled performance have proposed automatic mechanisms that merge knowlege structures associated with the task into fewer, larger structures. The present study investigated how the representation of similar cognitive procedures might interact with the success of such automatic mechanisms. In five experiments, subjects learned complex, multistep mental arithmetic procedures. These procedures included two types of knowledge thought to characterize most cognitive procedures: “component” knowledge for achieving intermediate results and “integrative” knowledge for organizing and integrating intermediate results. Subjects simultaneously practiced two procedures that had either the same component steps or the same integrative structure. Practiceeffect models supported a procedure-independent representation for common component steps. The availability of these common steps for use in a new procedure was also measured. Steps practiced in the context of two procedures were expected to show greater transfer to a new procedure than steps learned in the context of a single procedure. This did not always occur. A model using component/integrative knowledge distinction reconciled these results by proposing that integrative knowledge operated on all steps of the procedure: An integral part of the knowledge associated with achieving an intermediate result or state includes how it contributes to later task demands. These results are discussed in the context of automatic mechanisms for skill acquisition.

Representation of Similar Well‐Learned Cognitive Procedures

Continued practice on a task is characterized by several quantitative and qualitative changes in performance. The most salient is the speed‐up in the time to execute the task. To account for these effects, some models of skilled performance have proposed automatic mechanisms that merge knowlege structures associated with the task into fewer, larger structures. The present study investigated how the representation of similar cognitive procedures might interact with the success of such automatic mechanisms. In five experiments, subjects learned complex, multistep mental arithmetic procedures. These procedures included two types of knowledge thought to characterize most cognitive procedures: “component” knowledge for achieving intermediate results and “integrative” knowledge for organizing and integrating intermediate results. Subjects simultaneously practiced two procedures that had either the same component steps or the same integrative structure. Practiceeffect models supported a procedure‐independent representation for common component steps. The availability of these common steps for use in a new procedure was also measured. Steps practiced in the context of two procedures were expected to show greater transfer to a new procedure than steps learned in the context of a single procedure. This did not always occur. A model using component/integrative knowledge distinction reconciled these results by proposing that integrative knowledge operated on all steps of the procedure: An integral part of the knowledge associated with achieving an intermediate result or state includes how it contributes to later task demands. These results are discussed in the context of automatic mechanisms for skill acquisition.

Treatment for depression in children and adolescents.

In the management of depressive states in children and adolescents a distinction should be drawn between: General antidepressive treatment, as exemplified by the attitude and approach adopted by the physician and by close reference persons towards the depressive child. Indirect antidepressive treatment consisting in: counselling of the parents or treatment for them (psychotherapy, psychotropic medication), family therapy, or admission of the child to a home; learning and teaching hygiene: preventing the child from becoming overtaxed as a result of his difficulty in learning and his impaired performance, recourse to conditioning procedures, demotion to a lower class at school, or transference to another school; initial and follow-up psychotherapy or cognitive therapeutic procedures in cases of 'endogenous' depression. Direct antidepressive treatment (sleep deprival, phototherapy, antidepressants).

Cognitive therapy for depression.

Cognitive therapy alone without concurrent behavioral components seems to be ineffective in the treatment of depressive patients. However, the combination of cognitive and behavioral treatment procedures including social skills training is effective even in the therapy of definite endogenous depression. Three important characteristics are mentioned explaining the therapeutical effectiveness: a concrete rationale, a highly structured therapy program and feedback- and support-techniques. Effectiveness and outcome of the various treatment methods are discussed in the light of three aetiological cognitive hypotheses: the Precipitation theory, the Vulnerability theory and the 'depression about depression' hypothesis.

The withdrawal of stimulant medication for hyperactivity: Overcoming detrimental attributions

This case study documents the difficulties involved in withdrawing a 9-yearold hyperactive boy from methylphenidate (Ritalin), and highlights the detrimental effects caused by this child's maladaptive attributions. Treatment involved a behavioral approach and cognitive procedures aimed at changing the dysfunctional attributions. The role of attributions made by hyperactive, children treated with stimulant medication is discussed

The use of self-monitoring procedures with low IQ learning disabled students.

Given the changes in the population served in programs for the learning-disabled, there is a continuing need to verify the effectiveness of teaching methods used with D students. This research investigated the efficacy of two cognitive behavior modification procedures—self-monitoring of attention and self-monitoring of academic accuracy—with a group of low functioning students in a LD self-contained class. Data are presented which indicate that the combination of both procedures was effective for all four students in improving attention-to-task and for three of the four children in percentage of accurate responses in an arithmetic task. The discussion highlights the importance of possible modification of CBM methods and training procedures in order to develop successsful intervention programs for LD students whose cognitive functioning levels are below average.

Treatment outlines for the management of anxiety states. The Quality Assurance Project.

The Quality Assurance Project is developing explicit and detailed treatment outlines for each of the major psychiatric disorders. Three sources of information are used: a meta-analysis of the treatment outcome literature, the opinions of a sample of practising psychiatrists, and the views of a panel of nominated experts. The recommendations for the treatment of anxiety states were as follows: Phenelzine and then the tricyclic antidepressants were the treatments of choice for panic disorder. Behaviour therapy--cognitive anxiety management, relaxation and hyperventilation control--being recommended as an essential adjunct to drug therapy. Relaxation and dynamic psychotherapy separately, or in combination, were the treatments of choice for generalised anxiety disorder with cognitive procedures being of value and benzodiazepines only being recommended for short-term use. In complicated cases of either panic disorder or generalised anxiety disorder a long-term supportive psychotherapeutic relationship was regarded as essential to ensure smooth progress in treatment. In adjustment disorder with anxious mood, procedures to permit adaptation to the stressor were recommended, while in post-traumatic stress disorder psychotherapeutic techniques to allow the trauma to be re-experienced and worked through were favoured.

Components of rational-emotive imagery: Two experiments with nonassertive students

Unassertive students took part in two experiments to assess the contributions of emotional and cognitive rehearsal procedures in rational-emotive imagery. In each study participants received analogue treatment in groups, which met twice for one and a half hours. In Experiment 1 behavior rehearsal (BR) was more effective than emotional rehearsal (ER, which involved tryping to attenuate unwanted feelings in fantasy) and cognitive rehearsal (CR, which involved examining negative, and rehearsing helpful, self-statements) as assessed by a self-report measure of assertiveness. In Experiment 2 combinations of Experiment 1 procedures were tested in a factorial design. On a behavioral test, BR proved more effective than the treatment combinations, but on questionnaire measures of social anxiety and irrational beliefs rational-emotive imagery (the combination of CR with ER) was superior to the other treatment conditions. Results are encouraging in that rational-emotive imagery was more successful than either component in isolation, even within the limits of a brief analogue study. Further clinical trials are needed.

Task involvement and cardiac response in young children

Abstract Of a group of 60 3-year-old children, the 10 with consistently high and stable heart rates across a variety of cognitive procedures, in contrast to 11 children with consistently low and variable heart rates, were described by their mothers as motivated for intellectual mastery and obedient toward them, and these children behaved in accord with these descriptions on selected cognitive tests and during observations at home. It is suggested that heart rate reactions in testing situations might prove helpful when included as part of a larger set of procedures designed to evaluate a young child's motivational involvement in psychological tasks.

The effects of cognitive level and training procedures on the generalization of self-instructions

Preoperational and concrete operational first- and second-graders performed on a training task (Matching Familiar Figures Test) and a generalization task (a perceptual perspective-taking test) prior to and after serving in one of four self-instruction groups varying in the delivery procedures of the instructions. The instruction groups were a no-training control group, a didactic instruction control group, a fading self-instructions group, and a directed discovery self-instructions group. Children in the didactic instructions group received the same instructional content as children in the fading and directed discovery self-instructions groups, but without an active rehearsal component. Children in the fading group received the traditional five-step overt-to-covert rehearsal of instructions; those in the directed discovery group were led to “discover” the instructions through a Socratic dialogue exchange with the experimenter. Children in the fading and directed discovery self-instructions groups significantly improved their performance on the training task relative to children in both control groups. Only the concrete operational children in the directed discovery self-instruction group demonstrated significant improvement on the generalization task.

Assessing the impact of cognitive differences in the treatment of obsessive-compulsives.

Demonstrated a set of research techniques that combine multidimensional scaling, a quantitative cognitive procedure, and cost outcome analysis. The multidimensional scaling results supported Reed's (1969) notion that obsessive-compulsive clients are underinclusive and did not support Foa and Steketee's (1979) contention that they are overinclusive. Significant differences in extent of follow-up therapy were found between obsessive compulsives (N = 12) with the underinclusive cognitive style and those with a normal cognitive style.

"No two fields ever grow grass the same way": assessment of conservation abilities in the elderly.

Within the past ten years, standard cognitive assessment procedures, including Piagetian tasks, have often been used with the elderly. The present paper examines several possible difficulties in interpreting the results of studied which employ Piagetian tasks, especially conservation tasks, with older individuals. First, it is noted that Piaget's clinical method allows more flexibility in the assessment of competence than do the more quantifiable, American techniques. However, most of the research studies suggesting a cognitive decline with age have utilized rigid assessment procedures. Second, the paper examines the possibility of task misinterpretation by the elderly. Examples from recent research, in which older persons stressed reality-based problem solving strategies rather than the more abstract strategies traditionally associated with Piagetian tasks, are provided. The possibility of cognitive change instead of cognitive decline with age is discussed, and the importance of utilizing procedures which can measure this change is stressed.

A cognitive behavioral intervention for compulsive handwashing with a thirteen-year-old boy

Cognitive behavioral procedures have been shown to be effective in the treatment of adult obsessive-compulsive disorders. This article presents a case of successful treatment of compulsive handwashing in a thirteen-year-old boy through a cognitive behavioral intervention, showing the potential efficacy of these procedures with children for this type of behavior problem. The principal cognitive intervention was thought-stopping with which the child's obsessive ruminations were disrupted. Handwashing was reduced during treatment to fewer than six occurrences per day, and behavior change was maintained at follow-up 6 and 18 months after the intervention ended.

Assertiveness Training with Outpatients: The Effectiveness of Skill and Cognitive Procedures

Forty-four community mental health outpatients participated in an assertiveness training program in which three treatment methods were compared. Skill training aimed at training specific assertive responses by means of instruction, modeling, behavioral rehearsal, feedback, and homework assignments. Cognitive training focused on altering the irrational cognitions which theoretically inhibit the expression of assertive responses. A third group (Cognitive–Skill) received both forms of training simultaneously, and a fourth group (Waiting List) was included as a control. A behavioral roleplaying test (B.R.P.T.) and the Social Fear Scale were administered prior to and immediately following four individual training sessions occurring at one week intervals for all three treatment groups. Analyses of covariance of assertive content ratings made by independent judges for B.R.P.T. responses revealed that all three treatment groups evidenced significantly more assertive and effective responses on both refusal and behavior change situations when compared to the Waiting List control. Analyses of paralinguistic dimensions of the B.R.P.T. revealed training generally to be more successful for the Skill group.