Cognitive Rehearsal Research Articles

Cortical Plasticity Following Motor Skill Learning During Mental Practice in Stroke

Background and purpose. Mental practice (MP), which involves cognitive rehearsal of physical movements, is a noninvasive, inexpensive method of enabling repetitive, task-specific practice (RTP). Recent, randomized controlled data suggest that MP, when combined with an RTP therapy program, increases affected arm use and function significantly more than RTP only. As a next step, this 10-subject case series examined the possibility that cortical plasticity is a mechanism underlying the treatment effect of MP when combined with RTP. Method. Ten chronic stroke patients (mean = 36.7 months) exhibiting stable, moderate motor deficits received 30-minute therapy sessions for their affected arms, occurring 3 days/week for 10 weeks, and emphasizing valued activities of daily living (ADLs). Directly after therapy, subjects received 30-minute MP sessions, which required MP of the ADLs performed during therapy. Behavioral outcomes were blindly evaluated using the Action Research Arm Test (ARAT) and the Fugl-Meyer Assessment (FM). Functional magnetic resonance imaging (fMRI) was administered before and after intervention to assess cortical changes. Results. Before intervention, subjects exhibited stable motor deficits. After intervention, subjects exhibited ARAT and FM score increases (+5.3 and +4.2, respectively) and clinically significant gains in ADLs. Postintervention fMRI revealed significant increases in activation to wrist flexion and extension of the affected hand in the premotor area and primary motor cortex ipsilateral and contralateral to the affected hand, as well as in superior parietal cortex ipsilateral to the affected hand. Decreased activation was noted in parietal cortex of the hemisphere ipsilateral to the affected hand. These changes correlated with anatomical regions in which behavioral changes were observed in the ARAT and FM. Conclusions. MP is an easy to use, cost-effective strategy that was again shown to improve affected arm outcomes after stroke. This is the first study to demonstrate alteration in the cortical map in response to MP training.

Posttraumatic growth and PTSD symptomatology among colorectal cancer survivors: a 3‐month longitudinal examination of cognitive processing

The experience of cancer can be understood as a psychosocial transition, producing both positive and negative outcomes. Cognitive processing may facilitate psychological adjustment. Fifty-five post-treatment, colorectal cancer survivors (M=65.9 years old; SD=12.7), an average of 13 months post-diagnosis, were recruited from a state cancer registry and completed baseline and 3-month questionnaires assessing dispositional (social desirability), cognitive processing (cognitive intrusions, cognitive rehearsal), and psychological adjustment variables (posttraumatic growth (PTG), posttraumatic stress disorder (PTSD) symptomatology, depression, anxiety, positive affectivity). PTSD symptomatology was positively associated with depression, anxiety, and negatively associated with positive affectivity. In contrast, PTG scores were unrelated to PTSD symptomatology, depression, anxiety, and positive affectivity. In addition, PTG was independent of social desirability. Notably, after controlling for age at diagnosis and education, multiple regression analyses indicated that cognitive processing (intrusions, rehearsal) was differentially predictive of psychological adjustment. Baseline cognitive intrusions predicted 3-month PTSD symptomatology and there was a trend for baseline cognitive rehearsal predicting 3-month PTG. Additional research is needed to clarify the association between PTG and other indices of psychological adjustment, further delineate the nature of cognitive processing, and understand the trajectory of PTG over time for survivors with colorectal cancer.

Teaching Cognitive Rehearsal as a Shield for Lateral Violence: An Intervention for Newly Licensed Nurses

Recent literature defines lateral violence as nurses covertly or overtly directing their dissatisfaction inward toward each other, toward themselves, and toward those less powerful than themselves. Newly licensed nurses are an identified group that is vulnerable to lateral violence during their socialization to nursing practice. The use of cognitive rehearsal, an applied cognitive-behavioral technique, was used as an intervention and the theoretical underpinning for this study. Twenty-six newly licensed nurses hired by a large acute care tertiary hospital in Boston, Massachusetts, participated in an exploratory descriptive study. They were taught about lateral violence in nursing practice and the use of cognitive rehearsal techniques as a shield from the negative effects of lateral violence on learning and socialization. Small laminated cueing cards with written visual cues for the appropriate responses to the most common forms of lateral violence were provided. One year later, videotaped focus groups designed to collect qualitative data about the applied intervention were conducted. Twenty-six newly licensed nurses in three different focus groups were videotaped responding to six open-ended questions designed to elicit information on their experience with lateral violence, use of cognitive rehearsal as an intervention, and the overall socialization process. Knowledge of lateral violence in nursing appeared to allow newly licensed nurses to depersonalize it, thus allowing them to ask questions and continue to learn. The learned cognitive responses helped them confront the lateral violence offender. Confrontation was described as difficult but resulted in the resolution of the lateral violence behavior. Overall, the retention rate in this study population was positively affected.

Controlled trial of Internet-based treatment with telephone support for chronic back pain

The purpose of this study was to investigate the effects of an Internet-based cognitive-behavioral intervention with telephone support for chronic back pain. Participants who met the criteria for chronic back pain ( N=56) were randomly assigned to either an Internet-based cognitive behavioral self-help treatment or to a waiting-list control condition. The study period lasted 8 weeks and consisted of 1 week of self-monitoring prior to the intervention, 6 weeks of intervention, and 1 week of post-intervention assessment. Treatment consisted of education, cognitive skill acquisition, behavioral rehearsal, generalization and maintenance. The dropout rate was 9% ( N=5). Results showed statistically significant improvements in catastrophizing, control over pain and ability to decrease pain. Some improvement was found in both the control group and the treatment group. A follow-up of 3 months after treatment termination was completed in 92% ( N=47) of the participants who completed the treatment intervention. Follow-up results showed that some improvement was maintained. Findings indicate that Internet-based self-help with telephone support, based on established psychological treatment methods, holds promise as an effective approach for treating disability in association with pain.

Video modeling: A window into the world of autism.

Video modeling is a well-validated behavioral intervention documented in the behavioral sciences. The methodology appears particularly beneficial for children with autism. The underlying theoretical explanations are posited and discussed. A single case study is presented using video modeling to improve the perception of emotion in a child with autism and mild mental retardation. The subject was shown a series of video tapes of typically developing children engaged in a variety of play and social scenarios showing four basic emotions: happy, sad, angry and afraid. The preliminary results, based on behavioral and neuropsychological data, demonstrated video modeling to be an efficacious intervention for the attainment and generalization of emotion perception. The acquisition of skills using video modeling is often very rapid compared to other methods of intervention and requires limited time and personal resources to implement. The skill is then maintained with careful behavioral programming, which includes stable attainment of mastery and built-in generalization conditions (e.g., multiple exemplars). Further, video modeling appears to be particularly useful in eliciting generalized responses across behaviors and stimuli that is corroborated by improvement on neuropsychological instruments. Implications for current and future research are discussed. Keywords: autism, video modeling, behavioral treatment ********** Autism is a severe neurodevelopmental disorder characterized by qualitative impairment before the age of three in verbal and nonverbal communication, reciprocal social interaction, and a markedly restricted repertoire of activities and interests (American Psychiatric Association, 1994). There is substantial evidence that children with autism show benefit from early-intervention behavioral techniques (e.g., Birnbrauer & Leach, 1993; Harris et al., 1991; Lovaas, 1987). Various programs have been formulated to instruct care providers on the application of behavioral methodology for children with autism, such as an intensive applied behavior analysis (ABA) program (Lovaas, 1981; Maurice, 1996). The disadvantage of an intensive ABA program is the extraordinary time commitment and financial burden to implement the program. Observational Learning: Much of human learning occurs vicariously by simply watching others. Bandura's social learning theory (1977) emphasizes the role of observational learning and incorporates the concept of behavioral modeling. Observational learning refers to the cognitive and behavioral change that occurs as a result of observing others engaged in similar actions (Bandura, 1986). Modeling is defined as the process by which an individual or model demonstrates behavior that can be imitated. The modeled behavior can be presented in vivo (live), recorded (e.g. filmed, videotaped), or imagined. In observational learning there are four factors that mediate the process: attentional, retentional, production and motivational (Bandura, 1986). The attentional processes refer to the initial act of attending to and accurately perceiving an event. The retentional process requires the capacity of the learner to symbolically process the modeled behavior in memory via verbal encoding and visual imagery. The retention of material is enhanced through concurrent visual monitoring, cognitive rehearsal, and behavioral reproduction (Carroll & Bandura, 1986). The Production processes occur when the learner accurately reproduces and rehearses the modeled behavior. In other words, the capacity to perform the rudimentary elements of the task must be within the child's repertoire. Lastly, the motivational process refers to learning that occurs in the presence of reinforcement. Early studies with children with autism show that they often do not naturally learn through observation and thus must be taught to imitate and learn this basic skill (Baer et al., 1967; Varni et al. …

Shyness and social phobia: a social work perspective on a problem in living.

Social phobia is classified as an anxiety disorder in psychiatric nomenclature. It represents a fear of performance or social interaction that significantly interferes with a person's social or occupational functioning. The author takes issue with the fact that social phobia is considered by many professionals to be a mental illness that is often treated best with medication. Social phobia can be conceptualized from a social work perspective as an extreme shyness that can be overcome with cognitive learning and behavioral rehearsal. This article reviews the biopsychosocial causes of social phobia and presents a summary of cognitive and behavioral interventions with empirically demonstrated effectiveness.

Small-group composition and peer effects

This paper reviews research on grouping of students within classes and its effects on learning. Primary consideration is given to grouping and mixing students by ability, though consideration is also given to grouping and mixing students by ethnicity and gender as well as to research on the effects of group size. Results of meta-analyses of grouping show a small but meaningful advantage of forming students into groups for instruction as compared to using whole-class instruction. In teacher-led, homogeneous ability groups, peer effects result from the normative environment to the extent that peers contribute to norms for behavior, constructed through cycles of reciprocal teacher–student interaction. In peer-led, heterogeneous ability groups, peer effects stem directly from group interactions and discourse among students that lead to cognitive restructuring, cognitive rehearsal, problem solving, and other forms of higher-level thinking. Similarly, in groups of different ethnic and gender composition, peer effects stem from interactions among students according to their perceived status and relative influence within the groups. We argue that these peer influences interact with instructional processes to mediate the effects of group composition on students’ learning.

Mental practice effect on line-tracing accuracy in persons with hemiparetic stroke: A preliminary study

Yoo E, Park E, Chung B. Mental practice effect on line-tracing accuracy in persons with hemiparetic stroke: a preliminary study. Arch Phys Med Rehabil 2001;82:1213-8. Objective: To investigate the effect of mental practice on line-tracing accuracy of persons with hemiparetic stroke. Design: A single-case, experimental, multiple baseline design. Setting: Electromyography laboratory of a rehabilitation medicine department of a university hospital. Participants: Three persons with right hemiparesis from stroke. Intervention: Mental practice for line-tracing training. Main Outcomes Measures: Two tracing tasks were used to evaluate the effect of mental practice: (1) tracing a 5.9-inch long horizontal line (task 1); and (2) tracing a 6-inch long curved line (task 2) as a generalization probe. Participants were first trained to master the cognitive rehearsal skill by checking the reduction level of tension in their upper trapezius while listening to a relaxation cassette tape. Second, participants were trained to trace task 1 immediately after listening to a cognitive rehearsal tape that contained the command to trace over a horizontal line as accurately as possible. Then, without the cognitive rehearsal process, participants traced over a curved line as a generalization probe. The dependent variable, called the line length error, was the total distance that the traced line deviated from the printed lines (both horizontal and curved). Results: Mean-line length errors of participants 1, 2, and 3 were: horizontal line tracing, 3.33, 7.38, and .30 inches, respectively, in the baseline and 1.41, 2.70, and .24 inches, respectively, after mental practice training. With the curved line tracing, mean length errors were 3.15, 6.56, and .52 inches in the baseline and 1.85, 4.36, and .80 inches postintervention, respectively. Conclusions: Mental practice can be an effective method to improve line tracing by persons with hemiparetic stroke. Training in horizontal line tracing showed a modest level of generalization to curved line tracing. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Empirically supported treatments in pediatric psychology: procedure-related pain.

To use the Chambless criteria for empirically supported treatments and determine if any interventions for procedure-related pain in children and adolescents can be designated as "well established," "probably efficacious," or "promising." The Chambless criteria were applied to 13 treatment outcome studies identified by a comprehensive literature review. A detailed summary is provided for each study, including the following information: citation, subjects, diagnostic criteria, baseline, experimental design, assessment measures, treatment protocol, outcome, and follow-up. Cognitive behavioral therapy is a "well-established treatment" for procedure-related pain in children and adolescents. Treatment includes breathing exercises and other forms of relaxation and distraction, imagery and other forms of cognitive coping skills, filmed modeling, reinforcement/incentive, behavioral rehearsal, and active coaching by a psychologist, parent, and/or medical staff member. I discuss future challenges for biobehavioral research and practice in the area of procedure-related pain.

Maintaining professionalism in the face of emotional abuse from clients

The harmful effects of emotional abuse have been studied in children, romantic relationships, and families, but little work has explored the phenomenon of therapists experiencing emotional abuse from their clients. The current paper examines the characteristics of emotional abuse as experienced by therapists, and presents methods by which clinicians can best maintain their professional decorum, responsibilities, objectivity, conceptual skills; and overall effectiveness in spite of aversive interactions with clients. Therapists can facilitate their own staying on task, and can reduce their subjective levels of stress by utilizing such self-help techniques as cognitive rehearsal, rational responding, assertiveness, and the use of social supports. These strategies help therapists to deal with patterns of hostile outbursts and boundary infringements from clients, without feeling helpless and burned out, and without terminating their clients prematurely out of desperation. Therapists also can remain suitably professional in managing emotionally abusive clients by making judicious use of documentation and supervisory consultations. Issues regarding appropriate termination of emotionally abusive clients are discussed in light of the ethical obligation not to abandon clients. The principle of “therapist self-preservation,” which takes into account the therapist's need to consider his or her own well-being, along with the client's, is addressed as well.

Effects of Mental Practice on Performance are Moderated by Cognitive Anxiety as Measured by the Sport Competition Anxiety Test

45 subjects were assessed for cognitive anxiety on the Sport Competition Anxiety Test. Two months later they observed a person performing a new motor task which required high cognitive processing to be performed well. After this observation, 22 subjects were randomly assigned to a Mental Practice and 23 to a Control group. The former performed a cognitive rehearsal of the task, whereas the latter did not. None practiced the task physically before being tested. Analysis of variance showed that both errors and performance time interacted significantly with Mental Practice versus Control group scores and scores on the Sport Competition Anxiety Test. Among subjects who practiced mentally, those scoring low on cognitive anxiety performed significantly better than subjects who scored high. Further, the relationship between test scores of cognitive anxiety and performance for the total sample was analysed by different curvilinear regression models. The cubic model fitted the data better and accounted for a greater percent of variance on error performance explained by anxiety test scores (R = .39) than the linear correlation (r = .25). This cubic model formed a polynomial relationship between cognitive anxiety test scores and error in performance.

Does mental practice enhance performance?

Mental practice is the cognitive rehearsal of a task prior to performance. Although most researchers contend that mental practice is an effective means of enhancing performance, a clear consensus is precluded because (a) mental practice is often denned so loosely as to include almost any type of mental preparation and (b) empirical results are inconclusive. A meta-analysis of the literature on mental practice was conducted to determine the effect of mental practice on performance and to identify conditions under which mental practice is most effective. Results indicated that mental practice has a positive and significant effect on performance, and the effectiveness of mental practice was moderated by the type of task, the retention interval between practice and performance, and the length or duration of the mental practice intervention. Mental practice refers to the cognitive rehearsal of a task in the absence of overt physical movement. When a musician practices a passage by thinking it through or when an athlete prepares for an event by visualizing the steps required to perform the task, he or she is engaging in mental practice. A number of studies have examined the effects of mental practice on performance. Whereas the research of Kelsey (1961) and Ryan and Simons (1982) supports the efficacy of mental practice for enhancing performance, Beasley (1978) reported negative results. An astute reviewer may be able to estimate the direction and magnitude of effect of the relationship between mental practice and performance from the preponderance of evidence across the majority of studies. For example, Richardson (1967a) concluded that most studies support the efficacy of mental practice on performance. However, Richardson, and later Corbin (1972), noted that this evidence was inconclusive. Because different studies use different types of tasks, with different types of subjects, and report different study statistics, it is difficult if not impossible to integrate these disparate research studies on an intuitive level to draw firm conclusions on the effectiveness of mental practice. The purpose of this study was to integrate the literature on mental practice, summarize the overall effects of mental practice on performance, and specify the conditions under which mental practice is most effective.

Symbolic Modeling and Cognitive Rehearsal

The research described in this article tested the social cognitive hypotheses that self-efficacy can be enhanced more effectively by symbolically modeling risk reduction information and by encouraging its cognitive rehearsal than by the presentation of risk reduction information alone. Young unmarried women (N = 138) viewed one of three videos: AIDS information only, information plus modeling, or information plus modeling with cognitive rehearsal. The hypotheses were confirmed at both posttest and one month follow-up: AIDS prevention self-efficacy was most improved among participants who watched the information plus modeling with rehearsal video, while participants viewing the information plus modeling video exhibited an intermediate level of improvement. Certain AIDS preventive behaviors, including condom purchases and conversations with friends about safe sex, also exhibited significant treatment-related changes at follow-up. These results indicate that symbolic modeling and cognitive rehearsal of modeled information are effective strategies for enhancing perceptions of self-efficacy through televised media.

Does the Grist Change the Mill? The Effect of the Perceiver's Inferential Goal on the Process of Social Inference

Previous research suggests that perceives estimate the cause of behavior by (a) identifying the behavior (b) inferring the actor's disposition from the behavior, and (c) correcting this inference for situational constraints. An experiment investigated whether perceivers' inferential goals alter this process. Perceivers viewed a silent videotape of an anxious interview. Some perceivers estimated the target's dispositional anxiety; others estimated the degree of anxiety provoked by the interview questions. Within these conditions, half simultaneously performed a cognitive rehearsal task. Of perceivers who estimated the target's dispositional anxiety, those who performed the rehearsal task inferred more dispositional anxiety. In contrast, of perceivers who estimated the anxiety provoked by the questions, those who performed the rehearsal task inferred less dispositional anxiety. These findings suggest that social inference is more flexible than previously thought.

Use of Sport Psychology Techniques by Professional Australian Football League Players

Responses to a postseason sport psychology questionnaire showed that most of the 22 members of a successful professional football team used cognitive rehearsal and self-instruction during or in preparation for games. Fewer players reported using relaxation strategies. Attitudes toward sport psychology were positive.

Stress and Trance in Freefall Parachuting: A Pilot Study

Freefall parachuting is a demanding activity which, at times, is profoundly stressful. Fifty-nine freefall parachutists completed a survey which dealt with parachuting experience, levels of perceived stress, sources of stress, episodes of altered consciousness, and use of hypnotic techniques in preparation for freefall. Over one third admitted to having experienced a "trance-like state" before, during, or after a jump; the same was true of a state of "altered consciousness." The great majority used mental imagery or another mental or physical technique to prepare for freefall. These results recall the theory that stress predisposes to hypnotic trance. Trance, when unconsciously evoked during emergencies (spontaneous dissociation), may account for some parachuting accidents. When consciously pursued, however, self-hypnosis may provide the jumper with a way to control his level of arousal, facilitate cognitive rehearsal, and enhance performance.

USE OF SPORT PSYCHOLOGY TECHNIQUES BY PROFESSIONAL AUSTRALIAN FOOTBALL LEAGUE PLAYERS

Responses to a postseason sport psychology questionnaire showed that most of the 22 members of a successful professional football team used cognitive rehearsal and self-instruction during or in preparation for games. Fewer players reported using relaxation strategies. Attitudes toward sport psychology were positive.

A Ten-Hour Social Skills Training Program on Giving and Receiving Criticism

Social skills programs have typically neglected the social skills of giving and receiving criticism, which recent studies indicate is a significant area of concern for college and university counseling services. A pretreatment interview and assessment is followed by a cognitive behavioral training program which includes cognitive restructuring, modeling, behavior rehearsal, homework, social support, and encouragement of in vivo practice between sessions. Brief commentary is given on the common themes and issues that emerge in the course of this type of group program.

Rehearsal for Widowhood

This study tested the hypothesis that rehearsal for widowhood would be associated with more positive long-term emotional adjustment. A total of 75 widowed women (aged 60–90) completed a questionnaire assessing short-term and long-term adjustment, as well as two domains of rehearsal: (1) cognitive rehearsal—the “work of worrying,” and (2) behavioral rehearsal (i.e., engaging in social comparison with similar others, planning and making decisions, and actually beginning to assume control of family finances, make new friends, etc.). The results indicate that behavioral rehearsal is associated with decreased emotional disruption and with better adjustment, whereas cognitive rehearsal may be associated with increased emotional disruption.

Reactivity, arousal, and coping with stress

This research stems from a recent finding (Klonowicz, 1987) that reactivity, which is considered as a basic dimension of temperament (Strelau, 1983), controls both the level of anticipatory arousal and its emotional tone. High reactives responded to conditions of uncertainty with a high level of general arousal and negative affect as reflected by their lesser readiness to work and higher self-reported levels of anxiety and tension. ‘Uncertainty’, in this study, referred to the questions of ‘what will happen’ and ‘when’ which constitute major sources of stress (Folkman, Schaefer and Lazarus, 1979; Lazarus and Launier, 1978). The negatively biased anticipation may reflect at least two phenomena. It seems possible that high reactives expect the worst and believe an unknown event to be potentially harmful. This pessimistic attitude may be the result of previous experience or general beliefs, like a belief in one’s own helplessness. The negative expectancy may interfere with effective coping both directly, through avoidance or unwillingness to initiate activity, and indirectly, by stimulating disruptive, negative emotions. Meichenbaum and Turk (1980) concluded that inadequate performance is related to self-referent negative thoughts involving preoccupation with imagined personal deficiencies, exaggerations of potential difficulties, and expectations of inefficacy. Carver and Scheier (1981) claim that worries are likely to reduce performance because they focus attention on the self rather than the relevant task. Another possibility is that the anticipatory ‘work of worrying’ may actually be a cognitive rehearsal which can facilitate the coping with future events (Breznitz, 1971; Fenz, 1975; Janis, 1958). This alternative suggests that there can be an advantage in the negative expectancy (cf. Epstein, 1973) even though it is inaccurate and will be eventually discarded (Klonowicz, 1987), because it may reduce the actual impact of a stimulus event. The current study was undertaken to investigate the effect of anticipated emotions on performance and aftereffects of performance in high and low reactive persons. The contrast in the two suggested outcomes of anticipatory arousal, increased or reduced performance, indicates that the empirical findings are thus far equivocal. While some data show that people can learn to modulate and use their emotions to good advantage, other data suggest the contrary. The effect of initial expectancies, or anticipation, depends on a number of factors such as the nature of the stressor and its duration (Averill, 1973; Harsh and Abbott, 1979), prior experience with the stressor (Epstein, Rosenthal and Szpiler, 1978; Fenz, 1975), controllability of the stressor or availability of means for coping, the duration of preparation time (i.e. the time allowed for anticipatory activity; Averill, O’Brien and Dewitt, 1977; Badia et al., 1979; Breznitz, 1967; Miller, 1979) accuracy of expectancies (Breznitz, 1976); individual differences in coping strategies (Averill et al., 1977; Miller, 1979), and stress relevant information (Averill, 1973; Cohen and Lazarus, 1973; Janis, 1958). Moreover, the literature suggests that there is no simple relationship between any of these factors and subsequent functioning and that the various factors interact in affecting performance. As an example, the classical studies of Fenz (1975) and Epstein indicated that the timing of anticipatory arousal depended on the experience with the stressor. The complexity of the variables and their effects is the reason why no specific hypotheses were formulated for the current study which concerns the effects of anticipation on subsequent functioning of lowand highreactive persons. An additional problem investigated in this study concerns the positive aftereffects of work. The literature in this area (Cohen, 1980; Klonowicz, 1973, 1974, 1985) suggests a great preoccupation