Compensatory Cognitive Training Research Articles

Comparative Effects of Exercise Interventions and Mindfulness-Based Interventions for Cognitive Impairment and Quality of Life in Breast Cancer Survivors During or After Cancer Treatment: A Systematic Review and Bayesian Network Meta-analysis.

The aim of this network meta-analysis was to compare the improvement effects of various exercise interventions and mindfulness-based interventions to determine the best interventions for the improvement of cognitive impairment. Seven databases were searched to screen randomized controlled trials of exercise interventions and mindfulness-based interventions to improve cognitive impairment. The network meta-analysis was performed using Revman 5.3, R 4.2.1 and ADDIS 1.16.8 software. Thirty-four randomized controlled trials involving 14 interventions were included in the study. In terms of cognitive function, except for mindfulness-based stress reduction, all interventions showed significantly greater improvement in cognitive function compared with conventional therapy. Physical activity and Qigong showed better effect in improving executive function. In terms of improving verbal memory, compensatory cognitive training, neurofeedback training, Qigong, and sham Qigong were more effective than other interventions. On performing surface under the cumulative ranking curve analysis, acceptance and commitment therapy, neurofeedback training, Qigong, and mediation had the best effects on cognitive function, quality of life, executive function, and processing speed, respectively. Mindfulness-based interventions were found to be more effective than exercise interventions for alleviating cognitive impairment. More robust randomized controlled trials focusing on acceptance and commitment therapy for cognitive impairment are required to support the current evidence.

Neuropsychological Correlates ofPTSD andDepressive Symptom Improvement inCompensatory Cognitive Training forVeterans With a History ofMild Traumatic Brain Injury.

Mild traumatic brain injury (mTBI), depression, and PTSD are highly prevalent in post-9/11 veterans. With the comorbidity of depression and PTSD in post-9/11 veterans with mTBI histories and their role in exacerbating cognitive and emotional dysfunction, interventions addressing cognitive and psychiatric functioning are critical. Compensatory Cognitive Training (CCT) is associated with improvements in prospective memory, attention, and executive functioning and has also yielded small-to-medium treatment effects on PTSD and depressive symptom severity. We sought to examine neuropsychological correlates of PTSD and depressive symptom improvement in veterans with a history of mTBI who received CCT. Thirty-seven post-9/11 veterans with mTBI histories and cognitive complaints received 10 weekly 120-minute CCT group sessions. Participants completed a baseline neuropsychological assessment, including tests of premorbid functioning, attention/working memory, processing speed, verbal learning/memory, and executive functioning, and completed psychiatric symptom measures (PTSD and depression) at baseline, post-treatment, and a 5-week follow-up. Paired samples t-tests were used to examine statistically significant changes in PTSD (total and symptom cluster scores) and depressive symptom scores over time. Pearson's correlations were calculated between neuropsychological scores and PTSD and depressive symptom change scores at post-treatment and follow-up. Neuropsychological measures identified as significantly correlated with psychiatric symptom change scores were entered as independent variables in multivariable regression analyses to examine their association with symptom change at post-treatment and follow-up. Over 50% of CCT participants had clinically meaningful improvement in depressive symptoms (≥17.5% score reduction), and over 20% had clinically meaningful improvement in PTSD symptoms (≥10-point improvement) at post-treatment and follow-up. Examination of PTSD symptom cluster scores revealed a statistically significant improvement in avoidance/numbing at follow-up. Bivariate correlations indicated that worse baseline performance on Category Fluency was moderately associated with PTSD symptom improvement at post-treatment. Worse performance on both Category Fluency and Category Switching Accuracy was associated with improvement in depressive symptoms at post-treatment and follow-up. Worse performance on Trail-Making Number-Letter Switching was also associated with improvement in depressive symptoms at follow-up. Subsequent regression analyses revealed that worse processing speed and worse aspects of executive functioning at baseline were associated with depressive symptom improvement at post-treatment and follow-up. Worse baseline performances on tests of processing speed and aspects of executive functioning were significantly associated with improvements in PTSD and depressive symptoms during the trial. Our results suggest that cognitive training may bolster skills that are helpful for PTSD and depressive symptom reduction and that those with worse baseline functioning may benefit more from treatment because they have more room to improve.

84 Preferred Compensatory Cognitive Training Strategies Among Older Adults with Mild Cognitive Difficulties

Objective:Older adults experiencing mild cognitive difficulties (MCD) may benefit from compensatory cognitive training (CCT) to address cognitive changes. CCT can be delivered over various lengths of time and can focus on a specific cognitive domain (e.g., memory) or multiple domains. Identifying the most relevant and impactful portions of a CCT intervention could allow for more effective and streamlined delivery of compensatory strategies, perhaps allowing this type of training to be included in feedback sessions or brief interventions. This study sought to investigate which factors older adults with MCD found to be most beneficial and applicable to their daily lives after completion of a brief telehealth CCT program.Participants and Methods:Adults age 55+ with documented MCD (n=28) and an optional care partner (CP; n=18) were recruited for video-chat delivery of a 6-week, motivationally-enhanced CCT program adapted from CogSMART. The six weeks included content addressing: Education and Lifestyle Strategies (Session 1); Organization, Prioritization, and Prospective Memory (Session 2); Attention, Concentration, and Working Memory (Session 3); Learning and Memory (Session 4); Executive Functions: Decision-Making, Problem-Solving, and Planning (Session 5); and Skills Integration and Next Steps (Session 6). After completing the course, participants (n=25) provided open-ended feedback on course content, including the areas they found most helpful. They were also asked which strategies from the course they had successfully applied in their daily lives, and which they expected to continue using following the course. Qualitative data were coded and analyzed by two researchers.Results:Participants most often endorsed strategies from Session 2 (44% of participants) and Session 3 (44%) as being helpful and applicable in daily life. Session 1 content was also frequently endorsed (36%). Content from Session 5 was noted to have been helpful/applicable least often (12%). Participants also reported having found common factors of the program to be helpful (35%), such as interaction with the clinician, education on relevant resources, or greater self-reflection and self-awareness through the program. A minority of participants reported “all” (22%) or “none” (24%) of the content to be helpful.Conclusions:Among older adults with MCD, strategies related to prospective memory (e.g., calendar training) and attention (e.g., mindfulness) were most frequently reported as being helpful and applicable in daily life. Participants reported confidence in their ability to continue using these strategies after the program, along with continued implementation of lifestyle factors to promote healthy brain aging (e.g., exercise). Clinicians interested in providing CCT to older adults with MCD may find the most benefit from emphasizing and prioritizing strategies within these domains. Future research could use ecological momentary assessment techniques to gather real-time measures of how these learned strategies are employed in daily life. Continued exploration of the most salient and effective compensatory strategies for older adults with MCD will support effective intervention and promote independence among aging patients.

Compensatory Cognitive Training for Psychosocial Outcomes and Self-Stigma in Individuals With Schizophrenia: A Randomized Controlled Trial Study

Individuals with schizophrenia often experience poor psychosocial outcomes and self-stigma. This study aimed to investigate the effect of compensatory cognitive training (CCT) on self-esteem, self-efficacy, quality of life, and self-stigma in schizophrenia. Forty-six participants with schizophrenia were randomly assigned to intervention (CCT group, n = 24) or treatment as usual (TAU group, n = 22). The Rosenberg Self-Esteem Scale (RSES), the General Self-Efficacy Scale (GSES), the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4), and the Internalized Stigma of Mental Illness Scale (ISMIS) were administered at pretest (T0), posttest (T1), and 1-month follow-up (T2). A significant result was found at T2 in the SQLS-R4 score between CCT and TAU groups ( P = 0.001). A significant result was also noted at T2 in the ISMIS score ( P = 0.004). These findings show that CCT contributes to improvement in quality of life and self-stigma in individuals with schizophrenia. Accordingly, CCT may enhance the effectiveness of psychiatric rehabilitation programs. [ Psychiatr Ann . 2023;53(10):473–481.]

Adding executive function training to cognitive behavioral therapy for binge eating disorder: A pilot randomized controlled trial

Evidence-based treatments for binge eating disorder (BED), such as cognitive behavioral therapy (CBT) lead to successful outcomes only about half the time. Individuals with BED often have measurable deficits in executive function (EF) that may challenge adherence to or impact of cognitive behavioral intervention components. The aim of this study was to evaluate the impact of adding EF training to CBT by combining CBT with a compensatory cognitive training approach (EF-CBT). Participants were 32 adults with BED, overweight/obesity, and comorbid anxiety or depression who were randomly assigned to four months of group treatment in either standard CBT or EF-CBT. Outcomes were assessed at baseline, post-treatment, and at 2-month follow-up. Results showed that EF-CBT was feasible and acceptable, comparable to CBT. Both groups significantly decreased loss of control (LOC) days, clinical impairment, and depression at post-treatment and 2-month follow-up; though there were no differences between groups. Neither group significantly reduced anxiety or weight. Exploratory analyses found that participants with lower EF treated with EF-CBT were less likely to have LOC at post-treatment than those with lower EF treated with CBT. Higher self-monitoring rates during treatment were associated with lower LOC at post-treatment and participants with lower EF were more likely to self-monitor in the EF-CBT arm relative to the CBT arm. These findings suggest that EF-CBT is feasible, acceptable and efficacious, although larger scale research is needed. EF-CBT may be particularly suited for individuals with BED who have lower EF.

Feasibility of a Telehealth Compensatory Cognitive Training Program for Older Adults with Mild Cognitive Impairment

ABSTRACT Objectives Older adults experiencing mild cognitive impairment (MCI) may benefit from compensatory cognitive training (CCT). This study investigated the feasibility of telehealth CCT among older adults with MCI. Methods Adults age 55+ with MCI (n = 28) and a care partner (n = 18) participated in telehealth CCT. Participants rated sessions’ technological interference on an adapted 0–100 session rating scale (higher scores=less interference). Clinicians provided ratings and qualitative feedback on types of interference experienced. Feasibility was assessed by enrollment and completion rates, and through ratings and feedback. Results 6% of contacts declined participation due to telehealth delivery. 24 of 28 participants completed the program, with no dropouts due to telehealth. Participants (M = 81.32, SD = 25.61) and clinicians (M = 76.24, SD = 33.37) rated technological interference as infrequent. Clinicians indicated most interference did not impact sessions, though 4% required rescheduling due to interference. Conclusions Telehealth delivery was not a barrier to recruitment, enrollment, or completion of CCT. Technological problems were mostly minor. Telehealth CCT could support access to and intervention among older adults with MCI. Clinical Implications Telehealth CCT for older adults with MCI was feasible, with mild issues not impacting session completion. Clinicians should be prepared to offer support as technological issues arise, or have dedicated technological support services.

Multi-method study of the implementation of Cognitive Symptom Management and Rehabilitation Training (CogSMART) in real-world settings

Cognitive Symptom Management and Rehabilitation Training (CogSMART) and Compensatory Cognitive Training (CCT) are evidence-based compensatory cognitive training interventions that improve cognition in persons with a history of traumatic brain injury or other neuropsychiatric disorders. Despite demonstrated efficacy, use and effectiveness of CogSMART/CCT in real-world settings is not known.We used a multi-method design to collect and analyze quantitative and qualitative survey data from several domains of the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to gather information about use of CogSMART/CCT in real-world settings from provider and patient perspectives. Surveys were sent to email addresses from persons who registered on the CogSMART website seeking access to training manuals and other resources. Descriptive statistics were generated, and we used Natural Language Processing methods to study the self-report free responses. Using n-gram analysis, we identified the most frequently reported responses.We found CogSMART/CCT was broadly used in real-world settings and delivered by a variety of providers for several patient groups with high attendance and overall high satisfaction. CogSMART/CCT seemed to be offered in VA- or university-related clinics more than in private practice or rehabilitation centers. The diversity of providers and variety of formats by which to deliver CogSMART/CCT (i.e., individual, group, telehealth) seemed to play a role in its widespread implementation, as did its adaptability. Most providers made adaptations to the intervention that reduced the length or number of sessions. These changes were most likely to be based on client characteristics. The low rates of formal training, however, may have contributed to lower levels of perceived helpfulness among patients.Reach and Adoption of a cognitive rehabilitation intervention improved by increasing access to the manuals. Attention to characteristics of dissemination and implementation in the design of an intervention may enhance its use in real-world settings. The relevant outcomes, easy access to training manuals, and adaptability of CogSMART/CCT seem to have been important factors in its use in a variety of settings and for several disorders with cognitive impairment. The adoption of CogSMART/CCT by a variety of providers other than neuropsychologists suggests its use may be broadened to other healthcare providers, if adequately trained, to increase access to an intervention with demonstrated efficacy for cognitive rehabilitation for several neuropsychiatric disorders.

Effect of a Combined Cognitive and Vocational Intervention on Change in HRQoL after TBI

<h3>Research Objectives</h3> To compare the effect of a combined cognitive and vocational intervention to treatment as usual (TAU) on change in health-related quality of life (HRQoL) after mild-to-moderate traumatic brain injury (TBI). <h3>Design</h3> Randomized controlled trial. <h3>Setting</h3> Specialized TBI outpatient clinic at Oslo University Hospital, Norway. <h3>Participants</h3> 116 patients aged 18-60 years with mild-to-moderate TBI were recruited 8-12 weeks post injury and randomized to the study intervention (n=60) or TAU (n=56). The participants' mean age was 42 years (SD 9.8) and 60% (n = 69) were female. Injury severity was mild in 94% of cases and the most frequent cause of injury were falls (43%). <h3>Interventions</h3> Compensatory Cognitive Training (CCT) and Supported Employment (SE) or multidisciplinary TAU provided for a maximum of six months. <h3>Main Outcome Measures</h3> HRQoL assessed at baseline, 3, 6 and 12 months using the 5-level EQ-5D version (EQ-5D-5L). EQ-5D-5L scores were converted into an index value ranging from 1 (full health) to 0 (worst possible health) using the Danish value set. <h3>Results</h3> At baseline, the mean (SD) EQ-5D-5L index values were 0.65 (0.15) for CCT-SE and 0.71 (0.12) for TAU. At 3 months, the index values were 0.71 (0.13) for CCT-SE and 0.75 (0.11) for TAU. At 6 months, the index value was 0.74 (0.15) for CCT-SE and 0.75 (0.16) for TAU. At 12 months, the index value was 0.76 (0.13) for CCT-SE and 0.78 (0.15) for TAU. Change in index value from baseline to 12 months was 0.11 in CCT-SE and 0.07 in the TAU group. <h3>Conclusions</h3> The CCT-SE intervention was associated with a greater improvement in HRQoL over 12 months when compared to TAU with improvement in the range of previously reported minimum clinically important difference for EQ-5D. <h3>Author(s) Disclosures</h3> The authors report no conflicts of interest.

Cognitively Assistive Robots at Home: Translating Clinical Interventions to Robots.

Much research in healthcare robotics explores extending rehabilitative interventions to the home. However, for adults, little guidance exists on how to translate human-delivered, clinic-based interventions into robot-delivered, home-based ones to support longitudinal interaction. This is particularly problematic for neurorehabilitation, where adults with cognitive impairments require unique styles of interaction to avoid frustration or overstimulation. For the past several years, our team has worked with neuropsychologists to develop cognitively assistive robots (CARs) that administer compensatory cognitive training (CCT) autonomously and longitudinally to people with mild cognitive impairment (PwMCI) at home. Our system helps users practice cognitive strategies to strengthen skills such as attention, learning/memory, and executive functioning. We explore the design of robot-delivered neurorehabilitation interventions for PwMCI. We used these prototypes as design probes to understand how neuropsychologists (n=6) envision translating CCT to a CAR, and features the robot intervention needs to be successful, such as supporting goal setting, content personalization, encouragement for real-world transfer, and ways to longitudinally maintain engagement. We also conducted interviews with PwMCI (n=3), the end users of the robot-administered intervention. We report our findings and specify design patterns and considerations for translating neurorehabilitation interventions to robots. First, we provide insights for translating neurorehabilitation interventions to CARs in order to contextualize them to the lives of PwMCI. Second, we present new interaction design patterns for robot-delivered neurorehabilitation interventions to maintain longitudinal engagement and intervention efficacy. Finally, we propose design considerations for developing robots for PwMCI, a population with unique needs and abilities distinct from those of people with dementia and older adults [1]. This work will serve as a basis for future endeavors to translate cognitive training and other clinical interventions onto a robot, support longitudinal engagement with home-deployed robots, and ultimately extend the accessibility of longitudinal health interventions for people with cognitive impairments. [1] Kubota, A., Cruz-Sandoval, D., Kim, S., Twamley, E., and Riek, L.D. "Cognitively Assistive Robots at Home: HRI Design Patterns for Translational Science." In Proceedings of the 17th Annual ACM/IEEE Conference on Human Robot Interaction (HRI). 2022.

A-114 Feasibility of Telehealth Compensatory Cognitive Training for Older Adults with Mild Cognitive Difficulties

Objective: Older adults (OA) experiencing mild cognitive difficulties (MCD) may benefit from compensatory cognitive training (CCT) to address cognitive changes. CCT is typically delivered in person, which was not possible during the COVID-19 pandemic. This study sought to investigate the feasibility of a telehealth CCT program among OA with MCD.Method: Adults age 55+ with documented MCD (n = 28) and an optional care partner (CP; n = 18) were recruited for video-chat delivery of a 6-week, motivationally-enhanced CCT program. Participants and CPs rated technological interference following sessions on a 0 to 100 scale (higher scores = less interference), as did clinicians. Participants and CPs also provided feedback on the benefits and drawbacks of telehealth. Feasibility was assessed by tracking enrollment and completion rates, session ratings, and qualitative feedback.Results: Of 78 potential participants, only 6% declined participation due to telehealth delivery. Eighty-six percent of participants (N = 24/28) completed the program, and no dropouts were due to telehealth. Participants (M = 81.32, SD = 25.61) and clinicians (M = 76.24, SD = 33.37) rated technological interference as occurring infrequently, though 4% of sessions were rescheduled due to technological problems. Qualitative feedback highlighted the convenience of telehealth and the drawback of mild frustration while navigating technical interference.Conclusion: Telehealth CCT was found to be feasible among OA with MCD and their CPs. Telehealth delivery was not a barrier to recruitment, enrollment, or completion of the program, and technological problems were mostly minor. The feasibility of telehealth CCT could increase access to underserved OA and, in turn, support early detection and intervention among an at-risk population.

P516. Compensatory Cognitive Training (CCT) Among Latinx Youth at Clinical High-Risk (CHR) for Psychosis: An Analysis of the Feasibility of a Collaborative United States and Mexico Randomized Controlled Trial (Progresar)

Individuals at clinical high-risk (CHR) for psychosis experience significant neurocognitive and functional deficits. Compensatory Cognitive Training (CCT), a manualized treatment, targets these deficits by teaching cognitive strategies to compensate for deficits associated with psychosis. Importantly, there is a dearth of psychosocial treatments for CHR minority youth. Latinx populations comprise the largest minority group in California, indicating a need to explore the feasibility and cultural adaptability of a CCT intervention in both the United States and Mexico.

A Randomized Pilot Study of a Cognitive Intervention for the Elderly with Mild Cognitive Impairment

The extension of life increased the prevalence of many non-communicable and chronic diseases, including neurodegenerative diseases. Identifying Mild Cognitive Impairment (MCI) in the early stage would allow to providing intervention at early that may reduce the progression of Alzheimer’s and other related cognitive disorders. The present study aimed to examine the effects of a new Indian adapted Motivationally Enhanced Compensatory Cognitive Training program for the elderly with MCI (IAME-CCT-MCI). This is a 4-week intervention program, utilized randomized pilot study with single-group pretest-posttest design conducted with 32 elderly participants screened with MCI using Tamil version of Montreal Cognitive Assessment (T-MoCA). The primary outcome measure was T-MoCA used to measure cognitive impairment, followed by PGI Battery for Assessment of Mental Efficiency in the Elderly (PGI-BAMEE). PGI Memory Scale (PGI-MS) was used to measure as the secondary outcome. The PGI-BAMEE consists of four subtests to assess mental efficiency, general information, orientation towards time and place, perceptuo-motor functions, and depressive symptomology. Whereas, the PGI-MS contains a detailed assessment of ten types of memory, viz., remote memory, recent memory, attention-concentration, delayed recall, immediate recall, verbal retention for similar pairs, verbal retention for dissimilar pairs, visual retention, and recognition. Through the paired t-test analysis, the IAME-CCT-MCI intervention program significantly improved the T-MoCA score and PGI-Memory Scale scores. The subtests of PGI-BAMEE were also significantly improved during the immediate pretest-posttest period. The findings provides preliminary support for the potential efficacy of the IAME-CCT-MCI cognitive intervention when delivered to the elderly with MCI.

A Conceptual View of Cognitive Intervention in Older Adults With and Without Cognitive Decline-A Systemic Review.

Background: Dementia is the one of the most common and prominent disease in the elderly person that results in the Cognitive interventions. In this study, we aim to conceptualize the cognitive intervention for older adults with and without cognitive dysfunction and to clarify the heterogeneity existing in this literature field by determining the main variables implicated. Methods: We conducted a study analysis using previous literature highlighting the significant data reporting empirical results from cognitive intervention for healthy older adults and other seniors with different types of dementia. Each paper was reviewed in terms of compensatory cognitive training, cognitive remediation, enrichment, cognitive activation, brain training, cognitive stimulation, cognitive training, and cognitive rehabilitation. The research analysis was performed following rigorous inclusion and exclusion criteria with the purpose of collecting relevant answers to our research questions. Results: We included a total of 168 studies in our review. Our findings indicated heterogeneity regarding methods, concepts, and procedures. Additionally, the values were integrated using different information existing in this field. Conclusion: In conclusion, we highlighted that this is the first review that clarify the discrepancy of various existing definitions, methods, and procedures, as well as the overlapping information in the cognitive interventions.

Digital Compensatory Cognitive Training for Older Adults with Memory Complaints

ABSTRACT Many older people experience everyday memory complaints which can be a precursor condition to mild cognitive impairment and dementia. Research has consistently shown that compensatory cognitive training (CCT) benefits cognition in older adults. Providing CCT in a computerized format makes it more accessible and reduces its costs. We studied a newly developed digital CCT for older adults with everyday memory complaints that is multi-factorial and based on empirically supported techniques to improve memory. 55 older adults with self-reported everyday memory complaints participated in a study with outcomes assessed at baseline and post-intervention. We found that participants in the experimental condition improved significantly on the main objective outcome measure assessing associative memory compared to participants in a waitlist control condition. Specifically, after correcting for learning effects, 28% of participants in the experimental condition showed a reliable improvement. No effects were found on other objective outcome measures, most notably those assessing transfer to novel tasks. Participants in the experimental condition scored higher on measures of memory satisfaction, use of internal memory strategies, and quality of life. These findings contribute to existing knowledge on CCT by providing partial evidence for the efficacy of a digital CCT for older adults with everyday memory complaints. We recommend the use of digital CCT for older adults who experience memory complaints in their everyday life, but who do not qualify for medical treatment. Particular attention needs to be given to enhancing transfer of the learned strategies to everyday life.

Cost-effectiveness analysis of combined cognitive and vocational rehabilitation in patients with mild-to-moderate TBI: results from a randomized controlled trial

BackgroundTraumatic brain injury (TBI) represents a financial burden to the healthcare system, patients, their families and society. Rehabilitation interventions with the potential for reducing costs associated with TBI are demanded. This study evaluated the cost-effectiveness of a randomized, controlled, parallel group trial that compared the effectiveness of a combined cognitive and vocational intervention to treatment as usual (TAU) on vocational outcomes.MethodsOne-hundred sixteen participants with mild-to-moderate TBI were recruited from an outpatient clinic at Oslo University Hospital, Norway. They were randomized to a cognitive rehabilitation intervention (Compensatory Cognitive Training, CCT) and Supported Employment (SE) or TAU in a 1:1 ratio. Costs of CCT-SE and TAU, healthcare services, informal care and productivity loss were assessed 3, 6 and 12 months after study inclusion. Cost-effectiveness was evaluated from the difference in number of days until return to pre-injury work levels between CCT-SE and TAU and quality-adjusted life years (QALYs) derived from the EQ-5D-5L across 12 months follow-up. Cost-utility was expressed in incremental cost-effectiveness ratio (ICER).ResultsThe mean total costs of healthcare services was € 3,281 in the CCT-SE group and € 2,300 in TAU, informal care was € 2,761 in CCT-SE and € 3,591 in TAU, and productivity loss was € 30,738 in CCT-SE and € 33,401 in TAU. Costs related to productivity loss accounted for 84% of the total costs. From a healthcare perspective, the ICER was € 56 per day earlier back to work in the CCT-SE group. Given a threshold of € 27,500 per QALY gained, adjusting for baseline difference in EQ-5D-5L index values revealed a net monetary benefit (NMB) of € -561 (0.009*27,500–979) from the healthcare perspective, indicating higher incremental costs for the CCT-SE group. From the societal perspective, the NMB was € 1,566 (0.009*27,500-(-1,319)), indicating that the CCT-SE intervention was a cost-effective alternative to TAU.ConclusionsCosts associated with productivity loss accounted for the majority of costs in both groups and were lower in the CCT-SE group. The CCT-SE intervention was a cost-effective alternative to TAU when considering the societal perspective, but not from a healthcare perspective.Trial registrationClinicalTrails.gov NCT03092713.

Integrated Cognitive-Behavioral Social Skills Training and Compensatory Cognitive Training for Negative Symptoms of Psychosis: Effects in a Pilot Randomized Controlled Trial.

Negative symptoms and cognitive impairment in schizophrenia (SZ) remain unmet treatment needs as they are highly prevalent, associated with poor functional outcomes, and resistant to pharmacologic treatment. The current pilot randomized controlled trial examined the efficacy of an integrated Cognitive-Behavioral Social Skills Training and Compensatory Cognitive Training (CBSST-CCT) intervention compared to Goal-focused Supportive Contact (SC) on negative symptoms and cognitive performance. Fifty-five adults with SZ or schizoaffective disorder with moderate-to-severe negative symptoms were randomized to receive 25 twice-weekly, 1-h manualized group sessions (12.5 weeks total duration) of either CBSST-CCT or SC delivered by master's level clinicians in five community settings. Assessments of negative symptom severity (primary outcomes) and neuropsychological performance, functional capacity, social skills performance, and self-reported functional ability/everyday functioning, psychiatric symptom severity, and motivation (secondary outcomes) were administered at baseline, mid-treatment, post-treatment, and 6-month follow-up. Mixed-effects models using baseline, mid-treatment, and post-treatment data demonstrated significant CBSST-CCT-associated effects on negative symptom severity, as assessed by the Scale for the Assessment of Negative Symptoms (p = .049, r = 0.22), with improvements in diminished motivation driving this effect (p = .037, r = 0.24). The CBSST-CCT group also demonstrated improved verbal learning compared to SC participants (p = .026, r = 0.36). The effects of CBSST-CCT appeared to be durable at 6-month follow-up. CBSST-CCT improved negative symptom severity and verbal learning in high-negative-symptom individuals relative to SC. CBSST-CCT warrants larger investigations to examine its efficacy in treating negative symptoms, along with other symptoms, cognition, and, ultimately, real-world functional outcomes. Clinical Trial registration number NCT02170051.

A-88 College Students with Depression or Anxiety: Greater Subjective Cognitive Concerns, Lower Academic Self-Efficacy, but Comparable Compensatory Cognitive Strategy Use

Abstract Objective This study examined whether college students with and without depression or anxiety differed in subjective cognitive concerns, college self-efficacy, and compensatory cognitive strategy use, hypothesizing that students with depression or anxiety would report greater cognitive concerns and lower self-efficacy in coursework, but comparable frequencies of compensatory cognitive strategy use. If confirmed, this finding would imply that, despite greater cognitive and academic problems, students with depression or anxiety do not implement behaviors in their everyday lives to address these problems. Method Participants (N = 582; age: 19.0 ± 1.0 years-old; 79.4% women; 81.9% White) completed online self-report questionnaires on subjective cognitive functioning, academic self-efficacy, compensatory cognitive strategy use, and depression and anxiety symptoms, which were used to categorize participants as having anxiety or depression based on established clinical cutoffs. Results Participants with anxiety or depression reported higher rates of elevated cognitive concerns, χ2 = 108.70, p &amp;lt; 0.001, OR = 7.75, and lower academic self-efficacy, t = 8.46, p &amp;lt; 0.001, d = 0.71, compared to participants without anxiety or depression, but these groups differed only modestly in compensatory cognitive strategy use, t = 2.42, p = 0.016, d = 0.20. Conclusion(s) Most students with depression or anxiety had elevated subjective cognitive concerns (52.0%), compared to a minority of participants without these conditions (12.3%). Despite substantially elevated cognitive concerns, participants with anxiety or depression reported only modestly greater compensatory cognitive strategy use. There appears to be a need to address cognitive concerns in college students with psychiatric conditions, and compensatory cognitive training may be a valuable supplemental service for clinicians working with college students in mental healthcare settings.

A-135 Telehealth Motivationally Enhanced Compensatory Cognitive Training for Older Veterans with Cognitive Complaints: A Pilot Study

Abstract Objective This study evaluated the effectiveness of Motivationally Enhanced Compensatory Cognitive Training (ME-CCT), conducted via telehealth. Cognitive performance, self-reported functioning, and activity engagement were expected to improve following participation. Compensatory strategy use was projected to predict posttest memory performance. Method Data from VA electronic medical records was obtained for five veterans (80% male; ages 68–84) who completed an 8-week ME-CCT protocol via telehealth. All completed pre/post neuropsychological screening (RBANS subtests, Oral TMT-B [O-TMT-B]) and self-report measures (PHQ-9, GAD-7, WHODAS, Multifactorial Memory Questionnaire [MMQ]). All had cognitive complaints but no cognitive disorder. Wilcoxon signed-rank test compared pretest-posttest scores. Hierarchical linear regression examined whether strategy use was predictive of posttest memory scores, controlling for age and pretest scores. Results O-TMT-B time (Z = -1.75, p = 0.040, r = −0.78) and errors (Z = -1.73; p = 0.042, r = −0.77) improved significantly, but not semantic fluency (p = 0.358). Immediate (p = 0.055) and Delayed Memory (p = 0.447) did not change. MMQ-Strategy increased (Z = -1.826; p = 0.034, r = −0.82). MMQ-Abilities (p = 0.055, r = −0.82) and MMQ-Satisfaction (p = 0.143 r = −0.48,) did not differ but showed a moderate to large effect. PHQ-9 was lower (Z = -1.841, p = 0.033, r = −0.82); there was a non-significant but large effect on GAD-7 (Z = -1.414, p = 0.079, r = −0.63). WHODAS-Total did not differ (p = 0.231). Use of strategies did not predict Immediate (p = 0.669) or Delayed (p = 0.631) Memory scores. Conclusions Preliminary findings support the use of the ME-CCT protocol with older adults via telehealth, as results suggest possible improvement in aspects of cognition, greater use of strategies, and reductions in mood-related symptoms. Further research with a larger sample is needed to replicate the results and further explore possible outcomes following ME-CCT.

Compensatory Cognitive Training—Cultural Adaptation to Persons with Schizophrenia in India

Compensatory Cognitive Training—Cultural Adaptation to Persons with Schizophrenia in India

Effects of Smartphone-Based Compensatory Cognitive Training and Physical Activity on Cognition, Depression, and Self-Esteem in Women with Subjective Cognitive Decline.

Subjective cognitive decline is a symptom that may appear in the early stages of Alzheimer’s disease. This study examined the effects of smartphone-based calendar training and walking exercise regimen on postmenopausal women experiencing subjective cognitive decline. Experimental group 1 participated in both calendar training and walking exercise, group 2 participated in calendar training only, and the control group did not receive either intervention. Forty-two participants completed a cognitive function test and questionnaire upon entering the study and 12 weeks later. The controlled oral word association score increased in experimental groups 1 and 2 and decreased in the control group. Memory contentment increased in experimental group 1, maintained in experimental group 2, and decreased in the control group. Smartphone-based calendar training and a walking exercise regimen improved executive function and memory contentment in everyday life, but the effects on depressive symptoms and self-esteem were not significant. Our findings demonstrate that smartphone-based calendar training and walking exercise improved cognitive function and have potential as nonpharmacologic interventions to strengthen cognitive function in women experiencing subjective cognitive decline.