Remediation Training Research Articles

Remote group therapies for cognitive health in schizophrenia-spectrum disorders: Feasible, acceptable, engaging

Severe cognitive impairments and cognitive distortions are core to schizophrenia-spectrum disorders (SSDs) and are associated with deteriorated social functioning. Despite well-established efficacy of group psychosocial therapies targeting cognitive health in SSDs, dissemination of these programs remains limited. Remote delivery offers a promising strategy for increasing the programs' accessibility. Yet, little research has evaluated group therapies for cognitive health delivered in this way. Thus, we aimed to assess, from participants' and therapists' perspectives, the feasibility, acceptability, as well as levels and process of engagement in a videoconference delivery of group psychosocial therapies for SSD patients' cognitive health. Participants, outpatients, attended Action Based Cognitive Remediation or Metacognitive Training, both adapted for videoconference. Then, participants and therapists completed post-therapy questionnaires. Of the 28 participants attending at least one session, 75% completed more than half of sessions and seven dropped out. Technology did not appear to significantly hinder participation in the programs. All completing participants reported a positive experience with therapy, 67% were not bothered by the distance from the therapist, and 77% trusted that the information shared was kept confidential. Therapist-rated levels of attention M = 7.5/9 (SD = 1.04), participation M = 6.91/9 (SD = 1.32), and social interactions M = 5.31/9 (SD = 1.96) were satisfactory. Nonetheless, participants indicated that they would have appreciated more social interactions with group members. These positive results validate the earliest stage in the implementation process for remote group therapies targeting cognitive health in SSDs. Remote delivery promises to improve access to therapies targeting cognitive health and, ultimately, facilitate functional recovery for SSD patients.

The Implementation and Review of Cognitive Remediation Training for First Episode Psychosis in Singapore.

Objective: Early intervention in patients with first episode psychosis (FEP) can improve cognitive abilities, with both short- and long-term benefits. In this paper, we describe the implementation and review of cognitive remediation training (CRT) in an Asian FEP population. The outcomes of the training are also evaluated and discussed.Methods: This naturalistic paper describes in detail the real-life implementation and conduct of CRT in an early psychosis intervention service. One hundred and nine patients with FEP underwent a 24-session CRT programme, using Cogpack and Neuropsychological Educational Approach to Remediation. The program is evaluated with pre- and post-CRT assessment scores which included Montreal Cognitive Assessment and Brief Assessment of Cognition in Schizophrenia. The rates of improvement on these cognitive assessments were evaluated using paired t-tests, with statistical significance set at p ≤ 0.05.Results: Of the 109 patients who underwent CRT, a total of 92 (84.4%) completed all 24 sessions. Paired t-tests between pre- and post-CRT assessments scores revealed that participants significantly improved on majority of the measures, including verbal memory, digit sequencing, and symbol coding.Conclusion: As with other cognitive remediation programmes, CRT has shown to improve cognitive functioning in patients with FEP. The results support the use of CRT in an Asian context and may serve as guidance for the implementation of similar training programmes in other Asian early psychosis intervention services.

Resident Remediation in Family Medicine Residency Programs: A CERA Survey of Program Directors.

Identifying underperforming residents and helping them become fully competent physicians is an important faculty responsibility. The process to identify and remediate these learners varies greatly between programs. The objective of this study was to evaluate the remediation landscape in family medicine residency programs by investigating resident remediation characteristics, tools to improve the process, and remediation challenges. This study analyzed responses from the Council of Academic Family Medicine Educational Research Alliance (CERA) national survey of family medicine program directors in 2017. Survey questions included topics on faculty remediation training, remediation prevalence, tools for remediation, and barriers to remediation. Two hundred sixty-seven of 503 program directors completed our survey (53% response rate). Most residency programs (245/264, 93%) had at least one resident undergoing remediation in the last 3 years. A majority (242/265, 91%) of residents undergoing remediation were successful within 12 months. The three most important tools to improve remediation were an accessible remediation toolkit (50%), formal remediation recommendations from national family medicine organizations (20%), and on-site faculty development and training (19%). The top-two challenges to the remediation process were a lack of documented evaluations to trigger remediation and a lack of faculty knowledge and skills with effective remediation strategies. Residents needing remediation are common, but most were successfully remediated within 12 months. Program directors wanted access to a standardized toolkit to help guide the remediation process.

Social and occupational recovery in early psychosis: a systematic review and meta-analysis of psychosocial interventions.

Psychosis, even in its early stages, ranks highly among the causes of disability worldwide, resulting in an increased focus on improved recovery of social and occupational functioning. This study aimed to provide an estimate of the effectiveness of psychosocial interventions for improving functioning in early psychosis. We also sought evidence of superiority between intervention approaches. An electronic search was conducted using PubMed and PsycINFO to identify original articles reporting on trials of psychosocial interventions in early-stage psychosis, published up to December 2020 and is reported following PRISMA guidelines. Data were extracted on validated measures of functioning from included studies and pooled standardised mean difference (SMD) was estimated. In total, 31 studies involving 2811 participants were included, focusing on: cognitive behavioural therapy for psychosis (CBTp), family-based therapy, supported employment, cognitive remediation training (CRT) and multi-component psychosocial interventions. Across interventions, improved function was observed (SMD = 0.239; 95% confidence interval 0.115-0.364, p < 0.001). Effect sizes varied by intervention type, stage of illness, length and duration of treatment and outcome measure used. In particular, interventions based on CRT significantly outperformed symptom-focused CBT interventions, while multi-component interventions were associated with largest gains. Psychosocial interventions, particularly when provided as part of a multi-component intervention model and delivered in community-based settings are associated with significant improvements in social and occupational function. This review underscores the value of sensitively tracking and targeting psychosocial function as part of the standard provided by early intervention services.

An fMRI study of cognitive remediation in drug-naïve subjects diagnosed with first episode schizophrenia.

ObjectiveThe purpose of our functional magnetic resonance imaging (fMRI) study was to examine brain activity using a “1-back” paradigm as working memory task in drug-naïve subjects with first episode schizophrenia before and after cognitive remediation training.MethodsIn this study 15 drug-naïve first episode subjects who met DSM-IV criteria for schizophrenia were randomized to receive either atypical antipsychotics (AP, n = 8) or atypical antipsychotics in combination with cognitive remediation therapy (AP + CR, n = 7), 11 subjects had a follow-up fMRI examination after therapy (AP, n = 5; AP + CR, n = 6).ResultsIn 4 of the 6 AP + CR subjects the number of activation clusters increased, whereas in 4 out of the 5 AP subjects the number of clusters decreased (mean number of clusters: AP + CR = 5.53, SD 12.79, AP = −5.8, SD 6.9).ConclusionIn this randomized study the number of activation clusters during a working memory task increased after cognitive remediation training. Our data show that neurobiological effects of cognitive remediation can be identified in the very early course of schizophrenia.

Treatment of anorexia nervosa in young people with autism: a literature review

AimsThe purpose of this review was to review existing literature relating to treatment of anorexia nervosa in young people with a diagnosis of autism. Hypothesis was that there would be a limited amount of literature in this age group.Previous research has suggested that there is over-representation of autistic traits in anorexia nervosa. There are implications for treatment outcomes for young people with anorexia nervosa and autism. Young people with autism may find it more difficult to engage in psychological treatments for anorexia nervosa, due to cognitive and behavioural inflexibility, or communication difficulties. Researchers are therefore looking at other options for treatment.MethodThis is a narrative review. Search was conducted in January 2020. Keywords used were “anorexia nervosa” combined with “autism” combined with “treatment”. Only published, peer-reviewed, full articles in English were included. Search of OVID (for MEDLINE, PsycINFO, EMBASE and ERIC databases) gave a result of 222 articles. 9 articles met the inclusion criteria. Search of CINAHL gave a result of 12 articles; 3 articles met the inclusion criteria but had been reviewed following OVID search.ResultThemes identified for discussion were: cognitive remediation therapy; improving emotional identification; adaptations to communication; dietary, sensory and environmental considerations; recognising the role of autism; and pharmacological therapies.ConclusionLiterature suggests that treatment targeting cognitive features, common to anorexia nervosa and autism, can be effective. There has been interest in the use of cognitive remediation therapy (CRT) and cognitive remediation and emotion skills training (CREST). However, more research is required in younger patient groups. Use of medication is in experimental stages, with studies considering a role for oxytocin from age 16. Qualitative studies provide information on modifications to treatment which could be helpful. The review highlights the need for a standardised, evidence-based treatment pathway for this patient group.

Improved Mild Closed Head Traumatic Brain Injury Outcomes With a Brain-Computer Interface Amplified Cognitive Remediation Training.

This study is a retrospective chart review of 200 clients who participated in a non-verbal restorative cognitive remediation training (rCRT) program between 2012 and 2020. Each client participated in the program for about 16 weeks, and the study as a whole occurred over a five-year period. The program was applied to effect proper neural functional remodeling needed to support resilient, flexible, and adaptable behaviors after encountering a mild closed head traumatic brain injury (mTBI). The rCRT program focused on improving functional performance in executive cognitive control networks as defined by fMRI studies. All rCRT activities were delivered in a semi-game-like manner, incorporating a brain-computer interface (BCI) that provided in-the-moment neural network performance integrity metrics (nPIMs) used to adjust the level of play required to properly engage long-term potentiation (LTP) and long-term depression (LTD) network learning rules.This study reports on t-test and Reliable Change Index (RCI) changes found within individual cognitive abilities’ performance metrics derived from the Woodcock-Johnson Cognitive Abilities III Test. We compared pre- and post-scores from seven cognitive abilities considered dependent on executive cognitive control networks against seven non-executive control abilities. We observed significant improvements (p < 10-4) with large Cohen’s deffect sizes (0.78-1.20) across 13 of 14 cognitive ability domains with a medium effect size (0.49) on the remaining one. The mean percent change for the pooled trained domain was double that observed for the pooled untrained domain, at 17.2% versus 8.3%, respectively. To further adjust for practice effects, practice effect RCI values were computed and further supported the effectiveness of the rCRT (trained RCI 1.4-4.8; untrained RCI 0.­08-0.75).

Side effects of the metacognitive training for depression compared to a cognitive remediation training in patients with depression

Although awareness of side effects over the course of psychotherapy is growing, side effects are still not always reported. The purpose of the present study was to examine side effects in a randomized controlled trial comparing Metacognitive Training for Depression (D-MCT) and a cognitive remediation training in patients with depression. 84 patients were randomized to receive either D-MCT or cognitive remediation training (MyBrainTraining) for 8 weeks. Side effects were assessed after the completion of each intervention (post) using the Short Inventory of the Assessment of Negative Effects (SIAN) and again 6 months later (follow-up) using the Negative Effects Questionnaire (NEQ). D-MCT and MyBrainTraining did not differ significantly in the number of side effects. At post assessment, 50% of the D-MCT group and 59% of the MyBrainTraining group reported at least one side effect in the SIAN. The most frequently reported side effect was disappointment in subjective benefit of study treatment. At follow-up, 52% reported at least one side effect related to MyBrainTraining, while 34% reported at least one side effect related to the D-MCT in the NEQ. The most frequently reported side effects fell into the categories of “symptoms” and “quality”. Our NEQ version was missing one item due to a technical error. Also, allegiance effects should be considered. The sample size resulted in low statistical power. The relatively tolerable number of side effects suggests D-MCT and MyBrainTraining are safe and well-received treatment options for people with depression. Future studies should also measure negative effects to corroborate our results.

Psychological training to improve psychosocial function in patients with major depressive disorder: A randomised clinical trial

Cognitive and emotional remediation training for depression (CERT-D): a randomised controlled trial to improve cognitive, emotional and functional outcomes in depressionThe aim of the current study was to evaluate an experimental treatment designed to improve psychosocial function in patients with Major Depressive Disorder (MDD) by reinforcing cognitive, emotional, and social-cognitive abilities. Participants (N = 112) with current or lifetime MDD were recruited to participate in a randomised, blinded, controlled trial. Exclusion criteria included diagnosis of a substance abuse disorder, bipolar disorder organic, eating disorders, or illness which affect cognitive function. The treatment involved repeated cognitive training designed to improve cognitive, emotional, and social-cognitive abilities. In training sessions, the principles of cognitive training were applied across cognitive, emotional, and social domains, with participants completing repeated mental exercises. Exercises included critically analysing interpretations of social interactions (e.g., body language), exploring emotional reactions to stimuli, and completing game-like cognitive training tasks. Training sessions placed great emphasis on the application of trained cognitive, emotional, and social cognitive skills to psychosocial outcomes. Outcomes demonstrated significant improvement in psychosocial function, symptom severity, self-reported cognition, and social-cognition. Our findings demonstrate the efficacy of multi-domain cognitive training to improve psychosocial functioning in individuals with MDD. We suggest that the present treatment could be deployed at a lower cost and with minimal training in comparison to established psychological therapies.

A Novel Method for Assessing and Training Everyday Functional Skills

Older adults, especially those with cognitive impairments often experience difficulty performing everyday tasks such as medication management, which threatens independence. Thus, there is an interest in developing treatment approaches for those who are experiencing or at risk for cognitive problems. Cognitive remediation training (CRT) programs have shown to be effective in improving cognitive abilities, but there is limited evidence to suggest that CRT results in everyday task performance gains. This presentation will discuss findings from a trial evaluating an innovative computer -based functional skills assessment and skills training program (CFSAT), which includes ecologically valid simulations of everyday tasks (e.g., shopping, money and medication management). The sample includes non-cognitively impaired (NC) older adults (n=50) and those with mild cognitive impairment (MCI) (n = 40), ranging in age from 60 -86 years (M= 73.10; SD = 6.06), is primarily female (90%), and ethnically diverse (69% minority). Participants were randomized into the CFSAT condition or a CFSAT + CRT condition. Performance data includes real time measures of accuracy, response time and efficiency. The findings indicate that the assessment component of the CFSAT program differentiated between the NC and MCI groups at the baseline assessment. Both NC and MCI participants demonstrated improvements in performance following training across all tasks; though the MCI participants required more training. Participants who received CFSAT + CRT training demonstrated increased efficiency in skill acquisition. The results indicate that the CFSAT program is an efficacious tool for assessing and training functional performance in both non-cognitively and cognitively impaired older adults.

“Group therapy for schizophrenia: A meta-analysis”: Correction to Burlingame et al. (2020).

Reports an error in "Group therapy for schizophrenia: A meta-analysis" by Gary M. Burlingame, Hal Svien, Lars Hoppe, Isaac Hunt and Jenny Rosendahl (Psychotherapy, 2020[Jun], Vol 57[2], 219-236). In the article, the Orfanos et al. (2015) meta-analysis was missing from Burlingame et al. (2020) and should have appeared as Footnote 1 at the end of the abstract. Consistent with Orfanos et al. (2015), the Burlingame et al. (2020) findings support the notion that group treatments can improve negative symptoms of schizophrenia, across active and passive controls. Unlike Orfanos et al.'s (2015) study, Burlingame et al. (2020) also found a significant effect size for positive symptoms. Reference Orfanos, S., Banks, C., & Priebe, S. (2015). Are group psychotherapeutic treatments effective for patients with schizophrenia? A systematic review and meta-analysis. Psychotherapy and Psychosomatics, 84, 241-249. https://doi.org/10.1159/ 000377705. Footnote 2 was missing from the end of the first sentence in the Method section. This meta-analysis is not registered with PROSPERO, and the PROSPERO protocol (CRD42013004419) does not include the disorder of schizophrenia... (The following abstract of the original article appeared in record 2020-37337-001.) The effectiveness of group treatments for people with schizophrenia has not been examined on symptom-specific (positive and negative symptoms) outcomes, and the differential effects of the most popular group treatments remain unknown. We conducted a meta-analysis of randomized controlled trials that tested (a) the effectiveness of 7 frequently used group treatments on positive and negative symptoms and (b) if treatment-specific outcome improvement was associated with improvement on schizophrenia symptoms. Major databases were searched from 1990 to 2018 for randomized controlled trials of group treatment for people with schizophrenia, including first-episode psychosis. A random effects meta-analysis and meta-regression was conducted on 52 studies representing 4,156 individuals that produced a significant, small effect on symptom-specific outcomes (g = 0.30), with 4 group treatments (cognitive remediation, multifamily, psychoeducational, and social skills training) posting significant improvement. In addition, change on treatment-specific outcomes explained 16% of schizophrenia symptom and 44% of general functioning improvement. Results are discussed with respect to how they replicate past meta-analytic findings and possible revision of practice guidelines to incorporate evidence-based group treatments for schizophrenia. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Individual and group format adjunct therapy on social emotional skills for adolescent inpatients with severe and complex eating disorders (CREST-A).

Relatively little is known about which psychological treatment adjuncts might be helpful for supporting people with the most severe and complex forms of anorexia nervosa (AN) with very low weight and malnutrition requiring inpatient admissions, but targeting key perpetuating factors such as social emotional difficulties may be one way to advance knowledge. This pilot feasibility project reports on the development of an adolescent adaptation of Cognitive Remediation and Emotion Skills Training (CREST-A) and explores its acceptability, feasibility and possible benefits. An uncontrolled, repeated measures design was employed with data collected at the start and end of treatment. CREST‑A was investigated in two formats: a10-session individual format delivered to acase series of 12patients and a5-session group format delivered to 3groups of 9patients. Acceptability, measured using aPatient Satisfaction Scale was 7/10 for the individual and 6/10 for the group format. Individual take-up was 100% and group take-up was 34.62%. Drop-out was 8.33% and 29.63% in the individual and group formats respectively. Homework was completed 66.67% and 75% of the time in the individual and group formats respectively. Patients reported medium-sized improvements in components of social emotional functioning measured using the Work and Social Adjustment Scale, the Toronto Alexithymia Scale and the Revised Social Anhedonia Scale in the individual and group formats. Future studies employing randomized controlled designs may now be warranted to advance this evidence base of this low intensity treatment adjunct.

Role of prefrontal cortex during Sudoku task: fNIRS study.

BackgroundSudoku is a popular cognitively stimulating leisure-time activity. Many studies have been directed toward finding an algorithm to solve Sudoku, but the investigation of the neural substrates involved in Sudoku has been challenging.MethodsSudoku task was divided into two steps to understand the differential function of the prefrontal cortex (PFC) while applying heuristic rules. PFC activity was recorded at 16 optode locations using functional near infrared spectroscopy. Classical two-way analysis of variance as well as general linear model-based approach was used to analyze the data from 28 noise-free recordings obtained from right-handed participants.Results Post hoc analysis showed a significant increase in oxyhemoglobin concentrations and decrease in deoxyhemoglobin concentrations at all 16 optode locations during step 1 (3 × 3 subgrids) and step 2 (easy level 9 × 9 Sudoku) when compared with the rest (p < 0.0001). Contrasting the step 2 – step 1 revealed that medial regions of PFC were preferentially activated.ConclusionBoth the medial and lateral regions of PFC are activated during Sudoku task. However, the medial regions of PFC play a differential role, especially when we consider searching and selecting the heuristic rules. Thus, Sudoku may be used for cognitive remediation training in neuropsychiatric disorders involving PFC.

Empathy and Social Attribution Skills Moderate the Relationship between Temporal Lobe Volume and Facial Expression Recognition Ability in Schizophrenia.

ObjectiveWhile impaired facial expression recognition has been closely associated with reduced temporal lobe volume in patients with schizophrenia, this study aimed at examining whether empathy and social attribution affect such a relationship.MethodsA total of 43 patients with schizophrenia and 43 healthy controls underwent a facial expression recognition task (FERT) and magnetic resonance imaging. Basic empathy scale and the social attribution task-multiple choice were used to measure empathy and social attribution.ResultsPatients with schizophrenia showed significant positive correlations between the total temporal lobe volume and the FERT-accuracy (FERT-ACC). Diminished temporal lobe volume predicted the impaired facial emotion recognition ability. Both empathy and social attribution played roles as moderators of the path from the left amygdala volume, left fusiform gyrus volume, both sides of the superior temporal gyrus volume, and left middle temporal gyrus volume to the FERT-ACC. In contrast, empathy alone functioned as a moderator between the right fusiform gyrus volume, right middle temporal gyrus volume, and FERT-ACC. No significant interaction was found for healthy controls.ConclusionOur results suggest that social cognition remediation training on empathy and social attribution, could buffer the negative effects of small temporal lobe volume on interpersonal emotional communication in patients with schizophrenia.

Learning and Motivation for Rewards in Schizophrenia: Implications for Behavioral Rehabilitation

Purpose of ReviewImpaired reward processing and amotivation are well documented in schizophrenia. We aim to review the current state of neuroimaging and behavioral research addressing components of motivational deficits in this complex and impairing syndrome. Evidence will be integrated to inform the ongoing development of effective strategies for behavioral rehabilitation.Recent FindingsWhile striatal dopamine and aberrant reward prediction errors have been connected to amotivation in schizophrenia, they are not sufficiently full explanations of reward processing impairments. Frontal dysfunction and associated cognitive control deficits also have evidenced involvement in atypical reward prediction, learning, and valuation. Ongoing work supports the utility of interventions (e.g., cognitive remediation) for improved motivation for rewards.SummaryWithin schizophrenia, greater negative symptoms (avolition and anhedonia) are associated with poorer functioning and more severely impaired reward processing. Utilizing behavioral interventions such as cognitive remediation and social cognition training hold promise for rehabilitation and increased community integration.

Group therapy for schizophrenia: A meta-analysis.

The effectiveness of group treatments for people with schizophrenia has not been examined on symptom-specific (positive and negative symptoms) outcomes, and the differential effects of the most popular group treatments remain unknown. We conducted a meta-analysis of randomized controlled trials that tested (a) the effectiveness of 7 frequently used group treatments on positive and negative symptoms and (b) if treatment-specific outcome improvement was associated with improvement on schizophrenia symptoms. Major databases were searched from 1990 to 2018 for randomized controlled trials of group treatment for people with schizophrenia, including first-episode psychosis. A random effects meta-analysis and meta-regression was conducted on 52 studies representing 4,156 individuals that produced a significant, small effect on symptom-specific outcomes (g = 0.30), with 4 group treatments (cognitive remediation, multifamily, psychoeducational, and social skills training) posting significant improvement. In addition, change on treatment-specific outcomes explained 16% of schizophrenia symptom and 44% of general functioning improvement. Results are discussed with respect to how they replicate past meta-analytic findings and possible revision of practice guidelines to incorporate evidence-based group treatments for schizophrenia. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Evidence-Based Integrated Intervention in Patients with Schizophrenia: A Pilot Study of Feasibility and Effectiveness in a Real-World Rehabilitation Setting.

Impairment in real-world functioning remains one of the most problematic challenges that people with schizophrenia have to face. Various psychosocial interventions have proven to be effective in promoting recovery and improving functioning in schizophrenia; however, their implementation and their effectiveness in routine rehabilitation practice are still objects of study. The present pilot study aimed to assess the feasibility and effectiveness on clinical and real-world outcomes of an integrated treatment protocol composed of stable pharmacological treatment, computer-assisted cognitive remediation and social skills training provided in a rehabilitation center. Predictors of functional improvement were also assessed. Seventy-two patients diagnosed with schizophrenia participated in the study. A significant (p < 0.001) improvement in positive, negative and total symptoms, as well as in global clinical severity and real-world functioning outcomes was observed, with a large effect size in positive and total symptoms, global clinical severity and real-world functioning, and a moderate effect size on negative symptoms. Improvement in total symptoms (p < 0.001) and in global clinical severity (p = 0.007) emerged as individual predictors of functional improvement. These findings, although preliminary, suggest that an integrated, evidence-based treatment program is feasible and effective in a real-world rehabilitation context, and that similar interventions should be further implemented in everyday clinical practice.

Adapted emotion skills training group for young people with anorexia nervosa : Amixed-methods evaluation.

Brief interventions focused on emotion processing are needed to support young people (YP) in inpatient treatment programmes to manage emotions. Cognitive Remediation and Emotion Skills Training (CREST) has been found beneficial in adult anorexia nervosa (AN) groups. An initial case series found that CREST is afeasible intervention for YP with AN. Further age-appropriate adaptations were needed to improve YP's engagement. Following qualitative feedback on the original CREST manual, asecond case series was conducted in an inpatient unit with age-appropriate adaptations to evaluate its feasibility in aYP inpatient setting. Amixed-methods methodology was used to evaluate the intervention. A total of 30YP were asked to write afeedback letter about their experience of the group and to complete the Emotion Skills Scale (ESS), an ad hoc 12-item self-report Likert scale assessing emotional functioning. The ESS was also completed by amember of the multidisciplinary team for an external assessment. Quantitative results showed no statistically significant changes in YP's emotional functioning, while qualitative results showed that YP found it helpful to learn about emotion processes, acknowledging their need to be supported to express them and understand the link with AN symptoms. Four high-order themes were identified: Helpfulness of CREST Group for Young People (CREST-GYP), Perception of contents, Challenges of group therapy, Suggestions for improvement. Pilot findings suggest that CREST-GYP is an acceptable intervention for YP with AN. Clinical and research studies are needed to clarify whether CREST-GYP can produce more beneficial treatment results than treatment as usual.

A cognitive remediation training for young adults with psychotic disorders to support their participation in education\xa0\u2014 study protocol for a pilot randomized controlled trial

BackgroundMost severe mental disorders have their onset between the age of 17 and 27, a time when many young adults begin participating in secondary or post-secondary education. The cognitive deficits typically associated with psychiatric disorders, especially psychotic disorders, increase the risk of leaving school early, which can lead to a reduction in employment opportunities later on in life and, in turn, a poorer long-term prognosis. Therefore, specific interventions aiming to improve these cognitive functions are needed. Cognitive remediation (CR) aims to improve cognitive functioning and may increase real-world functioning in educational performance. This study aims to examine the feasibility and applicability of a CR training named Mindset for students with psychotic disorders in the Netherlands.Methods/designSixty students diagnosed with a psychotic disorder and currently reporting cognitive deficits will be included from four Dutch Mental Health Care institutes. Half of the participants (N = 30) will be randomly assigned to the CR training consisting of twelve, individual, weekly 1-h meetings. The other half will be assigned to an active control condition consisting of twelve weekly assignments that will be sent by email aiming to improve school performance. Students will be evaluated at baseline (T0), directly after finishing the CR training or control intervention (T1), and 6 months later (T2). Treatment feasibility will be the primary outcome, using evaluation forms, interviews with trainers and participants, number of study drop outs, and patient eligibility and recruitment rates. School functioning, cognitive functioning, and strategy use will also be assessed to get a preliminary idea of the potential effectiveness of the intervention.DiscussionThe CR training in this study will provide real-world examples and exercises aimed to teach useful strategies to cope with the cognitive deficits experienced by students with psychotic disorders. Furthermore, since students with other psychiatric disorders might also experience cognitive deficits, the results of this study may also provide some further implications for future studies on the effect of this CR training for students with these disorders.Trial registrationThe study was registered with Trialregister.nl, no. NL6590 (NTR6764), date registered: September 7, 2017. Register name: Mindset. A cognitive rehabilitation training for young adults with psychotic spectrum disorder in an educational setting: A pilot study.Protocol version: 3, date December 23, 2019

A Lifespan Model of Interference Resolution and Inhibitory Control: Risk for Depression and Changes with Illness Progression.

The cognitive processes involved in inhibitory control accuracy (IC) and interference resolution speed (IR) or broadly - inhibition - are discussed in this review, and both are described within the context of a lifespan model of mood disorders. Inhibitory control (IC) is a binary outcome (success or no for response selection and inhibition of unwanted responses) for any given event that is influenced to an extent by IR. IR refers to the process of inhibition, which can be manipulated by task design in earlier and later stages through use of distractors and timing, and manipulation of individual differences in response proclivity. We describe the development of these two processes across the lifespan, noting factors that influence this development (e.g., environment, adversity and stress) as well as inherent difficulties in assessing IC/IR prior to adulthood (e.g., cross-informant reports). We use mood disorders as an illustrative example of how this multidimensional construct can be informative to state, trait, vulnerability and neuroprogression of disease. We present aggregated data across numerous studies and methodologies to examine the lifelong development and degradation of this subconstruct of executive function, particularly in mood disorders. We highlight the challenges in identifying and measuring IC/IR in late life, including specificity to complex, comorbid disease processes. Finally, we discuss some potential avenues for treatment and accommodation of these difficulties across the lifespan, including newer treatments using cognitive remediation training and neuromodulation.