Scaffolded instruction remediates Wisconsin Card Sorting Test deficits in schizophrenia: A comparison to other techniques

A Neurophysiological and Neuropsychological Consideration of Mindful Movement: Clinical and Research Implications

In this article, we present ideas related to three key aspects of mindfulness training: the regulation of attention via noradrenaline, the importance of working memory and its various components (particularly the central executive and episodic buffer), and the relationship of both of these to mind-wandering. These same aspects of mindfulness training are also involved in the preparation and execution of movement and implicated in the pathophysiology of psychosis. We argue that by moving in a mindful way, there may be an additive effect of training as the two elements of the practice (mindfulness and movement) independently, and perhaps synergistically, engage common underlying systems (the default mode network). We discuss how working with mindful movement may be one route to mindfulness training for individuals who would struggle to sit still to complete the more commonly taught mindfulness practices. Drawing on our clinical experience working with individuals with severe and enduring mental health conditions, we show the real world application of these ideas and how they can be used to help those who are suffering and for whom current treatments are still far from adequate.

Errorless learning for training individuals with schizophrenia at a community mental health setting providing work experience

The effects of errorless learning (EL) on work performance, tenure, and personal well-being were compared with conventional job training in a community mental health fellowship club offering 12-week time-limited work experience. Participants were 40 clinically stable schizophrenia and schizoaffective disorder outpatients randomly assigned to EL vs conventional instruction (CI) at a thrift-type clothing store. EL participants received training on how to perform their assigned job tasks based on principles of EL, such as error reduction and automation of task performance. CI participants received training common to other community-based entry-level jobs that included verbal instruction, a visual demonstration, independent practice, and corrective feedback. Participants were scheduled to work 2 hours per week for 12 weeks. For both groups, job training occurred during the first 2 weeks at the worksite. Work performance (assessed using the Work Behavior Inventory, WBI) and personal well-being (self-esteem, job satisfaction, and work stress) were assessed at weeks 2, 4, and 12. Job tenure was defined as the number of weeks on the job or total number of hours worked prior to quitting or study end. The EL group performed better than the CI group on the Work Quality Scale from the WBI, and the group differences were relatively consistent over time. Results from the survival analyses of job tenure revealed a non-significant trend favoring EL. There were no group differences on self-esteem, job satisfaction, or work stress. The findings provide modest support for the extensions of EL to community settings for enhancing work performance.

A comparison of remediation techniques on the Wisconsin Card Sorting Test in schizophrenia

A wealth of evidence has revealed that deficits on a commonly used measure of executive-function, the Wisconsin Card Sorting Test (WCST), can be improved through a variety of methods of instruction in patients with schizophrenia. Relatively little is known however, which of these remediation methods produce strongest and most durable effects and whether these effects generalize to other, untrained executive-function measures. Two of the most commonly studied methods for remediation on the WCST, step-by-step didactic instruction on the task and utilization of self-monitoring strategies, have both been shown to improve WCST performance, yet have never been directly compared. Thirty-four participants with schizophrenia were randomly assigned to one of three experimental conditions: Condition A consisted of didactic training which incorporated a detailed account of changing sorting principles throughout the test; Condition B consisted of a self-monitoring strategy that required that participants verbalize their strategies out loud after each card sort; Condition C was a non-trained control group that received the same outcome assessments as the two training groups at identical time intervals without intervening training. Patients were assessed with the WCST and two other executive-function tests immediately prior to training, immediately after training and at a 1-month follow-up. Results revealed: (1) participants assigned to the didactic and self-monitoring conditions made significant gains on the WCST relative to a no-intervention control condition; (2) the effects of self-monitoring, but not didactic training, were evident at a one-month follow-up; and (3) only participants assigned to the self-monitoring condition showed generalization to a second, non-trained measure of executive-function. The significance of these results for implementation of strategies for comprehensive and sustained programs of remediation are discussed.

[Executive function remediation in schizophrenia: possible strategies and methods]

AIM AND METHOD

The paper is a selective review of the literature on strategies and methods of cognitive remediation in schizophrenic disorders. It has been focused on the remediation of executive functions and the present hypotheses about the possibility of an improvement of the neurocognitive deficit through specific interventions.

RESULTS AND CONCLUSIONS

People with Schizophrenic Disorders have some degree of cognitive deficit that often precede the clinical onset not secondary to the pathology characteristics persisting even when the positive symptoms have been resolved. The possibility that the neurocognitive deficits could be modified by psychological remediation with effects not exclusively confined to the cognitive domain has been nowadays accepted and numerous studies demonstrate that these interventions are effective and durable with a positive impact on social and working abilities, symptomatology and self-esteem.