DOCSLIB.ORG

Cognitive Stimulation in Dementia: Time to Go Into Detail

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Cognitive Stimulation in Dementia: Time to Go Into Detail Kalbe E. J Neurol Neuromedicine (2018) 3(2): 14-18 Neuromedicine www.jneurology.com www.jneurology.com Journal of Neurology && NeuromedicineNeuromedicine Commentary Open Access Cognitive Stimulation in Dementia: Time to Go into Detail. A Commentary Elke Kalbe1*, Ann-Kristin Folkerts1 1Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Co- logne, Kerpenerstraße 62, 50937 Cologne, Germany Article Info ABSTRACT Article Notes While it is undeniable that cognitive stimulation (CS) is effective in patients with Received: March 22, 2018 dementia, there is still a lack of understanding of the underlying mechanisms of Accepted: April 11, 2018 the effects, and questions like “Who benefits?” or “Which factors determine the *Correspondence: benefits?” are not yet answered. Therefore, this commentary gives an overview Prof. Dr. Elke Kalbe, Medical Psychology | Neuropsychology of different aspects (e.g., sociodemographic factors, disease characteristics, living and Gender Studies & Center for Neuropsychological setting) that need to be considered while doing research on CS to understand their Diagnostics and Intervention (CeNDI), University Hospital impact on CS effects. It is also necessary to examine the effects of CS in real-life Cologne, Kerpenerstr. 62, 50937 Cologne, Germany; settings (e.g., geriatric hospitals) with mixed samples (e.g., patients with different Telephone: +49 221 478- 96244; Fax: +49 221 478-3420, severity of dementia). Additionally, important factors for future studies on CS in Email: [email protected] dementia (e.g., reporting according to the CONSORT guidelines, more health- © 2018 Kalbe E. This article is distributed under the terms of the economics studies) are outlined. Creative Commons Attribution 4.0 International License Introduction Keywords Cognitive stimulation (CS) as a non-pharmacological intervention Dementia Alzheimer’s disease in patients with dementia has attracted great interest during the past Intervention Cognitive stimulation Cognition decade. CS is defined as conducting a range of activities (e.g., cognitive Prediction stimulating games, sensory exercises) and discussions (e.g., talking about past experiences), usually carried out in small groups of 3 to 6 patients, with1,2 the aim of a general enhancement of cognitive and social functioning . Meta-analyses have shown that demonstrated CS 2-5has positive a positive effects on various cognitive and non-cognitive symptoms2 . For example, the Cochrane review by Woods and colleagues impact on the global cognitive state, on quality of life, and on well-being, as well as on communication and social interaction – with effects over and above those of any medication. However, although the benefits of CS are undeniable, it is true that, upon closer inspection, many open questions remain. One major concern that challenges the generalisability of the found effects is that the target group of “patients with dementia” in itself is so heterogeneous and that the samples in the published studies differ so substantially. Thus, to boost the predictive power of CS, the next step will be to ask: “Do all patients benefit?” (which is unlikely) or, more precisely, “Who benefits under which circumstances?” and “Which factors determine whether a patient with dementia profits?” or “Which CSPossible intervention factors is withbest foran whichimpact patients?” on CS benefits Sociodemographic variables Many variables have the potential to have an impact on the effects of CS in patients with dementia (Table 1). For example, sociodemographic Page 14 of 18 Kalbe E. J Neurol Neuromedicine (2018) 3(2): 14-18 Journal of Neurology & Neuromedicine variables may be relevant. Age is one of them. Notably, Therefore, it is imaginable that patients in a more advanced betterwhile some results studies that examined cognitive training effects stage of the disease need CS programs that are cognitively in healthy older6-8 adults showed that younger age yield less challenging. Regarding disease severity, randomised (a finding that fits the notion that ageing9,10 controlled trials (RCTs) demonstrated that patients with. is related to reduced cognitive11 or ageand having neural no plasticity impact ),. a lower cognitive baseline level were able to benefit more13,14 with CS, conflicting results exist, with higher age being12-14 from CS than patients with higher baseline results predictive of better results Besides the interpretation that there is more “room for Gender effects may also play a role. Besides the fact that improvement” in patients with lower cognitive baseline cognitive profiles might differ in female and male patients and levels, it is also possible that the CS exercises were too easy with dementia (e.g., verbal memory is more affected15 for the fitter patients and demanded too little of them. In in female patients16 with Alzheimer´s dementia this context, also, the question of group selection needs to Parkinson´s disease ), gender effects on benefits of CS for11. be reflected upon: Are mixed groups better (so that patients patients with dementia have been reported, indicating that arewith more more homogeneous severe symptoms groups will better profit (sofrom that those all patientsthat are cognitive outcomes improve more in female participants fitter, and the fitter ones profit from helping the others)? Or withA stronger mild cognitive benefit impairmentin verbal memory/working (MCI) attending cognitivememory trainingwas also17 demonstrated for female than for male patients are cognitively challenged according to their own level of been proposed carefunctioning)? units vs. traditional This issue careis still units under investigation when it , and 18gender-specific cognitive plasticity has comes to nursing home structures22-24 (e.g., dementia special . An alternative explanation, which has ), and, to the authors’ been proposed but not yet investigated in the context of knowledge, has not yet been studied in the context of the toCS, be could involved be that in womentheir health have issuesa more than active men) attitude19 (i.e., conduct of CS interventions. Possibly, and according to the show more knowledge, positive emotion, and motivation authors´ own experiences in conducting CS on patients . Finally, participantswith dementia, can groups be implemented in which the much intervention easier in programa rather although to the authors’ knowledge, level of education has can be matched to the level of functioning and needs of the not been found (and rarely studied) to have an impact on CS benefits, it has been identified as a predictor of cognitive homogenous setting with patients of similar dementia training effects within the ACTIVE Trial with older people severity. without dementia20 (Mini Mental State Examination (MMSE) While there are studies that only include patients > 23 points) , indicating that more years of education yields with possible or probable Alzheimer´s2,3,25-28 disease, vascular a better training response. Thus, it might also be relevant . dementia, and/or mixed dementia , other etiologies for CS effects, even more so as education21 is regarded as a have not been studied separately. However, cognitive Diseasedriver of characteristicsneural and cognitive and plasticitygroup composition aphasiaand neuropsychiatric be able to participate symptoms in differ a CS betweenprogram typesdespite of dementia. For example, will a patient with progressive a cognitiveDisease characteristicsmotor rehabilitation may also program have anwith impact patients on his or her problems in understanding/communication? benefits of CS. For example, in an observational reported study that using the Are patients with frontotemporal dementia willing to 12 participate, and do they constitute a challenge in a group with MCI and dementia, Binetti et al. setting due to behavioural symptoms? Indeed, the profile of aberrantresponders motor had significantlybehaviours lessthan impairment the non-responders. in insight, non-cognitive symptoms in patients with dementia might larger functional ability and less delusions, euphoria, and have a substantial influence on the benefits of CS, and the Table 1: Factors that potentially influence effects of cognitive ourrelationships own group between symptoms might be complex and stimulation in patients with dementia. need more research.14 For example, in the RCT conducted by • Sociodemographic variables: age, gender, education low cognitive baseline which examinedscores predicted the effects better of CSoutcome versus • Disease characteristics: dementia type/etiology, disease usual care in patients with dementia in long-term care, duration, disease severity, cognitive profile, other symptoms (e.g., depression and behavioural and psychiatric symptoms, comorbidities), medication in cognition. However, this association was moderated by • Living setting: at home, day-care facility, hospital, nursing home depressive symptoms, indicating that patients with lower • Characteristics of the cognitive stimulation intervention: cognitive baseline scores only benefitted more if they were frequency, intensity, type of tasks/activities, number of not (or less) depressed. This leads to the presumption that participants therapy of depressive symptoms could be an important • Group composition: heterogeneous vs. homogeneous (e.g., precondition for success of CS. Thus, although the ultimate regarding type of dementia/symptomatology/severity of aim should be to make efficient
Load more

Recommended publications
  • Cognitive Behavioral Therapy (CBT)
    University of Nebraska - Lincoln DigitalCommons@University of Nebraska - Lincoln Educational Psychology Papers and Publications Educational Psychology, Department of 2010 Cognitive Behavioral Therapy (CBT) Rhonda Turner University of Nebraska-Lincoln Susan M. Swearer Napolitano University of Nebraska-Lincoln, [email protected] Follow this and additional works at: https://digitalcommons.unl.edu/edpsychpapers Part of the Educational Psychology Commons Turner, Rhonda and Swearer Napolitano, Susan M., "Cognitive Behavioral Therapy (CBT)" (2010). Educational Psychology Papers and Publications. 147. https://digitalcommons.unl.edu/edpsychpapers/147 This Article is brought to you for free and open access by the Educational Psychology, Department of at DigitalCommons@University of Nebraska - Lincoln. It has been accepted for inclusion in Educational Psychology Papers and Publications by an authorized administrator of DigitalCommons@University of Nebraska - Lincoln. Published in Encyclopedia of Cross-Cultural School Psychology (2010), p. 226-229. Copyright 2010, Springer. Used by permission. Cognitive Behavioral Therapy (CBT) Therapy, Rational Living Therapy, Schema Focused Therapy and Dialectical Behavior Rhonda Turner and Susan M. Swearer Therapy. Department of Educational Psychology, Uni- History of CBT versity of Nebraska-Lincoln, Lincoln, Nebraska, A precursor to the development of CBT U.S.A. was the emergence of Albert Bandura’s So- cial Learning Theory. Unlike the prevail- Cognitive Behavioral Therapy (CBT) is a ing psychodynamic or behavioral views form of psychotherapy that focuses on the of psychological disturbance, Bandura role of cognition in the expression of emo- viewed people as consciously and actively tions and behaviors. CBT assumes that mal- interacting cognitively with their environ- adaptive feelings and behaviors develop ments. He introduced the notion that cog- through cognitive processes which evolve nitive mediation occurs in the stimulus-re- from interactions with others and experi- sponse cycle of human behavior.
    [Show full text]
  • Primary and Secondary Prevention Interventions for Cognitive Decline
    2016 Primary and secondary prevention interventions for cognitive decline and dementia Overview of reviews Published by The Norwegian Institute of Public Health Section for evidence summaries in the Knowledge Centre Title Primary and secondary prevention interventions for cognitive decline and dementia Norwegian title Primær‐ og sekundærforebyggende tiltak for kognitiv svikt og demens Responsible Camilla Stoltenberg, direktør Authors Gerd M Flodgren, project leader, researcher, the Knowledge Centre Rigmor C Berg, Head of Unit, for Social Welfare Research at the Knowledge Centre ISBN 978‐82‐8082‐745‐6 Projectnumber 798 Type of publication Overview of reviews No of pages 69 (110 inklusiv vedlegg) Client Nasjonalforeningen for folkehelsen MeSH terms Alzheimer’s disease, dementia, cognition, cognitive impairment, cognitive disorders, memory complaints, primary prevention, secondary prevention Citation Flodgren GM, Berg RC. Primary and secondary prevention interventions for cognitive decline and dementia. [Primær‐ og sekundærforebyggende tiltak for kognitiv svikt og demens] Rapport −2016. Oslo: Folkehelseinstituttet, 2016. 2 Table of contents Table of contents TABLE OF CONTENTS 3 KEY MESSAGES 5 EXECUTIVE SUMMARY 6 Background 6 Objectives 6 Methods 6 Results 6 Discussion 8 Conclusions 8 HOVEDFUNN (NORSK) 9 SAMMENDRAG (NORSK) 10 Bakgrunn 10 Problemstillinger 10 Metoder 10 Resultat 10 Diskusjon 12 Konklusjon 12 PREFACE 13 OBJECTIVES 15 BACKGROUND 16 Description of the condition 16 How the interventions may work 18 Why is it important to do this
    [Show full text]
  • FAP) in Ibero-America: Review of Current Status and Some Proposals
    INTERNATIONAL JOURNAL OF BEHAVIORAL CONSULTATION AND THERAPY ©2012, ALL RIGHTS RESERVED 2012, VOL. 7, NO. 2–3 ISSN: 1555–7855 Functional Analytic Psychotherapy (FAP) in Ibero-America: Review of current status and some proposals Amanda Muñoz-Martínez, Mónica Novoa-Gómez, & Rochy Vargas Gutiérrez H Abstract Functional Analytic Psychotherapy (FAP) has been making an important rise in Ibero-America in recent years. This paper presents a review of different contributions, problems and some proposals Three principal topics are reviewed: (a) general characteristics and theoretical bases of FAP, (b) the uses of FAP and its relationship with other therapies, and (c) FAP´s empirical research. A number V in Ibero-America emphasize epistemological and conceptual aspects of FAP and its relationship with other interventions from Third Wave Behavior Therapies, especially Acceptance and Commitment Therapy (ACT). With regard to the third topic, FAP is an effective therapeutic perspective, but it is important to increase the research in this area. Keywords Functional Analytic Psicotherapy, Third Wave Behavior Therapy, Behavioral Analysis and Clinical Psychology n recent years, the Third Wave Behavior Therapies have made ciples and therapeutic rules described by Kohlenberg and Tsai Ian important impact on the field of clinical psychology, becom- (1991). ing an alternative to treating clients with personality disorders As indicated by Parada, Sarmiento and Urbina (2008), FAP is or serious behavioral problems, difficulties not as frequently based on the findings of the Experimental Analysis of Behavior, focused on by cognitive-behavioral therapists (Rodríguez- from which established the principles of radical behaviorism and Naranjo, 1998). The third generation behavior therapies provide based on which they derived both as Applied Behavioral Analy- contextual explanations for clinical problems, fostering more sis and Clinical Behavioral Analysis (Dougher & Hayes, 1999).
    [Show full text]
  • Risk Reduction of Cognitive Decline and Dementia: WHO Guidelines
    RISK REDUCTION OF COGNITIVE DECLINE AND DEMENTIA WHO GUIDELINES RISK REDUCTION OF COGNITIVE DECLINE AND DEMENTIA WHO GUIDELINES i Risk reduction of cognitive decline and dementia: WHO guidelines ISBN 978-92-4-155054-3 © World Health Organization 2019 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. Risk reduction of cognitive decline and dementia: WHO guidelines. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris.
    [Show full text]
  • THERAPIST TECHNIQUE 1 Cognitive Behavioural Therapy for Major
    CBT FOR MAJOR DEPRESSION: THERAPIST TECHNIQUE 1 Cognitive Behavioural Therapy for Major Depression: Identifying and Examining Core Therapist Techniques Amanda Sheptycki, M.A., Ph.D. (c) Department of Educational and Counselling Psychology McGill University, Montréal March 2020 A thesis submitted to McGill University in partial fulfillment of the requirements of the degree of Doctor in the Philosophy of Psychology. © Amanda Sheptycki 2020 CBT FOR MAJOR DEPRESSION: THERAPIST TECHNIQUE 2 Table of Contents Table of Contents……………………………………………………………………………….2 List of Tables and Figures……………………………………………………………………....5 Abstract…………………………………………………………………………………………7 Résumé………………………………………………………………………………………….9 Acknowledgements……………………………………………………………………………..11 Contributions to Original Knowledge………………………………………………………….12 Contribution of Authors………………………………………………………………………..13 Chapter 1. Introduction: Literature Review……………………………………………………14 Cognitive Behavioural Model of Major Depression…………………………………..17 Cognitive Behavioural Therapy Core Principles……………………………………...18 Therapist Technique in Cognitive Behaviour Therapy……………………………….20 Cognitive Restructuring Techniques………………………………….20 Definition and examples of techniques……………………………….20 Effects on patient outcome……………………………………………21 Criticisms and limitations of current research………………………..23 Behavioural Activation Techniques………………………………………….27 Definition and examples of techniques………………………………27 Effects on patient outcome…………………………………………..28 Criticisms and limitations of current research……………………….32 A Need for
    [Show full text]
  • Examination of the Skills of Cognitive Therapy for Depression
    Examination of the Skills of Cognitive Therapy for Depression: Evaluating Specificity and Prediction of Differential Response in Cognitive and Behavioral Treatments DISSERTATION Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in the Graduate School of The Ohio State University By Shannon Nicole Hollars, M.A. Graduate Program in Psychology The Ohio State University 2015 Dissertation Committee: Professor Daniel R. Strunk, Advisor Professor Jennifer S. Cheavens Professor Michael C. Edwards Copyrighted by Shannon Nicole Hollars, M.A. 2015 Abstract Researchers seeking to improve outcomes for Major Depressive Disorder (MDD) have investigated pre-treatment patient characteristics with the goal of identifying treatments or treatment components that might be more effective for some patients than others. Other studies have focused on improving the effectiveness of existing interventions by evaluating the relation of treatment components to outcomes both directly and indirectly via their association with putative therapeutic mechanisms. In the context of cognitive behavioral therapy (also called cognitive therapy (CT)), cognitive and behavioral change procedures and associated cognitive and behavioral changes have been the subjects of a growing body of research (Lorenzo, German, & DeRubeis, 2014). In the current study, I examined whether cognitive and behavioral change procedures were associated with specific changes in patients’ cognitive and behavioral skills. Previous studies have examined the extent that particular components within CT are more effective than others in modifying cognitive and behavioral vulnerabilities but have not found consistent evidence to support the specificity of these changes to CT or components in CT (Jacobson, Dobson, Truax, Addis, & Koerner, 1996). To our knowledge, this study is the first to evaluate skill specificity in the context of the cognitive and behavioral components from CT.
    [Show full text]
  • Apps with Maps—Anxiety and Depression Mobile Apps With
    JMIR MENTAL HEALTH Marshall et al Original Paper Apps With MapsÐAnxiety and Depression Mobile Apps With Evidence-Based Frameworks: Systematic Search of Major App Stores Jamie M Marshall, MClinPsych; Debra A Dunstan, PhD; Warren Bartik, PhD School of Psychology, Faculty of Medicine and Health, University of New England, Armidale, Australia Corresponding Author: Jamie M Marshall, MClinPsych School of Psychology Faculty of Medicine and Health University of New England Elm Ave Armidale, 2351 Australia Phone: 61 2 6773 3012 Email: [email protected] Abstract Background: Mobile mental health apps have become ubiquitous tools to assist people in managing symptoms of anxiety and depression. However, due to the lack of research and expert input that has accompanied the development of most apps, concerns have been raised by clinicians, researchers, and government authorities about their efficacy. Objective: This review aimed to estimate the proportion of mental health apps offering comprehensive therapeutic treatments for anxiety and/or depression available in the app stores that have been developed using evidence-based frameworks. It also aimed to estimate the proportions of specific frameworks being used in an effort to understand which frameworks are having the most influence on app developers in this area. Methods: A systematic review of the Apple App Store and Google Play store was performed to identify apps offering comprehensive therapeutic interventions that targeted anxiety and/or depression. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist was adapted to guide this approach. Results: Of the 293 apps shortlisted as offering a therapeutic treatment for anxiety and/or depression, 162 (55.3%) mentioned an evidence-based framework in their app store descriptions.
    [Show full text]
  • Approaches to Cognitive Stimulation in the Prevention of Dementia
    y olog & G nt er o ia r tr e i c G f R o e l s Journal of e a a n Niederstrasser, et al., J Gerontol Geriatr Res 2016, r r c u h o J S5:005 ISSN: 2167-7182 Gerontology & Geriatric Research DOI: 10.4172/2167-7182.S5-005 Research Article Open Access Approaches to Cognitive Stimulation in the Prevention of Dementia Nils Georg Niederstrasser1*, Eef Hogervorst1, Eleftheria Giannouli2 and Stephan Bandelow1 1School of Sports, Exercise and Health Sciences, Loughborough University, UK 2Institute of Movement and Sports Gerontology, German Sports University Cologne, Germany *Corresponding author: Nils Georg Niederstrasser, School of Sports, Exercise and Health Sciences Loughborough University, Ashby Road, Loughborough LE11 3TU, UK, Tel: 4401509226302; Fax: 4401509226301; E-mail: [email protected] Rec date: Jun 07, 2016; Acc date: Jun 29, 2016; Pub date: Jul 03, 2016 Copyright: © 2016 Niederstrasser NG, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract The prevalence of dementia and age-related cognitive impairment is rising due to an aging population worldwide. There is currently no effective pharmacological treatment, but cognitive activity programs could contribute to prevention and risk reduction. However, the results of intervention studies are inconclusive, which may be related to methodological issues. For example, the inconsistent use of umbrella categories to describe cognitive intervention strategies, such as cognitive training or cognitive rehabilitation, has led to confusion regarding their respective contents and efficacies.
    [Show full text]
  • Acceptance and Mindfulness in Cognitive Behavior Therapy
    Acceptance and Mindfulness in Cognitive Behavior Therapy Understanding and Applying the New Therapies Edited by James D. Herbert Evan M. Forman John Wiley & Sons, Inc. JWBT357-FM_i-x.indd i 10/7/10 2:41:53 PM This book is printed on acid-free paper. ϱ Copyright © 2011 by John Wiley & Sons, Inc. All rights reserved. Published by John Wiley & Sons, Inc., Hoboken, New Jersey. Published simultaneously in Canada. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, (978) 750-8400, fax (978) 646-8600, or on the web at www. copyright.com. Requests to the publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, (201) 748-6011, fax (201) 748-6008. Limit of Liability/Disclaimer of Warranty: While the publisher and author have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives or written sales materials. The advice and strategies contained herein may not be suitable for your situation.
    [Show full text]
  • Cognitive-Behavioral Therapy and Neuroscience: Towards Closer Integration
    Psychological Topics 19 (2010), 2, 235-254 Original scientific paper - UDC – 615.851:612.8 612.8:615.851 616-89-0008.441 Cognitive-Behavioral Therapy and Neuroscience: Towards Closer Integration Nataša Jokić-Begić Faculty of Humanities and Social Sciences, University of Zagreb, Croatia Abstract The aim of this review article is to provide an integrative perspective by combining basic assumptions of cognitive-behavioral therapy (CBT) with neuroscience research results. In recent years, interdisciplinary research in the field of neuroscience has expanded our knowledge about neurobiological correlates of mental processes and changes occurring in the brain due to therapeutic interventions. The studies are largely based on non-invasive brain imaging techniques, such as functional neuroimaging technologies of positron emission tomography (PET) and functional magnetic resonance imaging (fMRI). The neuroscientific investigations of basic CBT hypotheses have shown that (i) functional and non-functional behavior and experiences may be learned through lifelong learning, due to brain neuroplasticity that continues across the entire lifespan; (ii) cognitive activity contributes to dysfunctional behavior and emotional experience through focusing, selective perception, memory and recall, and characteristic cognitive distortion; on a neurobiological level, there is a relationship between top-down and bottom-up regulation of unpleasant emotional states; and (iii) cognitive activity may be changed, as shown by therapeutic success achieved by metacognitive and mindfulness techniques, which also have their neurobiological correlates in the changes occurring in the cortical and subcortical structures and endocrine and immune systems. The empirical research also shows that neurobiological changes occur after CBT in patients with arachnophobia, obsessive-compulsive disorder, panic disorder, social phobia, major depressive disorder and chronic fatigue syndrome.
    [Show full text]
  • Chapter 7 COGNITION ASSESSMENT and INTERVENTION
    Cognition Assessment and Intervention Chapter 7 COGNITION ASSESSMENT AND INTERVENTION † MARY VINING RADOMSKI, PHD, OTR/L*; SHARI GOO-YOSHINO, MS ; CAROL SMITH HAMMOND, PHD, CCC/ ‡ § ¥ ¶ SLP ; EMI ISAKI, PHD ; DON MACLENNAN, MA ; R. KEVIN MANNING, PHD ; PAULINE MASHIMA, PHD, CCC/ ** †† ‡‡ §§ SLP ; LINDA M. PICON, MCD, CCC/SLP ; CAROLE R. ROTH, PHD, BC-ANCDS ; AND JOETTE ZOLA, BS, OT INTRODUCTION SECTION 1: ASSESSMENT Introduction Brief Cognitive Assessment Broad Assessment of Cognitive-Linguistic Abilities Domain-Specific Assessments Functional Performance Assessments SECTION 2: INTERVENTION Introduction Overview of Cognitive Rehabilitation Intervention Methods Clinician Tip Sheet: Principles of Cognitive Rehabilitation Cognitive Intervention Techniques to Promote Patient Engagement, Awareness, and Learning Clinician Tip Sheet: Motivational Interviewing Clinician Tip Sheet: AAA Self-Reflection Form Clinician Tip Sheet: Methods to Promote Compensatory Cognitive Strategy Learning Clinician Tip Sheet: Core Cognitive Strategy Recommendations Grid and Working Log Cognition Education Clinician Tip Sheet: How to Explain Human Information Processing Improving Attention and Speed of Processing Clinician Tip Sheet: Inventory of Attention/Speed-of-Processing Difficulties 175 Mild TBI Rehabilitation Toolkit Clinician Tip Sheet: Experiencing Attention Levels Clinician Tip Sheet: Overview of Strategies to Cope with Attention and Speed-of-Processing Difficulties Clinician Tip Sheet: Strategies to Improve Attention—Identifying High- and Low-Demand Tasks
    [Show full text]
  • Using CBT Effectively for Treating Depression and Anxiety
    Using CBT effectively for treating depression and anxiety Modify the elements of CBT to address specific anxiety disorders, patient factors ewer than 20% of people seeking help for depression and anxiety disorders receive cognitive-behavioral therapy (CBT), the most established evidence-based psychother- F 1 apeutic treatment. Efforts are being made to increase access to CBT,2 but a substantial barrier remains: therapist training is a strong predictor of treatment outcome, and many therapists offering CBT services are not sufficiently trained to deliver multiple manual-based interventions with adequate fidelity to the model. Proposed solutions to this barrier include: • abbreviated versions of CBT training for practitioners in primary care and community settings • culturally adapted CBT training for community health workers3 © 2010 PHOTOS.COM • Internet-based CBT and telemedicine (telephone and video conferencing)2 Heather A. Flynn, PhD • mobile phone applications that use text messaging, Associate Professor and Vice Chair for Research Department of Behavioral Sciences and Social Medicine social support, and physiological monitoring as adjuncts Florida State University College of Medicine to clinical practice or stand-alone interventions.4 Tallahassee, Florida New models of CBT also are emerging, including transdi- Ricks Warren, PhD, ABPP agnostic CBT and metacognitive approaches (mindfulness- Clinical Assistant Professor based cognitive therapy and acceptance and commitment University of Michigan Medical School Department of Psychiatry therapy), and several new foci for exposure therapy. Ann Arbor, Michigan In light of these ongoing modulations, this article is intended to help clinicians make informed decisions about CBT when selecting treatment for patients with depressive and anxiety disorders (Box,5 page 46).
    [Show full text]