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Kristina K Hardy - One of the best experts on this subject based on the ideXlab platform.
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working memory Training in survivors of pediatric cancer a randomized pilot study
Psycho-oncology, 2013Co-Authors: Kristina K Hardy, Victoria W Willard, Taryn M Allen, Melanie J BonnerAbstract:It is well known that survivors of brain tumors and acute lymphoblastic leukemia (ALL) are at increased risk for neurocognitive late effects [1–3]. More specifically, many survivors develop primary impairments in attention, working memory, and processing speed that are then associated with declines in cognitive and academic functioning [4,5], as well as poor long-term social and vocational outcomes [6–8]. As such, recent efforts have focused on developing and testing interventions designed to ameliorate these deficits [9]. A number of treatment approaches have been evaluated in recent years, including medication, clinic-based cognitive remediation, and home-based computerized cognitive Training [9]. Psychostimulant medication, long established as an effective treatment for symptoms of attention-deficit hyperactivity disorder (ADHD), has also been found to reduce attention deficits in survivors [10–16]. Despite these positive results, there remain several concerns about the use of psychostimulants, including a greater susceptibility to side effects in survivors than in children with ADHD [11, 17], unknown long-term effects [18], and a potential reluctance to using psychoactive medications [19]. Cognitive remediation has also been evaluated as a treatment approach for survivors with neurocognitive deficits. Based on an approach developed for use with individuals with traumatic-brain injury (TBI), these programs typically focus on the repetition of tasks thought to develop core cognitive skills (e.g., immediate and working memory), as well as the acquisition and practice of strategies to compensate for deficits in these areas (e.g., organizational skills, self-monitoring) [20]. To date, clinic-based programs involving primarily face-to-face work with one or more providers have been the focus of most empirical study. A multi-center randomized trial [21] of a hospital-based cognitive remediation program was completed with 161 survivors of pediatric cancer. While treatment efficacy was demonstrated through increases in attention and academic achievement, effect sizes were small for a number of functional outcomes. Conclusions about the effectiveness of the program also were mitigated by a sizable percentage of participants who failed to complete the 6-month program [21]. A similar intervention that focused on Problem-Solving Training was piloted with a small group of survivors [22]. Again, preliminary efficacy was demonstrated through improvements on each outcome measure; however, this study was also characterized by a low participation rate and suboptimal adherence. The authors noted that the most frequent reason given for lower adherence was perceived inconvenience of coming to the clinic. Collectively, these results suggest that intensive, therapist-directed, in-person interventions may not be practical or desirable for some subgroups of the survivor population. Given the limitations associated with these treatment approaches, there remains a critical need for efficacious interventions targeting symptoms associated with neurocognitive late effects in pediatric cancer survivors. Home-based, computerized cognitive Training has recently emerged as a cognitive remediation paradigm with the potential to address core neuropsychological deficits in survivors [23, 24]. This approach is associated with a low risk of side effects (compared to pharmacological treatment) and may carry a reduced treatment burden (compared to clinic-based interventions) because it can be completed at home, any time of day. Computerized cognitive Training employs game-like exercises to target core cognitive skills such as working memory and attention. Such programs have demonstrated efficacy across a wide variety of individuals with cognitive difficulties: children with ADHD [25–31], TBI and stroke [32, 33], schizophrenia [34, 35], extremely low birth weight [36], cochlear implants [37], and borderline intellectual disabilities [38]. A recent study piloted the use of one such intervention with a small group (n = 9) of survivors [23]. Results were promising, with survivors demonstrating improvements in both performance-based and questionnaire measures of attention. However, several limitations were noted, including a small sample size, lack of a control group, and improvement in measures of attention, but not working memory [23]. Kesler and colleagues [24] subsequently investigated the preliminary efficacy of an internet-based cognitive rehabilitation program with a small sample of survivors (n = 23). Survivors demonstrated improvements in processing speed, cognitive flexibility, and visual and verbal declarative memory. However, there were no significant changes observed in either working memory or attention. Of interest, fMRI data documented significant increases in dorsolateral prefrontal cortex activation in participants who completed Training [24]. Results from both intervention studies [23, 24] suggest that computerized cognitive Training programs are feasible for use and potentially efficacious with survivors of pediatric cancer, though neither used a randomized, controlled design. In order to extend the literature in this area, we evaluated an existing computerized cognitive Training program, CogmedRM, with survivors of pediatric cancer. CogmedRM has significant advantages over other computerized cognitive Training programs for the survivor population. First, unlike the previous programs evaluated with cancer survivors, its use has been associated with significant efficacy in a number of well-designed and controlled trials with children and adolescents [27, 29–31]. Moreover, CogmedRM specifically targets working memory skills, which have been proposed to underlie the changes in intelligence and academic performance frequently seen in survivors with cognitive late effects [4, 5]. Finally, CogmedRM consists of a fixed “dose” of Training (i.e., 25 sessions) and also has an active control version of the program, making it ideally suited for empirical study in a randomized, controlled design. The objectives of this study were to describe the feasibility and preliminary efficacy of this program in a small, randomized clinical trial with survivors of pediatric brain tumors and ALL. Outcomes included an assessment of treatment adherence and acceptability, as well as improvement on parent-rated and performance-based measures of working memory. Specifically, in keeping with prior pilot work using this program, we evaluated a near-transfer task as our primary endpoint (WRAML-2 Symbolic Working Memory) [27,28]. Secondary endpoints included performance-based measures of verbal working memory (WRAML-2 Verbal Working Memory), auditory and visual short-term memory (WRAML-2 Letter Number and Finger Windows), and caregiver ratings of attention and learning problems (Conners’ 3 Rating Scale – Inattention and Learning Problems).
Melanie J Bonner - One of the best experts on this subject based on the ideXlab platform.
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working memory Training in survivors of pediatric cancer a randomized pilot study
Psycho-oncology, 2013Co-Authors: Kristina K Hardy, Victoria W Willard, Taryn M Allen, Melanie J BonnerAbstract:It is well known that survivors of brain tumors and acute lymphoblastic leukemia (ALL) are at increased risk for neurocognitive late effects [1–3]. More specifically, many survivors develop primary impairments in attention, working memory, and processing speed that are then associated with declines in cognitive and academic functioning [4,5], as well as poor long-term social and vocational outcomes [6–8]. As such, recent efforts have focused on developing and testing interventions designed to ameliorate these deficits [9]. A number of treatment approaches have been evaluated in recent years, including medication, clinic-based cognitive remediation, and home-based computerized cognitive Training [9]. Psychostimulant medication, long established as an effective treatment for symptoms of attention-deficit hyperactivity disorder (ADHD), has also been found to reduce attention deficits in survivors [10–16]. Despite these positive results, there remain several concerns about the use of psychostimulants, including a greater susceptibility to side effects in survivors than in children with ADHD [11, 17], unknown long-term effects [18], and a potential reluctance to using psychoactive medications [19]. Cognitive remediation has also been evaluated as a treatment approach for survivors with neurocognitive deficits. Based on an approach developed for use with individuals with traumatic-brain injury (TBI), these programs typically focus on the repetition of tasks thought to develop core cognitive skills (e.g., immediate and working memory), as well as the acquisition and practice of strategies to compensate for deficits in these areas (e.g., organizational skills, self-monitoring) [20]. To date, clinic-based programs involving primarily face-to-face work with one or more providers have been the focus of most empirical study. A multi-center randomized trial [21] of a hospital-based cognitive remediation program was completed with 161 survivors of pediatric cancer. While treatment efficacy was demonstrated through increases in attention and academic achievement, effect sizes were small for a number of functional outcomes. Conclusions about the effectiveness of the program also were mitigated by a sizable percentage of participants who failed to complete the 6-month program [21]. A similar intervention that focused on Problem-Solving Training was piloted with a small group of survivors [22]. Again, preliminary efficacy was demonstrated through improvements on each outcome measure; however, this study was also characterized by a low participation rate and suboptimal adherence. The authors noted that the most frequent reason given for lower adherence was perceived inconvenience of coming to the clinic. Collectively, these results suggest that intensive, therapist-directed, in-person interventions may not be practical or desirable for some subgroups of the survivor population. Given the limitations associated with these treatment approaches, there remains a critical need for efficacious interventions targeting symptoms associated with neurocognitive late effects in pediatric cancer survivors. Home-based, computerized cognitive Training has recently emerged as a cognitive remediation paradigm with the potential to address core neuropsychological deficits in survivors [23, 24]. This approach is associated with a low risk of side effects (compared to pharmacological treatment) and may carry a reduced treatment burden (compared to clinic-based interventions) because it can be completed at home, any time of day. Computerized cognitive Training employs game-like exercises to target core cognitive skills such as working memory and attention. Such programs have demonstrated efficacy across a wide variety of individuals with cognitive difficulties: children with ADHD [25–31], TBI and stroke [32, 33], schizophrenia [34, 35], extremely low birth weight [36], cochlear implants [37], and borderline intellectual disabilities [38]. A recent study piloted the use of one such intervention with a small group (n = 9) of survivors [23]. Results were promising, with survivors demonstrating improvements in both performance-based and questionnaire measures of attention. However, several limitations were noted, including a small sample size, lack of a control group, and improvement in measures of attention, but not working memory [23]. Kesler and colleagues [24] subsequently investigated the preliminary efficacy of an internet-based cognitive rehabilitation program with a small sample of survivors (n = 23). Survivors demonstrated improvements in processing speed, cognitive flexibility, and visual and verbal declarative memory. However, there were no significant changes observed in either working memory or attention. Of interest, fMRI data documented significant increases in dorsolateral prefrontal cortex activation in participants who completed Training [24]. Results from both intervention studies [23, 24] suggest that computerized cognitive Training programs are feasible for use and potentially efficacious with survivors of pediatric cancer, though neither used a randomized, controlled design. In order to extend the literature in this area, we evaluated an existing computerized cognitive Training program, CogmedRM, with survivors of pediatric cancer. CogmedRM has significant advantages over other computerized cognitive Training programs for the survivor population. First, unlike the previous programs evaluated with cancer survivors, its use has been associated with significant efficacy in a number of well-designed and controlled trials with children and adolescents [27, 29–31]. Moreover, CogmedRM specifically targets working memory skills, which have been proposed to underlie the changes in intelligence and academic performance frequently seen in survivors with cognitive late effects [4, 5]. Finally, CogmedRM consists of a fixed “dose” of Training (i.e., 25 sessions) and also has an active control version of the program, making it ideally suited for empirical study in a randomized, controlled design. The objectives of this study were to describe the feasibility and preliminary efficacy of this program in a small, randomized clinical trial with survivors of pediatric brain tumors and ALL. Outcomes included an assessment of treatment adherence and acceptability, as well as improvement on parent-rated and performance-based measures of working memory. Specifically, in keeping with prior pilot work using this program, we evaluated a near-transfer task as our primary endpoint (WRAML-2 Symbolic Working Memory) [27,28]. Secondary endpoints included performance-based measures of verbal working memory (WRAML-2 Verbal Working Memory), auditory and visual short-term memory (WRAML-2 Letter Number and Finger Windows), and caregiver ratings of attention and learning problems (Conners’ 3 Rating Scale – Inattention and Learning Problems).
Lamia P. Barakat - One of the best experts on this subject based on the ideXlab platform.
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Acceptability and Feasibility in a Pilot Randomized Clinical Trial of Computerized Working Memory Training and Parental Problem-Solving Training With Pediatric Brain Tumor Survivors.
Journal of pediatric psychology, 2019Co-Authors: Matthew C. Hocking, Iris Paltin, Lauren F. Quast, Lamia P. BarakatAbstract:OBJECTIVE To evaluate the feasibility and acceptability of computerized working memory Training in pediatric brain tumor survivors (PBTS) with cognitive deficits, as well as computerized working memory Training that is enhanced with parental Problem-Solving skills Training (PSST). METHODS Twenty-seven PBTS (ages 7-16) recruited from a large, tertiary academic medical center were randomly assigned to computerized working memory Training (Standard; n = 14) or computerized working memory Training plus PSST (Combined; n = 13). PBTS completed a baseline assessment and parents completed acceptability surveys. Primary outcomes included number of intervention sessions completed and acceptability ratings. RESULTS Fourteen of the 27 participants completed at least 20 sessions of the computerized Training with average sessions lasting over an hour (M = 68.42 min, SD = 14.63). Completers had significantly better baseline auditory attention abilities than noncompleters. Parents reported both frustration and satisfaction related to the interventions and identified barriers to completing intervention sessions. CONCLUSIONS This pilot randomized clinical trial raises significant questions related to the feasibility of computerized working memory Training in PBTS with cognitive deficits. Findings also offer considerations for integrating family-based treatment approaches into cognitive remediation interventions for PBTS.
Perczel-forintos Dóra - One of the best experts on this subject based on the ideXlab platform.
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Gátolt menekülés: Az öngyilkosság kognitív modellje = The arrested flight: The cognitive model of suicidal behaviour
'Akademiai Kiado Zrt.', 2031Co-Authors: Perczel-forintos DóraAbstract:Az öngyilkossági kísérletet megelőző állapotot eddig leginkább a Ringel-féle „cry for help” jelenségével jellemezte a szakirodalom. Mivel a legtöbb öngyilkossági kísérlet depressziós állapotban következik be, az 1990-es évektől kezdve számos szerző, így Teasdale, Williams, Zullinger és Nezu empirikus vizsgálatai egyre pontosabban beazonosították az öngyilkosságot megkísérlő személyek legfontosabb kognitív jellemzőit. Ezek a következők: a negatív kognitív triád, a túláltalánosított önéletrajzi emlékezet, ami összefüggésben áll a problémamegoldó képességek alacsony szintjével és a reménytelenséggel. Ismert, hogy a reménytelenség, mint az öngyilkossági veszélyeztetettség megbízható prediktora a jövőperspektíva lezárulásával jár. Williams „gátolt menekülés” modellje mindezeket koherens elméleti keretbe foglalja. Kulcsfogalma a „csapdába esettség”, ami az evolúciós pszichológiából származik. Csapdába esettség akkor fordul elő, amikor az egyén úgy véli, nem képes elmenekülni a számára averzív környezetből, ahol legyőzték, megalázták vagy veszteség érte. Mivel a pszichés tényezők a módosítható kockázati tényezők közé tartoznak, ezért nagy fontossággal bírnak a prevenció szempontjából. A problémamegoldó készségek fejlesztése, a problémamegoldó tréning jelenleg az öngyilkossági veszélyállapot megelőzésének egyik legfontosabb, empirikusan alátámasztott módja. A tanulmány célja, hogy felhívja a figyelmet a problémamegoldó tréning alkalmazására hazánkban az öngyilkossági veszélyeztetettség hatékony megelőzésében. | Literature refers to the presuicidal condition as the “cry for help” syndrome by Ringel. Since most suicide attempts happen in major depression, empirical research by Teasdale, Williams, Zullinger and Nezu from the 1990s identified more clearly the cognitive characteristics of patients with suicide attempt. These are the followings: the negative cognitive triad, overgeneralized autobiographical memory related to low levels of problem solving skills and hopelessness. Hopelessness can be characterized by negative perspectives of the future and it is considered as a reliable predictor of suicidality. The arrested flight model by Williams provides a coherent theoretical framework for these different characteristics. The keyword of the model is called „entrapment” which is borrowed from evolutionary psychology. Entrapment occurs when the individual can not escape from the aversive situation where she/he was defeated or humiliated. Since psychological characteristics belong to the modifiable risk factors in suicidality, they are extremely important in prevention. Development of problem solving skills by problem solving Training is one of the most important empirically grounded approaches in suicide prevention. The aim of this paper is to draw attention to problem solving approaches in effective suicide prevention in Hungary
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Az alacsony intenzitású, bizonyítottan hatékony kognitív viselkedésterápia Crohn-betegségben
'Akademiai Kiado Zrt.', 2018Co-Authors: Antal-uram Dóra, Harsányi László, Perczel-forintos DóraAbstract:Inflammatory bowel disease (Crohn's disease and colitis ulcerosa) is a chronic, long-term condition that causes chronic inflammation in the digestive tract, and shows an increasing incidence and prevalence worldwide. Changes in disease activity over time affect psychological distress which increases the risk of exacerbations. Beside somatic symptoms (such as abdominal pain, diarrhoea and weight loss), psychiatric comorbidity (in particular major depression, anxiety, social phobia) is common in patients with Crohn's disease. This case study illustrates the management and stabilization of a 21-year-old adult male patient with active Crohn's disease and with severe psychiatric comorbidity. The patient was diagnosed with avoidant personality disorder and dysruptive mood dysregulation disorder based on the results of psychodiagnostics (SCID-II structured clinical interview, MMPI personality inventory and disease-specific clinical questionnaires such as Beck Depression Inventory, Beck Hopelessness Scale, Social Cognition Questionnaire, Anger Expression Scale, Cognitive Emotion Regulation Questionnaire, Rosenberg Self-Esteem Scale). The main aim of psychotherapy is to increase the adherence to pharmacotherapy, to promote psychosocial functioning, to improve well-being and to enhance adaptive coping strategies. Low-intensity cognitive-behavioural psychotherapy was used which included psychoeducation, motivational interview, behavioural activation, patient diary, cognitive restructuring, Problem-Solving Training, and family consulting. Twenty-five sessions were held weekly in outpatient form and 3 sessions of crisis intervention after the surgery at the hospital. The efficacy of the treatment was measured by self-reported questionnaires at baseline and at two follow-up sessions which corroborated a very significant decrease in the severity of depression, hopelessness, while emotional regulation and self-esteem became more adaptive. The remission of the above-mentioned psychiatric symptoms resulted in the improvement of the pharmacotherapy adherence and the quality of life. Low- intensity psychosocial interventions are proven to be an effective way of delivering evidence-based psychotherapy. Orv Hetil. 2018; 159(9): 363-369
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Az alacsony intenzitású, bizonyítottan hatékony kognitív viselkedésterápia Crohn-betegségben = Low-intensity, evidence-based cognitive-behavioural therapy of a patient with Crohn’s disease
'Akademiai Kiado Zrt.', 2018Co-Authors: Antal-uram Dóra, Harsányi László, Perczel-forintos DóraAbstract:Absztrakt: A gyulladásos bélbetegségek (inflammatory bowel disease, IBD) olyan krónikus szomatikus betegségek, melyek prevalenciája világszerte növekvő tendenciát mutat. A tünetek megjósolhatatlansága, a betegséggel járó megváltozott életminőség, testkép, énkép, valamint a lefolyás kiszámíthatatlansága miatt a betegséghez való alkalmazkodásban kiemelt fontosságú a pszichés tényezők, megküzdési stratégiák szerepe. A szomatikus tünetek mellett a kutatások a pszichiátriai kórképekkel (elsősorban hangulat- és szorongásos zavarok) való magas komorbiditást jelzik. A jelen esettanulmány célja bemutatni az eseten keresztül az alacsony intenzitású kognitív viselkedésterápia (low-intensity psychosocial intervention – LIPI) eszközeit, a terápiás indikációt a krónikus szomatikus betegséghez társuló pszichés zavarok kapcsán. Tanulmányunk egy serdülőkorban Crohn-betegséggel diagnosztizált 21 éves férfi beteg esetét ismerteti, aki a farmakoterápiás nonadherencia mentén került pszichodiagnosztikai célú kivizsgálásra. A diagnosztika diszruptív hangulatszabályozási zavar mellett elkerülő személyiségzavart jelzett (személyiségvizsgáló eljárások: SCID-II és MMPI személyiségteszt, valamint betegségspecifikus kérdőívek: Beck Depresszió Kérdőív, Beck Reménytelenség Skála, Szociális Kogníció Kérdőív, Harag és Düh Kifejezési Mód Skála, Kognitív Érzelemszabályozási Kérdőív, Rosenberg Önértékelés Kérdőív). A pszichoterápia elsődleges célja a Crohn-betegséghez való adaptív alkalmazkodás elősegítése és a farmakoterápiával való együttműködés kiépítése mellett az indulatszabályozás javítása volt, ezáltal pedig az adaptív megküzdési stratégiák kialakítása. A 25 üléses, alacsony intenzitású kognitív viselkedésterápia elemei között említhető a pszichoedukáció, a motivációs interjú, a kognitív terápia, a viselkedésterápiás intervenciók és a problémamegoldó tréning. A terápia krízisintervenciót és a szomatikus állapotrosszabbodás kapcsán szükséges operációra való felkészítést is magában foglalta. A terápia hatékonyságát az állapotkövető kérdőívek eredményei alátámasztották. A klinikailag jelentős szenvedést okozó pszichiátriai tünetek csökkenése a farmakoterápiás adherencia és az életminőség egyértelmű javulását eredményezték. Mindez alátámasztja tehát, hogy az alacsony intenzitású pszichoszociális intervenciók bizonyítottan hatékony pszichoterápiás formának tekinthetők. Orv Hetil. 2018; 159(9): 363–369. | Abstract: Inflammatory bowel disease (Crohn’s disease and colitis ulcerosa) is a chronic, long-term condition that causes chronic inflammation in the digestive tract, and shows an increasing incidence and prevalence worldwide. Changes in disease activity over time affect psychological distress which increases the risk of exacerbations. Beside somatic symptoms (such as abdominal pain, diarrhoea and weight loss), psychiatric comorbidity (in particular major depression, anxiety, social phobia) is common in patients with Crohn’s disease. This case study illustrates the management and stabilization of a 21-year-old adult male patient with active Crohn’s disease and with severe psychiatric comorbidity. The patient was diagnosed with avoidant personality disorder and dysruptive mood dysregulation disorder based on the results of psychodiagnostics (SCID-II structured clinical interview, MMPI personality inventory and disease-specific clinical questionnaires such as Beck Depression Inventory, Beck Hopelessness Scale, Social Cognition Questionnaire, Anger Expression Scale, Cognitive Emotion Regulation Questionnaire, Rosenberg Self-Esteem Scale). The main aim of psychotherapy is to increase the adherence to pharmacotherapy, to promote psychosocial functioning, to improve well-being and to enhance adaptive coping strategies. Low-intensity cognitive-behavioural psychotherapy was used which included psychoeducation, motivational interview, behavioural activation, patient diary, cognitive restructuring, Problem-Solving Training, and family consulting. Twenty-five sessions were held weekly in outpatient form and 3 sessions of crisis intervention after the surgery at the hospital. The efficacy of the treatment was measured by self-reported questionnaires at baseline and at two follow-up sessions which corroborated a very significant decrease in the severity of depression, hopelessness, while emotional regulation and self-esteem became more adaptive. The remission of the above-mentioned psychiatric symptoms resulted in the improvement of the pharmacotherapy adherence and the quality of life. Low-intensity psychosocial interventions are proven to be an effective way of delivering evidence-based psychotherapy. Orv Hetil. 2018; 159(9): 363–369
Matthew C. Hocking - One of the best experts on this subject based on the ideXlab platform.
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Acceptability and Feasibility in a Pilot Randomized Clinical Trial of Computerized Working Memory Training and Parental Problem-Solving Training With Pediatric Brain Tumor Survivors.
Journal of pediatric psychology, 2019Co-Authors: Matthew C. Hocking, Iris Paltin, Lauren F. Quast, Lamia P. BarakatAbstract:OBJECTIVE To evaluate the feasibility and acceptability of computerized working memory Training in pediatric brain tumor survivors (PBTS) with cognitive deficits, as well as computerized working memory Training that is enhanced with parental Problem-Solving skills Training (PSST). METHODS Twenty-seven PBTS (ages 7-16) recruited from a large, tertiary academic medical center were randomly assigned to computerized working memory Training (Standard; n = 14) or computerized working memory Training plus PSST (Combined; n = 13). PBTS completed a baseline assessment and parents completed acceptability surveys. Primary outcomes included number of intervention sessions completed and acceptability ratings. RESULTS Fourteen of the 27 participants completed at least 20 sessions of the computerized Training with average sessions lasting over an hour (M = 68.42 min, SD = 14.63). Completers had significantly better baseline auditory attention abilities than noncompleters. Parents reported both frustration and satisfaction related to the interventions and identified barriers to completing intervention sessions. CONCLUSIONS This pilot randomized clinical trial raises significant questions related to the feasibility of computerized working memory Training in PBTS with cognitive deficits. Findings also offer considerations for integrating family-based treatment approaches into cognitive remediation interventions for PBTS.