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PubMed2001

Prospective matching of alcoholic clients to cognitive-behavioral or interactional group therapy.

OBJECTIVE: In earlier work, client sociopathy and global psychopathology were effective variables for treatment matching: clients low on both sociopathy and severity of psychopathology were likely to benefit from interactional group therapy, whereas those scoring high on either of these dimensions benefited more from a coping skills intervention. The present study assessed whether outcomes improve further when clients are assigned to group treatments prospectively based on a matching strategy derived from the previous findings. METHOD: All participants (N = 250, 66% men) met criteria for alcohol dependence or abuse. About half were prospectively assigned to either cognitive-behavioral (CB) coping skills training or interactional therapy, those with higher levels of psychiatric severity or sociopathy were given CB and those who were low on both dimensions were given interactional therapy. The other half were randomly assigned to those treatments, replicating the procedure of the earlier study. Outcome data were collected at the conclusion of treatment and at 3-month intervals for 1 year following. RESULTS: Prospective matching of clients to treatment did not produce superior drinking outcomes compared to random treatment assignment. Randomly assigned clients were more likely to be abstinent at the end of treatment, but this effect disappeared at later follow-ups. Prospectively matched clients had fewer negative consequences of drinking than did those assigned randomly (unmatched). Neither sociopathy nor psychiatric severity was particularly effective for matching. CONCLUSIONS: The matching effects from our previous study were not replicated. Nevertheless, prospective matching did reduce the negative consequences of drinking, consistent with our previous results.

Adult↗
PubMed2005

Parenting schemas and the process of change.

Parents' childrearing behaviors are guided by schemas of the caregiving role, their functioning in that role, what children need in general, and what their own children are like in particular. Sometimes, however, parenting schemas can be maladaptive because they are too rigid or simple, involve inappropriate content, or are dominated by negative affect. In this article, we describe parenting schemas and provide an overview of empirical work documenting the characteristics of maladaptive parenting schemas. We review how intervention practices common to multiple therapeutic approaches (cognitive-behavior therapy, family therapy, parent training, attachment-based interventions, and psychoanalytic parent-infant psychotherapy) attempt to modify schemas to promote more optimal functioning among parents. We highlight how research in cognitive science may explain, in part, treatment effectiveness.

Adaptation, Psychological↗
PubMed1998

The effects of resistance training on well-being and memory in elderly volunteers.

OBJECTIVE: To determine the short- and long-term effects of resistance training on muscle strength, psychological well-being, control-beliefs, cognitive speed and memory in normally active elderly people. METHODS: 46 elderly people (mean age 73.2 years; 18 women and 28 men), were randomly assigned to training and control groups (n=23 each). Pre- and post-tests were administered 1 week before and 1 week after the 8-week training intervention. The training sessions, performed once a week, consisted of a 10 min warm-up phase and eight resistance exercises on machines. RESULTS: There was a significant increase in maximum dynamic strength in the training group. This training effect was associated with a significant decrease in self-attentiveness, which is known to enhance psychological well-being. No significant changes could be observed in control-beliefs. Modest effects on cognitive functioning occurred with the training procedure: although there were no changes in cognitive speed, significant pre/post-changes could be shown in free recall and recognition in the experimental group. A post-test comparison between the experimental group and control group showed a weak effect for recognition but no significant differences in free recall. Significant long-term effects were found in the training group for muscular strength and memory performance (free recall) 1 year later. CONCLUSION: An 8-week programme of resistance training lessens anxiety and self-attentiveness and improves muscle strength.

Aged↗
PubMed2003

Cognitive rehabilitation in schizophrenia: a quantitative analysis of controlled studies.

RATIONALE: Cognitive rehabilitation is now recognized as an important tool in the treatment of schizophrenia, and findings in this area are emerging rapidly. There is a need for a systematic review of the effects of the different training programs. OBJECTIVES: To review quantitatively the controlled studies on cognitive rehabilitation in schizophrenia for the effect of training on performance on tasks other than those practiced in the training procedure. METHODS: A meta-analysis was conducted on 12 controlled studies of cognitive rehabilitation in schizophrenia taking into account the effects of type of rehabilitation approach (rehearsal or strategy learning) and duration of training. RESULTS: The mean weighted effect size was 0.45, with a 95% confidence interval from 0.26 to 0.64. Effect sizes differed slightly, depending on rehabilitation approach, in favor of strategy learning, but this difference did not reach statistical significance. Duration of training did not influence effect size. CONCLUSIONS: Cognitive rehabilitation can improve task performance in patients with schizophrenia and this effect is apparent on tasks outside those practiced during the training procedure. Future studies should include more real-world outcomes and perform longitudinal evaluations.

Brief Psychiatric Rating Scale↗
PubMed2005

Effect of simulator training on driving after stroke: a randomized controlled trial.

BACKGROUND: Neurologically impaired persons seem to benefit from driving-training programs, but there is no convincing evidence to support this notion. The authors therefore investigated the effect of simulator-based training on driving after stroke. METHODS: Eighty-three first-ever subacute stroke patients entered a 5-week 15-hour training program in which they were randomly allocated to either an experimental (simulator-based training) or control (driving-related cognitive tasks) group. Performance in off-road evaluations and an on-road test were used to assess the driving ability of subjects pre- and post-training. Outcome of an official predriving assessment administered 6 to 9 months poststroke was also considered. RESULTS: Both groups significantly improved in a visual and many neuropsychological evaluations and in the on-road test after training. There were no significant differences between both groups in improvements from pre- to post-training except in the "road sign recognition test" in which the experimental subjects improved more. Significant improvements in the three-class decision ("fit to drive," "temporarily unfit to drive," and "unfit to drive") were found in favor of the experimental group post-training. Academic qualification and overall disability together determined subjects that benefited most from the simulator-based driving training. Significantly more experimental subjects (73%) than control subjects (42%) passed the follow-up official predriving assessment and were legally allowed to resume driving. CONCLUSIONS: Simulator-based driving training improved driving ability, especially for well educated and less disabled stroke patients. However, the findings of the study may have been modified as a result of the large number of dropouts and the possibility of some neurologic recovery unrelated to training.

Accidents, Traffic↗
PubMedDate not supplied

Effects of cognitive and pharmacologic strategies on analogued labor pain.

Using an analogued labor pain procedure, the efficacy of combinations of five cognitive and one pharmacologic approach to pain management was examined. Nulliparous undergraduates (N = 120) were randomly assigned to 1 of 12 groups. Cognitive groups included: systematic desensitization (SYS DENS); sensory description (SEN DESC); sensory transformation (ST); modeling (M); and relaxation (R); combined groups: SYS DENS, SEN DESC, and ST; SEN DESC, ST, and R; SEN DESC, R, ST, and Demerol. Pharmacologic groups included expected Demerol, did not expect Demerol, placebo, and no treatment control. Subjects assigned to a cognitive group received two 1-hour training sessions 1 week apart. Remaining subjects were given the assigned pharmacologic treatment one-half hour prior to the exposure to the painful stimulus. Assessment of the cognitive and pharmacologic approaches were made in a 1-hour session involving twenty 80-second exposures to a laboratory pain stimulus patterned to resemble labor contractions. Dependent variables included self-reported pain, blood pressure, frontalis electromyograph, heart rate, and respiratory rate. Significant treatment by trials and treatment effects were found for self-reported pain. No other effects achieved statistical significance.

Adult↗
PubMed1996

U.S. Air Force pilot selection tests: what is measured and what is predictive?

Selection of military pilots has long included the use of multiple aptitude test batteries. Although the names and appearances of the tests used in pilot selection vary, most are to a large extent measures of general cognitive ability, or g. This is consistent with the central role played by cognitive ability measures in the prediction of numerous job training (r = 0.43) and performance (r = 0.34) criteria. Measures of specific cognitive abilities (e.g., verbal, quantitative, spatial, perceptual speed) have shown little incremental validity beyond g (increase in correlation of about 0.02). The incremental validity, beyond g, of measures of pilot job knowledge (e.g., aviation concepts, instruments, principles and terms; increase in correlation beyond g of about 0.08), psychomotor abilities, and personality scores (increase in correlation beyond g between 0.02 and 0.04) also has been small, but significant. The unavoidable requirement to reason in responding to test material causes g to be measured. In broad-ability-range samples, the positive correlations of the measures demonstrate that general cognitive ability is always present as a higher-order factor. Future measures of pilot aptitude may include tests based on cognitive components, chronometric methods, neural conductive velocity, or other methods. These measures, despite their appearance, have been shown to mostly measure g. Subsequently, we expect that future U.S. Air Force pilot selection tests will mostly be measures of g and will, therefore, continue to be predictive of performance.

Cognition↗
PubMed1988

Cognitive activity in sleep and responsiveness to external stimuli.

The relationship between responsiveness to auditory stimuli presented during sleep and cognitive activity during sleep was assessed. Sixteen college-aged women were instructed while awake to turn off a tone by taking a deep breath. The tone was then presented during Stage 2 and REM sleep. Subjects were awakened after select trials to assess the relationship between responding and reports of ongoing cognitive activity. Consistent with the view that cognitive activity reduces responsiveness, significantly fewer responses were found on report (cognitive activity) trials relative to no-report (no cognitive activity) trials in analyses involving all trials and Stage 2 trials alone. Trained judges then rated the subjects' reports of cognitive activity as indicating incorporation or not indicating incorporation of the tone and/or the breathing response. Incorporation was associated with a reduced likelihood of responding relative to no incorporation in analyses involving all trials. No difference in responding was found between no-incorporation trials and no-report trials, suggesting that reduced responsiveness is associated with cognitive activity only when incorporation occurs. These findings support hypotheses that the reduced responsiveness to external stimulation during sleep is at least in part due to ongoing cognitive activity.

Adolescent↗
PubMed2005

Severe decrements in cognition function and mood induced by sleep loss, heat, dehydration, and undernutrition during simulated combat.

BACKGROUND: Military exercises generate high levels of stress to simulate combat, providing a unique opportunity to examine cognitive and physiologic responses of normal humans to acute stress. METHODS: Cognitive and physiologic markers of stress were evaluated before, during, and after an intense training exercise conducted for 53 hours in the heat. Cognitive performance, mood, physical activity, sleep, body composition, hydration, and saliva cortisol, testosterone, and melatonin were assessed. Volunteers were 31 male U.S. Army officers from an elite unit, aged 31.6 +/- .4 years. RESULTS: Wrist activity monitors documented that soldiers slept only 3.0 +/- .3 hours during the exercise and were active throughout. Volunteers lost 4.1 +/- .2 kg (p < .001) of weight, predominately water (3.1 +/- .3 L) (p < .001). Substantial degradation in cognitive function, assessed with computerized tests, occurred. Vigilance, reaction time, attention, memory, and reasoning were impaired (p < .001). Mood, including vigor (p < .001), fatigue (p < .001), confusion (p < .001), depression (p < .001), and tension (p < .002), assessed by questionnaire, deteriorated. The highest cortisol and testosterone levels were observed before the exercise. CONCLUSIONS: This study quantifies the overwhelmingly adverse impact of multiple stressors on cognitive performance, mood, and physiologic parameters, during a continuous but brief military exercise conducted by highly motivated, well-trained officers.

Adult↗
PubMed1994

Training in upper gastrointestinal endoscopy.

Training in upper gastrointestinal endoscopy is a vital portion of the education received by gastroenterology trainees. Proper training involves the acquisition of adequate technical, cognitive, and interpretive skills necessary for good patient care. With the continued technological advancement in endoscopy, advanced training in the form of an additional year of fellowship or hands-on workshops and courses will become essential.

Clinical Competence↗
PubMed2005

Improved evaluation and management of cognitive impairment: results of a comprehensive intervention in long-term care.

OBJECTIVES: Although as many as 50% of patients in long-term care have dementia, it is often not diagnosed and therefore, undertreated. We determined whether an intervention could improve the diagnosis and management of patients with cognitive impairment (CI) in long-term care. DESIGN, SETTING, AND PARTICIPANTS: The assessment phase consisted of a record review of 60 consecutively admitted patients to the San Francisco VA Nursing Home Care Unit (NHCU). Cognitive impairment was determined by admission MMSE < or = 24, indication of cognitive problem on MDS, or chart diagnosis of dementia. The evaluation consisted of a repeat chart review of 60 additional consecutively admitted patients. INTERVENTION: The intervention consisted of low-cost and easy-to-implement educational activities (training, focus groups), strategies to document cognitive status, and consultation with dementia experts. MEASUREMENTS/RESULTS: The 2 cohorts of 60 patients did not differ on demographics or on other characteristics (P > .25 for all). Prior to the intervention, of the 23 patients with CI, 52% had an identified etiology, 35% had a physician management plan, and 22% had a multidisciplinary care plan. Postintervention, of the 22 patients with CI, 91% had an identified etiology (P = .007), 86% had a physician plan (P = .001), and 59% had a multidisciplinary plan (P = .016). CONCLUSIONS: Initial results confirmed the underdiagnosis and undertreatment of CI in our long-term care facility. Our intervention with educational programs, increased documentation of cognitive status, and consultation resulted in increased identification of etiology and improved plans for management of patients with CI.

Aged↗
PubMed2003

Psychophysics in functional strength and power training: review and implementation framework.

Functional training is considered to be training that attempts to mimic the specific physiological demands of real-life activities. Most approaches to functional training, though, omit important factors that contribute to physiological and neuromotor adaptations. Cognitive factors related to sports influence physiological performance, and subsequently, physiological and neuromotor adaptations. We present a rationale and a theoretical framework by which to create effective functional training methods that incorporate cognitive factors. This framework draws upon recent developments and strong empirical evidence in the areas of dynamic systems theory, perceptual skills training, and motor learning/control. Emphasized within rigorous physical training are practice-related techniques and motor-learning strategies. In particular, mental effort, attention, and intention manipulated in a discovery-learning paradigm provide a framework for functional strength and power training. This framework is suggested to help maximize sport-specific physiological adaptations, and subsequently, sports performance.

Adaptation, Physiological↗
PubMed2001

Strategies for managing cancer-related fatigue syndrome: a rehabilitation approach.

Although technologic advances and insights into the mechanisms of cancer and cancer treatments have resulted in hope of increased survival and even cure in many cancer populations, parallel efforts to promote quality of life through a commitment to rehabilitation and aggressive palliation have lagged. Recent studies have demonstrated fatigue to be the most distressing phenomenon experienced by cancer patients. This article examines fatigue from a rehabilitation perspective. Application of innovations in therapeutic exercise training, diet therapy, sleep therapy, cognitive therapy, and pharmacologic therapy and their attendant rationales are discussed. From clinical as well as research perspectives of palliation and rehabilitation, the manifestations of fatigue are better appreciated if fatigue is conceptualized as a syndrome, namely, cancer-related fatigue syndrome (CRFS). Experience of CRFS by cancer patients, regardless of their diagnosis, stage of disease, treatment regimen, or age, influences all aspects of quality of life and aggravates the experience of other distressing symptoms such as pain, nausea, and dyspnea. Understanding the underlying mechanisms for energy loss and gain, as well as the relationship between the right amount and type of activity and sleep, can lead toward more effective and innovative rehabilitation programs. Development of research based clinical interventions in these areas holds promise for significant improvement in functioning and quality of life for cancer survivors and may constitute valuable rehabilitative techniques that can be adjunctive to standard therapies.

Cognition Disorders↗
PubMed1985

Effects of progressive muscle relaxation training on anxiety and health locus of control among hypertensive adults.

The effects of progressive muscle relaxation (PMR) on anxiety and perceptions of personal control over health status are evaluated in this study. After collection of baseline data, 22 hypertensive clients received relaxation training in a series of weekly group sessions followed by individual monitoring sessions over a 6-week period. The 22 hypertensive clients in the control group received blood pressure monitoring, weight checks, and health counseling but were given no relaxation training during the study period. The group instructed in relaxation exhibited significantly lower anxiety than the control group at 4-month followup. After training, the relaxation group also scored significantly higher than the control group on beliefs in personal control of health and lower in beliefs that chance or luck affected health outcomes. At followup, the groups did not differ significantly on perceived influence of powerful others over health status. Findings support the potential usefulness of relaxation training in modifying affective and cognitive characteristics of hypertensive clients.

Anxiety↗
PubMed1995

A preventive, psychoeducational approach to increase perceived social support.

Investigated the effects of a 13-week preventive, psychoeducational intervention program to improve perceived social support. Fifty-one, low-perceived support, community residents were randomly assigned to an intervention or wait-list control condition. Intervention subjects received training in social skills and cognitive reframing regarding the self and social relations. The intervention led to increased perceived social support from family, but not from friends. As hypothesized by social cognition models, increases in perceived support appeared to be mediated by changes in self-esteem and frequency of self-reinforcement. Further, such changes in cognition about the self were larger than the changes observed for perceived support, suggesting that it may be easier to change cognition about the self than perceptions of support.

Adult↗
PubMed1996

[Multidisciplinary treatment program for chronic low back pain, part 1. Overview].

UNLABELLED: A multimodal treatment program is presented in cases of functional restoration for chronic low back pain. The study comprises four parts. Part I gives an overview of the different results of the study. Part II focuses on the medical and functional examination in comparison with persons who do not suffer from back pain. Part III describes psychosocial aspects (depression, complaints, ways of coping, disability) and psychotherapy. In part IV prognostic factors and their reliability for predicting treatment outcome (return to work, pain intensity, self-assessment of success by patients) are examined. In addition the relevant effects of the program on social and health care systems are also addressed. PROBLEM: The incidence of low back pain is continuously increasing, causing tremendous costs for the health insurance system. Therefore effective treatment methods are needed that take into account somatic, psychological and social factors. Chronic low back pain is conceptualized as a complex phenomenon including biological, social and psychological aspects, all of which should be addressed in a treatment program. A multimodal treatment program for chronic low back pain is presented, in which physical activity and cooperation of the patient are the primary targets. Therapeutic aims focus less on pain reduction and emphasize instead pain control, individual responsibility of the patient, and early reintegration into the working environment. The specific goals of the program are to increase the physical abilities of the patients (i. e., flexibility, strength and endurance), to increase patients' knowledge and the use of body mechanics and back protection techniques, to decrease medication-intake, to decrease dependency on the medical community, to improve patients' own positive coping skills and levels of emotional control, to increase the patient's activity level at home and to facilitate a return to work. METHODS: A total of 90 disabled patients with chronic low back pain were admitted to an 8-week program of functional restoration and behavioral support. The program consisted of a pre-program (3 weeks: education, stretching and calisthenic exercises) and an intensive treatment period (aerobics, functional strength and endurance exercises, back exercises, cognitive behavioral group therapy, relaxation training, socioeconomic and vocational counseling) which took place for 5 weeks, 7 h a day, on an outpatient basis. Apart from a medical examination and a personal interview, the patients' physical impairment, pain descriptions, and psychological distress (according to different criteria for evaluation) were also measured. This includes variables such as depression, psychovegetative complaints, quality of life and workplace satisfaction, disability, and coping with disease. Measurements were repeated at the end of the 8-week program, and after 6 and 12 months. RESULTS: In total 84 patients (94 %) were examined following treatment. There was a statistically significant improvement in flexibility, strength, lifting capacity, and endurance measurements ( p < 0.001) at the end of the treatment. In addition, significant reductions in pain, disability, depression, and psychovegetative signs were demonstrated ( p < 0.001). There was a decreased use of medical treatment for back pain following the program, with 42 % of the patients refraining from the intake of analgesics, followed by a significant reduction in physiotherapy and the consultation of physicians. Assessment of the patients' reported increased activity levels at home also supported findings that statistical improvements were significant. Sixty-three percent of the patients were found to have returned to active, productive work following discharge from the program. Most of the improvements remained stable at the 6- and 12-month follow-up examinations. CONCLUSION: The results demonstrate the effectiveness of the multimodal program of functional restoration, not only concerning positive changes in somatic, psychological and physical variables, but also with respect to the number of patients who returned to work. Our methods are also compared with the discrepant results of multimodal treatment in the United States and Scandinavia.

English Abstract↗
PubMed1997

[Multidisciplinary treatment program on chronic low back pain, part 4. Prognosis of treatment outcome and final conclusions].

PROBLEM: Studies using a multimodal approach in order to prognose therapeutic success in patients suffering from back pain were seen to have highly diverse results. However, in spite of various independent health care systems, a common interest prevails in identifying determinants of therapeutic success in order to improve therapy. METHODS: Ninety disabled patients with chronic low back pain were admitted to an 8-week out-patient program of functional restoration and behavioral support. The program consisted of a pre-program (education, stretching and calisthenic exercises 4 h a day, three times a week for 3 weeks) and an intensive treatment period (physical exercises, back school education, cognitive behavioral group therapy, relaxation training, occupational therapy, socioeconomic and vocational counseling) which took place for 5 weeks, 7 h a day as an outpatient program. The program's philosophy encourages active effort on the patients' part in order to improve their functional status within a therapeutic environment. This reinforces behavior conducive to getting well, enhances the patients' sense of self-control over their pain and the resulting disability. The main therapeutic target was to facilitate the patients' return to work. Apart from medical examination and personal interview, the patients' physical impairment, pain descriptions, and psychological distress were also measured. This included variables such as depression, psychovegetative complaints, quality of life and workplace satisfaction, disability, and coping with disease. Measurements were repeated at the end of the 8-week program, and following 6 and 12 month intervals. The reliability of prognostic factors in predicting treatment outcome (return to work, reduction of pain intensity, self-assessment of success by the patients) was tested by analyses of variance and discriminant function analyses. RESULTS: Patients' return to the workplace could be predicted in 85% of cases based on whether an application for pension had been made, on the length of duration of work disability, and on "fixed" assumptions on the part of the patient concerning his work situation. Pre-treatment somatic findings (for example, diagnosis, degree of physical impairment, and functional debilities), together with depressive and psychovegetative reactions, were shown to have no connection with the patient's ability to return to the workplace. Similar findings were demonstrated for the prediction of pain reduction and patient satisfaction with treatment. CONCLUSIONS: Predicting successful treatment is hardly possible without analyzing individual circumstances, focusing on sociodemographic variables, workplace-related conditions, and aspects of individual motivation. With regard to objective therapeutic success, subjective perceptions proved highly influential. Treatment proved successful only when the patient's perception of functional disability was minimized. Hence, individual perceptions and experiences were more important than physical capabilities.

English Abstract↗
PubMed1993

Progressive supranuclear palsy: clinical presentation and rehabilitation of two patients.

Progressive supranuclear palsy (PSP), is an infrequent movement disorder characterized by supranuclear ophthalmoplegia, pseudobulbar palsy, and axial dystonia with frequent and unpredictable falls, usually backward. Median survival from time of diagnosis is two years. When diagnosis is reached, the patients are usually disabled and unable to ambulate independently. No specific rehabilitation protocol has been described for PSP. This article examines our rehabilitation experience with two PSP patients and our management of their frequent and unpredictable falls. The rehabilitation program consisted of a thorough physical evaluation; cognitive and speech evaluation and training; exercises to improve strength and coordination; and static and dynamic balance training. In order to improve safety during ambulation, we provided the patients with a heavy shopping cart or wheelchair that they could grab when in danger of losing their balance. The patients were able to achieve independence in ambulation.

Aged↗