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Cognitive Training aka “Brain Training” ©

Joe W Dixon PhD

Cognitive Training (CT) includes the identification of cognitive deficits plus highly focused mental abilities training targeting the identified deficits. There are three main components to CT:
1.    Cognitive Behavior Therapy (CBT),
2.    Mindfulness Instruction (MI), and
3.    CT Software utilizing computers and perhaps EEG-Biofeedback. 

These three components can be combined in a program individually designed for each patient based upon diagnostic findings.

The common goals of CBT, MI, and CT Software are enhanced self-awareness, self-control, improved attention, and improved memory function.  This leads to better capacity for academic performance plus improved social behavior.  CT can be enhanced with support groups for parents and patients alike, e.g., anger management group, etc.

Patients with cognitive deficits have for a variety of reasons not learned these mental skills naturally through normal development processes, but the good news is -- these skills can be specifically targeted, taught, and learned.

Diagnosis is key.  Prior to beginning cognitive training, a diagnostic work up is completed. This includes a check-up with the patient’s physician plus a review of medical, clinical, and school records.  The formal psychological assessment focuses on frontal lobe functioning and also examines the patient for deficits in:

Target populations include children, adolescents, and adults with:
 

·         WM deficits and learning disorders (math, reading, writing)
·
         communication disorders (expressive and receptive)
·
         attentional deficits (ADHD)
·
         pervasive developmental disorders (Autism, ChDD, Asperger’s, etc)
·
         brain injuries (TBI) or compromise secondary to disease processes
·
         oppositional, conduct, and disruptive disorders
·
         elimination disorders (if emotional dyscontrol is etiologic)
·
         separation and reactive attachment disorders

 These target populations all have in common weakness or failure in critical cognitive abilities that mediate and control behavior and emotions, and these cognitive abilities can be identified and strengthened.[1]  

 Therapeutic outcome varies by patient - group data indicates significant average improvement.[2]

                 CT leads to improvement in normal youth and adults as well. “Memory Clinics” are successfully being established in most major cites in the United States and throughout Europe.  Additionally, CT for older adults slows the decline of daily functioning abilities and memory loss.[3]

 Component 1:  Evidence-based CBT is claimed by many, but practiced by few.

  1. CBT is brief and time-limited, and is based upon measurable objectives and goals 

  2. CBT is based upon the belief that thoughts primarily govern our attitudes and behavior

  3. CBT teaches rational self-counseling and self-mediating skills useful throughout life

  4. CBT is a collaborative effort between therapist and patient  

  5. CBT teachers separation between events and feelings about events

  6. CBT uses the Socratic method of teaching

  7. CBT is structured and directive

  8. CBT is educational in philosophy

  9. CBT is based upon inductive logic (fact based)   

  10. CBT utilizes a great deal of homework

 Component 2: Mindfulness Instruction (MI) is based in part upon meditation and the philosophy of yoga. It includes learning how to be self-aware – both emotionally and physically. Self-monitoring is often lacking in patients with these target disorders. MI helps to maintain awareness and prevent relapse when stress and depression seek to overwhelm. Many of our patients are socially bankrupt and no longer care about themselves or the consequences of their behavior. MI combined with CBT corrects this learned behavior pattern and mental attitude. Specific training links the emotional state and behavior, relaxation is taught, and these aid in increased mental concentration and self-control.  MI compliments CBT.

Component 3: CT software specifically designed to train and increase WM, attention span, self-control, listening skills, reasoning ability, and general memory is available. Computers are tireless, can be used anytime, and keep excellent records of progress. There are numerous companies providing software for these target populations, both for clinic use and home use by patients.[4]    

The newest computer based technological innovation has been to combine the principles of Biofeedback with EEG recordings.  Known as EEG Biofeedback or Neurofeedback (NFB), patients learn in real time to produce targeted brain activity levels.[5]  Biomedical companies contracting with NASA in the 1990s developed and tested EEG Biofeedback equipment and procedures used to train astronauts.[6] 

Today, both clinic-based and home-based EEG Biofeedback equipment is commercially available to diagnostically test sustained attention, awareness, logic application, and performance with monitoring and instant feedback.[7] Patients learn to achieve optimal brain wave states for learning and problem solving. 

The downside to EEG-Biofeedback is that it is expensive, and while insurance will pay for wheelchairs, it does not as yet pay for home use EEG-Biofeedback equipment. Fortunately, most homes today do have computers, and clinicians can provide the more expensive EEG-Biofeedback equipment, CBT, and MI training and diagnostics.  

 

Footnotes Below -------------------------------------

 [1] Medication may be concurrently prescribed. Research indicates less medication is needed as cognitive training (CT) proceeds, and approximately 60% of children with mild or moderate ADHD are able to discontinue all medications with successful completion of CT.  See, Training the Brain, Scientific American (2006).

 [2]  Multimodal Treatment Study, the largest US longitudinal study of ADHD shows that after two years, youth treated with  behavior therapy only functioned as well as matched youth on high-dose medication.  See, W. Pelham (2007).

 [3] ACTIVE – the first multi-center, randomized controlled trial to examine the long-term outcome of cognitive interventions with older adults with five year follow-up demonstrated positive results.

[4] Captain’s Log is commercially available and has demonstrated efficacy with ADD, LD, and TBI patients as well as older patients with memory deficits. There are dozens of others with demonstrated efficacy.

 [5] Typically, the goal is the increase of activity in the 12–18 Hz band (beta1/SMR (sensorimotor rhythm)) and a decrease in the 4–8 Hz and/or 22–28 Hz bands (theta and/or beta2). The most common and well-documented use of neurofeedback is in the treatment of attention deficit hyperactivity disorder: multiple studies have shown neurofeedback to be useful in the treatment of ADHD. Cf,  J. Lubar (2006), Butnik (2005), Masterpasqual et al (2003). QEEG has shown that ADHD is often characterized by an abundance of slow brainwaves and a diminished quantity of fast wave activity; neurofeedback treatment seeks to teach individuals to produce more normalized EEG patterns that optimize their functioning.

 [6] The biofeedback video game concept (patented by NASA in 1994) evolved from a physiologically-adaptive simulator system that was developed in NASA flight deck research. Pope (2000)

 [7] Additional measured benefits of CT training include better sleep, less daytime fatigue, lowered anxiety levels, less depression, better eating habits, improved social relationships, and better emotional self-regulation.

 

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