Effectiveness Trial Of Attention Shaping For Schizophrenia

Steven M Silverstein, Associate Professor
Univ Of Med/dent Nj-r W Johnson Med Sch Robert Wood Johnson Medical Sch Piscataway, Nj 088548021

Grant 5R01MH074650-02 from National Institute Of Mental Health, IRG: APDA

Abstract: Among people with schizophrenia, attentional impairment is a major barrier to being able to engage in, and learn new skills in, psychosocial skills training interventions. Therefore, developing methods to promote attentiveness and learning during skills training is an important step in improving treatment outcomes. Prior case reports, one controlled study, and data from an ongoing R21 application indicate that attention shaping procedures (ASP) are highly effective methods to achieve these goals. ASP is a manualized, behavioral intervention that involves individualized goal-setting, and standardized observational rating, prompting, and reinforcement procedures to assist patients in increasing the duration and quality of their attentiveness in psychosocial interventions. To date, studies of ASP have been limited in their outcome evaluations to in- group attentiveness and learning of group material. Other cognitive outcomes, generalizability, functional outcomes and durability of gains have not been studied. This proposal, therefore, describes a controlled effectiveness study of ASP that would comprehensively assess relevant outcomes, generalizability, functional skills related to those taught in the intervention and maintenance of the gains over six months. ASP will be integrated within a standard form of social skills training [UCLA Basic Conversation Skills Module (BCS)], and compared to a BCS-alone condition. Specific aims of the study involve examinations of 1) the generalizability of ASP s effects to relevant domains of non-study-group attentiveness, and standardized measures of neurocognition; 2) functional outcomes involving social skills, as assessed through self-report, other-report, interview, and role-play based measures; and 3) the durability of ASP-associated gains, by conducting a 6-month follow-up assessment on all subjects. Statistical analyses will involve time-series and growth curve models that make use of daily in-group performance data to model treatment response. These data, plus more traditional analyses will determine whether, and to what extent, ASP confers advantages in attention, and learning and/or performance of behavioral skills to patients who receive it. The long-term objective of this project is to demonstrate that ASP can narrow the gap between the existence of potentially effective psychosocial interventions (such as skills training) and patients who, at present, cannot benefit from them due to attentional difficulties.

Keywords: attention, behavior modification, behavior therapy, human therapy evaluation, psychosocial rehabilitation, schizophrenia, clinical trial, outcomes research, reinforcer, behavioral /social science research tag, clinical research, human subject, medical rehabilitation related tag, neuropsychological test, patient oriented research

Project start date: 2006-09-14

Project end date: 2011-07-31

5R01MH074650-02 (2007): $455946

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Effectiveness Trial Of Attention Shaping For Schizophrenia

Steven M Silverstein, Associate Professor
Psychiatryuniv Of Med/dent Nj-r W Johnson Med Sch

Grant 5R01MH074650-03 from National Institute Of Mental Health, IRG: APDA

Abstract: Among people with schizophrenia, attentional impairment is a major barrier to being able to engage in, and learn new skills in, psychosocial skills training interventions. Therefore, developing methods to promote attentiveness and learning during skills training is an important step in improving treatment outcomes. Prior case reports, one controlled study, and data from an ongoing R21 application indicate that attention shaping procedures (ASP) are highly effective methods to achieve these goals. ASP is a manualized, behavioral intervention that involves individualized goal-setting, and standardized observational rating, prompting, and reinforcement procedures to assist patients in increasing the duration and quality of their attentiveness in psychosocial interventions. To date, studies of ASP have been limited in their outcome evaluations to in- group attentiveness and learning of group material. Other cognitive outcomes, generalizability, functional outcomes and durability of gains have not been studied. This proposal, therefore, describes a controlled effectiveness study of ASP that would comprehensively assess relevant outcomes, generalizability, functional skills related to those taught in the intervention and maintenance of the gains over six months. ASP will be integrated within a standard form of social skills training [UCLA Basic Conversation Skills Module (BCS)], and compared to a BCS-alone condition. Specific aims of the study involve examinations of 1) the generalizability of ASP´s effects to relevant domains of non-study-group attentiveness, and standardized measures of neurocognition; 2) functional outcomes involving social skills, as assessed through self-report, other-report, interview, and role-play based measures; and 3) the durability of ASP-associated gains, by conducting a 6-month follow-up assessment on all subjects. Statistical analyses will involve time-series and growth curve models that make use of daily in-group performance data to model treatment response. These data, plus more traditional analyses will determine whether, and to what extent, ASP confers advantages in attention, and learning and/or performance of behavioral skills to patients who receive it. The long-term objective of this project is to demonstrate that ASP can narrow the gap between the existence of potentially effective psychosocial interventions (such as skills training) and patients who, at present, cannot benefit from them due to attentional difficulties

Keywords: attention, behavior modification, behavior therapy, human therapy evaluation, psychosocial rehabilitation, schizophrenia clinical trial, outcomes research, reinforcer behavioral /social science research tag, clinical research, human subject, medical rehabilitation related tag, neuropsychological test, patient oriented research

Project start date: 2006-09-14

Project end date: 2011-07-31

3/5-Cognitive Neuroscience Task Reliability & Clinical Applications Consortium

Steven M Silverstein
Psychiatryuniv Of Med/dent Nj-r W Johnson Med Sch

Grant 1R01MH084828-01 from National Institute Of Mental Health, IRG: ZMH1

Abstract: Over the past decade there has been a growing awareness of the disabling effects of impaired cognition in individuals with schizophrenia. Along with this new awareness has come an increasing emphasis on the importance of developing new treatments that may positively impact these cognitive deficits. During this same period, the cognitive neuroscience field has seen an explosion of technical advances and new knowledge regarding the neural basis of cognition. Sadly, the translation and application of this cutting edge knowledge and paradigm development to new drug development in schizophrenia has lagged significantly behind overall progress in cognitive neuroscience, in large part due to the lack of data on the measurement properties of tasks used in cognitive neuroscience. This concern spawned the Cognitive Neuroscience Research To Improve Cognition in Schizophrenia (CNTRICS) initiative, which conducted a series of conferences designed to develop consensus on the constructs and paradigms from cognitive neuroscience that are ripe for translation, and the validation and psychometric goals when translating such tasks for use in clinical trials contexts. The current application is a logical and needed extension of the CNTRICS initiative that will begin the translation process for paradigms designed to assess four of the constructs identified as being ripe for translation in the first CNTRICS meeting. We have brought together a collaborative "translation" team that represents significant expertise from the many fields necessary for the success of this endeavor, including both basic and clinical cognitive neuroscientists, psychometricians, and clinical trials specialists. We have chosen to focus on four constructs that span both early (gain control and visual integration in perception) and higher-level (goal maintenance, relational encoding and retrieval) components of human cognitive processing. By examining multiple mechanisms, we will be able to establish the generality of the translational approach we propose across different levels and types of cognitive mechanisms. Specific Aim 1 is to validate (in both individuals with schizophrenia and comparison participants) optimized versions of the paradigms that assess our four constructs of interest, as well as to examine the relationship of task performance to clinical and functional outcomes in schizophrenia. By optimization, we mean examining modifications on already validated paradigms that are designed to 1) minimize task length; 2) simplify task administration across multiple sites; 3) maximize sensitivity and selectivity in assessing the specific cognitive mechanisms of interest; and 4) enhance reliability and minimize floor and ceiling effects. By validation, we mean ensuring that such optimizations designed to enhance the psychometric properties of the task do not alter its construct validity. Specific Aim 2 will be to assess and optimize test-retest reliability and practice effects for the task versions validated in Specific Aim 1. PROJECT NARRATIVE This project has high relevance for public health by significantly improving our ability to translate paradigms developed into the basic cognitive neuroscience literature for use in clinical trials aimed at improving cognition in schizophrenia. Cognitive deficits in schizophrenia are a major predictor of functional outcome in this debilitating illness. Thus, we need to improve our methods for detecting and enhancing cognitive function in schizophrenia in order to help individuals with this illness lead more productive and fulfilling lives

Project start date: 2008-09-30

Project end date: 2011-05-31

Shaping Attention In Treatment-Refractory Schizophrenia

Steven M Silverstein, Associate Professor
University Of Illinois At Chicago 310 Aob, M/c 672 Chicago, Il 60612

Grant 5R21MH063967-04 from National Institute Of Mental Health, IRG: ZRG1

Abstract: Despite pharmacologic treatment advances, there are many treatment-refractory schizophrenia patients remaining in state hospitals. Many of these patients are sufficiently cognitively impaired that they benefit little from psychosocial interventions and have little chance of returning to the community without the introduction of novel cognition-enhancing interventions. Moreover, many patients who have been discharged from state hospitals in the wake of recent census reductions also have attentional problems that preclude their ability to fully engage in, and benefit from, psychosocial interventions. Such patients can be considered at heightened risk for relapse and rehospitalization as long as their limited ability to benefit from treatment remains undressed. Compounding this problem is the inability of current cognitive rehabilitation interventions to improve attentional functioning in schizophrenia patients with the most severe attentional problems. For such patients, behaviorally oriented attention shaping procedures have demonstrated effectiveness in several small-scale studies. However, the lack of a user-friendly, standardized format for the delivery of this intervention has led to its almost complete nonuse outside of academic research centers. Therefore, the proposed study seeks to draw on the expertise of those investigators who have pioneered the use of shaping techniques to improve attention in treatment-refractory schizophrenia patients, in order to integrate these techniques into a standardized, manualized treatment intervention, along with an accompanying training videotape and therapist fidelity evaluation measure. The proposed project would develop this standardized treatment delivery format, and then refine it through a series of pilot treatment groups at three sites Weill Medical College of Cornell University, Lincoln Regional Center, and Hawaii State Hospital. In addition, data would be collected and pooled regarding treatment-related changes in attentional functioning, skill acquisition in groups, and symptomatology. The expected results of this project include 1) the development of a user-friendly set of materials to facilitate dissemination of the attention shaping intervention to real-world settings; 2) the collection of preliminary data on its effectiveness; and 3) the generation of estimates of power and subject variability which can serve as the foundation from which to design a large-scale controlled treatment study.

Keywords: attention, computer assisted patient care, computer program /software, human therapy evaluation, method development, neuropsychology, psychotherapy, schizophrenia, computer human interaction, handbook, information dissemination, learning, outcomes research, reinforcer, videotape /videodisc, behavioral /social science research tag, clinical research, data collection methodology /evaluation, human subject, interview, mental disorder diagnosis, patient oriented research, psychological test

Project start date: 2003-02-14

Project end date: 2007-01-31

5R21MH063967-04 (2005): $211187

5R21MH063967-03 (2004): $172878

Shaping Attention In Treatment--Refractory Schizophrenia

Steven M Silverstein, Associate Professor
Weill Medical College Of Cornell Univ 1300 York Avenue New York, Ny 10021

Grant 1R21MH063967-01A2 from National Institute Of Mental Health, IRG: ZRG1

Abstract: Despite pharmacologic treatment advances, there are many treatment-refractory schizophrenia patients remaining in state hospitals. Many of these patients are sufficiently cognitively impaired that they benefit little from psychosocial interventions and have little chance of returning to the community without the introduction of novel cognition-enhancing interventions. Moreover, many patients who have been discharged from state hospitals in the wake of recent census reductions also have attentional problems that preclude their ability to fully engage in, and benefit from, psychosocial interventions. Such patients can be considered at heightened risk for relapse and rehospitalization as long as their limited ability to benefit from treatment remains undressed. Compounding this problem is the inability of current cognitive rehabilitation interventions to improve attentional functioning in schizophrenia patients with the most severe attentional problems. For such patients, behaviorally oriented attention shaping procedures have demonstrated effectiveness in several small-scale studies. However, the lack of a user-friendly, standardized format for the delivery of this intervention has led to its almost complete nonuse outside of academic research centers. Therefore, the proposed study seeks to draw on the expertise of those investigators who have pioneered the use of shaping techniques to improve attention in treatment-refractory schizophrenia patients, in order to integrate these techniques into a standardized, manualized treatment intervention, along with an accompanying training videotape and therapist fidelity evaluation measure. The proposed project would develop this standardized treatment delivery format, and then refine it through a series of pilot treatment groups at three sites Weill Medical College of Cornell University, Lincoln Regional Center, and Hawaii State Hospital. In addition, data would be collected and pooled regarding treatment-related changes in attentional functioning, skill acquisition in groups, and symptomatology. The expected results of this project include 1) the development of a user-friendly set of materials to facilitate dissemination of the attention shaping intervention to real-world settings; 2) the collection of preliminary data on its effectiveness; and 3) the generation of estimates of power and subject variability which can serve as the foundation from which to design a large-scale controlled treatment study.

Keywords: attention, computer assisted patient care, computer program /software, human therapy evaluation, method development, neuropsychology, psychotherapy, schizophrenia, computer human interaction, handbook, information dissemination, learning, outcomes research, reinforcer, videotape /videodisc, behavioral /social science research tag, clinical research, data collection methodology /evaluation, human subject, interview, mental disorder diagnosis, patient oriented research, psychological test

Project start date: 2003-02-14

Project end date: 2003-09-26

1R21MH063967-01A2 (2003): $141280

Effectiveness Trial Of Attention Shaping For Schizophrenia

Steven M Silverstein, Associate Professor
Univ Of Med/dent Nj-r W Johnson Med Sch Robert Wood Johnson Medical Sch Piscataway, Nj 088548021

Grant 1R01MH074650-01A1 from National Institute Of Mental Health, IRG: APDA

Abstract: Among people with schizophrenia, attentional impairment is a major barrier to being able to engage in, and learn new skills in, psychosocial skills training interventions. Therefore, developing methods to promote attentiveness and learning during skills training is an important step in improving treatment outcomes. Prior case reports, one controlled study, and data from an ongoing R21 application indicate that attention shaping procedures (ASP) are highly effective methods to achieve these goals. ASP is a manualized, behavioral intervention that involves individualized goal-setting, and standardized observational rating, prompting, and reinforcement procedures to assist patients in increasing the duration and quality of their attentiveness in psychosocial interventions. To date, studies of ASP have been limited in their outcome evaluations to in- group attentiveness and learning of group material. Other cognitive outcomes, generalizability, functional outcomes and durability of gains have not been studied. This proposal, therefore, describes a controlled effectiveness study of ASP that would comprehensively assess relevant outcomes, generalizability, functional skills related to those taught in the intervention and maintenance of the gains over six months. ASP will be integrated within a standard form of social skills training [UCLA Basic Conversation Skills Module (BCS)], and compared to a BCS-alone condition. Specific aims of the study involve examinations of 1) the generalizability of ASP s effects to relevant domains of non-study-group attentiveness, and standardized measures of neurocognition; 2) functional outcomes involving social skills, as assessed through self-report, other-report, interview, and role-play based measures; and 3) the durability of ASP-associated gains, by conducting a 6-month follow-up assessment on all subjects. Statistical analyses will involve time-series and growth curve models that make use of daily in-group performance data to model treatment response. These data, plus more traditional analyses will determine whether, and to what extent, ASP confers advantages in attention, and learning and/or performance of behavioral skills to patients who receive it. The long-term objective of this project is to demonstrate that ASP can narrow the gap between the existence of potentially effective psychosocial interventions (such as skills training) and patients who, at present, cannot benefit from them due to attentional difficulties.

Keywords: attention, behavior modification, behavior therapy, human therapy evaluation, psychosocial rehabilitation, schizophrenia, clinical trial, outcomes research, reinforcer, behavioral /social science research tag, clinical research, human subject, medical rehabilitation related tag, neuropsychological test, patient oriented research

Project start date: 2006-09-14

Project end date: 2011-07-31

1R01MH074650-01A1 (2006): $446350