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
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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
Grants awarded to Steven M Silverstein
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
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
1R01MH074650-01A1 (2006): $446350
Related Publications
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