Marie-Noëlle Levaux

Cognitive rehabilitation of the updating sub-component of working memory in schizophrenia: A case study

Working memory problems have been identified as a core cognitive deficit in schizophrenia. In this paper, we present the results of a cognitive rehabilitation programme (Duval & Coyette, 2005) administered to a schizophrenia patient, and specifically designed to improve the updating sub-component of working memory. The original feature of this programme was that it involved two types of updating exercises: cognitive and ecological. The purpose was to enable the patient to acquire cognitive strategies that alleviate the mental load of the central executive and to transfer them to daily life. The specificity and efficacy of the programme were assessed with multiple (cognitive, ecological and non-target) baseline measurements. In addition, several questionnaires were administered to assess the effect of the programme on subjective cognitive complaints affecting daily life, psychiatric symptoms and self-esteem. The results demonstrated the efficacy of the rehabilitation programme on the updating function and the generalisation of these beneficial effects to daily life. A significant decrease in both subjective cognitive complaints and psychiatric symptoms was also observed. However, the patients self-esteem did not improve.

Rehabilitation of Executive Functions in a Real-Life Setting: Goal Management Training Applied to a Person with Schizophrenia

The aim was to assess the efficacy of a modified version of Goal Management Training (GMT) in a person with schizophrenia who had difficulties in attaining the final goal for new and multitasking daily-life situations. GMT is designed to improve abilities in establishing goal-directed plans and carrying them out effectively. Beneficial effects of GMT were measured for several clinical questionnaires, laboratory tasks, and three real-life situations: meal preparation (trained, familiar); washing (nontrained, familiar); meeting preparation (nontrained, unfamiliar). The results revealed improvement in planning and on trained laboratory and meal preparation tasks and a generalization of GMT effects on nontrained laboratory and everyday tasks. Self-esteem also improved. Finally, a two-year followup indicated the durability of the beneficial effects.

The Effectiveness of the Attention Training Technique in Reducing Intrusive Thoughts in Schizophrenia: A Case Study

The aim of this study was to investigate the effectiveness of the attention training technique (ATT) on the frequency of intrusive thoughts experienced by a person with schizophrenia in her daily life. The attentional procedure was designed to attenuate self-focused attention and to reinforce attentional control and consisted of auditory external exercises. Homework practice was included to promote transfer to everyday life. The efficacy and specificity of the ATT were assessed with cognitive, functional, and control measures. The impact of ATT on symptomatology, work functioning, and self-esteem was also measured. Postrehabilitation results showed that, after nine training sessions, there was a reduction in intrusive thoughts for the cognitive and ecological outcome measures. Selective attention, attention switching, and resistance to distractive interference specifically improved. The person reported a reduction in intrusive thoughts in her daily life. In addition, positive symptoms decreased. Finally, a 6-month follow-up assessment revealed the maintenance of most of the beneficial effects in daily life.

Multitasking capacities in persons diagnosed with schizophrenia: A preliminary examination of their neurocognitive underpinnings and ability to predict real world functioning

Difficulties in everyday life activities are core features of persons diagnosed with schizophrenia and in particular during multitasking activities. However, at present, patients׳ multitasking capacities have not been adequately examined in the literature due to the absence of suitable assessment strategies. We thus recently developed a computerized real-life activity task designed to take into account the complex and multitasking nature of certain everyday life activities where participants are required to prepare a room for a meeting. Twenty-one individuals diagnosed with schizophrenia and 20 matched healthy controls completed the computerized task. Patients were also evaluated with a cognitive battery, measures of symptomatology and real world functioning. To examine the ecological validity, 14 other patients were recruited and were given the computerized version and a real version of the meeting preparation task. Results showed that performance on the computerized task was significantly correlated with executive functioning, pointing to the major implication of these cognitive processes in multitasking situations. Performance on the computerized task also significantly predicted up to 50% of real world functioning. Moreover, the computerized task demonstrated good ecological validity. These findings suggest the importance of evaluating multitasking capacities in patients diagnosed with schizophrenia in order to predict real world functioning.

An Individualized and Everyday Life Approach to Cognitive Rehabilitation in Schizophrenia: A Case Illustration

Objective. The effectiveness of an individualized and everyday approach to cognitive rehabilitation for schizophrenia was examined in a case study. Method. After cognitive and functional assessment, concrete objectives were targeted for the persons everyday complaints. Strategies were constructed based on an analysis of the cognitive profile, daily life functioning, and processes involved in activities. They included a memory strategy for reading, a diary to compensate memory difficulties, and working memory exercises to improve immediate processing of information when reading and following conversations. Efficacy was assessed with outcome measures. Results. The program had beneficial effects on the persons cognitive and everyday functioning, which persisted at a 3-year follow-up. Conclusion. Findings provide suggestive evidence that an individualized and everyday approach may be a useful alternative in order to obtain a meaningfully lasting transfer of training to daily life, compared to the nomothetic ones which dominate the field.