Attention Shaping: a Reward-Based Learning Method to Enhance Skills Training Outcomes in Schizophrenia

Abstract

Disturbances in sustained attention commonly interfere with the ability of persons with schizophrenia to benefit from evidence-based psychosocial treatments. Cognitive remediation interventions have thus far demonstrated minimal effects on attention, as have medications. There is thus a gap between the existence of effective psychosocial treatments and patients' ability to effectively engage in and benefit from them. We report on the results of a multisite study of attention shaping (AS), a behavioral intervention for improving attentiveness and learning of social skills among highly distractible schizophrenia patients. Patients with chronic schizophrenia who were refractory to skills training were assigned to receive either the UCLA Basic Conversation Skills Module (BCSM) augmented with AS (n 5 47) or in the standard format (n 5 35). AS, a reward-based learning procedure, was employed to facilitate patients' meeting clearly defined and individualized attentiveness and participation goals during each session of a social skills training group. Primary outcome measures were observational ratings of attentiveness in each session and pre-and post-BCSM ratings of social skill and symptoms. Patients receiving social skills training augmented with AS demonstrated significantly more attentiveness in group sessions and higher levels of skill acquisition; moreover, significant relationships were found between changes in attentiveness and amount of skills acquired. Changes in attentiveness were unrelated to level or change in antipsychotic medication dose. AS is an effective example of supported cognition, in that cognitive abilities are improved within the environmental context where the patient is experiencing difficulty, leading to gains in both attention and functional outcome.

Feasibility, Safety, and Efficacy of the Combination of D-Serine and Computerized Cognitive Retraining in Schizophrenia: An International Collaborative Pilot Study

“…Umbricht, 2010), which have better bioavailability and are more target specific, might have greater promise. Consistent with some studies (Kurtz et al, 2009;Silverstein et al, 2009), CRT resulted in improvements in measures of attention/vigilance and verbal working memory. However, unlike other studies (d 'Amato et al, 2011;Hodge et al, 2010), CRT did not result in any improvements on reasoning and problem solving, and verbal learning and memory.…”

Mental health system funding of cognitive enhancement interventions for schizophrenia: Summary and update of the New York Office of Mental Health expert panel and stakeholder meeting.

“…Some CE programs are intended to be paired with a specific intervention such as supported employment; others fully integrate the psychiatric rehabilitation into the CE; while others are stand-alone interventions for use at home or in a clinician's office. For example, the TSW program is provided in combination with vocational rehabilitation (McGurk et al, 2005;McGurk et al, 2009), whereas CET integrates the practice of social problem solving and social-cognitive skills training (Eack et al, 2009), and attention shaping is typically delivered within the context of skills training groups to promote learning of skills (Silverstein et al, 2005;Silverstein, Pierce, et al, 1998;Silverstein et al, 2009), although it can also be run as a standalone intervention. On the other hand, some programs, like CRT (Wykes & Reeder, 2005) and PositScience (Fisher et al, 2009), have been offered as standalone interventions, although they could be combined with psychiatric rehabilitation in future applications.…”

“…Therefore, given the limited data available, we recommend that CE programs provide one or more of drill-and-practice exercises, strategy coaching, or teaching compensatory strategies. We also note that an attention-shaping procedure developed by Silverstein et al (2005Silverstein et al ( , 2009, can be integrated into the actual provision of social skills training without utilizing these three CE methods.…”

Attentional-shaping as a means to improve emotion perception deficits in schizophrenia

“…Typically, interventions for social cognition are categorized as either "broad-based" or "targeted" strategies . Broad-based interventions, such as cognitive remediation, focus on restoring the core cognitive deficits in schizophrenia with the expectation that an improvement in lower level cognitive abilities will lead to an improvement in emotion perception (Spaulding et al, 1999;Van der Gaag et al, 2002). However, because these interventions use a large number of techniques, it becomes difficult to discern what treatment components exert beneficial effects (Kurtz et al, 2001;Twamley et al, 2003).…”