Pupillometer-based neurofeedback cognitive training to improve processing speed and social functioning in individuals at clinical high risk for psychosis.

Abstract

Objective Among individuals at clinical high risk (CHR) for psychosis, processing speed (PS) has been related to social and role functioning regardless of conversion to schizophrenia. This information processing dysfunction is a gateway to broader behavioral deficits such as difficulty executing social behaviors. We examined the feasibility of improving information processing relevant to social situations in CHR, including its sustainability at 2-month follow-up, and its association with concurrent social function. Methods This was a double-blind RCT in which 62 CHR participants were randomized to Processing Speed Training (PST) or an active control matched for training format and the same dose and duration of treatment. PST is a tablet-based program that uses pupillometry-based neurofeedback to continually adjust training parameters for an optimal neurocognitive load and to improve visual scanning efficiency by inhibiting selection of non-essential targets and discriminating figure-ground details. Results The PST group showed faster motoric and non-motoric PS at post training and 2-month follow-up. At 2 month follow-up, the PST group reported better overall social adjustment. Changes in PS from baseline to 2 months were correlated with overall social adjustment and social avoidance in the entire sample. Conclusions and Implications for Practice This is the first study to test focal neurofeedback-based cognitive training for PS deficits in the putatively prodromal phase of schizophrenia to address associated social morbidity. Targeting PS appears to be a promising pathway to decreasing co-morbidity and mitigating a risk factor for psychosis.

Attenuated psychotic symptom interventions in youth at risk of psychosis: A systematic review and meta‐analysis

“…The mean treatment duration was 30.0 weeks (range = 4‐104 weeks.). Interventions included: CRT ( N = 6) (Choi et al, ; Hooker et al, ; Loewy et al, ; Piskulic, Barbato, & Addington, ; Rauchensteiner et al, ; Urben, Pihet, Jaugey, Halfon, & Holzer, ), family‐based treatments ( N = 5) (Grano et al, ; Landa et al, ; McFarlane et al, ; Miklowitz Dj et al, ; O'Brien et al, ), CBT ( N = 6) (Addington et al, ; Kim et al, ; Morrison Ap et al, ; Morrison et al, ; Stain et al, ; van der Gaag et al, ), aripiprazole ( N = 3) (Kobayashi et al, ; Liu et al, ; Woods et al, ), NMDAR modulators ( N = 3) (Kantrowitz et al, ; Woods et al, ), omega‐3 ( N = 3) (Amminger et al, ; Cadenhead et al, ; McGorry et al, ), integrated psychological intervention ( N = 3) (Albert et al, ; Nordentoft et al, ; Wessels et al, ), risperidone plus CBT ( N = 2) (McGorry et al, ; McGorry Pd et al, ), amisulpride ( N = 1) (Ruhrmann et al, ), olanzapine ( N = 1) (McGlashan Th et al, ), low‐dose lithium ( N = 1) (Berger et al, ), ziprasidone ( N = 1) (Woods et al, ), perospirone ( N = 1) (Tsujino et al, ), second generation anti‐psychotics ( N = 1) (Cornblatt et al, ), anti‐psychotics not specified ( N = 3) (Morita et al, ; Shim et al, ; Walker et al, ) and heart rate variability biofeedback training ( N = 1) (McAusland & Addington, ). The control conditions varied as well; placebo ( N = 8), computer games ( N = 4), needs‐based interventions ( N = 12), supportive therapy ( N = 3) and enhanced care ( N = 1).…”

“…Interventions included: CRT (N = 6) (Choi et al, 2016;Hooker et al, 2014;Loewy et al, 2016;Piskulic, Barbato, & Addington, 2012;Rauchensteiner et al, 2011;Urben, Pihet, Jaugey, Halfon, & Holzer, 2012), family-based treatments (N = 5) (Grano et al, 2016;Landa et al, 2016;McFarlane et al, 2015;Miklowitz Dj et al, 2014;O'Brien et al, 2007), CBT (N = 6) (Addington et al, 2011;Kim et al, 2011;Morrison Ap et al, 2004;Morrison et al, 2012;Stain et al, 2016;van der Gaag et al, 2012), aripiprazole (N = 3) (Kobayashi et al, 2009;Liu et al, 2013;Woods et al, 2007) Thirteen studies did not use a control group.…”

Interventions and social functioning in youth at risk of psychosis: A systematic review and meta‐analysis

“…To our knowledge the CR studies included in this current review did not employ any social skills training in addition to the computer based training, which in combination has been demonstrated to increase the impact of CR on social outcomes in schizophrenia trials (Hogarty et al, ; Spaulding, Reed, Sullivan, Richardson, & Weiler, ). Lastly, it has been suggested that processing speed may be an important cognitive competent to target impaired social functioning (Choi et al, ; Kelleher et al, ). All CR studies in this review reported that the CR intervention groups employed some element that targeted processing speeds specifically, but only one CR study improved social functioning compared to controls at 4 month follow‐up (Choi et al, ).…”

Decisional Informatics for Psychosocial Rehabilitation

“…The following four therapies were modularized for this particular demonstration of FORT: (1) Incentive Work Therapy (IWT) (Bell and Lysaker, 1997), 2 to 4 hours per week of paid work activity throughout the medical center (e.g. mailroom, janitorial service) including a weekly 50-minute session on performance feedback and goal setting, (2) Indianapolis Vocational Intervention Program (Lysaker et al, 2009), a weekly 50-minute cognitive behavioral therapy group that focused on modifying negative expectations about vocational issues, (3) computer-based social cognitive drill and practice training called Understanding Social Situations (Fiszdon et al, 2016) that targets attributional bias and theory of mind, and (4) a tablet-based cognitive remediation program for psychosis (Choi et al, 2016) designed to improve processing speed and working memory.…”