Attention Shaping: a Reward-Based Learning Method to Enhance Skills Training Outcomes in Schizophrenia
Open Access
- 1 January 2009
- journal article
- research article
- Published by Oxford University Press (OUP) in Schizophrenia Bulletin
- Vol. 35 (1) , 222-232
- https://doi.org/10.1093/schbul/sbm150
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 = 47) or in the standard format (n = 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.Keywords
This publication has 59 references indexed in Scilit:
- Behavioral rehabilitation of the "treatment-refractory" schizophrenia patient: Conceptual foundations, interventions, and outcome data.Psychological Services, 2006
- Factors Associated With a Positive Response to Cognitive Remediation in a Community Psychiatric SamplePsychiatric Services, 2005
- Longitudinal studies of cognition and functional outcome in schizophrenia: implications for MATRICSPublished by Elsevier ,2004
- The Effects Of Shaping Classes On Academic Skills, Self Care Skills and On-ward Behavior with Persons Who Are Cognitively Impaired and Chronic Psychiatric InpatientsPsychiatric Rehabilitation Skills, 1999
- Integrating Shaping and Skills Training Techniques in the Treatment of Chronic Treatment Refractory Individuals with SchizophreniaPsychiatric Rehabilitation Skills, 1999
- University-state hospital collaboration in an inpatient psychiatric rehabilitation programCommunity Mental Health Journal, 1991
- Reduction of perseverative error in patients with schizophrenia using monetary feedback.Journal of Abnormal Psychology, 1991
- The use of a rating scale of attentional behaviourNeuropsychological Rehabilitation, 1991
- Cognitive habilitation in schizophrenia: A theoretical review and model of treatmentNeuropsychology Review, 1990
- Choice Reaction Time of Chronic and Acute Psychiatric Patients under Primary or Secondary Aversive StimulationBritish Journal of Social and Clinical Psychology, 1968