Attention shaping: a reward-based learning method to enhance skills training outcomes in schizophrenia.
Attention shaping: a reward-based learning method to enhance skills training outcomes in schizophrenia.
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DOI：
10.1093/schbul/sbm150
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发表时间：
2009-01-01
影响因子：
6.6
通讯作者：
Starobin, Hannah
中科院分区：
文献类型：
--
作者：
Silverstein, Steven M;Spaulding, William D;Starobin, Hannah
持续注意力障碍通常会干扰精神分裂症患者从循证心理社会治疗中获益的能力。到目前为止，认知补救干预对注意力的影响微乎其微，药物也是如此。因此，有效的社会心理治疗与患者有效参与并从中受益的能力之间存在差距。我们报告了一项关于注意力塑造（AS）的多地点研究的结果，这是一种在高度注意力分散的精神分裂症患者中提高注意力和学习社交技能的行为干预。对技能训练难以耐受的慢性精神分裂症患者被分配接受UCLA基本会话技能模块（BCSM）增强AS （n = 47）或标准格式（n = 35）。AS是一种基于奖励的学习程序，用于促进患者在社交技能训练组的每次会议中达到明确定义和个性化的注意力和参与目标。主要结果测量是每次治疗中注意力的观察性评分，以及bcsm前后对社交技能和症状的评分。接受社交技能训练的患者在小组会议中表现出更强的注意力和更高的技能习得水平；此外，在注意力的变化和获得的技能数量之间发现了显著的关系。注意力的变化与抗精神病药物的水平或剂量变化无关。AS是支持性认知的一个有效例子，在患者经历困难的环境背景下，认知能力得到改善，从而获得注意力和功能结果。
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.