Effectiveness Trial of Attention Shaping for Schizophrenia

描述(申请人提供)：在精神分裂症患者中，注意力障碍是从事心理社会技能培训干预并学习新技能的主要障碍。因此，在技能培训中开发促进注意力和学习的方法是改善治疗结果的重要一步。先前的病例报告、一项对照研究和一项正在进行的R21应用的数据表明，注意力塑造程序(ASP)是实现这些目标的高效方法。ASP是一种手动的行为干预，包括个性化的目标设置，以及标准化的观察评级、提示和强化程序，以帮助患者在心理社会干预中增加他们的注意力的持续时间和质量。到目前为止，对ASP的研究一直局限于对结果的评估，仅限于小组内注意和学习小组材料。其他认知结果、概括性、功能结果和增益的持久性尚未被研究。因此，这项提案描述了一项关于ASP的受控有效性研究，该研究将全面评估相关结果、泛化能力、与干预和维持六个月收益相关的功能技能。ASP将被整合到标准形式的社交技能培训[加州大学洛杉矶分校基本会话技能模块(BCS)]中，并与单独使用BCS进行比较。这项研究的具体目标包括：1)通过对所有受试者进行为期6个月的跟踪评估，考察ASP对非研究小组注意相关领域的影响的概括性，以及神经认知的标准化测量；2)涉及社交技能的功能结果，通过自我报告、他人报告、访谈和基于角色扮演的测量来评估；以及3)与ASP相关的收益的持久性。统计分析将涉及时间序列和增长曲线模型，这些模型利用每日的组内绩效数据来模拟治疗反应。这些数据，加上更传统的分析，将决定ASP是否以及在多大程度上使接受它的患者在注意力、学习和/或行为技能表现方面具有优势。这个项目的长期目标是证明ASP可以缩小潜在有效的心理社会干预(如技能培训)的存在与目前由于注意力困难而无法从中受益的患者之间的差距。

DESCRIPTION (provided by applicant): Among people with schizophrenia, attentional impairment is a major barrier to being able to engage in, and learn new skills in, psychosocial skills training interventions. Therefore, developing methods to promote attentiveness and learning during skills training is an important step in improving treatment outcomes. Prior case reports, one controlled study, and data from an ongoing R21 application indicate that attention shaping procedures (ASP) are highly effective methods to achieve these goals. ASP is a manualized, behavioral intervention that involves individualized goal-setting, and standardized observational rating, prompting, and reinforcement procedures to assist patients in increasing the duration and quality of their attentiveness in psychosocial interventions. To date, studies of ASP have been limited in their outcome evaluations to in- group attentiveness and learning of group material. Other cognitive outcomes, generalizability, functional outcomes and durability of gains have not been studied. This proposal, therefore, describes a controlled effectiveness study of ASP that would comprehensively assess relevant outcomes, generalizability, functional skills related to those taught in the intervention and maintenance of the gains over six months. ASP will be integrated within a standard form of social skills training [UCLA Basic Conversation Skills Module (BCS)], and compared to a BCS-alone condition. Specific aims of the study involve examinations of: 1) the generalizability of ASP's effects to relevant domains of non-study-group attentiveness, and standardized measures of neurocognition; 2) functional outcomes involving social skills, as assessed through self-report, other-report, interview, and role-play based measures; and 3) the durability of ASP-associated gains, by conducting a 6-month follow-up assessment on all subjects. Statistical analyses will involve time-series and growth curve models that make use of daily in-group performance data to model treatment response. These data, plus more traditional analyses will determine whether, and to what extent, ASP confers advantages in attention, and learning and/or performance of behavioral skills to patients who receive it. The long-term objective of this project is to demonstrate that ASP can narrow the gap between the existence of potentially effective psychosocial interventions (such as skills training) and patients who, at present, cannot benefit from them due to attentional difficulties.