Matching Cognitive Remediation to Cognitive Deficits in Substance-Abusing Inmates

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DESCRIPTION (provided by applicant): People with psychopathy are at high risk for alcohol and drug abuse as well as diverse forms of antisocial behavior (Smith & Newman, 1990). Thus, addressing the risk factors associated with psychopathy may prove to be crucial for the successful treatment of substance abuse, especially in incarcerated samples. In this regard, there is a strong precedent for differentiating the risk factors associated with emotionally reactive or emotionally stable forms of psychopathy. Although both types are associated with significant substance abuse, the self-control problems of these two subtypes are associated with distinct cognitive-affective deficits. In the proposed research, we use recent progress in distinguishing and characterizing the psychobiological deficits associated with these subtypes to develop novel cognitive remediation protocols that match their respective skill deficits and evaluate whether these protocols result in greater change than those that do not address the putative deficits. Specifically, 128 incarcerated offenders diagnosed with emotionally reactive or emotionally stable forms of psychopathy will receive one of two computer-based interventions designed to develop core cognitive skills that have been linked to self-regulation deficits in either emotionally reactive or emotionally stable psychopathic offenders. One intervention (ACC) targets the affective cognitive control deficits associated with emotionally reactive offenders whereas the other intervention (ATC) targets the attention to context deficits associated with emotionally stable offenders. To evaluate the impact and specificity of the ACC and ATC in this initial investigation, we will use pre- and post-treatment behavioral and brain-related measures that have been found to distinguish emotionally reactive and emotionally stable psychopathic offenders in past research. We predict that a treatment designed to remediate the cognitive deficits of one experimental group will result in significantly greater change than a treatment designed to remediate the cognitive deficits of the other experimental group. The results of the study will (a) provide important baseline information concerning the magnitude of change that may be expected from a brief computer-based intervention in the absence of supporting cognitive-behavioral materials designed to enhance the generalization of such training to daily functioning and (b) shed light on the plausibility of demonstrating differential treatment responses in these two similarly antisocial, but etiologically distinct, subtypes. PUBLIC HEALTH RELEVANCE: To realize the potential of research advances in experimental psychopathology, it is necessary to improve the technology for translating these advances into meaningful therapeutic interventions. Toward this end, we (a) translate research on the distinct psychobiological mechanisms associated with emotionally-reactive and emotionally-stable criminal offenders into distinct computer-assisted interventions that train skills designed to overcome their deficits and reduce alcohol / drug abuse, (b) examine the extent to which these deficit-focused interventions modify brain-related responses associated with the disorders, and (c) test the hypothesis that deficit-matched treatments produce significantly greater post-treatment change.