Effectiveness Trial of Attention Shaping for Schizophrenia

描述（由申请人提供）：在精神分裂症患者中，注意力障碍是能够参与和学习新技能的心理社会技能培训干预的主要障碍。因此，在技能培训过程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、一项对照研究和正在进行的R21应用数据表明，注意塑造程序（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定，标准化的观察评级，提示和强化程序，以帮助患者增加他们在社会心理干预中的注意力的持续时间和质量。迄今为止，ASP研究的结果评价仅限于小组内注意力和小组材料的学习。其他认知结果、普遍性、功能结果和获益的持久性尚未得到研究。因此，本提案描述了一项ASP的对照有效性研究，该研究将全面评估相关结果、概括性、与干预中教授的内容相关的功能技能，并在六个月内保持收益。ASP将被整合到一个标准形式的社交技能训练中[UCLA基本会话技能模块（BCS）]，并与单独的BCS条件进行比较。本研究的具体目的包括检验：1)ASP对非研究组注意力相关领域的影响的普遍性，以及神经认知的标准化测量；2)包括社交技能在内的功能结果，通过自我报告、他人报告、访谈和基于角色扮演的测量进行评估；3)通过对所有受试者进行为期6个月的随访评估，观察asp相关获益的持久性。统计分析将涉及时间序列和增长曲线模型，这些模型利用每日组内表现数据来模拟治疗反应。这些数据，加上更多的传统分析，将决定ASP是否以及在多大程度上给接受它的患者在注意力、学习和/或行为技能表现方面带来优势。该项目的长期目标是证明ASP可以缩小潜在有效的社会心理干预（如技能培训）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.