The Automated Test of Embodied Cognition: Concept, Development, and Preliminary Findings.

(1) Background: The Automated Test of Embodied Cognition (ATEC) uses video administration of cognitively demanding physical tasks and motion capture technology to assess cognition in action. Embodied cognition is a radical departure from conventional approaches to cognitive assessment and is in keeping with contemporary neuroscience. (2) Methods: ATEC was administered to a convenience sample of 20 patients with substance use disorder and 25 age-matched community controls. Patients were administered concurrent cognitive assessments. (3) Results: Psychometric analysis revealed excellent internal consistency, test-retest reliability and small practice effects. Groups were significantly different on ATEC scores and ATEC scores significantly related to concurrent measures of cognition. (4) Conclusions: The preliminary results support the reliability and validity of ATEC for older adults.

The Activate Test of Embodied Cognition (ATEC): Reliability, concurrent validity and discriminant validity in a community sample of children using cognitively demanding physical tasks related to executive functioning.

Embodied cognition assessment may be more closely related to how children function than standard measures of executive functioning (EF) that require little body movement. Activate Test of Embodied Cognition (ATEC) measures cognitive functioning based on cognitively demanding physical tasks assessed using an automated administration with motion capture technology. This study evaluated the psychometrics of ATEC.Children ages 5-11 years were recruited from the community (N = 55). ATEC was performed twice for a subsample, approximately 2 weeks apart. Motion capture data were collected and converted into ATEC Total Score. Concurrent measures included scores from NIH Toolbox for EF (Flanker, Working Memory, Go/No-Go task, Balloon Analogue Risk Task (BART)), and parent reports (Child Behavior Checklist (CBCL), Behavioral Rating Inventory of Executive Function (BRIEF-2) and Swanson, Nolan, and Pelham Rating Scale (SNAP-IV) for ADHD).ATEC Total Score was significantly correlated with concurrent measures of EF and showed significant discriminant validity between At-Risk children and Normal Range children on CBCL Competency, CBCL ADHD Combined score, BRIEF-2 Global Executive Composite, BRIEF-2 Cognitive Regulation Index and SNAP-IV ADHD Combined Score. Regression analyses showed that ATEC Total score was a better predictor of CBCL Competency than any of the standard EF assessments. ATEC Total Score had excellent test-retest reliability, (ICC = .945, df = 27, p < .001) with a small practice effect (Cohen's d = 0.33). ATEC Total Score correlated with age (r = .42, p < .003) suggesting improvement with normal development. ATEC produces reliable scores that may identify children at risk for EF impairments.

Attitude change after a curriculum on the science and philosophy of well-being and happiness for high school students: A classroom-randomized trial.

BACKGROUND: Multiple interventions have been tested to promote well-being in high school students, often focusing on depression prevention. AIMS: To test the impact of a one-semester active learning curriculum covering the modern science and philosophy of well-being and happiness on attitudinal measures related to the curriculum and standard measures of depression and well-being. SAMPLE: Subjects were first-year students in an urban high school in Beijing, China (equivalent to US tenth grade). METHODS: Nine classrooms were randomly assigned to the intervention curriculum (n = 252), and nine classrooms were randomly assigned to a traditional psychology curriculum (n = 263). Students completed questionnaires pre- and post-semester including a Positive Attitude Scale (PAS, concerning Relatedness, Competence, Autonomy, Gratitude, Calmness, Mindfulness, and Hope), Positive and Negative Affect Scale (PANAS), Centers for Epidemiological Studies Depression Scale (CES-D), Life Satisfaction Scale (LS), Subjective Happiness Scale (SHS), Meaning in Life Questionnaire (MLQ), and a test of knowledge about well-being (Knowledge Test, KT). RESULTS: In a hierarchical linear model, there were statistically significant intervention effects on six of the seven subscales of the PAS, on PANAS balance, and on the KT. CES-D, LS, SHS, and MLQ were improved but not significantly so. Notable overall secular trends in measures of well-being were observed, with a peak in September and nadir in April. CONCLUSIONS: A one-semester course for high school students regarding well-being and happiness demonstrated significant changes in positive attitudes, affective balance, and knowledge about happiness. Circannual trends in well-being measures over the academic year have implications for those designing school intervention studies.

Randomized clinical trial of Cognitive Remediation Therapy with Work Therapy in the early phase of substance use disorder recovery for older Veterans: 12-Month follow-up.

OBJECTIVE: In a previous report on a randomized clinical trial of a 3-month program of Cognitive Remediation Therapy (CRT) augmented by Work Therapy (WT) compared with WT alone for older veterans with substance use disorder (SUD), we reported significantly greater improvements at six-month follow-up on neurocognitive outcomes of working memory and executive functions for the CRT + WT condition. However, no difference was found between conditions on SUD outcomes, with both groups showing unusually high levels of abstinence. In this study, we extended follow-up to 12 months to test whether there was an SUD outcome "sleeper effect" from CRT + WT. To better understand the effects of WT, we added a treatment-as-usual (TAU) comparison sample. METHOD: Forty-eight veterans with SUD receiving standard outpatient VA care were randomized into CRT + WT or WT. Clinical Global Impression (CGI) ratings were performed on 43/48 participants with up-to-date medical records. A TAU comparison group (n = 44) with similar demographic and illness characteristics was added to the analysis. RESULTS: Treatment groups did not differ significantly at 12 months on CGI (p = 0.27), with 77% receiving CRT + WT showing favorable SUD outcomes compared to 62% in WT. Both groups had better CGI outcomes (p < 0.01) compared to the TAU comparison group (27%). Hours of WT participation (r = -0.49, p = 0.001) and hours of CRT (r = -0.45, p = 0.048) were associated with better CGI scores. CONCLUSION: While no sleeper effect was found for CRT, a robust effect was strongly supported for WT on SUD outcomes.

Cognitive Training and Work Therapy for the Treatment of Verbal Learning and Memory Deficits in Veterans With Alcohol Use Disorders.

OBJECTIVE: This study focused on the efficacy of cognitive training for verbal learning and memory deficits in a population of older veterans with alcohol use disorders. METHODS: Veterans with alcohol use disorders, who were in outpatient treatment at VA facilities and in early-phase recovery (N = 31), were randomized to receive a three-month trial of daily cognitive training plus work therapy (n = 15) or work therapy alone (n = 16), along with treatment as usual. Participants completed assessments at baseline and at three- and six-month follow-ups; the Hopkins Verbal Learning Task (HVLT) was the primary outcome measure. RESULTS: Participants were primarily male (97%) and in their mid-50s (M = 55.16, SD = 5.16) and had been sober for 1.64 (SD = 2.81) months. Study retention was excellent (91% at three-month follow-up) and adherence to treatment in both conditions was very good. On average, participants in the cognitive training condition had more than 41 hours of cognitive training, and both conditions had more than 230 hours of productive activity. HVLT results at three-month follow-up revealed significant condition effects favoring cognitive training for verbal learning (HVLT Trial-3 T-score, p < .005, Cohen's d = 1.3) and verbal memory (HVLT Total T-score, p < .01, Cohen's d = 1.1). Condition effects were sustained at six-month follow-up. At baseline, 55.9% of participants showed a significant deficit in verbal memory and 58.8% showed a deficit in verbal learning compared with a premorbid estimate of verbal IQ. At three-month follow-up there was a significant reduction in the number of participants in the cognitive training condition with clinically significant verbal memory deficits (p < .01, number needed to treat = 3.0) compared with the work therapy alone condition and a trend toward significance for verbal learning deficits, which was not sustained at six-month follow-up. CONCLUSIONS: This National Institute on Drug Abuse-funded pilot study demonstrates that cognitive training within the context of another activating intervention (work therapy) may have efficacy in remediating verbal learning and memory deficits in patients with alcohol use disorder. Findings indicate a large effect for cognitive training in this pilot study, which suggests that further research is warranted. This study is registered on ClinicalTrials.gov (NCT 01410110).

Visual and verbal learning deficits in Veterans with alcohol and substance use disorders.

BACKGROUND: This study examined visual and verbal learning in the early phase of recovery for 48 Veterans with alcohol use (AUD) and substance use disorders (SUD, primarily cocaine and opiate abusers). Previous studies have demonstrated visual and verbal learning deficits in AUD, however little is known about the differences between AUD and SUD on these domains. Since the DSM-5 specifically identifies problems with learning in AUD and not in SUD, and problems with visual and verbal learning have been more prevalent in the literature for AUD than SUD, we predicted that people with AUD would be more impaired on measures of visual and verbal learning than people with SUD. METHODS: Participants were enrolled in a comprehensive rehabilitation program and were assessed within the first 5 weeks of abstinence. Verbal learning was measured using the Hopkins Verbal Learning Test (HVLT) and visual learning was assessed using the Brief Visuospatial Memory Test (BVMT). RESULTS: Results indicated significantly greater decline in verbal learning on the HVLT across the three learning trials for AUD participants but not for SUD participants (F=4.653, df=48, p=0.036). Visual learning was less impaired than verbal learning across learning trials for both diagnostic groups (F=0.197, df=48, p=0.674); there was no significant difference between groups on visual learning (F=0.401, df=14, p=0.538). DISCUSSION: Older Veterans in the early phase of recovery from AUD may have difficulty learning new verbal information. Deficits in verbal learning may reduce the effectiveness of verbally-based interventions such as psycho-education.

Proactive psychiatric consultation services reduce length of stay for admissions to an inpatient medical team.

BACKGROUND: Some studies suggest intensive psychiatric consultation services facilitate medical care and reduce length of stay (LOS) in general hospitals. OBJECTIVE: To compare LOS between a consultation-as-usual model and a proactive consultation model involving review of all admissions, rapid consultation, and close follow-up. METHODS: LOS was compared in an ABA design between a 33-day intervention period and 10 similar control periods, 5 before and 5 after the intervention, on an internal medical unit. During the intervention period, a staff psychiatrist met with the medical team each weekday, reviewed all admissions, provided immediate consultation as needed, and followed all cases throughout their hospital stay. RESULTS: Time required for initial case review was brief, 2.9 ± 2.2 minutes per patient (mean ± S.D.). Over 50% of admissions had mental health needs: 20.3% were estimated to require specialist consultation to avoid potential delay of discharge. The consultation rate for the intervention sample was 22.6%, significantly greater than in the control sample, 10.7%. Mean LOS was significantly shorter in the intervention sample, 2.90 ± 2.12 versus 3.82 ± 3.30 days, and the fraction of cases with LOS > 4 days was significantly lower, 14.5% versus 27.9%. A rough cost benefit analysis was favorable with at least a 4.2 ratio of financial benefit to cost. CONCLUSIONS: Psychiatric review of all admissions is feasible, indicates a high incidence of mental health barriers to discharge, identifies more necessary consultations than typically requested, and results in earlier consultation. A proactive consultation model can reduce hospital LOS.

Mindfulness training for smoking cessation: results from a randomized controlled trial.

BACKGROUND: Cigarette smoking is the leading cause of preventable death in the world, and long-term abstinence rates remain modest. Mindfulness training (MT) has begun to show benefits in a number of psychiatric disorders, including depression, anxiety and more recently, in addictions. However, MT has not been evaluated for smoking cessation through randomized clinical trials. METHODS: 88 treatment-seeking, nicotine-dependent adults who were smoking an average of 20cigarettes/day were randomly assigned to receive MT or the American Lung Association's freedom from smoking (FFS) treatment. Both treatments were delivered twice weekly over 4 weeks (eight sessions total) in a group format. The primary outcomes were expired-air carbon monoxide-confirmed 7-day point prevalence abstinence and number of cigarettes/day at the end of the 4-week treatment and at a follow-up interview at week 17. RESULTS: 88% of individuals received MT and 84% of individuals received FFS completed treatment. Compared to those randomized to the FFS intervention, individuals who received MT showed a greater rate of reduction in cigarette use during treatment and maintained these gains during follow-up (F=11.11, p=.001). They also exhibited a trend toward greater point prevalence abstinence rate at the end of treatment (36% vs. 15%, p=.063), which was significant at the 17-week follow-up (31% vs. 6%, p=.012). CONCLUSIONS: This initial trial of mindfulness training may confer benefits greater than those associated with current standard treatments for smoking cessation.

A controlled trial of the Litebook light-emitting diode (LED) light therapy device for treatment of Seasonal Affective Disorder (SAD).

BACKGROUND: Recent research has emphasized that the human circadian rhythm system is differentially sensitive to short wavelength light. Light treatment devices using efficient light-emitting diodes (LEDs) whose output is relatively concentrated in short wavelengths may enable a more convenient effective therapy for Seasonal Affective Disorder (SAD). METHODS: The efficacy of a LED light therapy device in the treatment of SAD was tested in a randomized, double-blind, placebo-controlled, multi-center trial. Participants aged 18 to 65 with SAD (DSM-IV major depression with seasonal pattern) were seen at Baseline and Randomization visits separated by 1 week, and after 1, 2, 3 and 4 weeks of treatment. Hamilton Depression Rating Scale scores (SIGH-SAD) were obtained at each visit. Participants with SIGH-SAD of 20 or greater at Baseline and Randomization visits were randomized to active or control treatment: exposure to the Litebook LED treatment device (The Litebook Company Ltd., Alberta, Canada) which delivers 1,350 lux white light (with spectral emission peaks at 464 nm and 564 nm) at a distance of 20 inches or to an inactivated negative ion generator at a distance of 20 inches, for 30 minutes a day upon awakening and prior to 8 A.M. RESULTS: Of the 26 participants randomized, 23 completed the trial. Mean group SIGH-SAD scores did not differ significantly at randomization. At trial end, the proportions of participants in remission (SIGH-SAD less than 9) were significantly greater (Fisher's exact test), and SIGH-SAD scores, as percent individual score at randomization, were significantly lower (t-test), with active treatment than with control, both in an intent-to-treat analysis and an observed cases analysis. A longitudinal repeated measures ANOVA analysis of SIGH-SAD scores also indicated a significant interaction of time and treatment, showing superiority of the Litebook over the placebo condition. CONCLUSION: The results of this pilot study support the hypothesis that light therapy with the Litebook is an effective treatment for SAD. TRIAL REGISTRATION: Clinicaltrials.gov: NCT00139997.